The Illustrious Dead

by Stephan Talty

  “We found whole families stricken down with typhus,” wrote the Prussian army doctor Krantz, “in whose dwelling soldiers, showing no signs of disease, had stayed overnight.” In Berlin, there was an almost poignant reminder of what could have been had Larrey and his fellow doctors instituted at least some hygienic practices. As the typhus brought into Germany by the returning soldiers took hold and began to rage through the city, the Charité Hospital instituted a rigorous program to stop the disease within its own corridors. Typhus patients were given their own ward on the second floor, and special grating was installed to bar uninfected patients from entering while still allowing fresh air to enter. The clothes of the sick brought to the hospital were removed and soaked in hydrochloric acid for days, before being tossed into vats filled with boiling water and lye. The patients were dressed in fresh linen and placed in the typhus ward, which was thoroughly cleaned and disinfected daily. The doctors and nurses, before entering the ward, donned special black capes made of glazed linen (which, in theory, any infected material would have trouble sticking to), and as they exited, they doused their faces and hands in cold water and also gargled. As a result, Rickettsia was confined to the typhus ward and the rest of the hospital and its staff remained free from infection.

  The Belgian doctor de Kerckhove, as acerbic as ever, contemplated the spread of Rickettsia. “It was a fatal present which we gave them,” he wrote, “and which caused such a high mortality among the inhabitants of the country through which we passed. Wherever we went, the inhabitants were filled with terror and refused to quarter the soldiers.” Rickettsia visited a new level of suffering on civilians during wartime, which had in the past largely escaped the military carnage if they weren’t in the direct route of the armies or weren’t trapped with defenders in besieged cities. Distance from the line of march had brought relative safety. In terms of civilian impact, the available armaments had not yet caught up with the creation of mega-armies, but the very size of these new forces extended both their geographic reach and the lethality of the pathogens they carried. Epidemics did the work that would be later taken over by the V-2 rocket and the night raids of B-52s.

  The northeast of France, near the border with Germany, was particularly hard hit by the epidemiological aftermath of the Russian campaign. One town named Mors was almost depopulated by the epidemic. In December 1813, the microbe reached the town of Pont-à-Mousson, a city of abbeys that would be ravaged by Luftwaffe bombing raids in 1945. But now it was the pathogen that struck with the arrival of the sick and wounded from Napoleon’s latest campaign. A Frenchman remembered:

  Who of us will not remember as long as he lives those harrowing scenes, which one cannot describe without shuddering? Who will ever forget those hundreds of wagons filled with unhappy wounded men who had no medical care since Leipzig; and packed in with them were sick men suffering from dysentery, typhus fever, etc., almost all of them succumbing to inanition, weakness, and filth, as well as disease. Those unfortunate men begged only for a place in a hospital already filled with dying men, only to receive in reply a forced refusal. And so they were under the cruel necessity of going further to pass away, with the result that they infected all the towns and villages along their route, wherever they were granted a gracious hospitality.

  Typhus brought the war home to thousands of villages and towns throughout Europe and traveled thousands of miles. It was, for the microbe, its greatest triumph in five centuries of conquest.

  Then, inexplicably, it disappeared.

  After 1814, the disease ceased to be a major epidemic killer in Europe, outside of Ireland and the eastern border countries. The contagion moved to the more vulnerable populations of the planet in Africa and the Middle East, especially. It was as if, having spurred the downfall of the greatest conqueror it ever faced, it now retired from the field.

  And its pursuers followed it. The search for the killer’s nature would be picked up again far from the nations it had tormented for so long.

  Author’s Note:

  The Doorway of the Hospital at Tunis

  IN JANUARY OF 1909, IN THE SMALL VILLAGES MILES FROM THE capital of Tunisia, men began to fall sick. The symptoms were fever, headache, lethargy, and spots on the trunk, legs, and arms. The relatives of the stricken men knew from experience that there was little to do but wait the disease out. Death would take those it wanted.

  In the spring, the disease started to appear in the city itself. Men—it seemed mostly to be men, and young men especially— began turning up at local hospitals or were found prostrate in the “Moorish” cafés frequented by locals, as well as in the zaouias, the Sufi spiritual schools where people from the countryside traveled for instruction in mystic Islam. Men would wander into the local hospitals and collapse, their faces puffy and darkened, their eyes staring or manic, days from death. In April, the numbers rose steadily; in May, there was a sudden spike in cases. Doctors sent the overflow patients to a lazaret outside of the city, as their wards were overwhelmed. Some 4,000 Tunisians caught the disease, 836 in the capital. And 32.6 percent of them died.

  Typhus was endemic in Tunisia. It had become a part of the natural cycle, as expected a part of the seasons as rain or the raising of crops. But 1909 was different for two reasons: Typhus had bloomed into a serious epidemic. And Charles Nicolle was waiting for it.

  Nicolle was a French doctor who had come to Tunisia to head up the Pasteur Institute and make his name. He was a scientist to the marrow, a believer in the precise inductive reasoning that had led the master to his great contributions to germ theory that finally banished miasmism as a medical philosophy. Nicolle even admitted he wished to become the “next Pasteur.”

  Sailing for the North African colony, Nicolle was in one way following in the footsteps of Napoleon; the Pasteurians saw themselves as benign imperialists, venturing to the corners of the earth to spread rational French science and culture by persuasion and not war. The “civilizing mission” that Napoleon had marched under, promising progress and liberty when in fact he most often brought tyranny, was the same banner that brought Nicolle to this outpost of the French Empire.

  Nicolle began his pursuit of the disease’s cause only a year after arriving in Tunisia, when he and two colleagues planned a research trip to one of the small villages, Djouggar, about fifty miles outside the capital, that acted as incubators for the disease. But days before their departure, Nicolle began spitting up blood and was unable to make the journey (the illness, a lung ailment, turned out not to be serious). His collaborators, the doctor in charge of the village and his servant, set out for the outlying town. While there, both caught typhus, and when they returned, after days of agony, both died of the disease. Rickettsia had claimed two more of the countless pursuers it had killed without granting them a basic insight into its secrets. “Without this incident,” Nicolle later wrote, “my first contact with typhus would doubtlessly have been my last.”

  Nicolle soon learned that most of the doctors in Tunisia eventually caught the disease, and one-third of them died of it. This was made even more disturbing by the fact that animals never seemed to succumb, so that one couldn’t study typhus safely in lab specimens or keep the pathogen alive between epidemics. Humans alone seemed to carry the pathogen and die from it, and to get close to it one had to take the chance of catching it. Nicolle needed to figure out typhus’s modus operandi not only to make his name but also to have a fair chance of staying alive. And despite hundreds of years of study and millions of victims, the accumulated scientific knowledge of the disease’s cause was near zero. Humankind essentially knew nothing definitive about what caused the disease, how it spread, or how to stop it.

  For three years, the expatriate doctor had been following the clues that typhus left in its annual cycle. It arrived in the rural districts outside Tunis in winter, then spread to the “doss-houses and the prisons” of the small villages and towns by early spring. From there it would reach into Tunis itself through the jails and the tightly pac
ked neighborhoods populated by natives. By June or July it was gone. It favored a particular type of person: Many of the victims belonged to the underclass of the French colony— single men who worked as day laborers or farmhands, or begged in the streets for alms, barely able to live on the small coins dropped in their hands. Women and children were far less likely to come down with the disease. And curiously, one of the established facts about typhus’s spread, that it flourished in confined spaces, seemed exactly the opposite of what was happening in Tunisia. The disease spread across the country not in winter, when families stayed in their closely packed homes and villages, but in the spring, when people began to move and travel. Why?

  And, if the pattern of infection was so consistent and followed a perennial route, why did the disease reach epidemic proportions in some years (such as 1906 and 1909) but not in others (1907 and 1908)? After looking at other factors that affected the poor— especially food supplies and weather—Nicolle and his collaborator, Ernest Conseil, realized that the most severe typhus years coincided with famines that sent unemployed single men flocking to the cities.

  The local hospitals were known to be flash points, as so many of the doctors and staff who came in contact with typhus victims eventually died from the disease. That argued for person-to-person infection. But when Nicolle and Conseil looked more closely at the data, they realized that not everyone in the hospitals was catching the disease; even though typhus victims were mixed in with other patients, the other patients failed to fall ill with the fever. There was clearly a dividing line over which the pathogen didn’t cross. It was killing people in the receiving wards, but somehow it was stopped before reaching the upper floors.

  Clearly, the microbe wasn’t spread by simple human-to-human contact. Nicolle began to suspect that the vector was an insect. Following the postulates developed by the pioneering researcher Robert Koch, he began injecting monkeys with blood from infected patients in 1906. The first trials failed, and Nicolle theorized that it was the fault of the test subjects: monkeys were too distant from their human cousins to have the same susceptibilities to disease. He sent for a chimpanzee, physiologically the creature closest to man. The chimp had to be imported from Marseille at the exorbitant cost of 550 francs. As Nicolle waited for the Pan troglodytes to reach Tunis, June arrived and the number of typhus cases began to fall off. The epidemic, as it did every summer, was fading; if the chimp didn’t arrive soon, Nicolle would have no infected blood with which to inoculate it, and he would have to wait until the next plague swept Tunisia.

  Finally, the chimp arrived in its crate and Nicolle quickly injected it with blood from an infected thirty-five-year-old Tunisian man. Now he watched and waited. At first, nothing happened. The chimpanzee stared back at the French scientist with its warm, placid brown eyes, revealing no signs of sickness. Nicolle went home and dropped off to sleep. When he returned in the morning, the chimp still regarded him with the same bored and perfectly healthy gaze. But twenty-four days after receiving the infected blood, his test subject began to display unmistakable signs of fever. The chimp was the first nonhuman vertebrate victim of Rickettsia ever observed.

  Nicolle worked quickly. He took blood from the chimp and infected a macaque, a Chinese monkey. Nothing happened. For twelve days, Nicolle watched the macaque closely. On the thirteenth day, the monkey’s eyes began drooping and a thermometer revealed that he was running a high fever. Nicolle had isolated the microbe. Now he had to locate the vector.

  The doctor had narrowed his search for the typhus carrier to one insect: the common body louse. In Tunisia, especially in the rural districts, lice were the only parasites universally found on the body and clothing of “the wretches” who spread the disease. Nicolle placed a number of healthy lice on the fur of the sick Chinese monkey. After giving them time to feed on their host, he transferred the lice to a healthy monkey. Within days, it had fallen ill with typhus. Nicolle had proved that the body louse had been from time immemorial the carrier of the fatal disease.

  IN HIS SPEECH accepting the Nobel Prize for Medicine in 1928, Nicolle compressed years of medical detective work into a flash of understanding. “Often, when going to the hospital, I had to step over the bodies of typhus patients who were awaiting admission to the hospital and had fallen exhausted at the door,” he wrote. But once upstairs these febrile men infected no one. “The contagious agent was therefore something attached to his skin and clothing, something which soap and water could remove. It could only be the louse. It was the louse.” Perhaps this image—the scientist suddenly struck by a world-changing idea while stepping over the bodies of the poor and desperately ill—made for a more thrilling story. Perhaps Nicolle felt the pressure to give the solving of the riddle a classic “eureka” moment in line with public expectations of how medical breakthroughs were made. But the process had been far more involved and much more a classical inductive pursuit than the story expressed.

  Nor did Nicolle mention his most controversial step. Attempting to create a simple vaccine, he ground up the bodies of infected lice and mixed them with the blood serum of men who had survived typhus. He injected the vaccine into his arm, but didn’t develop any symptoms. Driven to complete the holy grail of typhus research, he then walked up to the children’s ward of the hospital and injected the mixture into two Arab boys, without advising them or their parents of what was happening. The two fell sick but luckily survived.

  The protocol was complete. After five hundred years, Rickettsia’s secret was out.

  Had it not been for Nicolle’s discovery, the pathogen would have soon had one more chance at a battlefield coup: World War I. As the doctor wrote in his Nobel speech:

  If in 1914 we had been unaware of the mode of transmission of typhus, and if infected lice had been imported into Europe, the war would not have ended by a bloody victory. It would have ended in an unparalleled catastrophe, the most terrible in human history. Soldiers at the front, reserves, prisoners, civilians, neutrals even, the whole of humanity would have collapsed.

  The last phrase is speculative, of course, but Nicolle had solid evidence of a possible conflagration should typhus have run un checked during the war. Unable to delouse their army with the same proficiency as the Allied forces, the Russians saw the scourge revisit the towns and cities of Russia in the first great epidemic since the Crimean War, when 900,000 had died from Rickettsia. During 1914-18, it hit the armies of the Balkans and Russia itself and as many as 3 million troops and civilians died. If typhus had burned through western Europe as well, with the size of the armies roaming the Continent, that number could have risen to 10 million or more. (As it turned out, the Allies were spectacularly successful at combating the pathogen: only 104 cases of typhus were reported among Allied troops during the entire conflict.) After the war, Lenin declared, “Either socialism will defeat the louse, or the louse will defeat socialism.” In fact, the contest was a draw. Stalin and his minions couldn’t control the disease, and it went on killing.

  The Red Army had been shocked at the ferocity of the epidemic and decided to try to harness the power of the tiny microbe that had nearly collapsed their eastern front. In 1928, a secret program was initiated to weaponize Rickettsia under the auspices of the GPU, which later became the KGB. They decided that the best way to spread typhus in enemy armies would be to spray them with an aerosolized version of Rickettsia dropped from airplanes.

  The Red Army’s scientists first inoculated chicken eggs at the Leningrad Military Academy. According to the epidemiologist Ken Alibek, who defected from the former Soviet Union in 1992, thousands of chicken eggs arrived at the institute every week during a time of widespread hunger in the country. The researchers also injected rats and other test animals in their labs, let the Rickettsia multiply in their bodies, then extracted the pathogen and mixed it with liquids in huge blenders. The concoction was turned into a powder and a liquid, ready to be inserted into bombs that could be dropped over the enemy.

  In 1938, the USSR’s
defense commissar warned that the Red Army stood ready to use typhus “against an aggressor on his own soil.” What nature had achieved spontaneously against Napoleon the Soviets were now ready to deploy as a man-made weapon. The United States responded by beginning its own biological weapons research at Fort Detrick in Maryland, under the leadership of George Merck of the famous pharmaceutical company.

  We have no reliable evidence that the Russians ever used typhus on the Germans. But one group of Polish resistance guerrillas apparently did utilize the pathogen against the Nazis: in a report from the Polish Secret Army to the Combined Chiefs of Staff of the Allied Forces dated September 7, 1943, the liaison officer (using the wrong name for the pathogen) detailed under “Activities of retaliation” the use of “typhoid fever microbes and typhoid fever lice” in a “few hundred cases.” If true, the rickettsial weapon most likely came from Russian stockpiles.

  For the Germans, typhus became a tool. The disease ran rampant in the concentration camps, where the Nazis deliberately used it as an instrument of genocidal germ warfare. Scholar Naomi Baumslag estimates that 1.5 million prisoners of the camps died of the disease, and it was at Bergen-Belsen that typhus would claim its most famous victim in five hundred years.

  Anne Frank arrived at the concentration camp on October 28, 1944. She had barely escaped death at Auschwitz earlier in the fall, where, having just turned fifteen (the cutoff for immediate death), she was spared a trip to the gas chambers and was separated from her father. Her head was shaved, and she was stripped naked, disinfected, and tattooed with her camp number. When she was later transported to Bergen-Belsen, she arrived already ill and malnourished along with her sister Margot. Anne survived, working in the bullet factory and sleeping in the unheated, desperately crowded barracks, until March 1945, when just weeks before the Allied liberation of the camp, a typhus epidemic raged through the camp. About 1 in 5 of the 500 prisoners in her barracks caught the disease. Near the end, Anne told the barracks leader, Irma Sonnenberg Menkel, “I am very sick” and soon was unable to make the roll call. “She didn’t know that she was dying,” Menkel remembered. Anne soon fell into the coma-like stupor that marks the final stage of the disease. Along with Margot, she was among the approximately 17,000 men and women who perished in the epidemic.