Few people today know about typhoid fever, the disease that has made history and determined the fate of empires over the centuries. But those who have lived through a typhoid epidemic have certainly never forgotten the experience. They know that the disease is transmitted by lice, which live comfortably in the hems of warm clothes, sucking blood and leaving the body only when it gets cold or too hot. In this case, they simply find a new human host.
In centuries past, people in colder places in particular often had lice because they rarely bathed, providing ideal living conditions for these tiny animals. But the typhoid epidemic was not just a result of not washing; the disease really only took off when people were at the end of their rope. Hunger, fear, exhaustion and physical exertion are the prerequisites that must be met for the disease to really flourish. “Typhoid fever occurs when human stupidity and brutality allow it to do so,” say Harvard.
At the end of World War I, the worst typhoid epidemic in history first nearly wiped out the population of Siberia and the rest of Russia, and then continued its devastating path through Poland, causing 30 to 40 million cases and three million deaths. It was then that Dr Rudolf Weigl and his assistant, Dr Ludwik Fleck, began to work intensively on it. They knew that the disease was transmitted by lice and vowed to do everything they could to tame it.
When Austria-Hungary entered the war, Weigl was 31 years old and Fleck was only 18. They had to leave their hometown of Lviv to become doctors in the Kaiser’s army and began to work on typhoid fever in prison camps in western Galicia, around the towns of Lvov, Tarnow and Przemysl. From 1917 to 1921, Weigl was head of the military laboratory, first under the Habsburgs and then under the new Polish state in Przemysl, a town with many fortifications, now on the border between Poland and Ukraine. Galicia, which included these towns, was then a multicultural area, with Ukrainians predominating in the countryside and Poles and Jews and a German minority in the towns.
Rudolf Weigl was born in 1883 in the Moravian town of Prerov to ethnic German parents. After the death of her father, her mother married a Pole, so the language was the dominant one in the family. He graduated from the University of Lviv, as did Fleck, who later earned his doctorate under Weigl. In the laboratory where they worked, they soon began to work on typhoid fever. They knew from the start that this was a very difficult and complex disease and that their work would not be easy.
A hundred years ago, it was very difficult to maintain live typhoid bacteria in an artificial environment or on the bodies of mice or hamsters. And it was virtually impossible to contract typhoid any other way than by feeding the lice you unwittingly hosted on the bodies of people who had contracted the disease. But such patients could only be obtained during epidemics. And medical ethics even then forbade deliberately infecting people with typhoid.
Weigl has found a solution to this problem. He took a healthy louse, inserted a small glass pipette into its anus and injected a small drop of infected fluid. Thus a new experimental animal was born – the louse. No one had ever used an insect as a test animal before.
This was an important and necessary step in the research of this disease. Before the First World War, typhoid fever had been almost eradicated in Austria-Hungary, so soldiers no longer had a natural immune system and were highly susceptible to infection. The process is that a body louse attaches itself to the skin, pushes a small tube through a layer of skin and starts feeding on the blood. The bite of a typhus-infected louse does not in itself cause typhus; the bite and the saliva only cause itching, which causes the person to scratch and become infected.
The infection is reported a week after the bite with fatigue, severe headache and back pain. The patient becomes pale and absent, his reflexes weaken. After a week, small red circles appear on the shoulders, body and arms. The patient lies down, grumbles and has occasional fits of anger, followed by incontinence with uncontrolled bowel movements. The temperature increases, as does the heart rate, the limbs stiffen, hallucinations occur and then death follows.
German doctors first realised the deadly significance of typhus when they destroyed two Russian armies and captured 92,000 prisoners of war at the Battle of Tannenberg in 1914. They did not know that typhus had always been a constant companion of the Tsarist armies. But they had the opportunity to learn quickly, and so a German doctor found as many as 6 000 lice on a single prisoner. But the worried Germans quickly found a solution to this scourge. Whatever the weather, the prisoners had to strip naked and wait for long hours until all the lice were cleaned off their clothes with hot steam. Then they had to bathe in large tubs full of disinfectant. During the war, the Germans “cleaned” millions of prisoners of war in this way.
The whole process was brutal and slow, but it produced good results, and the German soldiers avoided infection and the typhus did not spread throughout the Western Front. German soldiers also knew some practical ways to remove lice, as described by Erich Maria Remarque in his book In the West Nothing New. For example, they collected lice in tins and lit candles under them.
Typhoid fever also broke out in Serbia early in the war, when 60,000 Austrian soldiers were captured by the Serbs in December. Many died before the year was out. The typhoid epidemic was rapid and sudden, and half of Serbia’s doctors fell ill. At least 50 died every day, and half of the sick were so weak that they could not even tell their own name. It was particularly dangerous in the prisoner-of-war camps, and doctors and biologists risked their lives searching for a cure for typhus. “When we entered the prisoners’ barracks and slammed the door, lice fell from the ceilings and bunk beds like rain.” After a year, the typhus epidemic in Serbia had subsided, but events in Russia gave it a new chance.
Late in 1917, the Bolshevik government concluded an armistice with Germany and Russian troops returned home. They were hungry and dressed in dirty uniforms full of lice, so it was no wonder that typhus soon appeared among the civilian population. It spread with incredible speed and was followed by a devastating civil war that lasted until 1921. The situation was so dramatic that some observers said it was like the Middle Ages. “I do not think there was a house or apartment in southern Russia from Novorossiysk to Moscow that did not have at least one case of typhoid fever,” wrote a British doctor.
After the defeat of the White Army, a general flight began. Many people fled by train across Siberia to China and then on to Europe. Hundreds of hungry and cold refugees flooded the towns along the Trans-Siberian Railway. Many died on the way and the station warehouses were full of bodies. In some places, trains were not even allowed to stop at stations, so conductors threw corpses out of carriage windows. The locals took everything of value from them, especially warm clothes, but these were a breeding ground for lice and thus a breeding ground for typhus.
But it is not only refugees who have suffered. In December 1919, Lenin told a meeting of the People’s Commissars, “Comrades, it is impossible to imagine the terrible situation that prevails where typhus is raging, where the population is without help and where public life is no more.” People were eating tree bark, cooking straw and looking for roots in the soil. In those days, the western countries helped Poland in the fight against typhus, mainly because they wanted to prevent typhus spreading from Russia to Europe by means of border guards and disinfection stations. All travellers going west were interned, disinfected, wiped and bathed, and their clothes were cleaned with hot steam.
Living in Lviv
Weigl was proud of the new Polish state and criticised the famous scientist Marie Curie for raising her daughters as Frenchwomen. “Look at me, I am a pure German, I was Polish when Poland was not on the map, and I will remain so.” Poland suffered greatly from the typhus epidemic during those years. The country was shattered and devastated in the First World War, and in 1918 alone, 672 000 cases of typhoid fever and 145 000 deaths were recorded. It did little to help that the Americans sent six disinfectant trains to the Polish-Russian border. Several medical teams travelled to Lviv at the time, as the city had established itself as a centre for typhoid research, and it was here that Weigl began his first attempts to find a vaccine against the disease. In 1921, when he was appointed professor of general biology at the University of Lviv, he already had his first successes to boast of.
He was 38 years old at the time and the appointment was a great success for him. He also attracted Fleck and a few colleagues from Przemysl to Lviv, so that together they formed a dynamic group of public health scientists. Like many successful Polish academics, Weigl married Zofia Kulikowska, the daughter of a well-known lawyer, and in 1921 their son was born. The family lived a comfortable bourgeois life, as they both worked in the same laboratory.
Between the two wars, Lviv was a thriving multiethnic Polish city of 300,000 inhabitants, more than half Polish, a third Jewish and Ukrainian minorities, and a few Germans and Armenians, with the surrounding area being Ukrainian. It is said that the Poles despised the Jews, that the Ukrainians despised the Poles and the Jews, and that the Jews always expected the worst.
The new Polish state has had a lot of problems with anti-Semitism since its beginnings. In November 1918, Lviv experienced the worst pogrom in its history, resulting in 78 dead, 463 wounded and thousands homeless. No one has ever apologised to the Jews for the pogrom. Nevertheless, it was a period of significant cultural upsurge for the Jewish population. There was a Jewish theatre in Lvov, a Zionist movement, the socialist Bund and the Jewish political movement Agudath Israel were gaining strength, and the Communist Party had a large Jewish leadership.
However, anti-Semitism in Lviv was less laced with hatred than in Nazi Germany and was more an expression of economic competition between two separate communities. More worrying was the discrimination against Jews in science. For example, in 1934, 600 Jews in Lvov wanted to go to medical school, but only 11 were accepted, and none at all in 1937. Jewish students were often stopped in the street and beaten. On several occasions, anti-Semitic riots even led to the closure of the university.
Weigl was aware of all these problems and in 1937, when the Nationalist government passed a law requiring Jewish students to stand and not sit during lectures, he decided to ignore the law. But he knew that Poland as a country was not at all prepared for any serious test.
Ludvik Fleck also quickly became part of Lviv’s city life. By 1923, he was working in Weigl’s laboratory and developed a new method for the early detection of typhoid fever. It was also here that he married the daughter of a wealthy merchant in 1923. He bought a small laboratory with his wife’s dowry and worked there for the next 12 years to improve his state salary. His Jewishness excluded him from some academic circles in Lviv, but this did not diminish his interest in public health.
In the meantime, Weigl managed to gather around him a group of talented researchers who were not afraid to go to isolated Carpathian villages and collect data on typhoid fever. After many attempts, he succeeded in producing a vaccine against the disease, but had not yet managed to test it, let alone decide to produce it. He made many attempts to transmit typhus from lice to animals and back to lice. He paid particular attention to those experiments in which genetic changes were made to the typhoid bacteria during host-to-host transmission, resulting in a change in the level of infectivity. Despite all the successes, he was somehow hesitant to take the next step and experiment on humans.
The first human vaccination with his vaccine was carried out in 1928 at the Pasteur Institute’s branch in Tunis. Four children were vaccinated and then infected with typhoid fever, but all four remained healthy.
By the end of the 1930s, the Weibl Institute had become a mecca for scientists from all over the world working on typhoid fever. Frenchmen from the Pasteur Institute, Germans from the Koch Institute in Berlin, Americans from Harvard, Russians, Britons, Czechs and others came to Lviv. The Polish health authorities began to press Weigl to produce at least enough vaccine to vaccinate health workers who come into contact with typhoid patients. Thus, in 1931 and 1932, 2794 members of the medical staff were vaccinated, and only one of them actually contracted typhoid fever. So the vaccine worked.
In 1931, Josef Rutten, a missionary who had worked in the desert regions of Mongolia and northern China, appeared before Weigl and asked him to help him. Half of his missionaries had already died of typhus. Weigl gave him 600 doses of the vaccine and Rutten returned to China. He vaccinated all the missionaries and none of them contracted typhus.
Soon after, vaccinations were organised in different areas of Poland and by 1940, 160 000 people had been vaccinated. Whole villages gathered around the health teams, queued outside the disinfection tents and got vaccinated. This is how the vaccine moved from the experimental stage to production. However, the increasing demand for the vaccine required changes in production. In order to breed millions of healthy lice, the system of breeding, infestation and vaccine production had to be improved. Thus, stocks of larvae were now kept in containers at constant temperature and fed twice daily with human blood. The containers, the size of a matchbox, were tied to people’s feet so that the lice could do their work.
The next step was to inject the typhoid-infected solution into the anus of healthy lice. The artificially infected louse was then fed again on human blood, after which its intestines were removed and crushed with a small knife. The dead bacteria could no longer infect humans, and the intact proteins stimulated the human immune system to protect itself against typhoid fever. The human blood lice feeders were often members of the laboratory, and later 50 people were hired to do the work. It was the most unusual job imaginable. The donors had to be adult men with healthy, smooth skin and a lot of patience to avoid scratching themselves. They also had to be careful about their diet, as long-term lice feeders often developed allergies.
Both Dr Weigl and Dr Fleck continued their work even under the horrors of the Nazi system. Weigl continued to do research on typhoid fever, saving the lives of German soldiers, and referred to his German superior as “my junior colleague”. Fleck called his German supervisor a queer. Weigl’s “junior colleague”, of course, also had a first and a last name. His name was Dr Ding and he was a spy for the German security service, the Sicherheitdienst, headed by the infamous Heinrich Himmler.
Erwin Ding was born an illegitimate child in 1912, which prevented him from rising high in the regular army. With the SS, this was much easier. He was talented, having studied history and foreign languages, and began his medical studies. Somehow he became acquainted with Himmler and joined the SS in 1935. It was in that year that Dr Fleck could still say that he was quite content with his life. His private laboratory worked because, notwithstanding the growing anti-Semitism, his services were needed by Poles and Jews alike. Dr Fleck became a well-known and respected figure.
Geomedicine
At that time, the term geomedicine was established in medical science in Germany. It labelled disease as a racial and cultural problem, and it was the proponents of geomedicine, racial hygiene and other crazy Nazi ideas that became the medical authorities in the occupied European countries. The ideology of geomedicine, combined with the lack of cleanliness, had tragic consequences for the Jews in Eastern Europe, as it gave doctors who collaborated with the Nazi authorities the excuse not to treat Jews and to ghettoise them.
“Due to low culture, great poverty and lack of cleanliness, typhoid fever is a normal disease for a large number of the population in Eastern Europe, and is especially prevalent in the Jews,” wrote one geomedical advocate. The ear, the carrier of typhoid fever, was therefore a symbol of Judaism in Nazi ideology, which was supposed to have infiltrated the German Aryan population. “The Jew is a bacillus and a scourge, not a human being, but a carrier of a disease that must be exterminated in the name of humanity”, wrote the Nazi racial ideologue Julius Streicher in his printed tract Der Stürmer.
Geomedicine thus became a major philosophical trend in infectious diseases and public health in Germany in the 1930s. And although Dr Hermann Eyer, born in 1906, who later supervised the work of Rudolf Weigl after Dr Ding, was not an ideologically reliable Nazi, he nevertheless swore by such medical knowledge. He served the Nazis successfully, although his attitude towards the rulers of the time was ambiguous. His early actions suggested that he was an anti-Semite, but during the war he showed unusual civilian bravery. In 1935, he changed his mind and did not join the Nazi Party, believing that he could continue his academic career even in military dress. Soon afterwards, he became interested in virology, especially typhoid fever.
In December 1938, the Italian government invited Weigl, who was already being talked about as a candidate for the Nobel Prize, to Ethiopia, which had just been occupied, to help organise typhoid vaccinations for Italian soldiers to prevent them from bringing the disease back to Italy. Typhoid fever was known in Ethiopia as “yehadar hasheta”, a disease of the month of hadar (November), which is also the beginning of the cold season.
While not much has been said about his trip, there is some evidence that his vaccine did not work well in Ethiopia. The conditions in the African highlands must have been quite different from those in Eastern Europe, but he brought home samples of African lice from this trip and dug into his laboratory with the idea of making a vaccine that would be universal for all cases of typhoid.
Dr Erwin Ding, who graduated in medicine in 1937, became chief physician at Buchenwald in August 1938. He and his pregnant wife rented an apartment in Weimar, from where he rode his motorcycle to work every day in the camp, seven kilometres away. Buchenwald was established in 1937 primarily for communist prisoners, and although 56 000 people died there, it was not really built to be an extermination camp like Sobibor, Treblinka and Belzec. It was there to punish and control the enemies of the state, and if they died as a result of their efforts while they were working, that was bad luck.
If the entrance gate at Dachau bore the sign “Arbeit macht frei”, the camp inmates at Buchenwald were greeted by an even more ominous sign: ‘Jedem das Seine’ (To each his own). This was also the place where the camp’s uniforms were later conceived, with coloured textile triangles marking the type of prisoner; red for political prisoners, green for criminals, black for asocials, pink for homosexuals, blue for religious dissidents, and yellow for Jews.
The Germans did not care what diseases the campers died of, but there was one disease they did not want in their camp – typhus. They were afraid that the German soldiers and the surrounding population would also be infected, and they were also afraid that lice would spread. Therefore, they made it compulsory for all new arrivals to be quarantined, disinfected and sheared.
At Auschwitz, disinfection was also an excuse for Jews to undress and then be taken to the gas cells. There were no gas cells at Buchenwald, but there was a crematorium where the bodies of those who died of exhaustion or disease were burned. The professional status of a camp inmate at Buchenwald meant nothing. After a few weeks, it was impossible to distinguish at a glance between a professor and a worker, a priest and a criminal, a scientist and a farmer. There were, however, a few professions in the biomedical field that could be an advantage. Some imprisoned doctors survived as camp doctors, needed by the SS for various reasons. Although camp hospitals were places where terrible things happened, it was also possible to hide in them. The most coveted position was that of assistant doctor, who moved around the camp almost unhindered in his white coat.
According to the testimony of Dr Ding’s assistant, one Poller, Erwin Ding had two tasks as SS doctor at Buchenwald. At the beginning, when the camp was still being set up, he had to falsify eight-point reports in order to cover up the torture and ill-treatment of the camp inmates. His second task was medical murder. He killed prisoners by injecting atropine into their hearts, he castrated Jews, he killed autistic people with apomorphine and electric shocks. He also published scientific papers by collecting the scientific papers of his prisoners, mostly Jews, adding a few notes of his own, and publishing all this as his own research. Dr Ding probably did not have a strong supporter, however, as he was sent to the front line of the Waffen SS in May 1940 and had to take part in the invasion of France.
The war began on 1 September 1939, when Germany invaded Poland. The Germans soon occupied Kraków and made it the capital of the Governorate General, which encompassed part of central and southern Europe. Hermann Eyer soon found himself in Kraków with the task of organising the mass production of typhoid vaccine according to the Weigl method. Eyer immediately seized all the vaccine stocks of the Polish army and soon had enough vaccine for the German personnel who came into contact with the local population. “The Jews,” he wrote, “must be isolated in the ghetto, since the danger of infection comes from dank and dirty dwellings.”
Lviv, too, could not escape the horrors of war. Nazi bombing destroyed the gas, water and electricity supply. Thousands of the city’s inhabitants sought refuge in the countryside to escape the plague. But on 20 September, in the third week of the German occupation of the city, everything suddenly went quiet. The Germans withdrew and the city was occupied by the Russians, in accordance with the agreement on the partition of Poland between Hitler and Stalin. Night raids soon began and the 20 000 townspeople, political opponents, rich people and Jews who had fled to the city from the west were sent to Siberia and Kazakhstan. Ukrainian became the official language in schools.
For many young Jews, the Soviet occupation was a kind of balm, except when their families were scheduled for deportation. Fleck’s private laboratory was nationalised and he was made head of the university’s microbiology department. Some of his colleagues resented him for accepting this job under Soviet occupation, and so he began to compete undignifiedly with his mentor Weigl. But Weigl was also appreciated by the Russians, and the Secretary of the Ukrainian Party himself, Nikita Khrushchev, visited him in his laboratory and offered him a lectureship at the Medical Faculty in Moscow. Weigl declined the offer.
During the 22 months of the Soviet occupation of Lviv, renamed Lviv by the Russians, Weigl increased vaccine production, visited Moscow, Kiev and Kharkiv, and lectured on his methods to fight typhoid fever. He was indispensable to every authority, fortunately he rarely published his findings. He knew that he would have been replaced long ago by his own staff, but they did not have his knowledge, nor his notes on the exact procedures for obtaining the vaccine.
Of course, Weigl made sure that his laboratory was not without colleagues. Whenever the Russians were about to take someone to Siberia, he usually stood up for them, claiming that they were urgently needed for their work. As the war continued and the Germans reoccupied Lvov and the Jewish ghetto grew, his vaccine became extremely important to the Germans. Everyone needed it, and production was falling behind demand. The Germans were aware of this at the beginning of the war. As early as 25 November 1939, a report from the occupied eastern areas was on Himmler’s desk. It said:
“Health measures on our part must be limited to preventing the epidemic from spreading to the territory of the Reich. We must be concerned about the medical fate of the Jews. We must adhere to the principle that their reproduction must be curbed by all available means.”
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Ghetto, the place of horrors
In April 1940, the Warsaw ghetto was already in operation, with almost half a million people living there that year during the terrible winter. German doctors constantly warned of the dangers of typhus, but they also did everything they could to ensure that it spread rapidly in the ghetto. By the second year, a major typhus epidemic had already broken out in the overcrowded, starving and stupid ghetto. Hundreds of people died every day. But some people wanted to live, and the only remedy they knew against typhus was the Weigl vaccine. But how to get it if Lvov was now on Soviet territory?
Ingenuity knew no bounds, of course, and relations between the Germans and the Soviets were quite good at the time, but the borders were not very well guarded. In November 1940, vaccines were the most coveted item on the black market and Weigl the most admired man. Over the next year and a half, some 30 000 doses of the vaccine found their way into the Warsaw ghetto. Weigl himself even sent some of it there, using as assistants his two colleagues who were officially there looking for lice for scientific experiments. They carried the vaccine in bottles that were supposed to contain black coffee.
The vaccine was sold at a low price by trustworthy people, who used the profits to buy medicines for young children. And at the Polish Medical Institute in Warsaw, now run by the Germans, some employees secretly produced their own vaccine, which was not very successful, and smuggled it into the ghetto and to the partisans in the forests. There were also dealers in Lvov who bought vaccines from hospital employees and then sold them in Warsaw for 1000 zlotys. This was a high price, as the average monthly salary at that time did not exceed 100 zlotys.
There were increasing reports that the Germans were about to invade the Soviet Union, and the Russians tightened their control over Weigl’s laboratory. In the event of an attack, they planned to move it to the Soviet Union. But the Soviets left Lvov as suddenly as they had come. On 21 June 1941, Stalin was taken completely by surprise by the German attack, even though he had received several reports that it was about to happen. Before they left, the Soviets killed 3,000 prisoners, presumably opponents of their regime.
Lviv was then a city where no one trusted anyone. Everyone was ready to betray everyone just to survive. The city was full of Jewish immigrants, so that the Jewish population grew to 150 000. Few survived.
On 29 June, German tanks appeared in the city and Lviv, which had been called Lviv under Soviet rule, became German Lemberg, and the Berlin clock, three hours behind Moscow time, was now in force instead of the Moscow clock. Proclamations decreed that Jews were not allowed to own radios or skis, that they were not allowed to treat Aryans, that no one was allowed to employ them, and that any help to Jews was punishable. The surrounding Ukrainians, mostly peasants, rushed into the town and began beating Jews in the streets, tearing off their beards, stripping women naked and forcing them to drink urine. Between 4 000 and 7 000 Jews were killed. The following month, the pogrom was repeated and another 2000 Jews died.
Dr Weigl stayed in his laboratory for several days. He covered his ears as others told him what was happening in the city. “I can’t listen to this. Don’t tell me any more about it.” Two days later, typhoid expert Hermann Eyer arrived in Lviv from Krakow to take control of the institute. He wanted Weigl to continue his work. He replied, “You have come at last, my colleague. Where have you been all this time?”
Weigl decided to work with the Germans at this time. He thought that it was still better to cooperate with the Wehrmacht than with the SS. He knew Eyer because of his professional articles and knew that he could only choose between suicide and cooperation. The persecution and murder of his Jewish colleagues came as a shock to him. But he was 58 years old, he had lived through the First World War and he knew that the Second World War would also end tragically.
The Germans, of course, suggested that he should join the list of Volksdeutsche, i.e. ethnic Germans, which would have brought him many privileges, and even offered him a professorship at the University of Berlin and a Nobel Prize. But he replied that he had no intention of moving and that he did not want to leave his Polish friends. They started to threaten him, but he replied: “Life is so sad and so disappointing for me today that an old man like me has no hope for better times. If you order me to be liquidated, you will only be doing me a favour.” When he saw that the laboratory could continue to operate under Eyer’s supervision, he decided to stay. But despite his attempts, he never agreed to be one of them.
Weigl’s laboratory soon expanded and recruited more and more people. For real or fictitious business, he recruited people who were at risk of deportation or who were connected to the resistance movement. He also took under his roof those who were in danger of starvation. He employed many of those who needed help as daily blood donors to lice. The orange identification paper with the eagle’s head and the inscription “Institut für Fleckfieber und Virus Forschung” saved many lives. After the war, attempts were made to compile a list of those who had escaped death in this way. They came to 500, but then gave up. The people who worked for Weigl were journalists, teachers, poets, workers, rich and poor, and they survived because the Germans were afraid of typhus and lice.
In October 1941, the Germans set up a ghetto in Lviv, and next to it a labour camp, from which there was only one way out – a trip to Auschwitz. Dr Fleck spent the first year and a half of the Nazi occupation of Lviv as head of the bacteriology laboratory in one of the hospitals. Then he was thrown out of his apartment and lived for a while in the laboratory. During this time, Dr Weigl intervened on his behalf and by 1942 Fleck was already on the staff list of Eyer’s “Institut für Fleckfieber und Virus Forschung”.
However, as the winter months began, the situation in the Lviv ghetto took a turn for the worse and a typhoid epidemic broke out. As many as 70% of the ghetto’s inhabitants were infected, and the Germans decided to use a model that had already proven itself in the Warsaw ghetto to save the day. There, they first tried to suppress the epidemic by disinfecting and quarantining the population, but this proved to be very impractical. At a meeting of 100 Nazi medical officers in a Carpathian health resort in October 1941, they therefore decided on a radical solution. They agreed that any Jewish refugee who tried to escape from the ghetto while looking for food should be shot without warning. So the Jewish population of the ghetto was condemned to death in any case. Either death by starvation or disease in the ghetto, or death by shooting outside the ghetto.
In April 1943, Himmler told SS officers, “Getting rid of lice is not a question of ideology. It is a matter of cleanliness. Similarly, anti-Semitism is not a question of ideology for us, but of cleanliness, and we will soon be done with that.”
But the Germans were unable to stop the spread of typhus outside the ghetto, because they were governed by two different policies. While the SS wanted to destroy the Jews and kept them in the ghetto, not allowing them to leave, the German army needed the Jews for labour. And so long columns of crippled and typhus-infected ghetto inhabitants went out every day to various construction sites, spreading typhus in the surrounding area.
Blood donors
During the German occupation, the Weigl Institute was a mysterious mixture of science and deception. Its external structure was already an unusual enough organisation, not least because it was based on lice. The so-called breeders grew the lice from eggs and developed them, while the blood donors represented the next rung of the pyramid. They were divided into those who fed their blood to infected lice and had already survived the infection (for which they were paid double), and those who fed their blood to healthy lice.
The next rung up the ladder were the vaccine manufacturers, and at the top of the pyramid stood proudly Dr Weigl himself, who was able to skilfully combine mechanical, chemical and biological processes to produce the typhoid vaccine and organise mass production based on precise standards and conditions. For those who did not work in the laboratory, the whole process seemed like a nightmare, but for its members it was an oasis of peace in the hell of war.
Of course, many vaccines were also produced illegally and found their way into the ghettos in Lvov and Warsaw, although the penalty for smuggling vaccines into the ghetto was death. The Germans, of course, controlled the amount of vaccine produced, but it was always possible to tell them that a certain amount had gone bad or that it was being used for further research.
In the Lviv ghetto, there was only one reason for the Gestapo to keep the Jewish doctor Fleck alive in February 1943. The German army needed him because its soldiers were regularly contracting typhus on the Eastern Front. Fleck made an important discovery on his own, finding that typhoid antigens acceptable to the immune system could be detected in the urine of patients at the beginning of a typhoid infection. After a complex process, it was possible to make an effective vaccine from this.
So now Dr Fleck could also employ permanent “urine donors” and save them from death. But in February 1943, a car pulled up outside the hospital where he worked, the SS grabbed him by the neck and he soon found himself on a train heading for Auschwitz. He did not ride with the other victims in a cramped cattle car, but in a special compartment.
Just as Fleck was riding to Auschwitz, the German Sixth Army surrendered at Stalingrad. Not only were its soldiers starving and freezing at minus 42 degrees Celsius, they were also full of lice and typhus was taking as many casualties as firearms. German soldiers on the Eastern Front were not vaccinated against typhus and only a tiny fraction of their doctors received three doses of the vaccine, enough to protect them for a single year.
But the Germans were not the only ones whose soldiers did not get the vaccine. The same happened to the British in North Africa, but the number of typhoid deaths was only marginal. Soviet soldiers were not vaccinated either, but they were warmly clothed and regularly fed. By the time the Americans entered the war, they already had their vaccine and millions of American soldiers going to Europe and North Africa were vaccinated against the disease.
At the beginning of the war, the Germans captured millions of Soviet soldiers and imprisoned them in camps, where they died in large numbers from starvation and typhus. And the infected German guards did the same. German doctors first reported an outbreak of typhus among German soldiers in December 1941, and thereafter, alarming news of typhus epidemics spread among all German soldiers. Many doctors expectorated and tried to treat the sick by transfusing blood from cured patients, in the hope that antibodies would be produced to stop the disease. All these procedures usually failed. The doctors knew this, but they said, “We have to do something.”
In 1942, the desperate Germans ordered 10,000 tonnes of DDT powder from Switzerland, but the process was later abandoned because someone realised that it could harm soldiers’ reproductive strength. The more the Germans retreated from the Eastern Front, the more their soldiers became unwell. By August 1942, 40,000 cases of typhus had already been counted. And there was no vaccine from anywhere. The quantities that Weigl and Fleck could produce were minimal and the process complicated. All attempts in other German laboratories to obtain vaccine from other ingredients, for example eggs rather than lice or urine, were unsuccessful because the vaccines were too weak.
The Eyer Institute under Weigl in Lvov was able to produce 20,000 doses of vaccine every month, enough to vaccinate 6,500 soldiers, but this was far too little, as there were five million Germans fighting on the Eastern battlefields.
Lacking a vaccine, German doctors decided to carry out the notorious experiment, which reverberated around the world for years and brought Weigl and Fleck closer together again. They decided to experiment with different types of typhoid vaccine, mainly egg-based, on prisoners in concentration camps, where the usual medical ethical rules do not apply. Being sent to Auschwitz was only in very few cases a lucky escape. Fleck, his family and a few of his closest colleagues did.
On 8 April 1943, the so-called Hygienic Bacteriological Research Department, a department of the Waffen SS, or Hygiene Institute for short, was opened in Auschwitz, directly next to the execution block in Block 10. In the same block, the female sterilisation department was also operating. On 5 May 1943, it was transferred to the Auschwitz branch camp at Rajsko. Fleck and his group were in charge of serological research. They examined samples for syphilis, typhus, dysentery and other blood diseases. Dr Mengele also sent them blood samples from time to time for his research on the twins. Although Fleck was sent to the camp to work on the typhoid vaccine, for unknown reasons he was never asked to do so.
In December 1943, however, the Hygienic Institute of the laboratory headed by Dr Ding in another camp, Buchenwald, encountered great difficulties in the production of the typhoid vaccine and it was decided that Dr Fleck should be the one to solve the problem. So, at the end of the month, Dr Fleck left Auschwitz in a special car. He was taken to a camp on the outskirts of Weimar. He left behind his wife and son and promised them that if they lived, they would meet in Lvov after the war.
Buchenwald
Block 50 in Buchenwald, where Fleck was housed and where the Hygiene Institute was also located, was further away from the death zone than Block 10 in Auschwitz. The staff did not have to get up at half past five in the morning, they did not have to assemble on Appellplatz for hours of counting, they slept on sheets and had adequate food. What kind of vaccine was to be produced in Buchenwald?
Setting up a farm to grow aphids was an impractical solution. Making a vaccine from eggs would also require a chicken farm, and there was the question of who would supervise it, and the accusation that the vaccine was unreliable. A vaccine derived from rabbit lungs, produced in small quantities by the Pasteur Institute in Paris, has already been tested in Buchenwald and proved to be as effective as Weigl’s.
There were always enough doctors, real or imaginary, in the laboratory, but the most important prisoner in Block 50 was neither a doctor nor a scientist. He was Eugen Kogon, a Catholic humanist and journalist who had managed to win the trust of his superiors. He skilfully managed to convince Dr Ding that the Nazis would lose the war and that Ding’s fate after the war depended on his behaviour. Thus Block 50 became an occasional refuge for some of the endangered camp inmates and a centre of conspiracies against the Nazi system, although Dr Ding was often unaware of this. The vaccine department thus soon grew to 65 men.
From the beginning, Dr Ding struggled with problems he didn’t fully understand when making the vaccine. He knew that it was absurd to expect camp inmates, even if they were doctors, to produce such a vaccine in a concentration camp, because it is not a mechanical job like making pencils, but the scientific work of many years by highly specialised and skilled experts with appropriate and ever new technical apparatus. But the Nazi medical bureaucracy was not prepared to listen to his explanations. Moreover, the prisoners were intelligent enough to realise that only the lengthy procedures of vaccine production could keep them alive. So they deliberately worked slowly. Sometimes the temperature in the modified laboratory was a degree too low, sometimes the process was stopped prematurely, sometimes there was a lack of clarity in the translation of the instructions.
Fleck immediately noticed that Dr. Ding ” is a little con-man” who probably knows that his work is meaningless. But others recognised Fleck’s vast medical knowledge and took note. They asked him not to point out the flaws he sees in the vaccine trials, but to work well with them in general. Fleck agreed to do so. Thus, 500 litres of ineffective vaccine were produced in Block 50, enough to vaccinate 200,000 people. The guards used it in the camp and for combat troops on the Eastern Front. Six litres of real vaccine were saved by the camp guards for the suffering people in the camp.
The SS on the battlefields suspected that something was not as it should be, so they asked Block 50 to check the vaccine. Of course, the test was always positive. But everybody knows that no vaccine works 100% of the time. Only some in Block 50 knew that the vaccine was not good. The others thought that what they were sending forward was perfect.
In the summer of 1944, things began to change dramatically. After the Normandy landings, Paris was liberated on 24 August and on the same day the Allies bombed Buchenwald. Munitions factories on the outskirts of the camp were destroyed and the buildings inside the camp were set on fire. That evening, despite the large number of dead campers, everyone in Block 50 had a hearty rabbit stew for dinner.
In early April 1945, as the Americans were approaching Buchenwald, a group of campers entered Block 50 and went down to the basement, where they had stashed a pile of coal on which they were cooking rabbit scraps. They removed it and pulled out more than 100 rifles, a machine gun and a supply of ammunition and bombs. Meanwhile, the SS guards were already fleeing into the woods, but many were caught and shot. A few hours later, a column of American vehicles drove into the camp.
Dr Ding fled to Weimar, but soon surrendered to the Americans, hoping that they would be merciful to him under the circumstances. But he was disappointed because he was imprisoned. He attempted suicide twice and succeeded the second time. After the end of the war, Weigl was offered a professorship at the Jagiellonian University in Cracow (Lvov or Lwów had already been annexed to Ukraine), but he no longer had the strength for such a demanding job. He was also in disrepute for saving the lives of German soldiers with his vaccine. Many of his colleagues began to shun him and stopped using his name as a reference in their applications. In 1948, he was transferred to the medical faculty in Poznan, but soon retired and set up a small research centre in Krakow, which was completely dependent on government contracts. He died in Zakopane in August 1957 of a heart attack.
Ludwik Fleck returned to Lviv, a city that had lost half of its population during the war. Many of the Poles who were still here moved to Wroclaw in Poland, as Lviv was now a Ukrainian city. Fleck also moved to Lublin soon after and continued working with students, staying there until 1952. He travelled extensively in Europe and participated in many international meetings, as he was involved in haematology. After moving to Warsaw, he became director of the bacteriology laboratory at the hospital. After the campaign against the remaining Jews in Poland began in 1957, he decided to move to Israel. In 1961, after less than four years in Israel, he suffered a second heart attack while receiving treatment for malignant lymphoma and died a few days later.
