Excerpt: Typhus from now on took over its historic role along
the entire Eastern front. It flourished as usual in all the
Eastern armies, but was kept, by extraordinarily effective
sanitary measures, bathing and delousing, within
reasonable bounds among the Austrians and Germans.
Though it penetrated into the prison camps in Central
Europe, it was successfully prevented from spreading
to the civilian populations. Among the most remarkable
phenomena of the war is the total absence o r typhus from
the Western front.”


Being a Study in Biography, which, after Twelve Preliminary Chapters Indispensable for the Preparation of the Lay Reader, Deals with the Life History of TYPHUS FEVER

Also known, at various stages of its Adventurous Career, as Morbus pulicaris (Cardanus, 1545); Tabardiglio y puntos (DeToro, 1574); Pin fas; Febris pur- purea epidemica (Coyttarus, 1578); Febris quam lenticulas vel puncticulas vacant (Fracastorius, 1546); Morbus hungaricus; La Pourpre; Pipercorn; Febris petechialis vcra; Febris maligna pestilens; Febris putrida ct ma/tgna; Typhus carcerorum; Jayl Fever; Fievre des hopitaux; Pcstis bcllica; Morbus castremis; Famine Fever; Irish Ague; Typhus cxanthematicus; Faulfieber; Hauptkrank- heit; Pcstartigc Eraune; Exanthematisches Nervcnfiebcr, and so forth, and so forth.




and F*rint*d *n C^reat Britain by

This book is dedicated in affectionate friendship to
Charles Nicolle, scientist^ novelist, and ‘philosopher


THESE chapters we hesitate to call so rambling a per-
formance a book were written at odd moments as a
relaxation from studies of typhus fever in the laboratory
and in the field. In following infectious diseases about the
world, one ends by regarding them as biological individ-
uals which have lived through centuries, spanning many
generations of men and having existences which, in their
developments and wanderings, can be treated biograph-
ically. Typhus fever lends itself more than most others

to such treatment because of its extraordinary parasitic
cycles in the insect and animal worlds, the salient facts
of which have all been elucidated within the last ten years.
In no other infection does the bacteriologist find so favour-
able an opportunity for study of the evolution of a para-
sitism. Moreover, in its tragic relationship to mankind this
disease is second to none not even to plague or to chol-

In the course of many years of preoccupation with in-
fectious diseases, which has- taken us alternately into the
seats of biological warfare and into the laboratory, we have
become increasingly impressed with the importance
almost entirely neglected by historians and sociologists

of the influence of these calamities upon the fate of
nations, indeed upon the rise and fall of civilizations.


The chapters which deal with this phase of our subject
represent little more than preliminary notes. They may
serve to stimulate future historians, who possess the learn-
ing which we lack, to give these factors the attention
which they merit and to interpolate their effects into the
interpretations of the past history of mankind.

In no sense can we claim to have made any original
contributions to the history of medicine. We have taken
information where we could find it, and have freely used
the works of such profound scholars as Schnurrer, Hecker,
Ozanam, Haeser, Hirsch, Murchison, and others. In
consulting ancient and mediaeval texts our meagre classical
learning was re-enforced by the charitable good nature of
our colleagues Professors Gulick and Rand, of our friend
Dr. Charles Lund, and by the enthusiastic interest of Mr.
C. T. Murphy of the Harvard Classical Department.
Conversation and correspondence with Professor Sigerist
of Johns Hopkins, Professor Merriman of Harvard, Ma-
jor Hume of the United States Army, and many others
have brought us invaluable aid in critical places. We owe
a particular debt of gratitude to our wise and kindly friend,
Professor W. Morton Wheeler, who has been generous
with advice and encouragement. Since this is, in no sense,
a scientific treatise, we have left out references to recent
work and, in order to neglect no one, have mentioned
almost no names.

For our chapters and comments on matters of literary
interest we make no apologies. Although we regard them
as pertinent to the general scheme of our exposition, many
will regard them as merely impertinent. But, in a way,


this book is a protest against the prevailing attitude which
tends to insist that a specialist should have no interests
beyond his chosen field unless it be golf, fishing, or
contract bridge. A specialist according to this
should stick to his job like “a louse to a pig’s back.” We
risk because of this performance being thought less
of as a bacteriologist. It is worth the risk. But the day has
twenty-four hours j one can work but ten and sleep but

We hold that one type of intelligent occupation should,
in all but exceptional cases, increase the capacity for
comprehension in general} that it is an error to segre-
gate the minds of men into rigid guild classifications 5 and
that art and sciences have much in common and both may
profit by mutual appraisal. The Europeans have long ap-
preciated this. That our book has contributed in this re-
spect we have not the temerity to assert. At any rate, we
have written along as it has suited our fancy, and have
been amused and rested in so doing.

H. Z.

December 3, 1934


Preface vii

I In the nature of an explanation and an

apology …… 3

II Being a discussion of the relationship be-
tween science and art . . . .15

III Leading up to the definition of bacteria and

other parasiteSy and digressing briefly into

the question of the origin of life . . 34

IV On parasitism in general, and on the neces-

sity of considering the changing nature of
infectious diseases in the historical study
of epidemics . . * . .57

V Being a continuation of Chapter IV, but
dealing more particularly with so-called
new diseases and with some that have dis-
appeared . . . . . .77

VI Diseases of the ancient* world: a considera-
tion of the epidemic diseases which afflicted
the ancient world . . . . .105

VII A continuation of the consideration of dis-
eases of the ancients^ with particular at-
tention to epidemics and the jail of Rome 128

VIII On the influence of epidemic diseases on po-
litical and military history , and on the
relative unimportance of generals . . 150


IX On the louse: we are now ready to consider
the environment which has helped to form
the character of our subject . . .166

X More about the louse: the need for this chap-
ter will be apparent to those who have
entered into the spirit of this biography 179

XI Much about rats a little about mice . 1 89

XII We are at last arriving at the point at which
we can approach the subject of this biog-
raphy directly 212

XIII In which we consider the birth y childhood^

and adolescence of typhus . . . 229

XIV In which we follow the earliest epidemic ex-

ploits of our disease …. 240

XV Young manhood: the period, of early vigour

and wild oats ….. 265

XVI Appraisal of a contemporary and prospects of

future education and discipline . .282


In the nature of an explanation and an apology

THIS book, if it is ever written, and if written it
finds a publisher, and if published anyone reads it,
will be recognized with some difficulty as a biography.
We are living in an age of biography. We can no longer
say with Carlyle that a well-written life is as rare as a
well-spent one. Our bookstalls are filled with stories of
the great and near-great of all ages, and each month’s
publishers’ lists announce a new crop. The biographical
form of writing has largely displaced the novel, it has
/poached upon the territory that was once spoken of as
criticism, it has gone into successful competition with the
detective story and the erotic memoir, and it has even
entered the realm of the psychopathic clinic. One wonders
what has released this deluge.

There are many possible answers. It is not unlikely
that, together with other phases of modern life, literature
has gone “scientific.” As in science, a few men of origin-
ality work out the formulas for discovery in a chosen sub-
ject, and a mass of followers apply this formula to anal-
ogous problems and achieve profitable results. In an age
of meagre literary originality, it is a natural impulse for
workers to. endeavour to explain the genius of great mas-
ters. And for every novelist, poet, or inventor of any kind,


we have a dozen interpreters, commentators, and critics.
Once biography was a serious business and the task of
the scholar. When Plutarch wrote his Parallel Lives, his
mind as Mr. Clough rightly remarks was running
on the Aristotelian ethics and the Platonic theories which
formed the religion of the educated men of his time. He
dealt less with action, more with motives and the reaction
of ability and character upon the circumstances of the
great civilizations of Greece and of Rome. Scholarly
biographies of later ages followed similar methods, even in
such intensely personal records as Boswell’s Johnson, or
the Conversations by which so dull an ass as Eckermann
managed to write himself into permanent fame. The
minor details of intimate life were, in the past, regarded
as having consequence only as they had bearing on the
states of mind that led to high achievement. It was rec-
ognized that “les fetitesses de la vie privee peuvent
Saltier avec I’heroisme de la vie publique.” But they
were utilized only when they were significant or amusing.
But all this has changed. The new school sees the key
to personality in the petitesses. Biography has become
neurosis-conscious. Freud is a great man. But it is dan-
gerous when a great man is too easily half-understood.
The Freudian high explosives have been worked into
firecrackers for the simple to burn their fingers. It has
become easy to make a noise and a bad smell with materials
compounded by the great discoverer for the blasting of
tunnels. Biography is obviously the best playground for
the dilettante of psychoanalysis. The older biographers
lacked this knot-hole into the subconscious. They judged


their heroes only by the conscious. The subconscious de-
thrones the conscious. Great men are being reappraised
by their endocrine balances rather than by their perform-
ances. Poor Shelley! Poor Byron! Poor Wagner! Poor
Chopin! Poor Heine! Poor Mark Twain! Poor Henry
James! Poor Melville! Poor Dostoevski! Poor Tolstoy!
And even poor Jesus! There are still a lot left the
surface is hardly scratched. But even before the great ones
give out, the “damaged” ones make good reading: P. T.
Barnum, Brigham Young even unto Al Capone and
Pancho Villa.

In the present biography, we are forced by the nature of
our subject to revert to the older methods. We will profit
by no assistance from psychoanalysis. There will be no
prenatal influences} no QEdipus or mother complexes; no
early love affairs or later infidelities; no perversions,
urges, or maladjustments; no inhibitions by respectability,
and no frustration by suppressed desires. We shall have
no gossip to help us; no personal letters which there was
no time to burn. We cannot count upon the reclame of a
libel suit barely averted, or of scandals deftly hinted at.
We have not even the comfort of preceding biographers
and essayists whom we can copy, paraphrase, or refute.
Indeed, we are quite stripped of the sauces, spices, and
dressings by which biographers can usually make poets
and scientists into quite ordinary and often objectionable
people; by which they can divert attention from the work
of a man to his petty or perhaps vicious habits; by which
they can create a hero out of a successful commercial
highbinder; by which they can smother public guilt by


domestic virtue, or direct interest from the best and last-
ing accomplishments of their subject to the utterly un-
important private matters of which he was ashamed.

The habitue of biographies will ask himself how, with-
out these indispensable accessories of the biographical
tradesman, we can dare to enter this field. The answer is
a simple one: the subject of our biography is a disease.

We shall try to write it in as untechnical a manner as is
consistent with accuracy. It will of necessity be incomplete,
for the life of our subject has been a long and turbulent
one from which we can select only the high spots. Much
of its daily domestic history has been as commonplace and
repetitive as that of any human being, warrior, poet, or
shopkeeper. Above all, our narrative is not “popular
science.” If our story is, in places, dramatic, it will be the
fault of the story not our own. Nobody will be edu-
cated by it. We have chosen to write the biography of our
disease because we love it platonically as Amy Lowell
loved Keats and have sought its acquaintance wher-
ever we could find it. And in this growing intimacy we
have become increasingly impressed with the influence
that this and other infectious diseases, which span in
their protoplasmic continuities the entire history of
mankind, have had upon the fates of men.

In approaching our subject, however, we permit our-
selves a number of digressions into which our undertaking
inevitably forces us.


Infectious disease is one of the great tragedies of liv-
ing things the struggle for existence between different
forms of life. Man sees it from his own prejudiced point
of viewj but clams, oysters, insects, fish, flowers, tobacco,
potatoes, tomatoes, fruit, shrubs, trees, have their own
varieties of smallpox, measles, cancer, or tuberculosis.
Incessantly, the pitiless war goes on, without quarter or
armistice a nationalism of species against species. Usu-
ally, however, among the so-called “lower” forms of life,
there is a solidarity of class relationship which prevents
them from preying upon their own kind by that excess of
ferocity which appears to prevail only among human
beings, rats, and some of the more savage varieties of
fish. There are, it must be admitted, isolated instances in
the animal kingdom of a degree of ferocity within the
same species not yet attained by man. Husband eating is
an accepted custom with the spiders, and among the Ala-
cran or Scorpions, it is quite de rigueur for the mother to
devour the father and then, in her turn, to be eaten by
her “kiddies.” When male members of the larger cat
families that is, mountain lions waylay and eat their
own children, this is not truly an evidence of ferocity.
It is an indirect crime passionnel; the result of an im-
patient tenderness for the lioness who has become too ex-
clusively the mother. The motive is love, and, as La
Rochefoucauld has said, “Si on juge I’amour par la plu-
part de ses e$et$ y il ressemble plus a la haine qu’a


Nature seems to have intended that her creatures feed
upon one another. At any rate, she has so designed her
cycles that the only forms of life that are parasitic directly
upon Mother Earth herself are a proportion of the vege-
table kingdom that dig their roots into the sod for its
nitrogenous juices and spread their broad chlorophyllic
leaves to the sun and air. But these unless too un-
palatable or poisonous are devoured by the beasts and
by manj and the latter, in their turn, by other beasts and
by bacteria. In the Garden of Eden perhaps things may
have been so ordered that this mutual devouring was
postponed until death, by the natural course of old age,
had returned each creature’s store of nutriment to the
general stock. Chemically, this might have been possible,
and life maintained. But in the imperfect development
of cohabitation on a crowded planet, the habit of eating
one another dead and alive has become a general
custom, instinctively and dispassionately indulged in.
There is probably as little conscious cruelty in the lion
that devours a missionary as there is in the kind-hearted
old gentleman who dines upon a chicken pie, or in the
staphylococcus that is raising a boil on the old gentleman’s
neck. Broadly speaking, the lion is parasitic on the mission-
ary, as the old gentleman is on the chicken pie, and the
staphylococcus on the old gentleman. We shall not en-
large upon this, because it would lead us into that excess
of technicality which we. wish to avoid.

The important point is that infectious disease is merely
a disagreeable instance of a widely prevalent tendency
of all living creatures to save themselves the bother of


building, by their own efforts, the things they require.
Whenever they find it possible to take advantage of the
constructive labours of others, this is the direction of the
least resistance. The plant does the work with its roots
and its green leaves. The cow eats the plant. Man eats
both of themj and bacteria (or investment bankers) eat
the man. Complete elucidation would require elaborate
technical discussions, but the principle is clear. Life onj
earth is an endless chain of parasitism which would soon!
lead to the complete annihilation of all living beings^
unless the incorruptible workers of the vegetable king-I
dom constantly renewed the supply of suitable nitrogen *
and carbon compounds which other living things can;
filch. It is a topic that might lend itself to endless trite j
moralizing. In the last analysis, man may be defined as)
a parasite on a vegetable.

That form of parasitism which we call infection is as
old as animal and vegetable life. In a later chapter we
may have occasion to consider its origin; to this we have
some clue from the new diseases which appear to be
constantly developing as we begin to conquer the old
ones. But our chief purpose in writing the biography of
one of these diseases is to impress the fact that we are
dealing with a phase of man’s history on earth which
has received too little attention from poets, artists, and
historians. Swords and lances, arrows, machine guns, and
even high explosives have had far less power over the
fates of the nations than the typhus louse, the plague flea,
and the yellow-fever mosquito. Civilizations have re-
treated from the plasmodium of malaria, and armies


have crumbled into rabbles under the onslaught of cholera
spirilla, or of dysentery and typhoid bacilli. Huge areas
have been devastated by the trypanosome that travels on
the wings of the tsetse fly, and generations have been
‘ harassed by the syphilis of a courtier. War and conquest
and that herd existence which is an accompaniment of what
we call civilization have merely set the stage for these
more powerful agents of human tragedy.


Having written the preceding paragraphs, we read them
over and came to the conclusion that there was little in
them that mattered very much. We were, perhaps, a
little severe in discussing modern biographers. One is
lured into discussions of this kind by one’s irritations. One
can disagree with many of the opinions expressed by
Goethe in Eckermann, or by Renan, or Sainte-Beuve, or
by Babbitt, or by Whitehead, when one understands
what he is talking about, and come away with the
satisfaction of having been stimulated to oppose views
by the importance of those one disagreed with. But one
is merely irritated by the complacency with which the
sciences and the arts are dealt with e superiore loco by the
younger school of biographical critics, those who sit
between intelligence and beauty, like Voltaire between
Madame de Stael and a flirtatious Marquise, “with-
out possessing either.” One wishes to exclaim, with a simi-
larly irritated Frenchman: “Save us, dear Lord, from the
connaisseurs qw n’ont fas de connaissance and from the
amateurs qui rfont pas d* amour!” A part of our first


chapter, therefore, is nothing more than a growl. Yet it
still serves to introduce our subject; and we are further
inclined to retain it for the following reasons. We are
engaged in an occupation which philosophers, mathe-
maticians, physicists, physical chemists, biochemists, and
even physiologists (who may in many cases have been less
valuable to science than one of Pavlow’s dogs) do not
acknowledge as a science; and which poets, novelists,
critics, biographers, dramatists, painters, sculptors, and
even journalists categorically exclude from the arts. We
are in a position, therefore, to look both ways with the
clarity begotten of humility. But, in discussing our ideas
with representatives of the various callings named above,
we encountered a common misconception perhaps the
only opinion on which there was agreement to the
effect that men were impelled to enter the career of in-
vestigating infectious diseases from a noble desire to serve
mankind, to save life, and to relieve suffering.

A friend of ours is a professional writer. By this, we
mean a person who makes his living by writing in the
same way that a bricklayer makes his by laying bricks, or
a plumber supports himself by sweating joints. Writing,
of course, like speech, is a method of expressing ideas or
telling tales. It is also a means of conveying to others
emotions, conceptions, or original comprehensions which
might instruct, amuse, delight, or elevate. This kind of
writing used to be called art. And once when only the
intelligent could read writing also needed to be in-
telligent and artistic.

In our day, however, all kinds of people can read:


college professors and charwomen, doctors and lawyers,
bartenders, ministers of the gospel and trained nurses.
They all have the same ideal of the happy ending of a
dull day a comfortable couch, a bed lamp, and some-
thing to read. And there must, in consequence, be writers
to supply this need literature for the intelligent as for
the moron a book for every brain, like a motor car
for every purse.

The particular writer of whom we speak has been un-
usually successful in alternately supplying both markets

now satisfying the reasonably intelligent, and again
luring a fat cheque with stories about the poor boy and the
boss’s daughter. In the latter mood, he has scented the
rich possibilities of exploiting the sensationalisms of science

a source of revenue so successfully tapped by a num-
ber of his literary contemporaries. But never having had
any close association with workers in the field of infectious
diseases, he shared this misconception of the noble motives
which impelled these queer people. And not quite under-
standing how anyone could be impelled by noble motives,
he asked us: “How do bacteriologists get that way?” We
answered his question more or less in the following man-

A great deal of sentimental bosh has been written about
this totally erroneous assumption. When a bacteriologist
dies as other people do of incidental dissipation,
accident, or old age, devotion and self-sacrifice are the
themes of the minister’s eulogy. Let him succumb in the
course of his work, as an engineer falls down a hole, or
a lawyer gets shot by a client, he is consecrated as a


martyr. Novelists use him as they formerly did cavalry
officers, Polish patriots, or aviators. If an epidemiologist
on a plague study talked and behaved in the manner of
the hero of Arrowsmith, he would not only be useless, but
he would be regarded as something of a yellow ass and
a nuisance by his associates. And de Kruif is far too in-
telligent a man not to have known, when he wrote his
thriller on Men against T>eath y that raucous laughter
would be its reception in the laboratories and in the field
where the work he describes is being done.

As a matter of fact, men go into this branch of work
from a number of motives, the last of which is a self-
conscious desire to do good. The point is that it remains
one of the few sporting propositions left for individuals
who feel the need of a certain amount of excitement. In- ,
f ectious disease is one of the few genuine adventures left
in the world. The dragons are all dead, and the lance
grows rusty in the chimney corner. Wars are exercises in*
ballistics, chemical ingenuity, administration, hard physical 1
labour, and long-distance mass murder. Ships have wire-‘
less equipment. The American continent is a stage route of
petrol stations, and the Indians own oil wells. Africa is a
playground for animal photographers or museum adminis-
trators and their wives, who go there partly to have their
pictures taken with one foot on a dead lion or elephant
and disgusted-looking black boys carrying boxes of cham-
pagne and biscuits on their patient heads. Flying is ad-
venturous enough, but little more than a kind of acrobatics
for garage mechanics, like motor car racing. But how-
ever secure and well-regulated civilized life may become,


bacteria, Protozoa, viruses, infected fleas, lice, ticks, mos-
quitoes, and bedbugs will always lurk in the shadows ready
to pounce when neglect, poverty, famine, or war lets
down the defences. And even in normal times they prey
on the weak, the very young and the very old, living
along with us, in mysterious obscurity waiting their op-
portunities. About the only genuine sporting proposition
that remains unimpaired by the relentless domestication
of a once free-living human species is the war against
these ferocious little fellow creatures, which lurk in the
dark corners and stalk us in the bodies of rats, mice, and
all kinds of domestic animals ; which fly and crawl with the
insects, and waylay us in our food and drink and even
in our love.


Being a discussion of the relationship between science and

art a subject that has nothing to do with typhus jever,

but Was forced u$on us by the literary gentleman spoken of

in the last chapter

THIS chapter will be received with contemptuous shrugs
by the professionally literary. There is a prejudice wide-
spread that specialists should not trespass beyond their
own paddocks, however interestedly they may look over
the rails. But literary critics are constantly telling us that
science is this or that “science should not be exalted out
of its place,” and so onj and since we cannot possibly know
less about literature than most of these gentlemen know
about science, we venture to proceed, hoping that Messrs.
Edmund Wilson, Van Wyck Brooks, Mumford, Max
Eastman, and others who were the “Younger School,”
until they grew middle-aged, will skip this part of our

The biologist is in a peculiarly difficult position. He
cannot isolate individual reactions and study them one by
one, as the chemist often can. He is deprived of the math-
ematical forecasts by which the physicist can so frequently
guide his experimental efforts. Nature sets the conditions
under which the biologist works, and he must accept her
terms or give up the task altogether.


He knows that physicochemical analysis will never give
the final clue to life processes; yet he recognizes that
“vitalism” and “neovitalism” are little more than a sort
of amorphous theology born of a sense of the helplessness
of mere “mechanism.” 1 So the patient biologist plods
along, piling up his empirical observations as honestly as
he can getting what satisfaction he may from the fact
that he is helping, by infinite increments, to reduce the
scope of vitalistic vagueness to narrower and narrower
limits. As Bergson puts it: “A very small element of a
curve is near being a straight line; and the smaller it is,
the nearer. … So, likewise, Vitality’ is tangent, at
any and every point, to physical and chemical forces. . . .
In reality [however], life is no more made up of physico-
chemical elements than a curve is composed of straight
lines.” The biologist is constantly differentiating the curve
of vitality, quite aware that mankind can approach, but
never reach, the “limiting value” of complete compre-
hension. Moreover, he knows whenever he attacks a
problem that before he can advance toward his objec-
tive, he must first recede into analysis of the individual
elements that compose the complex systems with which
he is occupied.

Such difficulties engender a habit of mind that has ham-
pered us in the present undertaking. We approached the
writing of the biography of typhus fever with the care-

1 And, indeed, ultimately they both encounter the same ine r itable
perplexity, since, as Paley rightly asserts, mechanism presupposes God
as the mechanician. This is the difficulty faced by all the recent astro-
nomical and physicist school of ponderers.


less confidence which always accompanies the first concep-
tion of an experimental objective. We were first deflected
into contemplation of the general methods of biographical
writing} then arose the question why men occupied them-
selves with the study of disease. We thought we were
through with preliminaries, when our literary friend
dropped in again, and proceeded to scatter salt upon our

“How,” he said, “can a person who has spent his life
cultivating bacteria} inoculating guinea pigs, rabbits, mice,
horses, and monkeys; posting about the dirty corners of
the world in the study of epidemics; catching rats in
foreign cellars; disinfecting, delousing, fumigating; look-
ing at rashes, down throats and into other apertures of
man and animals; breeding lice, bedbugs, fleas, and ticks}
examining sputum, blood, urine, stools, milk, water, and
sewage how,” he repeated, “can such a person, who
is not quite a scientist and nothing of an artist, presume
to undertake a task which no one not an artist could success-
fully accomplish? You might be right about the keyhole
biographers and the pasteurized Rabelaisian school of
Freudian critics, but is that any worse than the literary-
scientific spinster movement? Do you want to be like
the popular scientists, ‘thc-Doctor-looks-at-this, the-
Doctor-] ooks-at-that’ business ? ”

“But !” we replied

“Look at all the rest of the middle-aged scientists who
have made fools of themselves dabbling with art. Read the
Atlantic Monthly.”


“Good Lord,” I said, “one need n’t stop being a bac-
teriologist just because one takes an intelligent interest
in other things. Here in America we seem to expect a
specialist to become a sort of Taylorized factory worker.
Why should a man look at the world through only one

“Oh, look through a dozen or climb up and look over
the fence if you like. But keep still about things you ‘re
not trained to handle. Biography is a job for an artist.
Stick your head out of your laboratory window and watch
the world go by. But if you want to write, pull it in again
and write for the Journal of Experimental Medicine.
You ’11 only end, if you keep this up, by losing what little
reputation you ‘ve got.”

“But,” we demurred, “is a man to be denied an in-
telligent appreciation of art just because he knows some-
thing about a science? Is literature to be appraised only
by those who have time to “read after breakfast? What’s
the essential difference between art and science anyway?”

“That ‘s a difficult question,” he said. “Goethe might
have answered it, but he did n’t think it was worth while.
The late war between humanists and antihumanists might
have brought an answer only both sides were so angry
at each other and so ignorant of science that they neglected
the main issue. Babbitt, with his vast erudition, might
have found a reply if he had lived. Toward the end, the
small fry were keeping him too busy with his heels. Any-
way, neither you nor I know enough to deal with it.”

Our friend’s opinions on matters of this sort have always
carried much weight with us, and, in this case, they im-


pelled us to delay embarking upon our project which,
as he said, transcended our scientific training until we
had given thought to the essential differences, if there
were any, between science and art.

We approached the problem modestly by examining the
opinions of others, and found that men far wiser than
ourselves had failed to agree. Eddington and Jeans in-
cline to limit science to the “metrical or mathematical
descriptions of phenomena,” a conception which would
exclude even the biological branches of learning. But
having ascended to these cold heights by laborious upward
paths of reason, they sit down in their metaphysical tobog-
‘gans and swish back into the warm and comfortable vales
of theology. Dingle attempts a more liberal view, defin-
ing science as a method of “dealing rationally with ex-
periences which have a certain quality; namely, that they
are common to all normal people.” This is dreadful
English, but once parsed it means, conversely, that
the territory of art is that of experiences which are “pe-
culiar to the individual, or perhaps shared by a limited
number of others.” This opinion is much like the pre-
Darwinian method of classifying animals by their super-
ficial similarities, which made the whale a fish and the
bat a bird. Whitehead penetrates more deeply beneath
the mere morphology of the problem into its comparative
anatomy and physiology. He includes, in the category of
science, the biological branches and geology, and, more
than that, he regards naturalistic art (Leonardo) as
closely akin to science. Indeed, he finds in great literatures
for instance, in the “scientific imagination” of ^Eschylus,


Sophocles, and Euripides, in their visions of Fate “urging
a tragic incident to its inevitable issue” the same princi-
ple of “Order” which is the “vision possessed by science.”
If Aristotle could return to us long enough to familiarize
himself with modern scientific thought, we venture to
say he would come pretty close to agreeing with White-
head. Incidentally, what a kick Aristotle would get out of

That any sharp separation between science and art is
impossible was also in the mind of Havelock Ellis, when
he wrote the following passage: “To press through, to
reveal, to possess, to direct and to ennoble, that is the
task and the longing alike of the lover and the natural
discoverer} so that every Ross or Franklin is a Werther
of the Pole, and whoever is in love is a Mungo Park of
the spirit.” We should have taken more pleasure in this
quotation had Mr. Park’s Christian name been other
than “Mungo.” But, as it stands, it expresses the burden
of the thought that was developing in our mind.


To most of the modern literary critics probably be-
cause of their almost incredible ignorance of scientific
thought the so-called scientist is a “mere rationalist,”
and science is held, in respect to art, as photography is to
painting. This separation on the basis of precision is
utterly untenable. Science is not a whit more photographic
than is art. Measurements and formulations are, even in
the so-called exact the physical sciences, not much
more than reasonably accurate approximations. Scientific


method is again and again forced to employ abstract con-
ceptions, irrational numbers like V^ and \/3, the line
without breadth, the point without volume, zero, the
negative quantity, or the idea of infinity. And scientific
thought continually sets sail from ports of hypothesis and
fiction, 2 advance bases of the exploring intellect. Matter
becomes molecules, molecules become atoms ; atoms, ionsj
ions, electrons; and these, in turn, become uncompre-
hended sources of energy not more clear as seizable
reality than the poet’s conception of the “soul,” which he
knows only from its “energy” the yearnings, delights,
and sorrows which he feels. The history of science is full
of examples of what, in art, would be spoken of as inspira-
tion, but for which Whitehead’s definition, “speculative

reason,” seems much more appropriate. ^* c – ~

“…*% ..,.. ~..* f * f

It is only too painfully obvious, moreover, that neither
the scientist nor the artist is ever a “creator.” The word
“creative,” so incessantly misused by our younger critical
schools, is a fiction of that optimism about human achieve-
ment which it has been said thrives most vigorously
in lunatic asylums. Nature, as Goethe puts it, runs its
course by such eternal and necessary principles that even
the gods themselves cannot alter them. The most that
the scientist and the artist accomplish is new understanding
of things that have always been. They “create” a clearer
perception. They are both, in this sense, observers, the
obvious difference being that the scientist impersonally
describes the external world, whereas the artist expresses

* This has been clearly set forth in Hans Vaihinger’s The Philosophy

of AS if r


the effects which external things exert upon his own mind
and heart. In both cases, the more generally applicable
the observations, the greater is the science or art. 8

Would it not be fair to say that an achievement of
observation becomes science or art according to the degree
to which its comprehension calls upon perception by the
reason or by the emotions, respectively? The capacities
of intelligence form a sort of spectrum which extends
from what we may call an infra-emotional to an ultra-
reason range. At the infra-emotional extreme lie the per-
ceptions set in motion by music and by lyrical poetry. At
the opposite end that of pure reason is placed the
perceptional capacity for mathematics. Between the two
there is a wide range of overlapping where art is scientific
and science artistic. Literature in the sense of prose may
be taken to hold a middle ground, shading on the left
into epic and narrative poetry, and on the right through
psychology, biology, and so forth, toward mathematics.

“What happens when you go off the deep end of either
side?” asked my friend.

8 I. A. Richards expresses this function of the artist as an observer
of the “facts” of human emotions in a precise manner when he says,
“In the arts we find the record, in the only form in which these things
can be recorded, of the experiences which have seemed worth having
to the most sensitive and discriminating persons.” In this sense Leonardo,
^Shakespeare, Cervantes, Goethe, Dostoevski, and countless other artists
were as truly accurate observers in the field of human experiences as
were Newton and Pascal in the field of the external world.

Andre Gide means the same thing when he says, “Everything has
always existed in man . . . and what new times uncover in him has
always slumbered there. . . . How many hidden heroes await only the
example of a hero in a book, only a spark of life given off by his life
in order to love, only a word from him in order to speak.”


“Well, beyond the 10″”” 10 range, experience seems to
show that the end organs give out and the physicist joins
the church; whereas on the other side, as I should judge
from Joyce, Gertrude Stein, and their imitators, the
spinal cord begins to horn in on the brain. In either case
it cea$es to be science or art.”


I continued the discussion with my friend at our next

“On that basis,” he said, “it should be easy to classify
any performance by a sort of intellectual spectroscopic

“With the older forms it was usually easy to fit them
into their proper places in the spectrum. Critics like Cole-
ridge or Sainte-Beuve needed to concern themselves only
with style, beauty of diction, clarity of thought, intensity,
sincerity, depth, and the qualities of taste and sensitive-
ness which, while vague and subtle, were still within the
scope of the underanged mind. Art could be judged by any ,
informed and intelligent critic without recourse to border- )
line psychiatry. The corner was turned by the French |
symbolists who followed Baudelaire, Rimbaud, Ver-*
laine, Mallarme, Laforgue. On occasion these great men
came close to the jumping-off place of uncomprehen-
sibility. But in the main they achieved a great beauty by
the very dusk and mist through which their thoughts,
sufferings, and joys were mysteriously, grotesquely,
vaguely, but still effectively perceived. One cannot, with
Lasserre, deny them their just places merely because they


applied their superb gifts to tristesse and laideur. We make
no plea for a return to Tennysonism or the Longfellow
era, but had Sainte-Beuve been required to pass judg-
ment on certain passages of T. S. Eliot, the later Joyce,
or Gertrude Stein, he would surely have gone into con-
sultation with Charcot or Bernheim, a dilemma which our
modern critics seem to admit in their judgments of
modern work by their habitual appeal to Sigmund
Freud. It is, of course, difficult, even in medical practice,
to survey sharply the line between sanity and border-
line derangements. But when the critic of a work of art
needs psychiatric training, this fact alone would serve to
throw suspicion on the artistic value of his subject. The
real difficulty of applying our kind of spectroscopic analysis
to much of the modern stuff lies in the fact that a good
deal of it lacks the rationality of science without possessing
the emotional appeal of art.

“Let us examine some of it. Take T. S. Eliot who,
in his prose, shows great clarity of thought and to whom
no one will deny talent, originality, and, on occasion, great
beauty. But in much of his poetry he plays, as has been
aptly remarked, a guessing game with readers, whom he
seems to appraise, apparently with some reason, as imbe-
ciles. ‘Guess which memory picture of my obviously one-
sided erudition I am alluding to? See note 6a. J Then he
drops suddenly, after a few lines of majestic verse, into
completely irrelevant babble.

“In the room the women go to and fro
Talking of Michael Angelo.


One is tempted to add, c Eenie, meenie, minie, mo.’ Or

“Madame Sosostrig, famous clairvoyante,
Had a bad cold, nevertheless
Is known to be the wisest woman in Europe
With a wicked pack of cards.

“Why Nevertheless’? Was she wise because she had a
bad cold? Or this (one has the choice of innumerable pas-
sages) :

“Now Albert’s coming back, make yourself a bit smart.
He ’11 want to know what you done with that money he gave you
To get yourself some teeth.

“Is that poetry? It sounds like trivial prose. It certainly
is n’t science.”

“Of course it J s not fair to take things out of their con-
texts like that. The thing as a whole symbolizes the Waste
Land of modern disillusionment. Of course it J s hard for
a scientist to understand.”

“It ‘s not whether a thing is hard to understand. It ‘s
whether, once understood, it makes any sense. Every now
and then my monkeys get loose in the laboratory and
achieve brilliant and bizarre effects by smashing bottles of
coloured liquids against microscopes and Bunsen burners.
The result is a stimulating chaos of lights, sounds, and
* excitements. But when they get through there ‘s nothing
left but disorder and litter that has to be swept up before
orderly scientific work can be resumed. You can do the
same thing with the workshops of art. What I don’t under-


stand is why a man of such obvious power will do that

sort of thing.”

“I suppose you will say the same thing about Baude-
laire?” he said.

“Oh, dear, it ‘s the old stuff that these people derive
themselves from Baudelaire and Rimbaud and Laforgue.
But those men were making discoveries. Baudelaire was
an organic chemist. He synthetized extraordinarily re-
pulsive but new compounds. But incoherence and a bad
smell don’t make a Baudelaire.”

“Well, let’s try another; perhaps you recognize this

“Nearly all of it to be as a wife has a cow. All of it to be as a
wife has a cow, all of it to be as a wife has a cow, a love story.
As to be all of it as to be a wife as a wife has a cow, a love story,
all of it as to be all of it as a wife all of it as to be as a wife has a
cow a love story. . . .


“A meal is mutton mutton why is lamb cheaper, it is cheaper
because so little is more.”

“That’s Gertrude Stein,” I said, “but listen to this

“Balloons coloured balloons my coloured balloons Who
busted my balloons? Bolony balloons; they have punctured my
categorical imperative.”

“I don’t seem to remember that in her writings,” he

“No, that isn’t Gertrude Stein. That’s Alice Gray,
whom I knew in the McLean Hospital. She was fifty,
but she imagined she was a baby. Listen to another:


“Pease porridge hot, pease porridge cold,
Pease porridge in the pot . . .”

“You ‘re only trying to be funny,” he interrupted me.
“As a matter of fact, Gertrude Stein can write quite sen-
sibly when she wants to.”

“Why doesn’t she?” I asked.

“She ‘s practising automatic writing.” *

“Then it ‘s science.”

“Oh, no she is creating an impression by an alter-
nation of conscious and subconscious explosions.”

“Then it ‘s art in the sense of fireworks.”

“But she ‘s had an immense influence on younger
writers,” he said.

“So have Mrs. Eddy and P. T. Barnum,” I replied.
“Without Baudelaire there might not have been a Rim-
baud or a Verlaine. Without Buffalo Bill, P. T. Barnum,
or Mrs. Eddy, there might have been no Gertrude Stein,
and Joyce might have continued to write distinguished

“Speaking of Joyce,” he said, “have you tried c Tam
and Shem’ or whatever their names are? Listen!

“Ems within a space and a weary wide space it wast, are wohned
a Mookse. The onesomeness wast all to lonely, archunsitlike,
broady oval and a Mookse he would a walking go (My hood! cries
Antony Romeo). So one grand summer evening after a great
morning and his good supper of gammon and spittish, having
(labelled his eyes, pilleoled his nostrils, vacticanated his ears . . .”

“Stop!” I cried. “I got a licking for that sort of thing
when I was a little boy.”

4 See B. F. Skinner in the Atlantic Monthly for January 1934.


“Is it science or art?” he asked.

“Neither, of course,” I said. “But what puzzles me
still is why they do it. It would be too easy to dismiss the
matter by assuming that they were mildly crazy. More-
over, the ability of the ones we have mentioned to return,
at will, to the rational state excludes this.”

“You forget,” he said, “the idea of Poesie Pure the
less it means, the better} the approximation of poetry to
music of Walter Pater and of Moore.”

“The relationship of poetry to music has also come in
for a great deal of learned twaddle. Valery says the poet
is merely a sort of musician. Wyndham Lewis calls it
‘critical mysticism.’ They speak a lot (Bremond) about
the ‘summons from within,’ the ‘weight of immortality
upon the heart/ poetry which ‘goes further than the word
which expresses it,’ and so forth. Sometimes the critic
goes much farther in his mysticism than the poets he
writes about.”

Incidentally it is a curious phenomenon that some of
the great scientists when they become critics, and are
caught in efforts to explain their own aesthetic reactions
to poetry, become almost as mystical as the literary
analysts. Occasionally a man’s authority is so great in
most particulars rightly so that to criticize him is, in
the eyes of the learned world, like spelling God with a
small g. I refer to Whitehead, and in disagreeing with
him I feel much like a Neanderthal man attacking a
mastodon with a bean-shooter. When he discusses the
application of Clerk Maxwell’s equation to the interior
of the atom, he has me on my back. But when he begins


to attribute reference to some form of Kantian, Berke-
leyan, or Platonic idealism to Shelley in his poem on
Mont Blanc, or derives Wordsworth’s nature worship from
a “criticism of science,” he merely reveals his own in-
ability to take his foot off the brake of reason and coast
freely with the emotions.

Now, when Shelley writes about the cloud or about
Mont Blanc, he is not thinking of the “elusive endless
change of things,” nor is he consciously refusing “to
accept the abstract materialism of science.” He is ex-
pressing in magnificent images the thoughts and emotions
that are aroused in him by the nature he views ; and no
amount of philosophical analysis can give the reader
Shelley’s full effect. The sheer beauty of the shifting
thoughts and feelings, and the musical beauty, not only
musical in sound, but in the harmony of images as well,
must arouse in the reader the same reaction, trans-
mitted from the poet, which nature aroused in the poet
himself. It is the old question that Shelley himself an-
swered by saying: “To analyse a work of art into its
elements is as useless as throwing a violet into a crucible.”
Of course, poetry approaches music, but unlike music it
has the power of concreteness in thought and imagery.
The greatest poetry is communication and is clear. It may,
through pure lyricism, progress sanely to the symbolism
of Mallarme and his contemporaries, growing less and less
intellectually clear more and more dependent upon
imagery and suggestion. When it goes beyond that, it
may come to the deep end where it tries to be purely
saxophonic, as in the “jug, jug, jug” or the “bam boo


him bam tree” gibberish in certain passages of Mr. Eliot.
Baudelaire had this in mind when in UAn Romantique
he said that “there are subjects which belong to paint-
ing, others to music, others to literature,” and “Est-ce
far une fatalite des decadences qu’aujourd’hw chaque art
manijeste I’envie d’empieter sur Part voisin?”* When
a work of literature, even if it is written in short, capital-
ized lines, becomes utterly incomprehensible to the sane
and sensitive, it has gone off the deep end.

Why, we must ask ourselves, have individuals of un-
questionably great powers chosen to play with their minds
like captive monkeys with their genitalia? It would be
merely tragic had they not created a sort of “holy-roller”
school of followers among the permanent intellectual un-
dergraduates. Wyndham Lewis comes close to a definition
when he calls it the “idiot child” cult the child over-
shadowed by the imbecile. As we have said, Skinner
thinks, in the Stein case, it is conscious experimentation
with “automatic writing.”

One could also postulate:

(1) That they are consciously pulling the legs of the

* It is pertinent, in this connection, to ask oneself what would have
been the result if D. H. Lawrence had been a professional instead of
an occasional painter. A painted Lady Chatterley the most exquisite
technique notwithstanding would surely have been so completely out
of drawing, with the lower parts so much larger than the upper, as to
have been hardly recognizable as a human figure. The picture could not
have been hung, even in a speak-easy.

In this matter of disproportionate emphasis on those phases of a
subject which correspond to the writer’s own neuroses, literature can
“get away” with a great deal that would be impossible in architecture,
sculpture, painting, or even music.


large neo-intellectual public either for fun or for

(2) That they are suffering from a well-recognized
form of exhibitionism the craving for sensational notice,
whether approval or attack. This is the mild derange-
ment that probably explains mediums. It is the impulse
that, in a less pronounced form, leads people to write to
the newspaper, to lend their names to cigarette advertise-
ments, or to say in print that they “suffered from fits”
until they had taken one bottle of Neuropop.

(3) That they are seriously carrying on psychological
experiments with themselves in which case, they ought
to do it in decent privacy, as though they were taking

Or (4) that it is barely possible they are yielding to the
uncontrollable impulse to expose their own diseases, just
as the physically sick like to tell about their operations or
their chronic colitis.

If they were commonplace people this exercise would
attract only sympathetic attention. These are formidable
machines and one wishes the insulation had not burnt off
the power lines. 6

However one looks at it, it appears to the medically
informed that these people are substituting the spinal cord
for the brain, or at any rate are moving down from the
frontal lobes towards the basal ganglia.

6 One could of course multiply examples with “cummins,” Ezra
Pound, and so forth. We distinctly exclude Hart Crane, whom we had
occasion to know when we were working on typhus in Mexico. He was
a man of great talent, appealing and tragic, for he was very sick in


“You ‘ve talked a great deal,” said my friend, “but in
the end it comes down to a definition of beauty does n’t

“Well, give me one,” I replied.

“Here ‘s the latest one,” he said. “Beauty is the mutual
adaptation of the several factors in an occasion of experi-
ence. Thus in its primary sense, beauty is a quality which
finds its exemplification in actual occasions. Or, put it
conversely, it is a quality in which such occasions can
severally participate.”

“Hail to thee, blithe spirit,” I replied. “Bird thou never

“Well, let ‘s go on,” he replied. “In order to under-
stand this definition of beauty, it is necessary to keep in
mind three doctrines which belong to the metaphysical
system in terms of which the world is being interpreted
in these chapters. These three doctrines, respectively, have
regard to mutual relations (a) between the objective
content of a prehension and the subjective form of that
prehension, and () between the subjective form of vari-
ous prehensions in the same occasion, and (c) between the
subjective form of a prehension and the spontaneity in-
volved in the subjective aim of the preh ending occasion.”

“Stop,” I said. “Is that by Gertrude Stein?”

“No,” he replied, “it ‘s by Whitehead.”

“Well, I ’11 be damned,” I said. “I think I Ve decided
that it ‘s perfectly safe for me to go ahead with my biog-
raphy of typhus.”

Indeed, I reflected when my friend had departed,
whenever I think about these things for any length of


time I feel grateful for good honest diseases like typhus,
syphilis, and a few others. You always know where you
have them. And if you begin indulging in “whimso-
whamso” while you are engaged with them they are sure
to make a fool of you by putting you on your back. You
either leave them alone or approach them with cautious
competence. Think what might happen to our modern
critics if the great dead whom they inexpertly dissect
could infect them with psychic boils and carbuncles; or
if Mr. Joyce’s preoccupation with the intestinal functions,
or if Mr. Eliot’s shadow boxing with passion, or if the
lubricities and sexual neuropathies of our too modern
writers could subtly invade the brains where they were
engendered with locomotor ataxia or paresis. Indeed, for
all I know, perhaps they can. And there is no arsphenamin
for the psychic treponema.
Typhus is far less perilous.


Leading up to the definition of bacteria and other parasites,

and digressing briefly into the question of the origin of life

a discussion without which the reader would be quite

unprepared for what is to follow

IN the history of the immense universe, that of our little
planet is an isolated and probably unimportant episode.
On some older island in the immeasurable spaces, some
other evolution may have produced beings so much wiser
than ourselves that they can comprehend the origin of
life. For there is no just reason to believe that we
transitional creatures in the upward progress of evolution
have reached the highest possibilities. The tragedy of
man is that he has developed an intelligence eager to un-j
cover mysteries, but not strong enough to penetrate them.
With minds but slightly evolved beyond those of our(
animal relations, we are tortured with precocious desires (
to pose questions which we are sometimes capable of ask- \
ing, but rarely are able to answer. We have learned to
dream of conquests of the forces about us; we investigate
matter and the energy that moves it, the order that con-
trols the worlds and the sun and the stars; we train our
minds inward upon themselves, and discover emotions,
ethical desires, and moral impulses love, justice, pity


that have no obvious relation to mere animal existence.
The more we discover, the greater is our hopelessness of
knowing origins and purposes. The more our ingenuity
reveals the orderliness of the nature about us and within
us, the greater grows our awe and wonder at the majestic
harmony which we can perceive more clearly with each
new achievement of art or of science, but which in ulti-
mate causes or in goal eludes us. To feel this awe and
to wish to fit into the harmony of natural things, with
a vision of the whole, is apparently a definite phenomenon
of human psychology; it is the force that has engendered
religions, just as the instinct to understand the material
environment has produced science, and the impulse to
express aesthetic reactions has produced art. It is obvious
that religion begins where philosophy takes off from the
solid shore of the exact sciences into speculative waters,
the shallows of which are metaphysics. It is not entirely
sensible in modern times, however, to speak of conflicts
between religion and science which, to truly civilized
people, have not existed for a long time. When perturbed
ministers, like the Reverend Dr. Fosdick, passionately
deny such a conflict, they are pounding the table and
asserting that the earth is round. They desire to preserve
the beneficent social and moral influences of an organized
church in a world not yet ready for a purely ethical code.
And when distinguished minds, like Millikan and others,
take wing from the ultimate peaks of exact science into
the stratosphere of an old-fashioned heaven, they illus-
trate the biological truth that the mind of man possesses
ethical desires which the most highly developed knowledge


of science cannot satisfy obviously, never will satisfy.

It is not entirely a matter of accident that astronomers,
physicists, and mathematicians are more prone than the
biologist to fall into the lap of Mother Church or at least
into that of one of her barren metaphysical sisters. The
biologist, in his work, is always confronted with the
mystery of life. He learns a reverence for it which, com-
pounded of wonder and awe, keeps him modest and will-
ing to admit without despair that here is something quite
amazing, worthy of continuous study, but, for the time
being, beyond his capacities to comprehend. The sagacious
physicists to whom I have alluded scamper back to God.
But they think they have reached a new understanding!
and have discovered a new and modern Jehovah, when as (
a matter of fact all they have done is perhaps to take away*;
his beard and express his thunder in ergs. In their hearts *
and minds he still remains the same old “Almighty.”
What might eventually be attained is what, for a time,
the Greeks achieved when the philosophy of Plato was
the religion of educated people, and what, in the form
of Confucianism, existed to some extent in China.

This, however, is too much to hope for in our present
overpopulated world, for as fast as ministers like Dr.
Fosdick throw overboard their ballast of mysticism in
order to cross the shoals into a quiet harbour of reason,
Millikan and other physicist-metaphysicians fish it out
again to steady them in making the high seas of specula-
tion. The prospect is hopeless unless someone can appear
who will be as rigid as was Christ in differentiating be-
tween issues of the spiritual and the material, and who at


the same time possesses a thorough familiarity with the
possibilities and limitations of modern science.

The scientist who achieves intellectual and emotional
maturity without losing his investigative vitality and
courage that is, without metaphysical surrender can
come to rest in philosophical tranquillity with the recogni-
tion that science, however highly developed, may never
answer the ultimate questions; but that there may be hap-
piness in contemplating nature’s orderly co-ordinations,
and peace in modest fellowship with the rational and
humane spirits who, throughout the brutalities of history,
have held to the purpose of reason. Complete compre-
hension could add very little.

Bergson suggests that on another planet life might
have been evolved by systems entirely different from our
own. The element characteristic of substances that supply
energy might have been other than carbon, and the ele-
ment characteristic of living matter might have been other
than nitrogen, leading to living bodies radically different
from our own in chemistry, anatomy, and physiology. This
may perhaps be truej but to believe it would require as-
sumptions to which earthly observations give no clue.
The origin of life, so far as we can analyse it on earth,
is made possible by the unique properties of the com-
bining powers of three elements, 1 and the infinite diversity
of the phases and systems made possible by the properties
of water. By these relations, says Henderson, “the path-
way from the simple compounds of the atmosphere to the
complex organic bodies is a direct one.”

1 Lawrence J. Henderson, The Order of Nature.


Out of these combinations and dissociations, in con-
tact with the other elements in the infinitely variable
conditions of pressure and concentrations, with the radiant
energy drawn from the sun, somewhere, at some time,

life was begotten. In that transition between the dead
organic combination and the similar one that is alive lies
the great, incomprehensible mystery. What came before
we can reasonably trace j what came after is at least open
to inquiry in the records of existing living forms. In that

! leap from the dead to the living lies the mysterious break
\of continuity which defies our understanding. Between
^the chemically definable protein molecule and the living
thought that water
was the source of all living things and that life arose in
the warm mud and ooze of the floor of the oceans. He
was followed in the same thoughts by Anaximander and
Xenophanes. Rain water was added by Anaxagoras, which
carried down fertile seeds from the infinite spaces. There
seems to have been a general agreement on mud.

That new creatures were born from the union of their

8 An extraordinarily complete and learned compilation of the subject,
from which we have freely quoted, has been published by von Lippmann.


similar ancestors was not denied. But, in addition, new
ones were being constantly added from the synthesis of
sun-warmed organic matter.

Parmenides, Empedocles, and Diogenes of Apollonia
favoured mud and moist earth as the sources whence life

Democritus, Epicurus, and their recorder, Lucretius,
started something new. Everything on earth has life. The
earth is the mother who, in her youth, gave birth to all
living things performing miracles of fecundity which
gave origin to plants and animals and even to man. But
as she grew old much of her power was lost, and only
trivial things like insects, reptiles, and other inferior be-
ings were begotten from decaying organic matter, with the
help of warm rain and sunlight.

Plato was reasonably agnostic in these matters, as was
Socrates, though the latter invented “Entelechia,” the
power of the spirit, which, infused into matter, gave it

Archelaus believed that the putrefying spinal cords of
animals and man were transformed into snakes.

Diodorus, about 30 B.C., revives the old louse story
its origin from human skin and perspiration; and he again
asserts that mice were produced from the mud of the
Nile, for he could see them slipping out perfectly
formed in front, but unfinished behind.

Vergil seems to have believed the old story about the
origin of bees from the dead bodies of steers. It is astonish-
ing, in this connection, that Homer in the Nineteenth
Book of the Iliad lets Achilles speak of the danger of


flies slipping into the open wounds of Patroklos and there
producing maggots perhaps the earliest exact observa-
tion in this matter. 4

Ovid has the same ideas as Vergil, only he thinks that
wasps come from the dead bodies of horses and beetles
from those of asses.

With the influence of Christianity, there was of course
a considerable change in some of the views. Gregory of
Nyssa, in the fourth century, sticks to the Bible and states
that the beasts and the plants were suddenly born from
the earth by God’s will; whereas Augustine was troubled
by his logical mind to the extent of wondering whether,
if the earth retained its power to bring forth animals by
spontaneous generation even after the flood, the Ark
would have been unnecessary; and he could not harmonize
his belief in the goodness of God with the divine produc-
tion of disagreeable things like mice.

All through the Middle Ages, the same type of rea-
soning persisted. There was a little less naivete in some
of the theories, but many others were more fantastic than
anything antiquity was able to produce. The great physi-
cian Avicenna believed that intestinal parasites were all
produced from putrefying materials and moisture, and he
completely accepted the origin of animals from properly
combined elements. Lippmann credits him with the state-
ment that, as the result of a thunderclap, an incomplete
calf dropped to earth from the sky.

4 “But I have grievous fear lest, meantime, on the gashed wounds of
Menoitios* valiant son, flies light and breed worms therein and defile
his corpse for the life is slain out of him and so all his flesh shall
rot.” (Lang, Leaf, and Myers* translation.)


Even the great Albertus Magnus, in his description De
Animalibus, adheres to the old ideas that many of the
lower animals spring from the materials on and in which
they were found, worms from rotting wood and refuse;
bees and beetles from decaying fruits and leaves, and
he seems even to have believed the story about the trans-
formation of a horsehair into a spindle worm a sup-
position which is still prevalent among a good many intel-
ligent people. The pious William of Auvergne, Bishop of
Paris, was quite willing to believe that worms and frogs
were produced in this way, but questioned the matter in
connection with horses.

A remarkable tale that kept cropping up again and
again until relatively modern times was the belief in the
origin of wild ducks and geese from barnacles. These birds
came and disappeared and were never seen to breed, so
that their origin became the subject of much speculation.
One of the stories traced to Saxo Grammaticus was to the
effect that the little geese came out of shells which grew
on trees in the Orkney Islands. The tale persisted until
the latter part of the sixteenth century, when a Dutch
sailor penetrated to the Arctic Ocean, where he observed
and reported the nesting and breeding of the birds.

Similar to this tale of the barnacle geese is the story
of de Mandeville, who, in his Travels, speaks of a tree
which bore huge, melon-formed fruit of which he him-
self had eaten, and in which, when it was opened, he
discovered a lamb. When the fruit ripens and falls, the
lamb’s legs become attached to the ground, and it eats
all the grass within its range. De Mandeville is now


known to have been one of the most talented liars of his-
tory. The descriptions of travellers who began to pene-
trate, in the late Middle Ages and early modern times, into

^all corners of the earth are responsible for innumerable
stories of the same kind. The story of the vegetable lamb
was not completely exploded until Linne, in the eight-
eenth century, examined specimens of the various plants
that were supposed to blossom as lambs.

The ideas of Paracelsus were, in regard to the origin
of life, not materially different from those of his contem-
poraries. However, the ^foris of Hippocrates was as-
sociated with the Christian belief in the soul in explaining
the manner in which God infused life into some of his

Bacon was a firm believer in spontaneous generation,

\ and Harvey, in 1651, must be regarded as the first who

j clearly opposed the older views with his famous Ornnia

\ ex Ovo.

Kepler, wise as he was, believed that plants could grow
out of the earth without ancestors, and fish could be
produced by spontaneous generation in salt water, just
as comets could arise in the skies. 5

There is practically no attempt through all this period
on the part of the most powerful intellects to approach
the problem by experimental methods, until the last half
of the seventeenth century. In this period, a Tuscan
physician, Francesco Redi, published experiments on the

5 It is to Kepler’s credit, however, that although one of the most
eminent physicists of all time he never wrote a book on God and
the Universe.


development of insects, in which he showed that rotting
materials are nothing more than the convenient nest for
‘ the depositing of eggs. He also asserted that various skin
diseases are produced by parasites, and not the other way
round; and Swammerdam comes to the same conclusion
by the convictions of piety, since he held it impossible that
flies, in which there has been expended so much wisdom
and art on the part of Almighty God, could have arisen
by chance from refuse. The honours are with Kedi, though
the conclusions are the same.

Leibnitz, in 1714, expresses the conviction that spon-
taneous generation is impossible, and that neither plants
nor animals could have originated from a chaos of putre-
faction. Leibnitz was frankly agnostic in other expressions
on this problem.

Descartes, who was familiar with the work of Leeuwen-
hoek and of all other important naturalists of his time,
gave little thought to the origin of living things, but
speculatively hit the nail on the head by taking for granted
that there may be a world of minute living things from
which life of other kinds can develop by a sort of evolu-

Between the end of the eighteenth century and the be-
ginning of the nineteenth, an accumulation of accurate
observations began to limit the field of speculation, and,
indeed, in surveying the history of the thoughts of men
upon this problem, it is quite apparent that here as in
all sciences there has been an inverse ratio between
speculation, on the one hand, and the accumulation of
observations on the other. The discovery of the methods


of reproduction in fungi and mosses in 1 729 by the Flor-
entine, Micheli, and Spallanzani’s experiments on insects,
led to an increasing conviction that no such thing as
spontaneous generation could take place. Lippmann men-
tions the amusing fact that one of the important observa-
tions on this subject was made in 1804 by a chef in a
Paris kitchen, Appert by name, who preserved foodstuffs
by heating them and putting them into hermetically sealed
pots an observation which was in line with a similar
one made by Scheele on the preservation of vinegar by
boiling and sealing in vessels. There were throwbacks,
like Needham, but the modern era had begun and the ex-
perimental method was soon to take charge of the de-
velopment of biological thought.


With the gradual development of experimental method,
those who were curious about the phenomenon of life
became, by the very precision of their observations, more
modest in regard to speculation. Modern biology was
born when scholars began to concentrate their complete
attention upon the study of the manner in which life
existed, and limited speculation entirely to the construc-
tion of trellises along which new experimentation might
grow. The final demonstration, by Pasteur, that alleged
observations of spontaneous generation were attributable
to experimental error marked the ending of biological
medievalism. But long before this, chemistry, emerging
from alchemy and physics, turning from the firmaments
to the minor affairs of this earth, had started biology on


its modern career. Thus, biology began as it will end
as applied chemistry and physics.

It will be of profit,” in maintaining this thesis, to set
forth, in the bare bone, the structure of biology as it has
come down to our time. The reader of imagination will
remember with sympathetic admiration the unnamed mul-
titude of patient toilers, the unknown soldiers of the
great struggle toward the truth, who helped to forge the
tools for the hands of genius.

Everyone who thinks about these matters can construct
a table of significant achievements for himself, and no
two will be alike. But since this book is written more for
our own amusement than for anyone who may possibly
buy it, we set down in chronological order those conquests
of understanding which seem to us to have most directly
contributed to the modern views of the mechanism of
living things. We give them without explanations, since
those to whom such matters are unfamiliar may look
them up in any up-to-date history of science.

1774. Priestley recognizes that “spoilt” air (spoilt by
mice) was made “good” by the presence of green plants.
In 1780, Ingenhousz shows that this action was due to the
presence of green plants which acted only under the in-
fluence of light; in the same year Senebier demonstrates
the change to be one from carbon dioxide to oxygen, and
in 1804 de Saussure proves the quantitative nature of
the conversion.

1784. Lavoisier demonstrates the indestructibility of
matter. Quantitative chemistry begins; respiration is re-
cognized as akin to combustion.


1812. Kirchhoff finds that starch can be converted into
glucose by the action of dilute sulphuric acid, which
itself remains unchanged. This may be regarded as the
first clue to the understanding of catalytic processes,
leading to Berzelius’s conception of a “new force,” in
which he saw a powerful factor in the explanation of
the chemical processes of the living body.

1821. Cuvier lays the foundation of palaeontology.

1824. Synthesis of an organic compound (urea) by

1828. Discovery of the mammalian ovum by von Baer.
The birth of modern embryology and the first great for-
ward step in this direction since Harvey.

1838-1839. Schleiden demonstrates the cell struc-
ture of plants, and Schwann the cell structure of animals.

1838. Cagniard de la Tour proves that fermentation
is dependent on yeast cells.

1838. Von Mohl describes protoplasm.

1840. Max Schultze conceives of it as the “physical
basis of life.”

1842. Mayer suggests the first ideas concerning the
conservation of energy, later developed in an orderly
manner by von Helmholtz in 1847 (Abhandlung fiber
die Erhahwng der Kraft), the eventual consequences of
which were the thermodynamic laws.

1 842. Birth of biochemistry with Liebig’s volume, Die
Thierchemie, and so forth, on the application of chemical
methods to animal tissues 5 also containing the important
conception of animal heat as combustion.

1857. Claude Bernard lays the foundation of modern


physiology, and discovers the production of glycogen by
the liver. The beginning of the application of biochemical
and physiological methods to the living animal.

1859. Darwin and Wallace advance the ideas of or-
ganic evolution, bringing in their train the energetic de-
velopment of comparative anatomy, embryology, and ra-
tional systematology.

1860. Final refutation of the experiments on sponta-
neous generation by Pasteur.

1 861. Recognition of differences in the laws of behaviour
of the so-called “crystalloids” and matter in particles
larger than molecules. The birth of colloidal chemistry
by the studies of Graham.

1862. Pasteur defines the dependence of fermentation
and putrefaction upon living organisms.

1865. MendePs work on the crossbreeding of sweet
peas. This work, which would probably have materially
modified Darwin’s original hypotheses, was completely
buried in a local scientific journal until 1900, when it
was discovered, confirmed, and extended by de Vries
and others. It was the foundation of the science of ge-

1867. Traube’s work on semi -permeable membranes.

1877. Discovery of osmosis by Pfeffer.

1880-1900. Development of modern bacteriology and
immunology, with the growth of technique for the study
of life in its simplest available form.

1885. The correlation of osmotic pressures with their
chemical and physical properties of solutions, by Van’t


1885. Rubner applies quantitative methods to the study
of the heat value of food materials.

1887. Beginning of the syntheses of organic matter by
Emil Fischer glucose, fructose, and finally polypeptide,
which is one of the higher cleavage products of protein.
With the era of Fischer begins the true structural knowl-
edge of the proteins.

1888. Elucidation of the carbon-nitrogen cycle by Hell-
riegel and Wilfarth.

1889. First discovery of an ultra- virus (mosaic disease
of plants), by Beijerinck.

1893. First discovery of ultra- virus causing disease in
animals (foot and mouth disease), by LSffler and Frosch.

1900. Beginning of knowledge of the effect of radiant
energy (X-ray, ultra-violet) on life processes.

1902. Sutton first pointed out that chromosome segre-
gation furnished the mechanism by which Mendelian
laws could be explained.

1904. Discovery of hormones or physiological messen-
gers; internal secretions defined by Bayliss and Starling.

1910. The significant beginning of the application of
physicochemical methods to protein and to living tissues}
acid base equilibrium; hydrogen ion concentrations; mem-
brane potentials; Donnan’s equilibrium; oxidation reduc-
tion phenomena; surface phenomena and electrophysics
of cells and fluids of living complexes. Those responsible:
Sorensen, Loeb, Henderson, Clark, and many others.

1912. Vitamins discovered by Hopkins and Funk.

1915. Discovery of the bacteriophage phenomenon
by Twort and d’Herelle, with the suggestion of the pos-


sibility that they may be intermediate substances between
the enzyme and the formed cell, having the power of
reproduction only in the presence of specific living cells,
upon which they act. Whether these substances are alive
or dead is at present almost an academic question.

1925. Discovery of the relationship between radiant
energy and the accessory food factors; the activation of
fats to vitamin functions by radiation with ultra-violet
light. Based on experiments of Steenboek and of Hess.

1930. The crystallization of enzymes, the credit for
which goes to Northrop.

All this may seem remote from the story of typhus
fever; but only to those who are impatient for the sen-
sational events in a turbulent narrative. Without the de-
velopments here recorded, we should now know little
about the true nature of the subject of our biography.


On parasitism in general, and on the necessity of consider-
ing the changing nature of infectious diseases in the his-
torical study of epidemics; with a brief consideration of
syphilis as an illustration of this contention. These matters
have direct bearing on our biography y since we must pro-
ceed as though we were writing of a man for readers
ignorant of the race of men

NOTHING in the world of living things is permanently
fixed. Evolution is continuous, though its progress is so
slow that the changes it produces can be perceived only
in the determinable relationship of existing forms, and
in their palaeontological and embryological histories.
Though the processes which determine evolutionary
change do not appear as simple to-day as they seemed
when the Origin of Species was published, it would occur
to no biologist to assume that any living form is perma-
nently stabilized. On purely biological grounds, there-
fore, it is entirely logical to suppose that infectious dis-
eases are constantly changing, new ones are in the process
of developing, and old ones being modified or disap-

Parasitism originated in dim primordial antiquity as a
consequence of habitual contacts between different living
things. It did not develop suddenly, but evolved gradu-
ally, as one form adapted itself, step by step, to the en-


vironmental conditions found in or upon another. Para-
sitism, in its origin, means a breaking down of that
opposition which, normally, every living cell complex
offers to invasion by another living entity. The simplest
illustration of this (for want of a better name, we may
call it “vital resistance”) is the well-known one of the
frogs’ eggs. They develop and remain free from invasion
in a pond which is swarming with bacteria and Protozoa.
A frost kills them overnight, and within a few hours
their substances have become culture media for innumer-
able micro-organisms. It is conceivable and, indeed,
could be supported by experimental evidence that a
diminution of this “vital resistance” which is, in itself,
a complex phenomenon may let down the bars suf-
ficiently to permit invaders to gain a preliminary foothold,
even though the host does not succumb to the injury which
rendered him susceptible. And once begun, the further
evolution of parasitism can proceed in an almost unlimited
variety of directions.

Parasitism represents that phase of evolutionary change
which lends itself most easily to analysis. There are few
parasites which cannot be traced with considerable clear-
ness to some free-living ancestral stock, either still existent
or available in fossil form. From this point of view, the
study of parasitic adaptation is one of the most important
buttresses of evolutionary theory. Each instance represents
a miniature system in which the host is the world by which
the parasite is moulded. The parasitism which is infec-
tious disease involves the invasion of more or less complex
plants or animals by simpler, in most cases, unicellular,


beings like the bacteria, the Protozoa, the Rickettsise,
and the curious, still undefinable agents of which we speak
as “ultramicroscopic” or “filterable” viruses. Though ac-
tually complex in function and metabolism, these sup-
posedly simple things display an amazing biologic and
chemical flexibility j and since, in them, generations suc-
ceed each other with great speed (at least two every
hour, under suitable circumstances), the phenomena of
infection constitute an accelerated evolution extraordi-
narily favorable for the observation of adaptive changes.
It would be surprising, therefore, if new forms of para-
sitism that is, infection did not constantly arise, and
if, among existing forms, modifications in the mutual
adjustment of parasites and hosts had not taken place
within the centuries of which we have record.

As a matter of fact, the evidence of modern bacteriology
lends much likelihood to the view that epidemic diseases
are constantly changing} not, perhaps, with sufficient
speed to confuse the diagnostic problems of any particular
period, but still rapidly enough to encourage the consid-
eration of this factor in the study of epidemic history.
To be sure, it has not so far been possible in the
laboratory to convert a pure saprophyte * into an habitual
parasite. But it is relatively easy to induce fatal infection
with an organism of ordinarily low parasitic powers by
reducing the resistance of an individual host. This has
been repeatedly done since the time of Pasteur. More-
over, recent advances concerning what is technically
spoken of as “bacterial dissociation” have developed simple

1 If the reader does not understand this word, it is too bad.


methods by which a majority of the highly infectious bac-
teria can be deprived of their virulence and then reversed
to their fully pathogenic conditions. Such changes in both
directions occur in the bodies of infected animals, can be
produced at will in test-tube experiments, and can be
correlated with morphological and chemical changes in
the bacteria themselves. The subject is one of the most
important fields of contemporary investigation, and the
results achieved have profoundly modified conceptions
of infection. To pursue it further would obviously lead
us into technical discussions, more suitable for a text-
book of bacteriology. The matter is mentioned in the pres-
ent connection merely to support our contention that the
historical study of infectious disease must, hereafter, take
into account the fact that parasitic adaptations are not
static, and that extraordinarily slight changes in mutual
adjustment between parasite and host may profoundly
alter clinical and epidemiological manifestations.

There is a wide range of delicate gradations between
saprophytism and parasitism, and the biological and chem-
ical properties along which adaptation changes progress
are to some degree dependent upon whether an
organism that causes disease in man and animals has re-
tained the capacities for life in nature, whether it passes
through intermediate hosts, or whether it is so closely
adapted to an individual host that it cannot exist apart
from him, and perishes when the host dies, unless trans-
mitted to another.

The last condition is the one in which noticeable modi-
fications can be most reasonably expected within the short


period of human records. In such cases, there is an un-
interrupted transmission from host to host, the parasite
is never subjected to environments other than those to
which it is most perfectly adapted, and, in consequence,
evolution may progress in a single direction toward
a more perfect mutual tolerance between invader and
invaded. It is conceivable that, when such parasitism
first begins, the host’s reactions are violent, and either
the invader or the host succumbs, according to complex
criteria which vary for individual cases. As adaptation
becomes more perfect, reaction is less energetic, and dis-
ease becomes less severe and more chronic } finally, a
stage may be reached in which mutual adjustment is so
nearly perfect that the host may show no signs of injury
whatever. This condition exists, for example, in certain
trypanosome infections of rats, in the spirochsetosis and
sarcosporidial infections of mice, and in a large variety of
other conditions of animals and plants. In these, the in-
fected animal shows practically no signs of discomfort
or pathological change in reaction to the parasite. The
principles have been thoroughly discussed by Theobald
Smith. In animal populations, the first impact of a new
virus is upon individuals of all ages. The survival of
some of them is a matter of chance, depending on genetic
differences or the accidental overlapping of immunity
derived from other possibly related diseases. The
extinction of many species of animals in past ages is best
explained by freshly introduced parasites. Subsequent im-
pacts are against the very young, and this tends to elim-
inate the weak variants and leads to a population gradually


growing more resistant to that particular form of infec-
tious agent.

In man, a condition which illustrates these principles
is syphilis. There is little doubt that when syphilis first
appeared in epidemic form, at the beginning of the six-
teenth century, it was a far more virulent, acute, and
fatal condition than it is now. Uninterrupted transmis-
sion from one human being to another, without intervals
of extraneous existence in the course of almost five hun-
dred years, has led to gradual mutual tolerance, one of
the consequences of which has been an increasing mild-
ness of the disease. If mankind could be kept as thor-
oughly syphilized in the future as it has been in the past,
another thousand years might produce a condition not
unlike the present spirochaetosis of mice, in which a peri-
toneal puncture of almost any bon vivant would reveal
the presence of a treponema pallidum infection of which
the host is all but unconscious. Arsphenamin has probably
ruined this prospect. 2

In those forms of parasitism in which the invading or-
ganism, in spite of its capacity for infection, has at the
same time retained saprophytic properties, it is less easy
to determine changes within the periods of historical
record. Anthrax and lockjaw deadly to man and ani-

2 This might be a loss to civilization: it has often been claimed that
since so many brilliant men have had syphilis, much of the world’s
greatest achievement was evidently formulated in brains stimulated by
the cerebral irritation of an early general paresis. We omit r eference to
specific instances of this among our contemporaries only to avoid, for
our publishers, the vulgar embarrassment of libel suits. Modern treat-
ment, and the agilities of expert testimony, render legal proof of such
contentions hopelessly difficult.


mals can, in spore form, be preserved for years in soil
without loss of pathogenicity, so that reinoculated by
accident they can again cause fatal disease. Typhoid
and dysentery bacilli, cholera spirilla, the streptococci
and staphylococci which cause surgical infections, and
many other micro-organisms can survive for longer or
shorter periods separated from the hostj and the circum-
stances under which this is possible, the length of time
of survival, and the alterations which take place in them
during such periods, are all of them of the greatest im-
portance to the student of epidemics. Yet even in such in-
fections by half-parasites if the infection is widely
disseminated the factors discussed above become active,
and successive generations tend to develop increased
resistance. For human infections, many examples of this
could be cited one of the most illustrative that of tu-
berculosis, in which the high susceptibility of aboriginal
peoples as compared with resistance of the thoroughly
tuberculized populations of European origin is a well-
known fact.

The idea that we may logically expect modifications
in the clinical and epidemiological manifestations of dis-
ease within the short period of human history is espe-
cially encouraged by, study of the so-called “filterable
virus” agents. Not an inconsiderable number of the more
important epidemic diseases are caused by these mysterious
“somethings” for example, smallpox, chicken pox,
measles, mumps, infantile paralysis, encephalitis, yellow
fever, dengue fever, rabies, and influenza, to say noth-
ing of a large number of the most important afflictions


of the animal kingdom. Here, as in bacterial disease, there
is a lively interchange of parasites between man and the
animal world. Indeed, since we can neither see these
infectious agents nor cultivate them, except in the pres-
ence of living tissues, the only opportunity we have of
subjecting any of them to systematic study is by finding
some animal in which disease can be produced. As a con-
sequence of such study, it has appeared that these agents,
even more than bacteria, are of an extraordinary biological
plasticity, and can often be modified by simple labora-
tory manipulation. The transformation of smallpox virus
into vaccinia by passage through cattle is far more pro-
found a change than the alteration which differentiates
the plague of Athens from smallpox as we know it to-
day. The mere passage of the virus through another
species has in this case so altered it that it will no
longer cause more than a negligible local reaction in
man$ but, nevertheless, it retains the fundamental bio-
logical properties by which it immunizes him. In the
same way, the passage of rabies virus through rabbits
rapidly increases its virulence for these animals, slightly
diminishing it at the same time for monkeys and man.
Yellow-fever virus, injected into the brains of mice,
ceases to produce typical yellow fever, but causes a form
of encephalitis which, thereafter, can be carried in series
from mouse to mouse. Carried back to monkeys, even
though passed through mosquitoes, it retains its affinity
for the nervous system. As a matter of fact, a large num-
ber of these viruses, including that of herpes, which causes
cold sores, vaccinia virus, and many others, can, by ap-


propriate manipulation, be adapted to what is spoken
of as “neurotropism” that is, so changed that they
will selectively invade the nervous system and cause

What we speak of as “new” disease, therefore, need not
be conceived as the acquisition de novo of forms
of parasitism that have not previously existed. While this
process is probably continuing, it is too gradual and slow
to be traceable from an established disease to its ultimate
origin. There remain two chief sources of new diseases
within historic periods: namely, the modifications of para-
sitisms already existing in man by gradual adaptative
changes in their mutual relations; and the invasion of
man by parasites, well established within the animal king-
dom, by new contacts with types of animals and insects
to which mankind was not previously exposed. That there
are many diseases already existing in nature which man
has not hitherto acquired only because of lack of oppor-
tunity is quite obvious from the recent experience with
the psittacosis of birds and a disease of sheep spoken of
as “louping ill.” In both of these conditions, although
isolated human cases had been observed, laboratory as-
sociation promptly demonstrated an extreme infectious-
ness to investigators. The Australian X disease a po-
liomyelitis-like condition was probably contracted by
man from sheep, and tularaemia a disease not recog-
nized before 1904, and at present spreading through the
United States is acquired from a number of animal

One of the most interesting phenomena of infectious


parasitism is the interchange of infectious agents between
insects and the world of higher animals. This is a large
field, which we have no intention of discussing except
in so far as it concerns the subject of our biography
typhus fever. Entirely apart from the medical and sani-
tary aspects of the typhus-fever problem, the circum-
stances of its transmission are of extraordinary biological
interest, because they give us more than any other
disease cycle the opportunity of studying the evolu-
tion of a parasitism which has taken different channels in
various parts of the world, adapting itself to the diver-
gent circumstances of local insect and rodent distribu-
tion. Typhus fever is one of the Rickettsia diseases which
form a closely related group. The minute, bacillus-like
organisms which cause these conditions (Rickettsix
named after Ricketts, an American who died while in-
vestigating typhus in Mexico) are closely related to a
number of similar and harmless micro-organisms which
are habitually found in the bodies of many insects. It is,
for this reason, not unlikely that the original parasitism
of these organisms was acquired by insects, and from
them was passed on to some of the lower animals (rodents)
and so to man. These conditions are discussed at some
length in a later chapter.


When circumstances are such that an infection can
saturate almost the entire population of crowded regions,
the result is what the Germans call Durchseuchung. The
accidentally less susceptible survive, and through gener-


ations a gradual alteration of the relationship between
parasite and host becomes established. The more thor-
ough the saturation, the more apparent the results. The
simplest demonstration of such changes is the rapidity
of spread and the virulence of a disease when it is first
introduced into the reservoir of an aboriginal that is,
entirely susceptible population. When measles first came
to the Fiji Islands in 1875, as a result of the visit of
the King of the Fijis and his son to Sydney in New South
.Wales, it caused the death of 40,000 people in a popula-
tion of about 150,000. Another example is the terrific
violence of smallpox when first introduced among the
Mexican Indians by a Negro from the ship of Narvaez.
The virulence of tuberculosis for Negroes, Eskimos, and
American Indians living in contact with whites is another
case in point. Any number of illustrations of this kind
might be cited. But even among crowded, thoroughly in-
fected populations, diseases have changed within relatively
short periods. Scarlet fever has become definitely milder
throughout Western Europe, England, and America since
about 1880. The same is true of measles and diphtheria, as
regards both incidence and mortality. The change began
well before modern preventive methods had exerted any
noticeable influence. Perhaps it is not an accident, however,
that, in the case of diphtheria, in the control of which
modern bacteriological methods have been most effective
since the late nineties, thus creating interference with
normal evolution, we are just beginning to observe
the return of excessively toxic and deadly cases, reported
in increasing numbers from Central Europe. It is not at


all unlikely that the successful control of an epidemic
disease through several generations may interfere with the
more permanently effective, though far more cruel, proc-
esses by which nature gradually immunizes a race.

Syphilis best exemplifies the alterations which may
take place in a disease within a short period, if the popula-
tion is once thoroughly “saturated.” The problems con-
nected with it are so interesting that they seem worth a
few paragraphs. Before the last decade of the fifteenth
century, there are few reliable records of syphilis in
Europe. The subject has been greatly disputed, and
many passages especially in ancient Hindu manuscripts
have been interpreted as signifying that venereal sores
similar to those characteristic of syphilis were known in
the ancient world. There are, however, forms of non-
syphilitic venereal sores, the so-called “soft chancres” or
“chancroids,” which cannot be distinguished from true
syphilis on the basis of extant descriptions j and no phy-
sicians whose writings have come down to us from ancient
or mediaeval literature describe any disease characterized
by the sequence of genital sores, followed by skin erup-
tions and the various secondary and tertiary lesions, which
were obvious enough to the physicians of the Renaissance
as consecutive stages of one and the same original cause.

Medical historians have cited many observations which
they regarded as indicating the ancient existence of syph-
ilis j but most of these, on close scrutiny, turn out to be
unconvincing. Talmudic references are not sufficiently pre-
cise to permit conclusions, and such allusions as those of
Celsus, in the Sixth Book of his Medicina, the regulations


for prostitutes issued by the Countess of Avignon in 1 347,
and similar ones, do not constitute reliable evidence.
Ozanam quotes two sonnets from a Florentine poet
one entitled “De Matrona,” the other “Ad Priapum”
which he accepts as definite proof that syphilis existed
in 1480, when the poems were written. Careful transla-
tion of these sonnets, with particular scrutiny of the ex-
pressions in them which are diagnostically significant,
leads to the conclusion that they are merely very nasty
poems, with no precise reference to the disease.

It is not, of course, possible to exclude with certainty
the ancient existence of a form of syphilis milder than
that which swept over Europe in the early sixteenth cen-
tury, and Haeser who does not subscribe to the opin-
ion of the American origin believes that syphilis may
have been prevalent to a limited degree and in a less
virulent form since ancient times. Sexual immorality was
widespread and quite shameless at many periods of an-
tiquity, in Rome, in the Middle Ages, in connection
with the great epidemics, and a strange and common
contradiction between idealism and license during the
‘period of the Crusades. Gonorrhoea undoubtedly was com-
mon all over the known world from most ancient times, 8
and was accurately described as the “running sore” in
England, and under the names of clap and chaudepisse in
France. There are unmistakable descriptions of chan-
croids and phagedenic ulcers, which sometimes extended

8 “No stewholder to keep a woman that hath the perilous infirmity
of Burning” (Beckit, Philosophical Transactions, xxxi, 47, fourteenth
century, cited from Haeser).


widely and destroyed the genitalia} and in these diseases
as now there were swellings of the inguinal gland
and the bubo. There are few descriptions, however, in
which it is possible to trace the relationship of a venereal
infection to secondary and tertiary consequences in other
parts of the body. This Haeser is inclined to believe
is due to the unwillingness of doctors and patients to
attribute venereal origin to conditions occurring several
weeks after infection and, similarly, he believes that the
later and usually mild manifestations may have been
overlooked, or described in unrecognizable form. There
are a few accounts cited by him which lend weight to his
views. One, taken from Littre, refers to the observa-
tions of the French physician de Berry (thirteenth cen-
tury), who described a condition venereally acquired
which, beginning in the genitalia, spread to the entire
body: “Nam virga inficitur, et aliquando alter at to turn
corpus.” Another case is that of Nicolas, Bishop of Posen,
who died in 1382, as a result of “morbus cancri” on the
genitals, followed by ulcers of the tongue and pharynx.
A similar case is that of King Ladislas of Poland, and of
Wenzel of Bohemia. 4

It is thus quite impossible to assert with confidence
that syphilis did not exist in pre-Columbian Europe. But
if it did, it must have been relatively rare, and certainly
so much less virulent than the later malady that the epi-

4 Won er Faulen fegan
An der stat da sich dy man
Vor Scham ungern sehen lant.



demic of 1500 marked the beginning of a new phase in
the parasitism of the treponema pallidum.

The American origin of syphilis forms the basis of a
theory that has become widely prevalent, and although it
cannot be proved beyond question that America was the
source from which the disease reached Europe, it is more
than likely that it existed in the Western Hemisphere
and that early explorers may have been infected by inter-
course with coastal Indians. In this connection, much has
been made of lesions on bones found in the graves of the
mound builders of Ohio and other regions notably,
New Mexico, Peru, Central America, and Mexico. Pro-
fessor Herbert U. Williams, who has recently sifted the
evidence, with attention both to the antiquity of examined
bones and to the trustworthiness of pathological examina-
tions, believes that there is unmistakable evidence of
syphilis in many of these lesions. 8 Williams has also re-
viewed some of the early Spanish literature bearing on
the same question. In the Life of Christopher Columbus,
by his son, Ferdinand, there are included passages from
the writings of a hermit of the order of Saint Jerome,
Pane, by name, written at the time of the second voy-
age of Columbus. The passage quoted by Williams reads
as follows:

They say that Guagagiona being in the land where he had
gone, saw a woman whom he had left on the sea, from whom

5 It must always be remembered that some of the lesions observed in
the Western Hemisphere and attributed to syphilis may have been due
to a disease which is more than a cousin, rather a half brother of syphilis
namely, yaws.


he had great pleasure, and immediately he sought to cleanse him-
self, on account of being plagued with the disease that we call
French; and afterwards he betook himself into Guanara, which
signifies a place by itself, where he recovered from his ulcers.

Oviedo y Valdes says, among other things, that the dis-
ease of Buas (probably syphilis) tormented the first Chris-
tian settlers in the West Indies, and adds: “Many times
in Italy I did laugh, hearing the Italians say the French
Disease, and the French calling it the Disease of Naples;
and in truth both would have hit on the right name if
they had called it the Disease from the Indies.” He also
speaks of a knight, Don Pedro Margarite, who had been
on the second voyage, as suffering from the affliction, and
regards him as probably one of the infectious foci from
which it spread at court. He says that it “was something
new, the physicians did not understand.” Similar evidence
comes from Las Casas, Sahagun, and de Isla. From the
manuscript of the last named writer, Williams quotes a
paragraph not represented in the printed editions,
left out for unknown reasons, which is of exceptional
importance. “As has been found by very long and well-
proved experience, and as this island was discovered and
found by the Admiral Dom Cristoual Colon at present
holding intercourse and communication with the Indies.
As it is of its very nature contagious, they got it easily:
and presently it was seen in the Armada itself, in a pilot
of Palos who- was called Pincon and others whom the
aforesaid malady kept attacking. And as it is a secret
disease never seen . . .” and so forth.

Whether syphilis originated in Europe or came to it


from America will probably never be decided. The the-
ory of American origin, however well-founded in other
respects, meets with an almost unanswerable objection in
the shortness of the period which elapsed between the
return of Columbus and the syphilis epidemic which broke
out in Naples in 1495. Moreover, Julien, a French naval
surgeon, has recorded that syphilis was more common
among the coastal tribes who were in contact with Euro-
peans than among the Indians of the interior, even in the
early days of exploration of the Western Hemisphere.
It is not at all unlikely that a mild form of syphilis oc-
curred all over the world, including China (according to
Dudgeon) and Japan (according to Scheube), long before
the fifteenth century. This is the view favoured by Haeser,
Hirsch, and other learned scholars.

While, thus, there remain legitimate differences of
opinion concerning the problem of origin, there is no
doubt whatever that syphilis flared up in a sudden, intense,
and widespread manner shortly after the time when
Charles VIII of France led his army through the South
of Italy against Naples. The city was taken by the French
in February 1495, and the disease promptly appeared
among the troops and the burghers. As the army dis-
persed, deserters, camp followers, and demobilized sol-
diers spread the infection far and wide, and, because of
the malignancy and disgusting character of the malady,
it was the custom of the day to blame it upon the enemy.
Thus it was at first known variously as the “French dis-
ease” or the “Neapolitan disease.” Benvenuto said he
had “the French affliction.”


The infection as it occurred in Naples was to all in-
tents and purposes a new disease in representing a com-
pletely altered relationship between parasite and host,
with consequent profound changes of symptoms. Some-
thing must have happened at that time, apart from war
and promiscuity, both of which had been present to
an equal degree many times before, which converted
a relatively benign infection into a highly virulent one.
The history of the subsequent fifty years strikingly illus-
trates the rapidity with which adaptive changes may take
place. It is probable that in all parasitisms these alterations
of mutual adjustment begin with considerable velocity,
the curve flattening out progressively with the increasing
number of passages of the parasite through the same species
of host. 6

But when the disease first broke out in Naples in the
army of Charles VIII, it possessed a violence that is un-
observed in syphilis to-day. According to Scharfenberg, it
was a feverless disease characterized by pustular and ve-
sicular eruptions with extensive ulceration. Though the
first ulcerations usually appeared on the genitals, this
was not always the case. Primary contact infections oc-
curred on many other parts of the skin, and the disease
was often transferred from mothers to children in ordinary
association. The ulcerations which often resulted from
the eruptions covered the body from the head to the

6 Fantastic theories as to the origin of syphilis were held in early
days. Van Helmont, Ozanam tells us, believed that it was started by the
intercourse of a man with a mare that had glanders. Linder thought
that it started by a similar relationship with a monkey, and Manard
thought it came from marriage with a leper.


knees. Crusts formed, and the sick presented so dreadful
an appearance that their companions abandoned them and
even the lepers avoided them. Extensive losses of tissue
in the nose, throat, and mouth followed the skin mani-
festations, and in the train of these came painful swellings
of the bones, often involving the skull. The disease it-
self, or secondary infection, caused many deaths. In sur-
vivors, emaciation and exhaustion lasted for many years.
Fracastorius says that some of the ulcers travelled, like
those that are called “phagedenic,” and extended even
into the bones themselves, where “gummositates” or
gummata as large as eggs developed on the limbs and,
when opened, contained white, sticky mucus.

Within a little more than fifty years, the disease had
already changed. Fracastorius’s De Contagione was pub-
lished in 1 546, sixteen years after his syphilis poem. 7 His
description of the disease, its methods of transmission and
course, is so complete and precise that we cannot question
the accuracy of his observations concerning the changes
that had taken place between his own time and the epi-
demic of 1495. The passage in the Second Book of De
Contagione reads as follows:

I use the past tense in describing these symptoms, because
though the contagion is still flourishing to-day, it seems to have

T The renowned poem of Fracastorius was written in 1530, and in
it the disease was given its modern name that, namely, of the shep-
herd Syphilus. The poem was finished in its earlier form in 1525, and
presented to the Sainte-Beuve of his time, Bembo. Within the next five
years it was rewritten and enlarged, and a third book was added, which
deals chiefly with the treatment of syphilis with guaiac. However, in both
the earlier and the later versions, Fracastorius indicates in an allegorical
manner that mercury is the best remedy.


changed its character since those earliest periods of its appear-
ance. I mean that, within the last twenty years or so, fewer
pustules began to appear, but more gummata; whereas the con-
trary had been the case in the earlier years. . . . Moreover, in
the course of time, within about six years of the present genera-
tion, another great change has taken place. I mean that pustules
are now observed in few cases, and hardly any pains or much
less severe but many gummata.


Being a continuation of Chapter IV y but dealing more

particularly with so-called new diseases and with $ome

that have disappeared

IT is obvious that when one searches the ancient and
mediaeval literature for the existence of maladies in which
differential diagnosis is difficult even to-day, one is likely
to make many mistakes. Accurate descriptions are rare
and, even when details of symptoms and courses are as
accurate as those to be found in Hippocrates, there is a
total lack of the laboratory evidence which is often in-
dispensable for certainty. The problem is particularly
confusing in connection with epidemic infections of the
nervous system, many of which are generally regarded
as new diseases at the present time. We are inclined to
believe that a few only of these conditions are new in
the sense that a virus is involved which had never in-
fected man before. It seems more than likely that in many
cases the diseases are new in that they represent a pre-
viously unknown biological relationship between parasite
and host. What we have said in the preceding chapter
about the changes which can be experimentally produced
in some of the filterable virus infections bears upon this

We have no reliable evidence of the existence of in-


fantile paralysis in epidemic form before 1840, and it
seems likely that if a disease of such striking character-
istics had existed in epidemic form it would have found
its way into the seventeenth- and eighteenth-century litera-
ture. In regard to encephalitis (vulgo dictu, sleeping sick-
ness), it is equally difficult to find reliable evidence of its
existence before the eighteenth century. In 1712, Biermer
studied an epidemic in Tubingen which was popularly
known as “sleeping sickness,” because it was accompanied
by somnolence and brain symptoms. The “coma somnolen-
tum” observed by le Pecque de la Cloture in 1769 was
similar and, like the disease of 1917, was associated with
influenza. Ozanam mentions a condition of like nature
occurring in Germany in the last decade of the eighteenth
century, in Lyons in 1800, and in Milan in 1802. After
this time no reliable evidence of any disease of this kind
can be found until 1917. In that year, synchronous with
the first considerable outbreak of influenza, a group of
encephalitis cases occurred in Vienna. Soon after that
others appeared in France, Great Britain, and Algeria;
then during the latter half of 1918 cases were seen in
North America, and by May 1919 had been reported
from twenty states the largest number from Illinois,
New York, Louisiana, and Tennessee. To all intents and
purposes, this was a new disease to our generation, and
up to the present time the virus of this form (lethargic
encephalitis) has never been successfully transferred to
animals. In 1924 a clinically similar and much more
severe malady appeared in Japan, and while it differed
only in severity from that reported previously, successful


transfer of the virus of the Japanese disease to rabbits
marked it as a new and different type. During the sum-
mer of 1932, an outbreak of encephalitis occurred in
Cincinnati and in certain parts of Ohio and Illinois, which
cannot at present be classified, but in the summer of 1933
again a similar disease started in the neighborhood of
St. Louis, attacking over a thousand people within several
months, killing 20 per cent of them. And the virus of
this disease, unlike any of the others, could be transferred
to mice. It appears, therefore, as though, within the
course of less than twenty years, at least three new types
of severe virus infections of the central nervous system had
appeared among us.

Vaccination has been practised on millions of people
since the time of Jenner, and never before the present
generation has the practice of vaccination been associated
with any kind of nervous disorder. Within the last twenty
years, however, a severe type of post-vaccinal encephalitis
has occurred in a few regions of the world, and since we
know, by experimental manipulation, that vaccinia virus
can be made “neurotropic” in animals, it is not impossible,
though not yet certain, that in these few cases peculiar
circumstances have permitted an invasion of the central
nervous system by the vaccinia virus. This condition de-
velops in such a disappearingly small percentage of the
vaccinated that it has practically no importance and
certainly is not an argument against the practice of vac-
cination. On the other hand, it appears to be a new disease
and for that reason is cited in this place. Indeed, under
circumstances which we do not understand, a large number


of the filterable virus infections may create disturbances
in the central nervous system. Thus encephalitis can oc-
cur in the train of measles, smallpox, German measles,
and influenza, and the laboratory infections which have
resulted from investigations of the parrot disease, psittaco-
sis, and the disease called “louping ill,” have in both in-
stances taken the form of encephalitis-like conditions.

In searching the literature for ancestral forms of infec-
tious diseases of the nervous system, one cannot overlook a
curious chapter of human affliction namely, that dealing
with the dancing manias spoken of in mediaeval accounts
variously as “St. John’s dance,” “St. Vitus’s dance,” and
“Tarantism.” These strange seizures, though not unheard
of in earlier times, became common during and im-
mediately after the dreadful miseries of the Black Death.
For the most part, the dancing manias present none of
the characteristics which we associate with epidemic in-
fectious diseases of the nervous system. They seem, rather,
like mass hysterias, brought on by terror and despair, in
populations oppressed, famished, and wretched to a degree
almost unimaginable to-day. To the miseries of constant
war, political and social disintegration, there was added
the dreadful affliction of inescapable, mysterious, and
deadly disease. Mankind stood helpless as though trapped
in a world of terror and peril against which there was no
defense. God and the devil were living conceptions to the
men of those days who cowered under afflictions which
they believed imposed by supernatural forces. For those
who broke down under the strain there was no road of
escape except to the inward refuge of mental derange-


ment which, under the circumstances of the times, took
the direction of religious fanaticism. In the earlier days
of the Black Death mass aberrations became apparent in
the sect of the flagellants, who joined in brotherhoods
and wandered by thousands from city to city. Later, for
a time, it took the form of persecution of the Jews, who
were held guilty of the spread of disease. The criminal
proceedings instituted against the Jews of Chillon were
followed by a degree of barbarism throughout Central
Europe that can only be regarded as a part of the mass
insanity of which the dancing manias were a manifesta-
tion. These manias are, in many respects, analogues of *
some of the political and economic crowd hysterias which !
have upset the balance of the civilized world in modern
times. In some parts of Europe the World War was
followed by famine, disease, and hopelessness not in-
comparable to the conditions which prevailed in the Mid-
dle Ages. For obvious reasons, in the reactions of our own
day, economic and political hysterias are substituted for
the religious ones of earlier times. Jew baiting alone seems
common to both.

Although it is likely that the overwhelming majority
of these outbreaks were purely functional nervous de-
rangements, a certain number of them may have repre-
sented early traceable beginnings of the group of epidemic
infectious diseases of the nervous system, in which we now
include infantile paralysis and the various forms of en-

In 1027, in the German village of Kolbig, there was
an outbreak among peasants which began with maniacal


quarreling, dancing, and hilariousness, but went on to
stupor and in many cases to death, and, in the survivors,
left behind permanent tremors, possibly not unlike the
“Parkinsonian syndrome” which follows encephalitis
lethargica. Hecker has given a detailed account of most
of the reliable historical records. In Erfurt, in 1237,
over one hundred children were taken with a dancing
and raving disease which, again, in many cases led to
death and permanent tremors in the survivors. The most
severe dancing mania began in 1374, in the wake of the
Black Death, at first at Aix-la-Chapelle, soon in the
Netherlands, at Liege, Utrecht, Tongres, and Cologne.
Men, women, and children lost all control, joined hands,
and danced in the streets for hours until complete ex-
haustion caused them to fall to the ground. They shrieked,
saw visions, and called upon God. The movement spread
widely, and undoubtedly the numbers of the truly afflicted
were enhanced by multitudes of the easily excited, in a
manner not unlike that observed in modern camp meet-
ings and evangelistic gatherings. Yet there must have
been a physical disease in many of the cases, because
throughout the accounts there is frequent reference to
abdominal swelling and pain, for which the dancers
bound their bellies with bandages. Many suffered from
nausea, vomiting, and prolonged stupor. The condition
was sufficiently widespread and important to warrant a
long dissertation by Paracelsus, who tried to classify the
malady into three subdivisions by a system not of suf-
ficient modern importance to warrant review.

The tarantism of Italy, supposed by many of its


chroniclers to have been caused by the bite of the tarantula,
belongs to the same category. It probably had little rela-
tionship to spider bite. The descriptions left behind by
Perotte, in the middle of the fifteenth century, and by
Matthiolo and Ferdinando in the sixteenth and seven-
teenth centuries, are quite clear in indicating that many of
the cases of tarantism represented a nervous disease of
probably infectious origin. Some of them have much re-
semblance with hydrophobia. Melancholy and depression,
followed by maniacal excitement and motor activity,
ended in death, or less fatally in semiconsciousness, with
alternating laughter and weeping. Ferdinando’s descrip-
tions add sleeplessness, swollen abdomens, diarrhoea,
vomiting, gradual loss of strength, and jaundice. By
the middle of the seventeenth century, the disease
as an epidemic menace had practically disappeared.
Schenck von Graffenberg, writing in 1643, says that
St. Vitus’s dance attacked chiefly sedentary people
tailors and artisans. When it came upon them, they
rushed about aimlessly, and many dashed out their
brains or drowned themselves. In others, renewed at-
tacks followed periods of exhaustion. Many never recov-
ered completely.

Hecker’s account, which is the source of most of the
facts here cited, includes extensive abstracts of the medi-
aeval literature which indicate that, in the dancing manias,
many things were involved. In great part, no doubt, the
outbreaks were hysterical reactions of a terror-stricken
and wretched population, which had broken down under
the stress of almost incredible hardship and danger. But


it seems likely that associated with these were nervous
diseases of infectious origin which followed the great
epidemics of plague, smallpox, and so forth, in the same
manner in which neurotropic virus diseases have followed
the widespread and severe epidemics which accompanied
the last war.


Diseases new to the population of any given part of
the world in many cases were “new” merely in their
territorial extension, as the result of established com-
munication by discovery or conquest. Yellow fever and
dengue fever transmitted to man by the same species
of mosquito (&des tegyptt) may well have existed
for ages in the West Indies and the continent of South
America. But no reliable account of the former exists in
Western medical history until Dutertre described the out-
breaks at Guadeloupe and St. Kitts in 1635, and Moseley
reported the epidemic on Jamaica in 1655. Since that
time, the disease has appeared in many parts of the world
though not all where the responsible mosquito ex-
ists or can survive. With smallpox, as Audouard makes
clear, it was probably widely distributed by the slave
trade, and, in view of the discovery of yellow-fever foci
in West Africa, we shall probably never know whether it
came to the Americas from there or vice versa. A serious
modern problem is that arising from the automobile and
aeroplane traffic now developing across the Sahara be-
tween Mediterranean North Africa, where the appropri-
ate mosquitoes are plentiful, but which is not yet infected,


and the West African coast, where the fever is firmly

As far as dengue fever (breakbone fever) is concerned,
there is no information of any corresponding epidemic
malady until the last twenty years of the eighteenth
century. Then, according to the researches of Hirsch, it
appeared in many places in rapid succession: 1779 in
Cairo} 1780 in Batavia (reported by Boylon)j in the
same year in Philadelphia (described by Rush)} 1784 in
Spain. From 1824 to 1827, the first great epidemics were
reported from India and from the West Indies and the
Caribbean coast, respectively. Since that time, it has been
prevalent, in varying intensity, in most of the tropical and
subtropical regions of the world. It is not at all impossible
that dengue is not in any sense a new disease of the
eighteenth century, but was present much earlier, though
unrecognized and wrongly regarded by early Spanish
writers as a mild form of yellow fever.

In the so-called “new” disease called tularaemia, we
have a problem of a different sort. Can man acquire a novel
type of infection, so late in the history of a crowded planet
as the twentieth century, by contact with infectious agents
long established in insects and wild animals? In 1911 a
curious plaguelike infection in ground squirrels was
found by McCoy and Chapin. After a great deal of dif-
ficulty, they managed to isolate a bacillus roughly similar
to the plague bacillus, but still quite easily distinguished
from it by appropriate methods. It was not until 1914
that the first proved infection of man was reported. Francis
names the disease “tularaemia” because the ground squir-


rel in which the disease was first observed had come from
Tulare County, California. On becoming thoroughly
familiar with the symptoms in man, he discovered that
cases had been reported in 1907 from Arizona and in 1911
from Utah. Since that time, the disease has been found in
every state except Maine, Vermont, and Connecticut. In
nature, it is an infection of the ground squirrels of the
Rocky Mountain states; of wild rabbits and hares; of
wild rats in Los Angeles; wild mice in California; quail,
sage hens, and grouse in Minnesota; sheep in Idaho; wild
rabbits in Japan, Norway, and Canada; water rats in Rus-
sia; sage hens and grouse and wild ducks in California and
Montana. Many animals that are not naturally infected
are experimentally susceptible. Man acquires the disease
by direct contact with the infected animal tissue es-
pecially hunters, butchers, and all who handle, skin, and
dress infected animals. The infection passes through small
wounds in the skin and may be rubbed into the eye with
an infected hand. Almost all investigators of tularaemia
have acquired it. Among animals, the disease is trans-
mitted by blood-sucking insects, chiefly ticks and flies. It
may be transmitted to man by the horsefly and the bite
of the wood tick. In ticks, the disease may be hereditary,
so that it is not necessary for a tick to bite an infected
animal in order to become dangerous to man. Thus we
have another disease of animals which may have caused
human infections in small numbers for a long time, and
has probably existed in animals for centuries, but which
did not become a menace to man until the beginning of
the twentieth century.


In the case of the so-called “abortus” type of undulant
fever closely related to Malta fever it is more than
likely that failure of recognition before the present era
is due to nothing more than the inevitable diagnostic in-
accuracy of former times. Fevers of clinical similarity were
known to Hippocrates, and Malta fever itself was de-
scribed in the early eighteenth century as a diagnostic
differentiation of familiar fevers, probably of ancient
existence, from similar conditions like malaria and the
true enteric fevers. But it was not until very recently
(1918) that the similarity of the Brucella melitensis, the
baccilli which cause abortion in cattle (Bang’s bacillus),
and a bacillus found in swine was recognized. And it was
not until 1922 that bacteriological methods enabled in-
vestigators to determine that the milk of infected cattle
and the handling of hogs or their fresh meat may produce
a disease not unlike that transmitted in the Mediterranean
basin with the milk of goats. Since then, these diseases
have become public-health problems on our continent
and in many parts of Europe. But they are probably new
only in the sense that we have been able to “cut out” a
new subdivision from an ancient disease group by refined


We have seen that the appraisal of the appearance of
a so-called “new” disease is fraught with many pitfalls
largely the uncertainty of historic data and the rela-
tively primitive diagnostic methods of earlier days. Never-
theless, even our very superficial discussion of these


problems may have supported our thesis that infectious
diseases are not static conditions, but depend upon a con-
stantly changing relationship between parasite and in-
vaded species, which is bound to result in modifications
both of clinical and of epidemiological manifestations.
The principle is illustrated with considerably more pre-
cision by a survey of infections which, once widely prev-
alent, were well described, and which have either be-
come modified or have actually disappeared regionally or
altogether. In such instances we possess premises for rea-
soning of considerable accuracy.

An interesting example of this is the vanishing of bu-
bonic and pneumonic plague from Western Europe. 1 The
Black Death, which was mainly bubonic plague, is one of
the major calamities of history, not excluding wars, earth-
quakes, floods, barbarian invasions, the Crusades, and the
last war. It is estimated by Hecker that about one quarter
of the entire population of Europe was destroyed by the
disease that is, at least 25,000,000. It carried in its wake
moral, religious, and political disintegration. This epi-
demic is an excellent example of the biological phenomena
which accompany the process of what the Germans call
Durchseuchung, which, as we have said, means thorough
saturation of a population with an infection. There were,
of course, as we shall mention elsewhere, formidable
plague epidemics in Europe before the fourteenth century,
but these as far as we can tell from the records did
not reach Central and Northern areas within the centuries

1 The history of plague has been ably recorded by many historians.
One of the most detailed accounts is that of Sticker.


immediately preceding the Black Death. Resistance to in-
fectious disease, an acquired characteristic, is not hereditary
except in the evolutionary sense of the selective sur-
vival of the more resistant. And such increase of resistance
by natural selection is not noticeably active, unless the
infection continues uninterruptedly throughout centuries
and is of such an order that a majority of the infected
survive. The Black Death, spreading in Europe, there-
fore, found an entirely susceptible population, which ac-
counts for its terrific ravages. When its first sweep across
the Continent was exhausted for want of victims, it re-
mained endemic, smouldering until relighted by the ac-
cumulation of new fuel; and thus it broke out again in
1361, 1371, and 1382. These successive calamities, cover-
ing only thirty-four years, illustrate the manner in which
an epidemic disease can become progressively less fatal,
when it occurs repeatedly in populations that have been
thoroughly saturated in immediately preceding years.
Statistics are of course incomplete, but the records left
behind by Chalin de Vinario, whom we cite from Haeser,
are particularly instructive in this regard. In 1348, two
thirds of the population were afflicted, and almost all
died; in 1361, half the population contracted the disease,
and very few survived; in 1371, only one tenth were sick,
and many survived; while in 1382, only one twentieth of
the population became sick, and almost all of these sur-
vived. Had the disease continued, constantly present, and
attacking a large proportion of the new generations as
they appeared, it might gradually have assumed an en-
demic, sporadic form, with relatively low mortality. As it


is, plague appeared throughout the fifteenth century in
Europe, but relatively localized and in incomparably
milder form, gradually diminishing until it again broke
out in the last European pandemic from 1663 to 1668,
reached London in 1 664, and was so vividly described by
Defoe and in some of its episodes by Pepys.

There was an outbreak in Turkey in 1661, which spread
first to the coast of Greece and the Greek Islands, then
traveled rapidly westward and, more slowly, in an east-
ward direction. In 1663, it reached Amsterdam, where
it killed 10,000 out of a total population of less than
200,000. In the following year it gained velocity, killing
about 24,000 in Amsterdam, spread to Brussels and Flan-
ders, and thence to London. In the first week of Decem-
ber, 1 664, two Frenchmen died in a house in Drury Lane.
No other cases occurred for six weeks. On the twentieth
of February, 1665, there was another case; then a pause
until April. By the middle of May, the epidemic was in
full swing. It is reported by Pepys:

This day (June 7th, 1665), much against my will, I did in
Drury Lane see two or three houses marked with a red cross
upon the doors and “Lord have mercy upon us” writ there;
which was a sad sight to me, being the first of the kind that, to
my remembrance, I ever saw. It put me into an ill conception
of myself and my smell, so that I was forced to buy some roll-
tobacco to smell and to chaw, which took away my apprehension.

King Charles, rejoicing in the victory over the Dutch
fleet, saw more and more houses marked with the terrifying
cross, and removed the court from town. Two thirds of
the inhabitants fled London, carrying the disease first to


other cities along the Thames, and finally throughout

The epidemic remained several years in Flanders,
passed thence to Westphalia, down the Rhine, into Nor-
mandy, Switzerland, and Austria, which it reached in
1668. Throughout the remainder of the seventeenth
century, trailers of the disease continued, and lasted well
into the eighteenth century. There were localized epi-
demics in Hungary, Silesia, Prussia, the Baltic Provinces,
and Scandinavia. In 1711, 215,000 people died of the
disease in Brandenburg} 300,000 in Austria. Another wave
spread from Marseilles across Provence in 1 720 and 1 72 1 .
After that, the disease, in severe but localized outbreaks,
continued through the second half of the eighteenth
century, but was gradually pushed eastward, so that the
considerable epidemic which occurred in Russia and the
Balkans between 1770 and 1772 failed to make headway
in a westerly direction. Russia and the Caucasus con-
tinued to suffer up to 1820, but since that time no great
plague epidemic has swept beyond Russia, and no wide-
spread outbreaks have occurred anywhere in what is spoken
of as the Western World.

This disappearance of epidemic plague from Europe
presents one of the unsolved mysteries of epidemiology.
The disease has been introduced into various parts of
Europe and America again and again during interven-
ing years, but has never shown any tendency to spread in
epidemic form. In 1 899, isolated cases occurred in Trieste,
Hamburg, Glasgow, Marseilles, and Naples in most
cases demonstrably the result of the landing of passengers


and sailors from ships arriving from plague foci. Similar
small group infections have occurred in a number of the
South American harbors. Adding considerably to the
mystery of the situation are such instances as the infections
that occurred in Sydney, Australia, in 1903. In January,
a dock laborer died of plague j and on February 14, dead
rats were found on the quays. Another laborer came down
with plague on the fifteenth of February, after traceable
contact with ratsj another on February 26. Within the
next few weeks, the keeper of a hotel close to the harbour
was found to have plague, and by the end of June isolated
cases occurred in the suburbs of the city. Comparable
conditions existed in Melbourne in April of the same
year, with scattered cases. In Adelaide the same thing
happened, and plague-infected rats were found, both in
the suburbs and in the city itself. Still no epidemic oc-
curred. In 1900, the disease was carried to New York,
again without serious results. The existence of plague
among the Chinese in San Francisco was discovered in
1900; and cases in different parts of California, widely
scattered, occurred from then on until the end of the
first decade of the twentieth century. As late as 1907,
twenty-four Chinese of San Francisco came down with
plague, with thirteen deaths, and a few cases were found
in Oakland and Berkeley. In the same way, harbours of
England and the larger cities of Central Europe have
occasionally had plague cases, and plague rats have been
discovered in one of the large European capitals as lately
as 1923. Yet no epidemics have resulted.


The first thought that occurs in explanation is that the
population of Europe has acquired considerable resistance.
That this is not the case is apparent from the susceptibil-
ity of Europeans living in India and other plague centres
of the East. We cannot, moreover, attribute the change
to any success in the destruction of rats. As for fleas, any-
one who has not travelled too luxuriously in Central and
Southern Europe during the flea month September
knows well that there is no dearth of fleas. When all is
said and done, we have no satisfactory explanation for the
disappearance of plague epidemics from the Western
countries, and we must assume that in spite of the in-
fectiousness of the plague bacillus, the plentifulness of
rats, their occasional infection with plague, and their in-
variable infestation with fleas, the evolution of an epi-
demic requires a delicate adjustment of many conditions
which have, fortunately, failed to eventuate in Western
Europe and America during the last century. The most
reasonable clue lies in the increased domestication of rats.
Plague epidemics in man are usually preceded by wide-
spread epizootics among rats; and under the conditions
of housing, food storage, cellar construction, and such,
that have gradually developed in civilized countries, rats
do not migrate through cities and villages as they formerly
did. The exemption of many may be directly dependent
upon the greater domestication of rats, which remain
contentedly at home, and, as a consequence of this, plague
foci among them remain restricted to individual families
and colonies.


Closely bound up with the biology of plague is that of
leprosy. This disease, well known in ancient times, in-
creased immensely in mediaeval Europe. It is assumed
that it was widely distributed in Europe by the returning
Crusaders, although there are indications that it was
present to some extent in France in the sixth century. By
the end of the eleventh century, institutions for the segre-
gation of lepers leprosaria were common, the first
one founded in 1067 in Spain by Ruy Diaz de Bivar,
commonly known as El Cid. Under the auspices of
the church, similar institutions grew in number and size,
so that by the time of Louis VIII, Haeser tells us, there
were as many as nineteen leprosaria in the diocese of
Troyes alone.

The story of leprosy is a chapter as extensive as that
of plague, and would require a volume in itself. The point
of interest in our present discussion is that after the middle
of the fifteenth century leprosy began to decline, and
leprosaria gradually became unnecessary. By the middle
of the sixteenth century, only a few centres of the disease
remained. In the seventeenth century, it had practically
disappeared. Medical histories have attributed this decline
to all kinds of vague conceptions, based upon assumptions
of improved sanitary conditions, and so forth, but none of
these are adequate. The most likely solution of the prob-
lem was suggested to us in conversation by Professor
Sigerist, who connects the disappearance of leprosy with
the immense mortality that occurred at the time of the
Black Death and its secondary waves. When the plague
struck Europe, with its dreadful destruction of human


life, immense numbers perhaps the majority of
lepers had been segregated in institutions, which thus
represented a concentration of relatively susceptible and
weak groups. It is not impossible, as Dr. Sigerist sug-
gests, that most of the lepers of Europe were wiped out
by the plague, and that the few who survived were too
scattered and represented too meagre a spark to revive
the disease. This seems especially likely in view of the
relative noncontagiousness of leprosy, the manner of
transmission of which we do not yet understand, but
about which we know that prolonged and intimate contact
alone gives rise to new cases.


The so-called “English sweating sickness” is probably
the most important of those severe plagues that tormented
mankind in brief and terrifying visitations and then com-
pletely and inexplicably vanished. The “sweat” came on
with tempestuous speed, and disappeared as suddenly as
it came. There is no mention of a similar fever before
1485 or after 1552.

After the battle of Bosworth, in which Henry VII
gained the ascendancy in England, there broke out in the
ranks of the conquering army a disease that completely
put a stop to the procession of the victorious troops. With
disbanded soldiers, it was carried into London. The speed
of spread can be estimated from the fact that the sick-
ness reached its height in London by September 21, the
battle of Bosworth having been fought on August 22. It
spread over England rapidly from east to west, carried


far and wide by the men scattered from the army. In
London it killed, within the first week, two Lord Mayors
and six Aldermeri. It attacked the young and robust,
this being one of the points in which it was similar to the
Picardy Sweat, of which we shall have something to say
presently. The mortality of this English sweating sick-
ness was such, according to Holinshed, that “scarce one
amongst an hundred that sickened did escape with lifej for
all in maner as soone as the sweate tooke them or in a
short time after yeelded up the ghost.” The Coronation
of Henry was postponed. In Oxford, where Thomas
Linacre who later founded the College of Physicians
was then a student, it was so severe that professors and
students fled the University, which was closed for six
weeks. This first outbreak remained entirely in England,
not even spreading to Scotland or Ireland.

The symptoms of the disease have been described by
many writers, and, though minor differences occur, the
accounts are in the main consistent. Particularly important
is the description by John Kaye, whose famous pamphlet
on The Sweate was published in 1552. The disease began
without warning, usually at night or toward morning,
with a chill and with tremors. Soon there was fever, and
profound weakness. Accompanying this were cardiac pain
and palpitation, in some cases vomiting, severe headache,
and stupor, but rarely delirium. Although some writers
make no mention of a rash, there are nevertheless de-
scriptions which do so especially that of lyengius,
whose accounts come to us from Forest, and who relates
that, after the perspiration was over, there appeared on


the limbs small vesicles “which were not confluent but
rendered the skin uneven.” The profuse sweating, which
was the most noticeable characteristic, began soon after
the onset of the fever. Death came with astonishing speed.
It is stated that many cases died within a day, and some
even within a few hours. A single attack did not immun-
ize, since a number of people had two or three attacks in
brief succession.

After a short and violent career, the disease completely
disappeared, and we find no mention of it from 1486
until 1507.

The second epidemic was apparently much like the
first, but there is not much reliable information available.
It again started in the summer this time in London
and, as Senf suggests, it is not improbable that it may
have remained endemic in that city during the inter-
epidemic quiescence.

In 1518, the disease appeared for the third time, and
with enhanced severity. Again it spread over England,
again sparing Scotland and Ireland. But this time it
reached the Continent, advancing only to Calais, where
strangely enough none but the English inhabitants
are said to have contracted it. Again it killed many pa-
tients within two or three hours, and it brought death to
many important men in Oxford and Cambridge ; in some
towns from a third to a half of the population was wiped

out. 2

The sweating sickness seems to have gained energy be-

2 It is stated that in some places 80 to 90 per cent of the population


tween epidemics, for the most severe outbreak was that
of 1529.* This started in May, again in London, and the
terror it inspired was so great that society was disorgan-
ized, agriculture stopped, and famine resulted. The disease
swept across the sea to the Continent, where it was first
reported in Hamburg, which it reached in July, probably
with a ship returning from England. In the same month
it spread across Eastern Germany to Ltibeck and Bremen j
by August, it had reached Mecklenburg; in September
it came to Konigsberg and Danzig j thence it traveled
southeastward to Gottingen, where the mortality was so
great that five to eight corpses had to be put into a single
grave. A curious fact noted by many who described it at
this time is the lateness with which the disease reached
the Netherlands, that is, four weeks later than its ap-
pearance in Hamburg, although active communication
by sea was carried on equally between both places and
England. In Marburg, the epidemic interrupted the Coun-
cil of the Reformation. In Augsburg, 15,000 fell sick in
the first five days. It reached Vienna during the siege of
the city by the Sultan Soliman and, probably ravaging the
Turkish army, may have had some effect on the raising of
the siege. A little later, it entered Switzerland j but it
never crossed into France.

The fifth and last epidemic of the sweat occurred in
1551. Again it started in England, this time in Shrews-
bury, in April, where 900 died in a few days. It spread

8 We are using the dates given by Haeser. Those of Hecker, and
many others, differ by one year, owing to the discrepancies between the
English and the Roman calendar.


over the whole county, carried about as Haeser puts it
“in the drift of poisonous clouds of fog.” A strange ob-
servation made at this time, which corresponds to the
previous limitation of the sickness to the English in-
habitants of Calais, is the apparent exemption of foreign-
ers in England. Yet the fifth epidemic seemed to follow
Englishmen into other countries, so that many died in
France and the Netherlands. This outbreak of 1551 is
the one that John Kaye described in his famous pamphlet.

Only once after this date (we take our information
from Senf ) has a sickness resembling the English sweat
occurred, unless we identify the disease as many have
done with the Picardy Sweat. About two hundred
and fifty years after the fifth epidemic, that is, in 1802,
at Rottingen in Franconia, a similar but regionally limited
malady appeared.

It is impossible to identify the sweating sickness with any
epidemic disease now prevalent. Purely on the basis of
synchronous occurrence, Schnurrer and others believe
that it was a modified form of typhus, and it is true as
Senf points out that it did not spread into any of the
countries where typhus was prevalent at the time. How-
ever, this opinion is not convincing. The sickness remains
an entirely individual condition which could not were
it to reappear at present be properly classified with any
of the known infectious diseases. The suddenness of onset,
the rapid death, were more violent than any of the dis-
eases of our day, with the exception of occasional cases of
meningitis or infantile paralysis. While speed and man-
ner of spread remind us of influenza, the apparent absence


of prominent catarrhal symptoms, the lack of a secondary
pneumonia fatality, and the nonexistence of successive
waves within a short period suffice to separate it from in-
fluenza, as it now occurs. Its general characteristics would
incline us to regard it as caused by a filterable virus of a
variety at present unknown. It is a reasonable speculation
that the sweat was due to a virus that had for centuries
been prevalent on the Continent in milder form, and in
England spread in an entirely susceptible community.
This is the only basis on which one can hope to explain
the reiterated observation that it was peculiar to the Eng-
lish people, even when they were living in foreign parts.
Knowing what we do about the wide general distribution
throughout modern populations of the virus of infantile
paralysis, with which a large proportion of the population
has probably been infected without manifest disease be-
fore adult life, it is not fantastic to assume that virus in-
fections may eventually become so widely distributed
that, in time, entire populations become immunized j and,
eventually, a disease which at first was epidemic and
severe may become endemic, modified, milder, and
finally extinct. This sort of thing is certainly going
on in diseases like measles, infantile paralysis, and in-
fluenza, which endemic with us cause destructive
and violent epidemics among primitive peoples when
carried among them.

Another disease which seems to have come suddenly
out of the blue and which, within less than two hundred
years, has almost completely disappeared is the so-called
“Suette des Picards.” There is some confusion regarding


the relationship of this disease to the English sweating
sickness, and to the so-called “military fevers.” Under the
latter term, there were probably included a great many
of the well-known eruptive fevers, such as measles, scarlet
fever, chicken pox, and so forth. It is impossible to re-
view the voluminous controversial literature dealing with
these problems, but there are accurate records which
show that a peculiar malady quite unlike any of the now
prevalent exanthemata suddenly appeared in Normandy
in 1718 and spread within a few years into Poitou, Bur-
gundy, and other regions of Northern France. Opinions
of the leading medical historians (Hirsch, Haeser, and
Ozanam) are at variance concerning the existence of a
similar disease in other parts of Europe before 1718.
Haeser believes that foci existed before this date in Alsace
and in Turin. But the descriptions of such outbreaks lack
precision until 1718. Most students agree that, apart
from localization, the Picardy Sweat can be differentiated
from the English sweating sickness largely on the basis
of the eruption and of the violent mental symptoms ac-
companying the Picardy disease.

Several excellent descriptions regarding its manifesta-
tions in different places and many years apart establish
its character as a definite clinical entity. The first of these
is the precise account by Dr. Belot of the outbreak of 1718.
And this corresponds almost exactly with that of Dr.
Vandermonde, who reported the epidemic at Guise in

The onset was sudden, often with a chill, abdominal
pain, and difficulty in breathing. There followed a severe


headache, high fever and insomnia, and often great ex-
citement. Profuse sweating began within twelve to
twenty-four hours, usually accompanied by violent itch-
ing. A rash, variously described as resembling measles
(rougeole) or erysipelas (which probably means an even
reddening something like the rash of scarlet fever), was
noticed within the first forty-eight hours. Nosebleeds were
frequent and violent. In fatal cases there was delirium,
and often death was accompanied by convulsions. Many
cases died within one or two days.

After 1718, many local epidemics occurred in France
at first at short intervals, later less frequently up to
the middle of the nineteenth century. In the latter part
of this period there were similar outbreaks in Northern
Italy and in Southern Germany. Altogether, according
to Hirsch, 1 94 epidemics occurred in France between 1718
and 1804. Nothing is known of the mode of transmission,
of the causes which led to outbreaks, or of the reasons for
their decline. Boyer, writing in 1751, declared that the
disease was not contagious, that is, there was no evi-
dence of transmission from one case to another, and in
this opinion most observers agree.

Unlike almost all other diseases of equal violence, the
Picardy Sweat was always closely circumscribed in the in-
dividual epidemics. Most of the outbreaks remained
limited to individual villages or towns. In only a few in-
stances did they extend beyond defined localities, though
on one or two occasions widely separated districts of France
were invaded. Individual epidemics rarely lasted more
than a few months.


It is impossible to form any trustworthy opinion con-
cerning the nature of this disease. It does not fit into any
of the categories of modern classification. While in some
respects it resembles rapidly fatal scarlet fever, the ab-
sence of any evidence of severe throat infection renders
its identification as this improbable. It was surely not
measles or smallpox. The only infection of which the
fatal and most violent cases of Picardy Sweat remind us
is the fulminating meningococcus infections which are
occasionally seen during meningitis epidemics. In such in-
fections many of which were seen in camps during the
late war the sudden onset, profuse rash, sweating, high
fever, and rapid death, often with delirium and convul-
sions, present a clinical picture closely resembling de-
scriptions of the severest cases of Picardy Sweat. Other
similarities between the two are the lack of traceable re-
lationship between cases (masked contagiousness) and the
limitations of spread. However, the milder cases which
were apparently in the majority have little resemblance
to meningococcus infections. We can only conclude that
we are here dealing with a disease which is either unique
or which represents a now unknown form of a surviving
disease, modified in the course of time. Typhus can be
excluded with confidence because of the sudden onset with
shaking chills and the rapidity with which the rash de-
veloped (one to two days). The violent itching so fre-
quently noticed is also uncharacteristic of typhus. More-
over, the first Picardy epidemic occurred at a time when
typhus in its present form had been well known for several


A few isolated cases of a condition resembling the
Picardy Sweat are occasionally reported by French physi-
cians at the present time, but even if these are genuine,
no outbreak even of limited extent has occurred
since the seventies of the last century.


Diseases of the ancient world: a consideration of the
epidemic diseases which afflicted the ancient world, with
attempts at making diagnoses which, if they are difficult
to make at the distance of a thousand years, are equally
difficult under the circumstances to disprove. Though this
may appear another unnecessary postponement of our
biography, it represents our effort to determine the
antiquity of typhus fever

THAT bacterial diseases have attacked the higher forms
of life since the very beginning is unquestionable.

There are, in the Vienna Museum, remains of pre-
historic bears which show unmistakable signs of large ab-
scesses of the teeth and jaws. Reasoner has collected from
the palaeontological literature a number of descriptions
of conditions of bacterial origin occurring in prehistoric
animal remains. He mentions the remains of a reptile,
Dimetrodon, of the Permian Age (21,000,000 years
ago), described by Gilmore, in which there was evidence
of chronic osteomyelitis of the spine ; also a Jurassic croco-
dile (14,000,000 years ago), described by Auer, which
presented signs of infection in the pelvis, with metastases
in the femur, the sacral vertebrae, and the palate. Signs
of carious teeth, of possibly rheumatic swellings of the
joints, have been found in numerous fossils by Renault,
Moody, and others. Evidences of bone necrosis and subse-


quent hyperostoses are not uncommon in fossil remains.

As far as primitive man is concerned, not much is
known although Raymond described a case of spondy-
litis deformans and one of arthritis of the knee in neolithic
bones of France. There is, however, much doubt as to the
antiquity of some of these fossils. The meagre palaeonto-
logical literature of man furnishes little direct informa-
tion on this problem. There is, however, a good deal of
evidence that bacteria became capable of producing in-
fections millions of years ago, and there is no reason to
doubt that man from the very beginning suffered from in-
fectious disease $ and at the time when mankind had
reached the period of the earliest historical records, in-
fectious diseases of many varieties already existed. And
though diagnosis is often difficult, it is certain that
epidemics were prevalent thousands of years before

The diagnostic determination of the various infectious
diseases from ancient medical literature presents many
difficulties because of the uncertainties involved in de-
termining the meanings of descriptive words, unless these
occur many times in different connections. Thus it is often
impossible to gain any accurate impression of the nature of
a skin eruption, since it is often difficult to know whether
the word used should be properly translated as referring
to raised surfaces, vesicles, pustules, or ulcers.

In Chinese literature, there is very little descriptive
material accessible to the Western student from which
opinions can be formed regarding the nature of the prev-
alent diseases. It is not impossible that smallpox and


some of the exanthemata originated in China and reached
Europe across Persia and North Africa. However, opin-
ions concerning this, as expressed by Wise and by Moore,
rest upon very slim evidence. Moore, taking his informa-
tion from the oldest available Chinese medical treatises,
believes that smallpox was prevalent in China at the
time of the Tsche-u dynasty, a period between 1 1 22 B.C.
and 249 B.C., and Smith, in an article in the Medical
Times and Gazette for 1871, cites evidence that the dis-
ease occurred during the dynasty of Han, about 200 B.C.,
and was imported from India. 1

In the ancient Indian writings, the Ayur-Veda (date
uncertain, but surely before 200 B.C., perhaps parts of it
as old as 900 B.C.), and the writings of Susruta, there are
accounts that may refer to tetanus and chorea. Fevers of
various kinds were known some of them quite surely
malaria, some possibly inflammatory rheumatism and per-
haps leprosy, known as “Kushta.” An intestinal disease,
interpreted with reasonable accuracy as cholera, was well
known. Haeser, who studied the translations of Wise, finds
evidence also of catarrhal jaundice, of gonorrhoea, and
possibly of tuberculosis. It is of particular interest that
in Susruta’s writings there are descriptions of genital ul-

1 This information is largely taken from Hirsch. The origin of
smallpox, however, is a much disputed problem, which has been a sub-
ject of learned dissertations by Krause, Hahn, Werlhof, and many others.
Haeser questions the validity of the evidence advanced for the existence
of smallpox in ancient India and China, though he admits the possibility.
He does not accept, as indicating smallpox, many of the descriptions so
interpreted from the writings of Hippocrates. Unmistakably accurate
descriptions of the disease are found in writings dating from and after
40 A.D.


cerations which Haeser thinks may have been syphilitic.

About ancient Egyptian diseases, we have a good deal
of information from the Papyrus Ebers, which was writ-
ten during the reign of King Re-Ser-Ka, approximately
1700 years before Christ. The infectious diseases men-
tioned were an erysipelas-like condition called “Hmaou,”
which was treated largely with the faeces of donkeys; in-
testinal worms, and varieties of ophthalmia. Examinations
made upon mummies by Sir Marc Ruffer, Dr. Elliot
Smith, and Dr. Wood Jones revealed evidences of Pott’s
disease, and in a mummy of the twentieth dynasty (about
1200 B.C.) there are spots on the skin which might have
been smallpox. A similar eruption was found on the
body and face of Rameses II. On Rameses V there was a
triangular ulcer above Poupart’s ligament in the region of
the inguinal glands, which might have been a plague bubo
or a venereal sore (the disease of kings). In some of the
older mummies, in which the abdominal viscera had not
been removed, Ruffer observed large spleens which may
indicate malaria. 2

The diseases mentioned in the Old Testament are sum-
marized by Garrison in his History of Medicine as in-
cluding gonorrhoea, leprosy, or possibly psoriasis; in Sam-
uel, enlarged inguinal glands are noted, indicating the
probability of plague. In the Talmud, there is mention
of conditions of the lung that might reasonably be re-
garded as tuberculosis; of an abscess of the kidney, and
of infections of the female genital organs.

2 For references to many of these observations, we are indebted to an
interesting essay by Colonel Reasoncr of the United States Army.


Jehovah seems to have been pretty hard on the poor
Philistines. In I Samuel iv, there is an account of a battle
in which the Philistines overcame the Jews, slaying about
30,000 of them in what appears to have been a perfectly
fair fight. The victory of the Philistines was facilitated
by the fact that the Hebrew army ran away, and tried to
hide in their tents. The conquerors then took the ark of
God (I Samuel v) into the house of their own god, whose
name was Dagon, and who was a sort of half fish, and
consequently more or less helpless. The Hebrew God then
smote Dagon, cutting off his hands and throwing him off
his pedestal, so that his face was on the ground. This
threw a terrible scare into the Philistines of Ashdod, so
that they sent the ark to Gath. Thereupon, “the head of
the Lord was against the city with a very great destruc-
tion: and He smote the men of the city, both small and
great, and they had emerods in their secret parts,” and
“the hand of God was very heavy there. And the men
that died not were smitten with the emerods.” This is the
sort of thing, of course, which throughout the ages
has led to what in modern terms we may speak of as “Nazi
movements.” But the Lord only knows what an “emerod”
was. Literally, it is a hemorrhoid the etymological re-
lationship of these two unpleasant words being obvious j
but it is hardly likely that even the Philistines could have
had a fatal epidemic of hemorrhoids. The words trans-
lated as “emerods” are “ophalim” and “teharim,” which
mean swellings, or rounded eminences. According to our
learned informant, the translation “emerods” depends on
a comparison with Psalms LXXVIII. 66, where God is


said to have smitten his enemies “in the hinder parts.”
This identification is very early, from Talmudic sources
and in Aramaic translations. “Ophalim,” according to
other translators, merely means an elevated, rounded
place. Hastings, in his Dictionary of the Bible, does not
believe that “emerods” were hemorrhoids, and connects
this description with bubonic plague. Granting, therefore,
that these words refer to swellings in the private parts,
the controversy merely turns upon whether it was the
hinder end or the front end which was affected. Al-
though the material available is insufficient for diagnostic
accuracy, rounded swellings in these regions, associated
with epidemic spread and high mortality, are suspicious
of plague.*

In the time of David, as a punishment for the forbidden
census, there was a severe pestilence, which destroyed
70,000 by sudden death. Most of these people are sup-
posed to have died in one day. No clue whatever to the
nature of this malady is available.

Among the plagues of the ancient Hebrews mentioned
by Josephus, there are none that are described with suf-
ficient detail to justify even an intelligent diagnostic
guess. Of the afflictions visited upon the Egyptians, one
had to do with polluted water, which gave them great
pains } in another an innumerable quantity of lice arose
out of their bodies (since many of them died, a louse-
borne disease like typhus may be suspected, though in
view of the absence of historical data concerning typhus

* Preuss, Medizin im Talmud, is the foremost authority on diseases
of Biblical times.


elsewhere at this period, this is most unlikely) j still an-
other was a fatal epidemic of boils.

There is repeated evidence in Biblical history that the
fair competition of other nations with the Jews was al-
ways rendered a triumph for the Hebrews by the inter-
ference of what, to the others, must have seemed a biased
and relentless God. We wonder whether this does not lend
a great deal of justice to the opinion of Houston Stewart
Chamberlain, who explains anti-Semitism entirely on the
basis of a clash between religions. Jewish teachings were
widely spread in the ancient world, and if the atrocious
vengeance of God on all who opposed the Jews who
apparently were no lilies in their relations with others
were believed, hatred and resentment would be easily

Interpretation of the infectious diseases that occurred
before the time of the Greeks is, in most instances, largely
guesswork. From the Greeks, however, a great deal of ac-
curate description has come down to us, which permits us
to form intelligent opinions concerning the symptoms,
clinical pictures, and often the epidemiology of the condi-
tions that occurred among them. Although there is much
medical information before Hippocrates, it has only oc-
casional bearing on the epidemic diseases in which we are
interested. Asclepius, a Thessalian king, son of Apollo,
was largely a mythical figure, but that a certain amount
of knowledge of infection was prevalent among his later
followers is apparent from the isolated places in which


his temples were built, and from the laws which in
Delos, for instance prohibited the burying of dead
bodies near the temple. Democritus mentions diseases that
were probably epidemic, and Empedocles is supposed to
have arrested by the closure of a crevice in a mountain

miasmas that came from a river. Democritus believed
that the epidemic diseases which ravaged mankind were
due to the destruction of heavenly bodies, the cinders of
which dropped upon the earth. Alcmaeon stopped a plague
in Athens by the lighting of fires. There is, however, no
material for ancient diagnostic opinion, even among the
Greeks, until the time of Hippocrates.

Hippocrates was probably not the first great physician
of antiquity. Indeed, it is likely that many skillful and
sagacious medical men practiced in ancient Egypt, where

Herodotus tells us physicians were even more highly
specialized than they are to-day, since often they limited
themselves to a single organ of the body. There were
dentists, as well as internists and surgeons. Hippocrates,
however, is the first great physician from whom we have
records and writings which show an approach to medical
problems entirely analogous to our own. Indeed, his de-
scriptions of cases in the Efidemton are so precise that
diagnoses more accurate than the ones he made himself
can be deduced from his clinical histories.

The Greeks suffered from a great variety of infectious
diseases. Being an outdoor people, living in a good climate,
with at first no formidable concentrations of popu-
lation, the earlier outbreaks of contagious disease among
them were not of sufficient extent to be noticed by histo-


rians. The medical reader is struck by the absence of any
serious descriptions of epidemics among the Greek armies
of Homeric times, during the early struggles between the
Spartans and the Athenians, and in the Persian wars. The
armies were large, often rapidly mobilized, and they must
have had disease j but neither Herodotus nor others who
deal with this period speak anywhere of the kind of wide-
spread epidemic mortality which one is justified in ex-
pecting. This is possibly due to the fact that any such oc-
currences would then have been interpreted as the wrath
of enraged deities, rather than as visitations of transmis-
sible disease.

In the time about which Hippocrates writes, we find
mention of epidemics of inflamed eyes at Thasos very
likely pink eye. There were diarrhoeas, with fever and
tenesmus, watery stools, vomiting, and sweating not
improbably forms of bacillary dysentery. The continued
fevers that occurred chiefly in the autumn and early winter
were, in part, quite clearly due to malaria of the quartan,
double tertian, and sestivo-autumnal varieties. There were
prolonged fevers lasting twenty-four or more days, with
occasionally late, nonsuppurating swellings of the
parotid glands, which we can reasonably interpret as
typhoid fever; others which, in view of their interrupted
nature and the cult of the goat in ancient Greece, might
well have been Malta fever. There is one description
which unquestionably refers to an epidemic of mumps
a mild fever, witHout mortality, and with bilateral parotid
swelling, dry cough, and occasional swellings of the testi-
cles. Sore throats, with coughs, fever, and often with de-


lirium, may have been either scarlet fever or diphtheria.

In the Efidemion, there are a considerable number of
case histories, quite as thoroughly recorded, from day to
day, as many of our modern ones, upon which diagnostic
judgment can be based. In many instances, the observa-
tions of Hippocrates are so precise that we can often sup-
ply, from modern knowledge, the exact type of infection
not infrequently the microorganism that must have
been responsible for the individual conditions. In regard
to many nonsurgical conditions Hippocrates did quite as
well, we surmise, as will be possible for the modern gen-
eral practitioner or “family medical adviser” who is so
dear to the hearts of many of our reactionary contempora-
ries, and who, by a return to medical muzzle-loading, is
to emancipate our profession from all the newfangled
laboratory doodads.*

Herophontos came down with an acute fever, with liquid
and bile-coloured movements, tenesmus, and abdominal
tenderness. On the fifth day, he became delirious and be-
gan to sweat, with continued liquid movements. On the
ninth day, there was a crisis with severe perspiration, and
a relapse seven days later. Herophontos must have had
either acute bacillary dysentery, typhoid or paratyphoid
fever, or cholera; but, since his was an isolated case, it was
probably not cholera.

The haemolytic streptococci were as formidable then as
they are now. The wife of Philinus and the wife of Do-
madeos unquestionably died of what we should now call
puerperal sepsis.

4 See Frothingham.


The wife of Epicrates developed a sore throat two days
before childbirth, had a prolonged fever, which lasted
without abatement for twenty-one days, and did not com-
pletely subside for eighty days. She might have had
typhoid fever, or a subacute streptococcus infection.

Criton, of Thasos, had a sudden pain in his big toe, fol-
lowed by fever and delirium on the same night. The next
day, his foot was red and oedematous, with little black
spots, and his leg began to swell. He was dead in two days,
and without doubt died of a virulent streptococcus in-
fection, perhaps starting from an ingrown toenail.

A Clasomenian had what was unquestionably typhoid

A pregnant woman, three months with child (the thir-
teenth case in the First Book), suffered from a sudden
pain in the back, rapidly followed by fever, headache,
pain in the neck and right hand, and loss of speech. There
was delirium on the fifth day, and paralysis of the right
hand and arm. There is no statement as to residual paraly-
sis after recovery on the fourteenth day, but the whole
story sounds like acute anterior poliomyelitis, or possibly
the encephalitis lethargica which we have thought to be a
new disease.

An unnamed man died of a condition which was with-
out much question an attack either of acute appendicitis
or of cholecystitis. In the middle of the night, after a
heavy meal, he was seized with sudden vomiting, fever,
and pain in the right hypochondrium. The symptoms
continued} the abdominal pain became general, and he
died on the eleventh day. We favour acute appendicitis,


because of the omission of any reference to jaundice. It is
interesting to note the care with which physical examina-
tions were made by Hippocrates. He states that on first
observing this patient, he found no abdominal rigidity.
This must have developed later, or we must assume that
even Hippocrates may have made a mistake.

Among the remaining cases there are carbuncles, ery-
sipelas, possible diphtheria, various forms of paralysis,
and, not impossibly, cases of plague, 5 since there are

8 If the cases described by Hippocrates were true plague, it is of
course strange that there is no description of epidemic spread. That
he knew plague in isolated cases seems likely from passages in his
Aphorisms, cited by Littre, in which he says that fevers with buboes
are all dangerous except those which last a very short time. The same
author also cites a sentence from the Second Book of the Epidemion,
which indicates a knowledge of true plague. Hippocrates was born at Cos,
in the first year of the eighteenth Olympiad that is, 460 B.C. The
great plague of Athens occurred in 430 B.C., and if this had been an
epidemic of bubonic plague, Hippocrates would have recognized it as
such. As we shall see in another place, notwithstanding the opinion of
Ozanam and some others, the Athenian plague cannot, in the light of
the descriptions, be regarded as plague. There was also, during the life-
time of Hippocrates, a severe contagious disease in Persia. Artaxerxes
sent envoys to the great physician, offering him rich treasure if he would
come to the aid of the stricken Persians. Although (it is so stated, but
also contradicted) Hippocrates declined this mission from motives of
patriotism, the nature of the Persian disease must have been thoroughly
described to him. It is likely, therefore, that if plague in its typical
manifestations had existed in Greece during the fifth century B.C.,
Hippocrates would have described it recognizably. The question has
been thoroughly sifted by all the leading medical historians. If Greece
was exempt from epidemics of plague at a time when it was prevalent
elsewhere, this may have been due to the scarcity or possible absence of
domesticated rats. In our chapter on the history of the rat, we discuss
the information on which this surmise rests. However, there may have
been other, more mysterious reasons. We are faced with a similar prob-
lem in the absence of epidemic plague from modern England and


descriptions of buboes of the thighs/ There were pneu-
monias and pleurisy, and protracted diseases of the lungs
which resemble pulmonary tuberculosis. Rheumatic fever
does not seem to have been unknown, but the descriptions
are vague.

Our primary purpose in examining the clinical histories
of Hippocrates was to find evidence of the early existence
of typhus fever. Ozanam and others have stated that Hip-
pocrates described typhus fever, and the case that has
often been cited as evidence for such an assumption is that
of the second patient in the First Book of Epidemion.
This individual, Silenus, “son of Eualcides, who lived near
the platform, was attacked by a fever as the result of
fatigue and excessive drinking and exercise. From the
beginning, he had pain in the back, headache and pain in
the neck.” For a number of days he had fever, with
intestinal symptoms, feelings of pressure in the abdomen,
insomnia, and delirium all of which might be con-
sistent with a number of different types of infectious
disease, but are quite consistent with the onset of typhus.
On the seventh and eighth days, he had severe sweats,
and on the eighth day he developed an eruption of red,
sphprical spots which continued without suppuration. He

Western Europe. Isolated cases of plague have been observed in some of
the larger European cities within the last twenty-five years, but not even
local outbreaks have occurred. Plague epidemics have not been known
in Western Europe since about 1721. In the nineteenth century there
were practically none west of Russia, and yet rats infested with fleas
are plentiful and ubiquitous.

6 Hippocrates seems to have employed a method of auscultation.
Laennec, the father of modern auscultation, says: “Iffocrate wait tente
I* auscultation immediate”


died on the eleventh day. The headache, the sweating,
the delirium, and the eruption, the onset and length of
the disease, are all as one would expect them to be in a
severe case of typhus. The question of the diagnosis turns
largely on the nature of the eruption, and this depends,
of course, entirely upon the exact meaning attached to
the words describing it. The significant expression is
QavQ4}HQ.T(L pcra idp&ros IpvQpa. 0oi, come from the skin moistures (he calls them
juices), and that they are either hard and crude, or in-
flamed j in the latter case, fever subvenes; and he then
gives several prescriptions for their treatment.” It is
therefore pure conjecture to regard this as a case of typhus
fever. Indeed we think this improbable, when it is con-
sidered that no other similar ones are mentioned.

The tenth case in the series, the Clasomenian, whom
Ozanam regards as definitely a case of typhus, appears


on careful reading of the original more like a severe
typhoid fever.

There is not, therefore, anywhere in Hippocrates a
clinical description which can be definitely recognized as
applying to typhus fever. The search is equally unsuccess-
ful if one investigates the writings of other classical au-
thors who are supposed to have described the disease.
Euryphon, a contemporary of Hippocrates, a physician of
the Cnidian School, is often cited in support of the an-
tiquity of typhus fever. Galen (xvn, 1, ed. Ktihn) says:
“Such fevers Euryphon names ‘livid’ (?roXids), and
he writes as follows: c The fever becomes livid and attacks
the top of the head (Ppeyubs) in recurrent attacks; the
head aches, a pain seizes the bowels, and the patient
vomits bilej when this pain holds him, it is not possible
to see what ails him; the belly becomes dry and all the
skin livid, and the lips as if he had eaten black mulber-
ries; the whites of the eyes become livid, and the patient
looks as if he were being strangled; when he suffers this
less, he suffers changes in his condition very often.’ ” This
again is obviously not typhus as we know it to-day, but
the description might well serve as a vivid portrayal of
a severe attack of cholera.


The oldest recorded epidemic often regarded as an out-
break of typhus is the Athenian plague of the Pelopon-
nesian Wars, which is described in the Second Book of
the History of Thucydides.

In trying to make the diagnosis of epidemics from


ancient descriptions, when the differentiation of simulta-
neously occurring diseases was impossible, it is important
to remember that in any great outbreak, while the large
majority of cases may represent a single type of infection,
there is usually a coincident increase of other forms of
contagious diseases j for the circumstances which favor the
spread of one infectious agent often create opportunities
for the transmission of others. Very rarely is there a pure
epidemic of a single malady. It is not unlikely that the
description of Thucydides is confused by the fact that
a number of diseases were epidemic in Athens at the time
of the great plague. The conditions were ripe for it.
Early in the summer of 430 B.C. large armies were camped
in Attica. The country population swarmed into Athens,
which became very much overcrowded. The disease seems
to have started in Ethiopia (? Mdioirias rfjs virlpMybirTov),
thence traveled through Egypt and Libya, and at
length reached the seaport of Piraeus. It spread rapidly.
Patients were seized suddenly, out of a clear sky. The
first symptoms were severe headache and redness of the
eyes. These were followed by inflammation of the tongue
and pharynx, accompanied by sneezing, hoarseness, and
cough. Soon after this, there was acute intestinal involve-
ment, with vomiting, diarrhoea, and excessive thirst. Delir-
ium was common. The patients that perished usually died
between the seventh and ninth days. Many of those who
survived the acute stage suffered from extreme weakness
and a continued diarrhoea that yielded to no treatment.
At the height of the fever, the body became covered with
reddish spots ( virtpvOpov, TrcXtr^, ^Xujcratpats /u/cpats ical


2\ic\(tKTau>a t a “rising” pimple, therefore unlike the “spot” of typhus.


fleet, which was attacking the Peloponnesian coast, and
prevented the carrying out of the objectives for which
their expeditions had been organized. Thus it is likely that
the struggle between the two contending powers was in-
fluenced in its duration and in the swinging back and
forth of the fortunes of war as much by the epidemic as
by any generalship or force of arms.

The plague of Thucydides can be identified with no
single known epidemic disease of our day. Haeser believes
it to be more like typhus fever than any of the conditions
familiar to us, and Hecker takes the view that it was
typhus in a form from which it has been altered in the
centuries that followed. The eruption was certainly not
like that of typhus at the present time, but corresponds
more nearly to that of smallpox. When all is said, we
must conclude that the nature of the Athenian epidemic
cannot be determined with certainty. The rapidity of
spread in a crowded town of 10,000 relatively small
buildings, with a tremendous influx of population, is
consistent with many forms of epidemic disease. The on-
set, the immediate respiratory symptoms, the nature of
the eruption, and the sequelae might reasonably be inter-
preted as smallpox.

In trying to make a diagnosis of the Athenian plague,
we must take seriously the suggestion made by Hecker
that epidemic diseases may have been modified con-
siderably in the course of centuries of alternating wide-
spread prevalence and quiescence. One of the greatest
achievements in the war which the medical sciences have
waged against epidemic diseases is the discovery that, dur-


ing times of quiescence in interepidemic periods, the po-
tential agents of disease may smoulder in human carriers,
in domestic animals, especially rodents, and in in-
sects. And modern bacteriology has made considerable
progress in revealing changes that take place in the
characteristics of bacteria and virus agents in the course of
their adaptation to different environments. In the typhus-
fever group, these circumstances have been most particu-
larly studied, and we already have knowledge of a number
of varieties of typhus and typhus-like fevers which have
developed within historic times, probably because of the
passage of the virus through different varieties of rodents
and of insects and through man. These are matters which
we have discussed more precisely in another place.

Thus, in endeavouring to classify the plague of Athens
in the fifth century B.C., we have to choose between typhus,
bubonic and pneumonic plague, and smallpox.

There is, in our opinion, practically no reason for
assuming that the disease in question was a variety of
typhus. Whatever may be the difference of opinion
about the words ^Xfomura or ?\Kea it seems fairly certain
that the eruption, unlike that of typhus, was raised
and, later, vesiculated; and the sudden onset, prominently
marked by the inflammatory symptoms of the upper
respiratory tract and severe coughs, is also inconsistent
with epidemic typhus as we know it. The necroses of the
extremities do suggest typhus, but this symptom is not
usually prominent except in winter epidemics in armies,
and the Athenian disease began early during a hot sum-
mer. This seasonal factor is also against typhus. More-


over, careful scrutiny of other ancient evidence does not
give us reason to believe that typhus was known or reli-
ably described until long after this period.

Bubonic plague probably existed. It is quite certain
that it was prevalent in the Near East and on the northern
coast of Africa at least three hundred years before Christ,
and in other places we have shown that the bubonic form,
or a closely related condition, caused severe epidemics in
Biblical times. But there is nothing whatever in the de-
scription of the Athenian plague by Thucydides which
would give an indication that the Bacillus pestis or a simi-
lar organism, either in the bubonic or in the pneumonic
form, could have caused this epidemic.

We are led to consider smallpox or a variety of small-
pox as the most likely classification. Whether smallpox
was prevalent in the world at this time or not has been
much disputed. Littre believed that there was no positive
evidence of this in ancient literature. On the other hand,
Haeser cites passages in Susruta which seem to refer to a
disease prevalent in ancient India which closely simulated
smallpox, and Paschen accepts the evidence which has
been advanced to show that smallpox existed in China
as early as 1700 B.C. In general, there seems to be con-
siderable unanimity on the part of learned writers that
smallpox was absent from Europe during the Greek and
Roman classical periods.* In spite of this, however, the

8 It is assumed by some writers that smallpox was spread over Europe
with the wandering Gothic and Germanic tribes, but this is more or
less guesswork. It is definite that it was a common condition all through
North Africa by the time of the sixth century A.D., and about the same


description of Thucydides seems to us to point directly
to a disease of this general type. This surmise is strength-
ened by the occurrence of another epidemic, described
by Diodorus Siculus, which attacked the Carthaginian
army besieging Syracuse in 396 B.C., less than forty years
after the outbreaks in Attica. Diodorus describes it as

period there was an epidemic in France, described by the Bishop of
Avranches and by Gregory of Tours, which was quite surely smallpox.
Rhazes, who wrote during the early part of the tenth century, describes
the disease accurately, and during his time it was widely distributed
throughout the Near East, which it is believed to have reached through
Arabia from Abyssinia during the “Elephant War” in the fourth cen-
tury A.D. Later, it was carried by the Saracens into Spain, whence it
quite naturally penetrated into Europe.

By the year 1000, it was present in practically all the European na-
tions and was again and again reintroduced from the East by returning
Crusaders. Indeed, it is likely that the sad fate of the army of Fred-
erick Barbarossa was brought about by smallpox and not by force of
arms. The Mongolian invasion brought a new mass inoculation, as a
consequence of which the first pesthouses had to be built to shelter the
immense numbers of the sick. Eventually, this disease was regarded
as one of the inevitable trials of all men.

After the discovery of America, smallpox followed close on the
heels of the discoverers. In the conquest of Mexico and in the rapid
subjection of the powerful native tribes, the European was unquestion-
ably assisted by his powerful allies the pestilences, to which the aborig-
ines were as susceptible as children. Among these, smallpox was the
most effective. A Negro from the ship of Narvaez carried smallpox
ashore, and over 3,000,000 Indians are said to have died. Negro
slaves, indeed, quite possibly played a considerable rdle in the rapid
distribution of the pox throughout the new continent. By the middle
of the sixteenth century, it is clear that the entire world had become
infected with the virus.

The smallpox epidemics of the subsequent two centuries, recurring
whenever susceptible fuel had accumulated, were of an extent and
severity of which it is hard for us to form any conception at the
present time; and it is safe to say that this condition would still pre-
vail, attacking each new generation, were it not for the single and
simple procedure of Jennerian vaccination.


follows: “First, before sunrise, because of the cold breezes
from the water, they had chills j in the middle of the day,
burning heat. During the first stage of the disease there
was a catarrh (icarAppovs) followed by a swelling in
the throat (rpAx^os); shortly after this, fever set in;
pains in the back and a heavy feeling in the limbs; next,
a dysentery and blisters (^Xfarcuj’a) upon the whole
surface of the body.” After this, some became delirious.
Death occurred on the fifth or sixth day in most cases.
Diodorus attributes the disease to the multitude gathered
together in one place, the dryness of the summer, and the
“hollow and marshy” nature of the place. There was an
enormous death rate; the siege had to be raised, and the
army dispersed. From an historical point of view, this
epidemic was of the greatest importance, because it meant
that less than one hundred years before the outbreak of
the Punic Wars, in which much of the early fighting took
place in Sicily, Carthage was prevented by this epidemic
from completely controlling Sicily with a powerful army
of occupation and well-organized naval bases. Rome had
the greatest difficulty in conquering the Carthaginians,
and decisive Carthaginian superiority in the earlier cam-
paigns might well have resulted in supplanting the mili-
tary and administrative civilization of Rome with the
commercial, Semitic culture of Carthage an event
which would have modified profoundly all subsequent
history. 9 The disease as described by Diodorus again
like the epidemic in Athens corresponds about as closely

9 It might have resulted in developing a commercial civilization like
our own several thousand years earlier.


as can be expected of ancient descriptions to the severe,
confluent type of smallpox in which death on the fifth or
sixth day is not exceptional.

It is interesting to note that a similar epidemic attacked
both the Roman and the Carthaginian army in 212 B.C.,
when they met in battle at Syracuse, but the description of
this outbreak is not sufficiently clear to permit diagnostic


A continuation of the consideration of diseases of the
ancients^ with particular attention to epidemics and the
fall of Rome. We are still engaged in our search for evi-
dences of the occurrence of typhus in ancient times

THE effects of a succession of epidemics upon a state are
not measurable in mortalities alone. Whenever pestilences
have attained particularly terrifying proportions, their
secondary consequences have been much more far-reaching
and disorganizing than anything that could have resulted
from the mere numerical reduction of the population.
In modern times, these secondary effects have been to
some extent mitigated by knowledge which has re-
moved much of the terror that always accompanies the
feeling of complete helplessness in the face of mys-
terious perils.

In this respect, modern bacteriology has brought about
a state of affairs which may exert profound influence
upon the future economic and political history of the
world. Some epidemic diseases it has converted from un-
controlled savagery into states of relatively mild domesti-
cation. Others it can confine to limited territories or
reservations. Others again, though still at large, can be
prevented from developing a velocity which once in
full swing is irresistible. But even in cases where no


effective means of defense have as yet been discovered
as, for instance, in influenza, infantile paralysis, and en-
cephalitis the enemy can be faced in an orderly manner,
with determination and with some knowledge of his prob-
able tactics; still, no doubt, with terror, but at least with-
out the panic and disorganization which have been as
destructive to ancient and mediaeval society as the actual
mortalities sustained.

In earlier ages, pestilences were mysterious visitations,
expressions of the wrath of higher powers which came out
of a dark nowhere, pitiless, dreadful, and inescapable. In
their terror and ignorance, men did the very things
which increased death rates and aggravated calamity. They
fled from towns and villages, but death mysteriously
traveled along with them. Panic bred social and moral
disorganization; farms were abandoned, and there was
shortage of food; famine led to displacement of popula-
tions, to revolution, to civil war, and, in some instances,
to fanatical religious movements which contributed to
profound spiritual and political transformations.

The disintegration of the Roman power was a gradual
process brought about by complex causes. Although, at
the death of Honorius, in 423 A.D., Britain alone had
broken away from formal Roman control, the cracks along
which the eventual cleavages were to come had already
been well started. The edict of Caracalla, long before this,
had raised the inhabitants of the provinces to the dignity
of Roman citizenship, but in actuality the knights of
Rome had no more in common with the burghers of
Nicomedia or Augusta Trevirorum than a banker Republi-


can of Boston or New York to-day has in common with
a farmer Democrat of Oklahoma. Gigantic bureaucracies
were eating up the government, budgets were almost
modernly unbalanced, and the barbarians, already
settled in the Empire, immigrants in the modern
sense, 1 were expressing their aspirations for political power
by marching on the capital whenever farming ceased to
pay. The Visigoths, settled by Theodosius south of the
Danube, started a farmers’ strike in 396 under Alaric,
and were stopped from occupying Rome only by the pay-
ment of a large farm loan, then spoken of as a ransom.
The Vandals and Suebi, in 405, took possession of Spain,
crossed into Africa, and established a sort of Middle West,
which could enforce its desires by controlling the grain

The problem has been dealt with from every con-
ceivable angle, for there is no greater historic puzzle
than that of the disappearance of the ancient civilization
a disappearance so complete that not a spark from its
embers shone through the barbaric darkness of several hun-
dred years. 2 Historians have analysed the causes according
to the prejudices of their own varieties of erudition.
Mommsen, Gibbon, Ferrero, deduce the disintegration
of the state, with variations of emphasis, from a com-

1 In support of this, we submit the fact that the final struggle for
supremacy in Italy itself was between Genseric, the Vandal, and Rici-
mer, the Suebian, a situation not unlike the political contest in New
York between Mr. O’Brien and Mr. La Guardia.

2 The desolate completeness of the disappearance of every vestige of
the ancient civilization and organization is vividly described in the first
chapter of Funck-Brentano’s Le Moytn Age.


bination of political, religious (moral), and sociological
causes. Ferrero lays fundamental stress upon the “inter-
minable civil wars which resulted from the efforts of
later Rome to reconcile the two essentially different
principles of monarchy and republican organizations.”
Some have attempted to explain the breakdown on a basis
of agricultural failure (Simkhovitch, Hay and History) j
a few associated with this the influence of a formidable in-
crease of malaria, which accelerated the desertion of
the farm lands (Ross). Pareto (Traite de Sociologie
Generate, Vol. II, Chap. XIII “L’fiquilibre Social
dans PHistoire”) seems to us to have given the most
reasonable analysis, in which, in an extraordinarily brief
treatment, he correlates the many complex factors that
were cooperatively active. But even he has failed to in-
clude any consideration of the calamitous epidemics which
sweeping the Roman world again and again during its
most turbulent political periods must have exerted a
material, if not a decisive influence upon the final outcome.
We are far from wishing to make the error against
which Pareto warns, “d’envisager comme similes des fails
extremement compliques”; and we do not mean to add
to other one-sided views an epidemic theory of the Roman
decline. But we believe that a simple survey of the fre-
quency, extent, and violence of the pestilences to which
Roman Europe and Asia were subjected, from the year
one to the final barbarian triumph, will convince the un-
prejudiced that these calamities must be interpolated in
any appraisal of the causes that wore down the power of
the greatest state the world has known. Indeed, we are


inclined to believe, from a consideration of the circum-
stances prevailing at that time, that it would be impossible
to maintain permanently a political and social organiza-
tion of the type and magnitude of Rome in the face of
complete lack of modern sanitary knowledge. A con-
centration of large populations in cities, free communica-
tion with all other parts of the world, especially Africa
and the East, constant and extensive military activity
involving the mobilization of armies in camps, and the
movement of large forces back and forth from all corners
of the world these alone are conditions which in-
evitably determine the outbreak of epidemic disease. 8
And against such outbreaks there was absolutely no de-
fense available at the time. Pestilences encountered no
obstacles. They were free to sweep across the entire world,
like flames through dry grass, finding fuel wherever men
lived, following trade routes on land, and carried over the
sea in ships. They slowed down only when they had burned

8 This is still entirely applicable to modern times. Experience in the
cantonments of 1917 and in the sanitation of active troops convincingly
showed that war is to-day, as much as ever, 75 per cent an engineering
and sanitary problem and a little less than 25 per cent a military one.
Other things being approximately equal, that army will win which
has the best engineering and sanitary services. The wise general will
do what the engineers and the sanitary officers let him. The only
reason why this is not entirely apparent in wars is because the military
minds on both sides are too superb to notice that both armies are si-
multaneously immobilized by the same diseases.

Incidentally, medicine has another indirect influence on war which
is not negligible. There seems little doubt that some of the reckless
courage of the American troops in the late war was stimulated by the
knowledge that in front of them were only the Germans, but behind
them there were the assembled surgeons of America, with sleeves
rolled up.


themselves out and even then, when they had travelled
as slowly as did the plagues of Cyprian and Justinian,
they often doubled on their own paths, finding, in a new
generation or in a community with fading immunity,
materials on which they could flame up again for another
period of terror. As soon as a state ceases to be mainly
agricultural, sanitary knowledge becomes indispensable
for its maintenance.

Justinian died in 565. Charlemagne was crowned in
800. Between 600 and 800, Italy was the battleground of
barbarian immigrants who were fighting for the spoils.
Rome, in the ancient sense, had ceased to exist. The final
collapse of its defensive energy corresponds, in time, with
the calamity of the great pestilence which bears Justinian’s
name. And while it would not be sensible to hold this
plague alone responsible, it can hardly be questioned that
it was one of the factors perhaps the most potent single
influence which gave the coupe de grace to the ancient

Moreover, the history of the preceding six hundred
years furnishes any number of examples to show that,
again and again, the forward march of Roman power and
world organization was interrupted by the only force
against which political genius and military valor were
utterly helpless epidemic disease. There is no parallel
in recent history by which the conditions then prevailing
can be judged, unless it is the state of Russia between
1917 and 1923. There, too, the unfettered violence of
typhus, cholera, dysentery, tuberculosis, malaria, and their
brothers exerted a profound influence upon political events.


But of this we shall have more to say presently. It was
only the highly developed system of sanitary defence on
the Polish and the southern fronts that prevented, dur-
ing those years, an invasion first of disease, misery, and
famine; then of political disruption from spreading
across Europe. This statement may, perhaps, be debatable.
But it is, at least, a reasonable probability.

At any rate, during the first centuries after Christ,
disease was unopposed by any barriers. And when it came,
as though carried on storm clouds, all other things gave
way, and men crouched in terror, abandoning all their
quarrels, undertakings, and ambitions, until the tempest
had blown over.

We have searched in vain for evidences of typhus
during this period but the significance of epidemics for
the decline of Rome is of such interest that we may be
forgiven another brief digression.

There is relatively little information in the literature of
the first century A.D. in regard to epidemics. In the reign
of Nero (after 54 B.C.), a plague occurred which is de-
scribed by Tacitus as “extraordinarily destructive”
though his text gives no clues from which a diagnosis can
be made. In the cities of Italy, there raged a disease which
was so severe that corpses were in all the houses, and
the streets were filled with funeral processions. “Slaves
as well as citizens died” (we quote from Schnurrer),
“and many who had mourned a beloved victim died them-
selves with such rapidity that they were carried to the


same pyre as those they had mourned.” Whether this
particular malady was confined to Italy or not, we have
no means of telling. But during the same period there
were a number of other epidemic diseases in the provinces,
one of which is described as “anthrax,” and was probably
similar or identical with the infection known by this name
to-day, since it attacked cattle and horses as well as men.
According to some writers, it was this disease which,
occurring among the Huns about 80 A.D., started 30,000
‘of them, with 40,000 horses and 100,000 cattle, on their
westward wanderings (Johannes von Mtiller).

Throughout the first century, there were earthquakes,
famines, volcanic eruptions, and vaguely reported epi-
demics. However, the first pestilence of which we have
reliable accounts is that which is spoken of as the “Plague
of Antoninus” (or of Galen). This disease started in the
army of Verus, which was campaigning in the East in
1 65 A.D. According to Ammianus Marcellinus, the original
infection came from a chest in a temple which the soldiers
had looted. As the army returned homeward, it scattered
the disease far and wide, and finally brought it to Rome.
By this time, the infection had radiated into all corners of
the world, and before long had extended “from Persia to
the shores of the Rhine,” even spreading through the
Gallic and Germanic tribes. The mortality in many of
the cities was such that, as Marcus Aurelius says, “corpses
were carried in carts and wagons.” Orosius states that so
many people died that cities and villages in Italy and in
the provinces were abandoned and fell into ruin. Distress
and disorganization were so severe that a campaign against


the Marcomanni was postponed. When, in 169, the war
was finally resumed, Haeser records that many of the
Germanic warriors men and women were found dead
on the field without wounds, having died from the epi-
demic. Marcus Aurelius contracted the disease and, rec-
ognizing the contagiousness of his affliction, refused to
see his son. 4 He died on the seventh day, his illness ag-
gravated by his refusal to take nourishment. Since this
was in 180 A.D., at which time Galen’s description, Meth-
odus Medendi, was written, it is plain that the pestilence
in Europe lasted at least fourteen years. There is no
definite information of the approximate number of deaths,
but there is no doubt about the fact that the mortality
was so great that it completely demoralized social, politi-
cal, and military life and created such terror that there
were none who dared nurse the sick. Our authority for
this is Ammianus Marcellinus. The temporary arrest of
the epidemic in 180 lasted only nine years. Dio Cassius
tells us that it broke out again under Commodus in 189.
“There arose the greatest plague of any I know of. Often
there were 2000 deaths a day at Rome.” It appears that
the later phases were even more deadly than the earlier

The nature of this disease is uncertain. It is, as usual,
more than likely that no single infection was responsible,
but that a number of different ones were raging at the

4 About the only thing that centuries and changing civilization,
religions, and customs have not been able to alter is the biological law
of affection.


same time. The most fatal of these, the one which gave
the epidemic its chief characteristics, was a condition which,
if not smallpox, was closely related to it. Indeed, the
epidemic of Antoninus seems to have closely resembled the
plague of Athens. Galen tells us that a majority of the
cases began with inflammations of the pharynx, fever, and
diarrhoea. On the ninth day, there was in most cases
an eruption which was sometimes pustular and some-
times dry. We are again faced with the difficulty of
accurately interpreting the words referring to the nature
of the exanthemata, but there is less uncertainty in con-
nection with this disease than there was in descriptions of
the plague of Athens, in regard to the raised, often vesic-
ular and pustular nature of the eruption. Haeser, whose
opinion in this matter we share, after reading the evi-
dence, inclines to the belief that the epidemic was one of
smallpox, or of a disease closely related to the modern
form of the disease. This fact is rendered particularly
likely by the speed and extensiveness with which the
malady spread across the entire known world.

There can be little room for doubt that a calamity of
this kind, lasting for over a decade, during a political
period rendered critical by internal strife and constant
war against encircling hostile barbarians, must have had a
profound effect upon the maintenance of the Roman
power. Military campaigns were stopped, cities depopu-
lated, agriculture all but destroyed, and commerce para-

Apart from the military and camp disease which at


brief intervals afflicted the frontier armies/ the Roman
world remained relatively free of great pestilences from
the time of Commbdus until the year 250, a period when
the empire was entering into its turbulent, ever-increas-
ing struggle against the barbarian inroads. The threat
became especially serious after the victory of the Goths
over Decimus at Forum Trebronii. There started at this
time a pandemic which is described, among others, by
Saint Cyprian and is therefore often spoken of as the
epidemic of Cyprian. This disease, like the Athenian
plague, was said to have originated in Ethiopia, reach-
ing Europe after passing across Eygpt. It lasted no less
than fifteen or sixteen years, during which it spread over
the entire known world “from Eygpt to Scotland.” It
swept over the same regions repeatedly, after intervals of
several years. Its contagiousness was extreme and, accord-
ing to Cedrenus, it was transmitted not only by direct
contact, but indirectly through clothing. Gregory of
Nyssa e and Eusebius have left records of the suddenness

6 An indication of the frequent occurrence of camp disease in the
Roman armies is found in Vegetius’s De Re Militari, dedicated to
Valentinian about 375 A.D. “An army must not use bad or marshy
water; for the drinking of bad water is like poison and causes plagues
among those who drink it.” And, at the end of the chapter: “If a
large group stays too long during the summer or autumn in one place,
the water becomes corrupt, and because of the corruption, drinking is
unhealthy, the air corrupt, and so malignant disease arises which cannot
be checked except by frequent change of camp.”

e In Gregory of Nyssa, the same plague is referred to a? occurring
during the life of Gregorius Thaumaturgus. There is also a descrip-
tion in Patrologia Graca, Gregorius III, in which the symptoms are
given as follows: “When once the disease attacked a man, it spread
rapidly over all his frame. A burning fever and thirst drove men to the


of its appearance, and of its terrifying violence. In a city
of Pontus, in 256, it appeared after the gathering of a
great crowd in a theatre, as a punishment for the temerity
of the spectators in challenging Jupiter, in whose honor
the performance was given. In Alexandria, the mortality
was enormous. The speed of extension was favored by the
active warfare going on in many of the provinces. The
Germanic tribes were invading Gaul and the Near East.
The Far Eastern provinces were being attacked by the
Goths, and the Parthians were conquering Mesopotamia.
Terror was extreme, and phantoms were seen to hover
over the houses of those who were about to fall sick.
Saint Cyprian made many conversions to Christianity by
exorcising these evil spirits. Throughout the early Chris-
tian period, every great calamity famine, earthquake,
and plague led to mass conversions, another indirect
influence by which epidemic diseases contributed to the
destruction of classical civilization. Christianity owes a
formidable debt to bubonic plague and to smallpox, no
less than to earthquake and volcanic eruptions.

The nature of the plague of Cyprian is even more
difficult to determine than is that of the Athenian pesti-
lence. Haeser believes that bubonic plague played a
dominant role, and bases this chiefly upon the seasonal
factor that is, upon the reports that in Egypt successive
outbreaks began in the autumn and lasted until the very
hot weather in July. In the absence of any definite informa-

springs and wells; but water was of no avail when once the disease had
attacked a person. The disease was very fatal. More died than survived,
and not sufficient people were left to bury the dead.”


tion of glandular swellings or buboes, however, this view
is pure surmise. Cyprian describes the disease as beginning
with redness of the eyes, inflammation of the pharynx
and throat, violent diarrhoea and vomiting. 7 He mentions
gangrene of the feet, paralysis of the lower extremities,
deafness, and blindness. No skin eruption is described.
One must assume again a synchronous prevalence of many
diseases, among which forms of meningitis and prob-
ably acute bacillary dysenteries were frequent, but no
specific diagnosis is possible from the symptoms observed
by writers of the period.

Whatever the conditions may have been, their violence
was so extreme that one cannot doubt their serious effects
upon political and social development. A conception of
the extreme distress may be obtained from the following,
which we quote literally from Haeser: “Men crowded
into the larger citiesj only the nearest fields were culti-
vated -y the more distant ones became overgrown, and were
used as hunting preserves j farm land had no value, be-
cause the population had so diminished that enough grain
to feed them could be grown on the limited cultivated
areas.” Even in the centre of Italy, large territories be-
came vacant; swamps developed, and rendered unhealthy
the formerly wholesome coast lands of Etruria and

T Cyprian’s description in De Mortditatc is as follows: “The bowels,
relaxed into a constant flux, use up the strength of the body. A fire,
conceived in the marrow, ferments into wounds in the jaw [fauces].
The intestines are shaken with continual vomiting. The eyes burn
with blood. Sometimes the feet or other parts of the limbs are cut off
because of the infection of disease, [causing] putrefaction [morbid a


Latium. Hieronymus writes that the human race had
been “all but destroyed,” and that the earth was return-
ing to a state of desert and forests. 8

During the plague of Cyprian, according to Baronius,
the Christian custom of wearing black as a colour of
mourning originated. It had been used before by Hadrian,
who, says Schnurrer, wore black for nine days after the
death of Plotina.

Between the pestilence of Cyprian and the next great
pandemic, spoken of as the plague of Justinian, there
occurred a succession of calamities earthquakes, famines,
and the severe, but relatively localized, epidemic diseases
such as one would expect in an empire in which there was
a constant movement of large armed forces and unin-
terrupted communication with the East and with the
north coast of Africa. At the same .time, the migration of
agricultural populations to the cities had already pro-
duced a great crowding of people into small areas, with-
out any of the indispensable safeguards of modern medi-

In the reign of Diocletian and Maximian, a plague is
described, without any specific symptomatology, by Ce-
drenus. Eusebius places this outbreak a little later, and

8 In studying the long cyclic swings of history, one learns that the
judgment of political, social, and other changes in human destinies
must be based on periods of not less than two or three centuries. With
our own experience, we can appraise only a fraction of the curve in
the cycle of which we are a part, and we cannot look forward clearly
unless we are trained and capable of looking backward to the beginning
of the curve, at least two or three hundred years in the past. Do Mr.
Roosevelt and his brain trusters realize this?


also speaks of a new disease possibly anthrax which
affected thousands of people, appeared in the form of
acute ulcerations and swellings of different parts of the
body, and blinded many in whom it occurred. Numbers
of domestic animals died at the same time. Disease and
famine continued into the year 313.

There follows a period about which we have relatively
little record, though it probably had its usual measure of
disease. It is the period during which Volkerwanderung
was in one of its most active stages. This phenomenon was
like the impact of human waves from east to west. The
movement may have been started when the Huns, or
Hiong-nus, were pushed out of China, and wandered to
the Caspian Sea. Impelled to move, possibly by disease,*
they began to migrate westward. Their first collision was
with the Alani, whom they scattered or carried along with
them in a thrust against the Goths. The latter had wan-
dered from the north along the river beds toward the
Black Sea. Crowded out by Huns and Alani, the Goths
fled into Roman territory, where they temporarily settled
along the Danube.

By 406, a general movement of barbarian tribes
Suebi, Alani, Burgundi, and Vandals was taking place
into Italy, Gaul, and across the Pyrenees to Spain. Ac-
cording to Idatius, it was a period of war, famine, and
pestilence. In 444, there was a terrible epidemic in
Britain, which seems to have been in part responsible for
the historically momentous conquest of Britain by the
Saxons. Baeda, in his Historia E celestas tica Gentis An-

9 Suggested by Schnurrcr.


glorwn states that Voltiger, hard pressed and in distress,
called upon the Saxon chieftains, Hengist and Horsa, for
assistance: “A terrible plague fell upon them, which
destroyed so many that the living could barely suffice to
bury the dead. They consulted what was to be done, and
where to seek aid against the frequent incursions of the
northern races [apparently their fighting forces were
greatly depleted by the plague], and agreed to call in the
Saxon nation from across the Sea. The Saxons arrived in
449, and acted as mercenary guards for the Britons.” It
requires little exercise of the imagination, therefore, to
conclude that the history of the British Isles in all its sub-
sequent developments of race, customs, architecture, and so
forth, was in large part determined by an epidemic disease.

Eusebius tells of an epidemic which occurred through-
out the Roman provinces and near Vienna (then known as
Orse Favianae) in 455 and 456. It began with inflamed
eyes, swelling and redness of the skin over the entire
body, and it ended sometimes fatally on the third
or fourth day, with severe pulmonary symptoms. It is
impossible to say what this disease might have been
possibly general streptococcus infection, or a form of
scarlet fever, with secondary streptococcic pneumonia. 11

In 467, Rome itself suffered from a disease about
which we know, from Baronius, only that it killed a great
many people. In the immediately succeeding years, much

Beda Ventrabilis, Of era Omnia, Giles Edition of 1843, Vol. II,
Book I, Chap. XIV and XV.

11 A haemolytic streptococcus pneumonia epidemic among troops oc-
curred in one of the American cantonments in 1917.


scattered but localized epidemic disease occurred in
the Gallic provinces} and in 477, when the Saxon King,
Odoacer, reached Anjou on his way to Italy, a severe
plague broke out among citizens and invaders alike.
Shortly after this, a famine and plague in North Africa
decimated the Vandals, thus preparing them for defeat
by the Mohammedans.

Of great diseases there is no record during the ensuing
fifty years, but in 526 occurred the great earthquake of
Antioch, which was responsible for the death of several
hundred thousand people.

This brings us to the greatest of all the pandemics that
helped to undermine the ancient civilization namely,
that of Justinian, details of which we know very largely
from the writings of Procopius.

The sixth century was a period of calamity rarelyj
equaled in history. Seibel in his Die Grosse Pest zur Zeit*
JustinianS) has thoroughly compiled the available informa-
tion, and is the authority from which most subsequent
writers quote. According to him, a succession of earth-
quakes, volcanic eruptions, Vesuvius in 5 1 3 was one,
and famines preceded and accompanied the series of
pestilences which wrought terror and destruction through-
out all of Europe, the Near East, and Asia for over sixty
years. Of the natural convulsions, the most destructive
was an earthquake, followed by conflagration, which de-
stroyed Antioch in 526, killed between 200,000 and
300,000 inhabitants, and frightened away most of the
remainder. There also were earthquakes in Constantinople
and in other cities of the East, as well as in many places in


Europe proper. Among others, there was a severe one in
Clermont, then called Civitas Averna. A succession of
floods and famines added to the general misery. The im-
poverishment, the displacement of populations, the agri-
cultural disorganization and famine which attended these
calamities must have contributed materially to the origin
and spread of the pestilence. Modern experience has
demonstrated this a number of times, when tidal waves,
earthquakes, and floods have wrought similar havoc.

The great plague of Justinian began in Eygpt, near
Pelusium. The suggested Ethiopian origin is vague; there
was a sort of ancient and traditional suspicion that disease
usually came out of Ethiopia. Procopius writes of this:

At this time [540], there started a plague. It appeared not
in one part of the world only, not in one race of men only, and
not in any particular season; but it spread over the entire earth,
and afflicted all without mercy of both sexes and of every age.
It began in Eygpt, at Pelusium; thence it spread to Alexandria
and to the rest of Eygpt; then went to Palestine, and from there
over the whole world; in such a manner that, in each place, it
had seasonal occurrence. And it spared no habitations of men,
however remote they may have been. And if, at times, it seemed
as though it had spared any region for a time, it would surely
appear there later, not then attacking those who had been afflicted
at an earlier time; and it lasted always until it had claimed its usual
number of victims. It seemed always to be spread inland from the
coastal regions, thence penetrating deeply into the interior.

In the second year, in the spring, it reached Byzantium and
began in the following manner: To many there appeared phan-
toms in human form. Those who were so encountered, were
struck by a blow from the phantom, and so contracted the sick-
ness. Others locked themselves into their houses. But then the


phantoms appeared to them in dreams, or they heard voices that
told them that they had been selected for death. 1 *

Since Procopius himself believed these things, his ac-
count reflects the terrified helplessness and panic which
spread with this pestilence.

Four months the plague remained in Byzantium. At
first, few died then there were 5000, later 10,000
deaths a day. “Finally, when there was a scarcity of grave-
diggers, the roofs were taken off the towers of the forts,
the interiors filled with the corpses, and the roofs re-
placed.” Corpses were placed on ships, and these aban-
doned to the sea. “And after the plague had ceased, there
was so much depravity and general licentiousness, that
it seemed as though the disease had left only the most

Procopius devotes a number of paragraphs to a de-
scription which is our only clue to diagnosis:

They were taken with a sudden fever: some suddenly wakened
from sleep; others while they were occupied with various mat-
ters during the daytime. The fever, from morning to night, was
so slight that neither the patients nor the physician feared danger,
and no one believed that he would die. But in many even on
the first day, in others on the day following, in others again not
until later, a bubo appeared both in the inguinal regions and
under the armpits; in some behind the ears, and in any part
of the body whatsoever.

To this point, the disease was the same in everyone, but in the
later stages there were individual differences. Some went into
a deep coma; others into violent delirium. If they neither fell
asleep nor became delirious, the swelling gangrened and these

12 DC Bella Persico, Chap. XXII.


died from excess of pain. It was not contagious to touch, since
no doctor or private individual fell ill from the sick or dead;
for many who nursed or buried, remained alive in their service,
contrary to all expectations. Some of the physicians unacquainted
with this disease and in the belief that the buboes were the chief
site of the sickness, examined the bodies of the dead, opened
the buboes and found a great many pustular places.

Some died at once; others after many days; and the bodies
of some broke out with black blisters the size of a lentil. These
did not live after one day, but died at once; and many were
quickly killed by a vomiting of blood which attacked them.
Physicians could not tell which cases were light and which severe,
and no remedies availed.

Agathius, speaking of the year 558, describes the same
disease at Byzantium and again mentions buboes and
sudden death which usually occurred on the fifth day.
It attacked all ages, but killed more men than women.

It is interesting to note that this epidemic displayed one
of the characteristics so often referred to in modern
epidemiology namely, when the outbreaks began, the
number of sick and the mortality were relatively slight,
but both rose with appalling violence as the epidemic
gathered velocity.

There can be little doubt that the pestilence of Justin-
ian was mainly one of bubonic plague, but the references
to the general eruption of black blisters in many cases
indicate that smallpox of a very severe type participated.
Whatever it was, its extent and severity were such that
commentators like Haeser believe it to have exerted an
influence upon the decline of the Eastern empire which
historians have too often overlooked. In the course of


sixty to seventy years, a considerable part of the known
world was devastated by the disease. Cities and villages
were abandoned, agriculture stopped, and famine, panic,
and the flight of large populations away from the infected
places threw the entire Roman world into confusion.

Gibbon, speaking of this plague, says: “No facts have
been preserved to sustain an account or even a conjecture
of the numbers that perished in this extraordinary mor-
tality. I only find that, during three months, five and at
length ten thousand persons died each day at Constanti-
nople} and many cities of the East were left vacant, and
that in several districts of Italy the harvest and the vin-
tage withered on the ground. The triple scourges of war,
pestilence and famine afflicted the subjects of Justinian \
and his reign is disgraced by a visible decrease of the
human species which has never been regained in some of
the fairest countries of the globe.”

Procopius was an eyewitness of most of the events which
he describes. He was associated closely with Belisarius in
his campaigns, and occupied a position of sufficient im-
portance to have the “inside” of what was going on in
Constantinople at the court. One may, therefore, assume
that his accounts of the turbulence of the period wars,
political corruption, and pestilence are not unduly
exaggerated. And since we have recently had a greater,
more widespread, and more destructive war than most
others of history, and since political corruption to-day is
probably quite as well developed and general as at any
time, it is a reasonable conjecture that it may have been
only our relative ability to control pestilence which has


preserved the modern world, for a time, from breaking
up as did the empire of Justinian.

In studying, through the eyes of Procopius, the reign
of Justinian, one obtains an extraordinarily vivid picture
of the manner in which the three major agencies co-
operated in bringing the empire to its knees. Justinian
was making a final effort to restore the imperial world
power. Wars with Persia, wars against the Vandals in
Africa and against the Goths in Italy, armies to main-
tain on all fronts, in widely separated parts of the world,
strained the resources of the government to their utmost.
Everywhere the ring of defence was being pushed back
by ever-increasing hordes of barbarians, who had by this
time learned much of the art of war and of organization
from their former overlords. Internal insurrections, as at
Byzantium in 532, threatened the rear. Treachery and
graft weakened the administrative power at court. And
superimposed upon these almost, perhaps entirely in-
superable difficulties was the pestilence, sweeping from
east to west, north to south, again and again, for almost
sixty years, killing, terrifying, and disorganizing.

The plague lasted until 590, or a little later. Between
568 and 570, most of Italy was conquered by the Lom-
bards, who, as Cunimund, another barbarian, said, “re-
semble in figure and in smell the mares of the Sarmatian
plains.” The power and the grace and the administrative
logic that once were Rome had died.


On the influence of epidemic diseases on political and
military history and on the relative unimportance of gen-
erals. This, we promise, is the last serious digression jrom
our main theme

IF it were not for the fact that so many utterly uninter-
ested people die of disease or are killed in them, wars
would not be taken so seriously. It is of course true that
rapacity for territory, commercial rivalry, and all other
expressions of that avarice which is as instinctive to the
human species as the sexual and intestinal functions, have
always been present as the underlying causes of war. But
it is doubtful whether these more or less realistic reasons
would fulminate to the actual point of explosion as often
as they do if mankind did not, in spite of repeated demon-
stration, obstinately harbor a totally erroneous conception
of what actually constitutes a war in terms of experience.
It is not, of course, the propaganda of glory, the dulce est
pro patrta mori y and so forth, that influence men so
deeply. These and similar “residues” (we hope we
are correct in our Pareto *) are only moderately effective
rationalizations of more fundamental impulses. Much
more deeply significant are the boredom with the un-

1 See An Introduction to Pareto, by Romans and Curtis, or write
a letter to Professor Lawrence J. Henderson.


utterably dull peace-time occupations of most people,
and the childish but universal delight men take in playing
soldiers. Until they actually suffered from dirt, lousiness,
fatigue, terror, disease, or wounds, most men enjoyed the
last war. Think of the man who has lived meagrely in a
frame house on the outskirts of Somerville or Weehawken,
and for ten years except for two weeks in August
has regularly caught the eight-fifteen, spent the rest of
the day floorwalking, and then caught the six-twenty
back to what he came from in the morning! Think of his
feelings of release and self-satisfaction when he is march-
ing up Broadway behind the band, between files of cheer-
ing garment workers. Think of his pride in a renewed
manhood, standing guard at dawn or lying behind a pile
of sandbags pot-shooting his fellow man, or drinking beer
with his comrades knowing that the world approves
him as a hero, and that his family has the government to
look out for it forever and ever!

But beyond the release from boredom there is the joy
in uniforms which stimulates war. The instinct for fancy
dress is hard to kill, as anybody knows who has been in a
town where the Mystic Knights or the Shriners or the Red
Indians were holding a convention} or even in Boston,
when the Ancient and Honorables are blocking traffic
on Beacon Hill. And, further, there is the applause of
the women, not women in general, but each man’s
own women, who, as instinctively as the men like to
play soldiers, have the hereditary longing to glorify
the brave brutalities that their heroes write home about:
“I threw a hand grenade into a dugout, and blew up


six Germans. I ‘m going to be kissed by the general.”
“Isn’t he wonderful? Just a big, brave boy!” One can
hear the devil’s grandmother, adoringly watching him
turn a squealing sinner on the spit, saying: “Oh, Beelzebub
you ‘re nothing but a great big boy! ”

We might expostulate on the minor causes of war in
a more convincingly thorough manner if we were writing
a tract for a peace foundation instead of the biography
of a disease. But since we are primarily interested in the
subject of typhus fever, we cannot give too much space to
these matters. The point is that war is visualized even
by the military expert as a sort of serious way of play-
ing soldiers. In point of fact, the tricks of marching and
of shooting and the game called strategy constitute only
a part the minor, although picturesquely appealing
part of the tragedy of war. They are only the terminal
operations engaged in by those remnants of the armies
which have survived the camp epidemics. These have often
determined victory or defeat before the generals know
where they are going to place the headquarters’ mess.

To the average professional officer, the military doctor
is an unwillingly tolerated noncombatant who takes sick
call, gives cathartic pills, makes transportation trouble,
complicates tactical plans, and causes the water to smell
bad. Of course, he is useful after an action, to remove the
debris, but otherwise he is almost, if not quite, a positive
nuisance. There was a tempest of respiratory diseases and
the threat of enteric fever in the Second American Army
at the end of the war. The inspector general, Colonel O.,
neither knew nor cared about that. He reprimanded a


weary chief sanitary inspector for saluting him with one
hand in his pocket. We pitied this poor gentleman when
we thought of all the buttons that were off and the puttees
wrongly adjusted among a hundred thousand men. How
he suffered and toiled! The same sanitary officer was
trying to locate water points for the advancing troops
in September 1918. “You don’t exist for me,” said Colonel
H. of the Engineers. “You are not in the Tables of Or-
ganization.” Occasionally there is a great soldier who
knows, like General Bullard. He stands out by contrast.
However, this may seem like spleen. But not at all; it
leads up to our theme that soldiers have rarely won wars.
They more often mop up after the barrage of epidemics.
And typhus, with its brothers and sisters, plague, chol-
era, typhoid, dysentery, has decided more campaigns
than Caesar, Hannibal, Napoleon, and all the inspector
generals of history. The epidemics get the blame for de-
feat, the generals the credit for victory. It ought to be
the other way round perhaps some day the organization
of armies will be changed, and the line officer will do what
the surgeon-general lets him do. Among other things,
this plan would remove about 90 per cent of the expenses
of the pension system.

Before we go on to the special military exploits of
typhus, it may be interesting to discuss the decisive in-
fluence of disease upon battle in a more general manner,
and so justify our contentions with a few facts.

The difficulty is not to find evidence, but to select from
the dreadful abundance. Von Linstow, a military surgeon
of the Prussian army, who thought along similar lines,


has culled the literature for some of the most enlighten-
ing examples in common historical records. We cite freely
from his studies, and from the writings of historians and
military surgeons who have accompanied great armies
in campaigns.

Herodotus, in the Eighth Book of his History, tells us
about the saving of Greece by Xoi/i6s (possibly plague
and dysentery), when Xerxes entered Thessalia with an
army estimated at about 800,000 men. Soon after Greek
territory was entered, supplies began to fail, and disease
stepped upon the heels of undernourishment and hard-
ship. The campaign was abandoned, and the Persian king
swept back into Asia with less than half a million fol-

It was the plague of Athens which laid low for a time
the power of Athens on land. In the second year of the
disease, 300 knights, 45,000 citizens, and 10,000 free-
men and slaves died. Pericles himself succumbed, and
the Lacedaemonians were left free to roam over the pen-

That the sieges of Syracuse by the Carthaginians in 414
and 396 B.C. were relieved by a disease probably iden-
tical with that of Athens is likely. There is no telling
what might have been the outcome of the Punic Wars
and of the future power of Rome if Hannibal had found
his fleet and armies firmly established in Sicily.

In the civil struggles of Rome, in 88 B.C., the victory of
Marius was decided by an epidemic which killed 17,000
men in the army of Octavius.

In 425 A.D., the Huns gave up their otherwise unim-


peded advance upon Constantinople because a plague of
unknown nature decimated their hordes.

What might have been the future of the power of the
Saracen Empire if the King of Abyssinia had not been
turned back from Mecca .by the “sacred fire,” no one
can tell. This was what is commonly spoken of as the
“Elephant War.” The Abyssinian army of 60,000 men was
completely disorganized by the ravages of a disease which,
in description, sounds either like a severe form of small-
pox or like a combination of erysipelas and general
staphylococcus infection.

That the Crusades were turned back by epidemics much
more effectively than they were by the armed power of
the Saracens can hardly be questioned. The history of
the Crusades reads like the chronicle of a series of dis-
eases, with scurvy as potent as infections. In 1098,. a
Christian army of 300,000 men besieged Antioch. Dis-
ease and famine killed so many and in such a short time
that the dead could not be buried. The cavalry were
rendered useless within a few months by the death of
5000 of their 7000 horses. Nevertheless, the city was
captured, after a nine months’ siege. On the march to
Jerusalem, the hosts were accompanied by an enemy
more potent than the heathen. When Jerusalem was
taken, in 1099, only 60,000 of the original 300,000 were
left, and these, by 1101, had melted to 20,000.

The story of the second Crusade, led by Louis VII of
France, is sadly similar. Of half a million men, only a
handful most of them without horses managed to
get back to Antioch, and few returned to Europe.


Antioch seems to have been the spot where all the
Christian armies were ambushed by pestilence. Error in
the road taken beybnd this city, through the treachery of
a Turkish guide, led the crusading army of 1 190 into the
desert. Famine, plague, and desertions reduced an army
of 100,000 to a mere 5000.

The fourth Crusade, under the Doge of Venice and
Baldwin of Flanders, never reached Jerusalem because
of a dreadful outbreak of bubonic plague which started
during the hottest part of the summer, soon after the
Crusaders left Constantinople.

When Frederick II of Germany took ship at Brindisi
in 1227, dysentery came aboard with his army; the fleet
turned back when the Emperor himself was taken sick,
and the expedition was a flat failure.

Scurvy is not an infectious disease and has no proper
place, therefore, among the relatives of typhus fever,
whose influence on history we are discussing. However,
it was an almost constant menace to armies whenever the
food supply ran low or became restricted. Under such
circumstances, which were common in besieged cities and
during long marches through devastated territories, scurvy
not infrequently became decisive in itself or so weakened
large bodies of men that subsequent infectious disease
found them without normal powers to resist. In this way
it was often a powerful ally of our disease. We have no
intention of further digressing from our main theme into
the interesting military history of scurvy, but cite a single
episode only, to illustrate the formidable influence of
scurvy in determining the outcome of campaigns.


Until the first Friday in Lent of 1250, the crusading
army of Saint Louis was reasonably holding its own
against the Saracens. Shortly after this, Joinville tells
us, “the host began to suffer very grievously.” He at-
tributes the nature of the illness to the stench of dead
bodies and to the eels from the river that “ate the dead
people, for they are a gluttonous fish.” The disease was,
without question, scurvy: “There came upon us the sick-
ness of the host, which sickness was such that the flesh of
our legs dried up, and the skin upon our legs became
spottedj black and earth colour like an old boot; and
with us who had this sickness, the flesh of our gums pu-
trefied; nor could anyone escape from this sickness but
he had to die. The sign of death was this, that when there
was bleeding of the nose, then death was sure.” The
Turks at about this time managed to blockade the river
against the supply ships, fresh food became still more
scarce, and many of the leaders fell sick. “The sickness
began to increase in the host in such sort, and the dead
flesh to grow upon the gums of our people, that the
barber surgeons had to remove the dead flesh in order
that the people might masticate their food and swallow
it. Great pity it was to hear the cry throughout the camp
of the people whose dead flesh was being cut away; for
they cried like women labouring of child.” The disease
made prompt retreat imperative, and the King decided
upon a desperate effort to break through the Saracen
blockade. Failure, defeat, and the capture of the King
with all his knights followed.

On the second attempt, Louis got no farther than


Tunis, where he and his son, the Due de Nevers, died of

dysentery on August 3 and August 25, 1270.

A curious disease that cannot be precisely classified
destroyed the army of Frederick Barbarossa in Rome in
1157. It is described by Kerner and also by Lersch. It
might have been typhus, for it began with severe head-
aches, pain in the limbs and abdomen, heat, chills, and
delirium. Many died within a few days. The mortality
was so high and the terror so great that on August 6
of 1167, four days after the plague began, the army
burned their tents and started northward. Rome was
abandoned, and the greater part of the host perished on
its march.

The centuries of struggles between Spain and France
were again and again decided by disease. Philip III of
France was turned back from his campaign into Aragon
in 1285 by a plague of uncertain nature that killed large
numbers of the soldiers, most of the officers, and, eventu-
ally, the King himself. In the subsequent military history
of Spain, typhus itself played a devastating role, to which
we shall have occasion to return in a later chapter.

In 1439, on October 1, the German Emperor, Al-
brecht, reached the walls of Bagdad. By the thirteenth
of the same month, the Emperor was dead and the army
in retreat, defeated by dysentery.

The role played by the sweating sickness in England
during the reign of Henry II we have elsewhere de-
scribed. We have also discussed the influences ^vhich the
epidemic of syphilis had upon the campaign of Charles
VIII of France against Naples} and in another place


we shall speak of the typhus epidemic which, in 1528,
decided whether France or Spain was to dominate the
European Continent.

In the sixteenth century, the story is the same in prin-
ciple, and though typhus and plague now begin to be cast
for the leading roles, dysentery, typhoid, and smallpox no
doubt contributed their share. The siege of Metz by
Charles V was raised by scurvy, dysentery, and typhus, and
the army retreated from the city after 30,000 men had died.

One of the earliest really decisive typhus epidemics
was that which dispersed the army of Maximilian II of
Germany, who was preparing with 80,000 men to face
the Sultan Soliman in Hungary. In the camp at Komorn,
in 1566, a disease broke out which was undoubtedly
typhus. It was so violent and deadly that the campaign
against the Turks was given up. The significance of this
episode for the permanent establishment of the disease in
Southeastern Europe is discussed in another chapter.

The Thirty Years’ War was in all its phases dominated
by deadly epidemics. To follow them in detail would be
to write the history of this war over again, for the pesti-
lences roamed the Continent in the trains of the armed
forces. There is one episode, however, which deserves
particular mention, because typhus, single-handed, de-
feated both armies before they could join battle. In 1632,
Gustavus Adolphus and Wallenstein faced each other be-
fore Nuremberg, which was the goal of both armies.
Typhus and scurvy killed 18,000 soldiers, whereupon both
the opposing forces marched away in the hope of escaping
the further ravages of the pestilence.


It is not impossible that the fate of Charles I was
sealed by typhus fever. In 1643, Charles was opposed
at Oxford by the Parliamentary army under Essex, each
general commanding about 20,000 men. The King was
forced to give up his plan of advancing upon London
by an epidemic of typhus fever which ravaged both

In 1708, the Swedes, having their own way in Southern
Russia, completely lost the fruits of their hard-fought
battles and were rendered helpless by an outbreak of

In November of 1741, Prague was surrendered to
the French army because 30,000 of the opposing Aus-
trians died of typhus.

Frederick the Great, victorious over the troops of
Maria Theresa, was forced out of Bohemia when violent
dysentery attacked his troops.

The outcome of the French Revolution was to some
extent decided by dysentery. In 1792, Frederick Wil-
liam II of Prussia, with Austrian allies, a total strength
of 42,000 men, was marching against the armies of the
Revolution. Dysentery, the Red, decided in favour of
Liberte, galite> and Fratermte, and with only 30,000
effectives remaining, the Prussians retreated across the

The establishment of the Haitian Republic, though
usually attributed to the genius of Toussaint POuverture,
was actually brought about by yellow fever. In 1801,
Napoleon sent General Leclerc with 25,000 men to
Haiti to put down the revolt of the Negroes. The French


troops landed at Cap Frangais, defeated Toussaint, and
drove him into the interior. The Negro army was rallied
and reorganized by Dessalines, but could not have suc-
cessfully opposed the well-disciplined and well-equipped
French troops had not an epidemic of yellow fever dis-
organized the invader. Of 25,000 Frenchmen, 22,000
died. There were only 3000 left to evacuate the island
in 1803.

Even the greatest general of them all, Napoleon, was
helpless when pitted against the tactics of epidemic dis-
ease. We have accounts of the Russian campaign from
Larrey. But records of more specific value for our sub-
ject are those of the Chevalier J. R. L. de Kerckhove (dit
de Kirckhoff), a corps surgeon of the army of invasion,
who on the title-page of his book signs himself
“Membre de la flupart des Academies savant es de
I’Europe.” The army of upward of half a million men
was mobilized in cantonments which extended from
Northern Germany to Italy. Until the main bodies were
assembled, there was little sickness, and the hospitals es-
tablished at Magdeburg, Erfurt, Posen, and Berlin had
few patients. Kerckhove describes the miserable conditions
encountered after the entry into Poland. He was shocked
by the poverty, wretchedness, and slavishness of the
people, and the contrast of the conditions here found
with those prevailing in other European countries. The
villages consisted of insect-infected hovels } the army was
forced to bivouac. Nutrition was bad; the days hot and
the nights cold. New hospitals were now established at
Danzig, Konigsberg, and Thorn, because of the rapidly


increasing sick rates, at this time largely due to respiratory
infections, including pneumonia and throat anginas
probably diphtheria. Typhus cases began to appear in
small numbers at about the time that the Niemen was
crossed, on June 24. In Lithuania, huge forests and
wretched roads were encountered; towns and villages
had been burned by the Russians; there was little shel-
ter, and less food. The water was bad, the heat intense,
and the disease rate now largely dysentery, enteric
fevers, and typhus became formidable. After the battle
of Ostrowo, in late July, there were over 80,000 sick.
The army corps to which Kerckhove was attached was
reduced to less than half of its original 42,000 men by
the time the River Moskva was reached in early Sep-
tember. An enormous number of wounded over 30,000
resulting from the battle, fought near the river, fur-
ther rendered the task of the medical officers an almost
impossible one. By September 12, typhus and dysentery
were becoming more and more intense. Moscow was en-
tered on September 14. It was at this time a city of 300,000
people, but most of the population had fled before the
French army entered. On the fifteenth, fires were started,
first at the Bourse, then all over the city set, presum-
ably, under orders of Governor Rostoptchin, by liberated
criminals who had been furnished with sulphur torches.
Moscow contained a number of well-equipped hospitals,
but these were soon filled with the sick and wounded,
and since so large a part of the city was either in ashes
or destroyed by bombardments, the thoroughly infected
troops were crowded in unsatisfactory shelters and camped


outside the city. Stores of food had been almost com-
pletely destroyed by the Russians.

From now on typhus and dysentery were Napoleon’s
chief opponents. When the retreat from Moscow was
begun, on October 19, there were not more than 80,000
men fit for duty. The homeward march became a rout,
and the exhausted and sick troops were constantly harassed
by the pursuing enemy. The weather grew intensely
cold, and a large number exhausted by sickness and
fatigue were frozen. In early November, when Smo-
lensk was reoccupied, only 2000 of the cavalry were left,
and there were about 20,000 patients in the hospitals
of the city. Many typhus patients were left behind in
Smolensk, which was evacuated on November 13. The
disastrous crossing of the Beresina, in which Larrey was
saved only by the grateful affection of soldiers who passed
him over their heads across the bridge, cost the army an
enormous number not precisely recorded, but esti-
mated at 40,000 men. While typhus remained the pre-
dominant disease, dysentery and pneumonia were also
increasing. Fifteen thousand men are said to have been
frozen on the way to Vilna, and when this city was
reached, on December 8, the magnificent army had
shrunken to 20,000 sick and disheartened men. Of the
Third Army Corps commanded by Marshal Ney, only
twenty men remained. In Vilna the hospitals were
crowded, the men lay on rotten straw in their own refuse,
hungry and cold, without care. They were driven to eat
leather and even human flesh. The diseases, especially
typhus, spread through all the cities and villages of the


surrounding country. At one time, in December, the sick
that had been evacuated to Vilna had accumulated to the
number of 25,000. By the end of June, 1813, only 3000
of these remained alive. The vestiges of the army which
escaped from Russia were almost without exception in-
fected with typhus.

It is suggested by de Kerckhove, whose book testifies
to a lively interest in the strategy of his great chief, that
if Napoleon had been content to occupy Poland and at-
tend to reorganization, including sanitary control, his
campaign might have been a success and his power per-
manently established.

It is perhaps the greatest testimony to the genius of
Napoleon that, after this disastrous failure, he was again
in 1813 able to raise a new army of 500,000 men.
These were mostly, for lack of available adult man power,
young recruits, particularly suitable fuel for epidemic
disease. By the time his new army faced the allies at Leip-
zig, preliminary battles at Bautzen, Dresden, and Karls-
bad, together with disease, had reduced his forces to little
more than 170,000 men with which to face 200,000 al-
lies. 2 It is hardly debatable that the power of Napoleon
in Europe was broken by disease more effectively than
by military opposition or even by Trafalgar.

As far as the Crimean War is concerned, it is not pos-
sible to deduce the results of the struggle from disease,
since the opposing armies suffered almost equally and
disastrously from cholera, typhus, dysentery, and the
lesser epidemic afflictions of armies. Nevertheless, this

2 Von Linstow states that 105,000 were lost for service by battle
casualty; 219,000 by disease.


war is of unusual interest for our theme, because there
are available unusually accurate records which demon-
strate how much more destructive than the clash of armed
conflict is the power of disease. We have reliable accounts
of the army epidemics of this war from Jacquot’s Du
Typhus de VArmee d y Orient, and Armand’s Histoire
Medico-Chirugical de la Guerre de la Crime e. There were
two separate typhus outbreaks one which started in
December 1854, the other in December of the follow-
ing year. The disease began among the Russians, then
attacked the British and the French, penetrated into Con-
stantinople, there spread to the fleets and the merchant
ships, and was distributed in all directions throughout
Russia and Turkey. In 1855, after the battle of Alma, a
severe cholera epidemic began which lasted through to
April 1856. At the time of the greatest violence of the
various diseases, 48,000 men were removed from the
ranks by sickness within four months or at the rate
of 12,000 a month. According to Armand, the French
sent something over 309,000 men east. Of these, 200,000
were hospitalized 50,000 by wounds and 150,000 by
disease. The following table, which we take from Von
Linstow, summarizes the conditions which prevailed from
1854 to 1856.

Died of

Died of




















8 Including

men lost in

battle, and

so forth.


On the louse: we are now ready to consider the environ-
ment which has helped to form the character of our subject

THE formula for writing biographies of individual men
and women has, as we have seen, been thoroughly worked
out. Apart from the recent introduction of psychoana-
lytical methods and a little libido, it has remained more
or less the same since Plutarch. In writing the biography
of a protoplasmic continuity like typhus, it becomes neces-
sary to develop a new formula. While, on the one hand,
we can avoid many of the keyhole indiscretions of the
Strachey, Ludwig, Maurois school, we are in this in-
stance forced to give considerable space and attention
to other unpleasant subjects more likely to repel than to
attract. For typhus spends prolonged and, for its sur-
vival, essential phases of its existence within the bodies
of lice, fleas, and rats. There may be other hosts not yet
determined. But of these we knowj and we must, there-
fore, follow our virus through these phases and endeavor
to get the point of view of the fellow creatures that,
though regarded with loathing by the superficial, are
sufferers even as we are, and quite as innocent of inten-
tional malice. For though we acquire the disease from
them, they get it from each other and from us. So there


would seem to be as much to be said on one side as on
the other.

Obviously it is much more difficult to present the
louse’s point of view in its relationship to man than to
elucidate the influence exerted, let us say, upon Chopin by
George Sand, or upon Mark Twain by the respectable re-
lations of Elmira, New York. We cannot, therefore, dis-
miss the matter with a brief scientific description of the
sojourn of typhus in the louse. To achieve our purpose,
though it may again delay the actual consideration of
typhus itself for another chapter, we must endeavor to pre-
sent the case of the louse in the humane spirit which a long
intimacy has engendered in us. For one cannot carry pill
boxes full of these little creatures under one’s sock for
weeks at a time without developing what we may call,
without exaggeration, an affectionate sympathy} especially
if one has taken advantage of them for scientific purposes
and finds each morning a corpse or two, with others obvi-
ously suffering crawling languidly, without appetite,
and hardly able to right themselves when placed on their

We advise the reader who is impatient to press through
to typhus fever to skip this chapter, therefore, since it
will occupy itself mainly with the louse. But to those
who are inclined to criticize us for being excessively dis-
cursive, we may state that we are following the distin-
guished model of Pierre Beyle, whose footnotes are four
times as extensive as his text.

The louse is foremost among the many important and
dignified things that are made the subjects of raucous hu-


mour by the ribald. Despite the immense influence of this
not unattractive insect upon the history of mankind, it is
given, in the Encyclopedia Entanmca^ two thirds of a
column half as much as is devoted to “Louth, a mari-
time county in the province of Leinster,” one fifth as much
as is allowed for Louisville, Kentucky. This creature,
which has carried the pestilence that has devastated cities,
driven populations into exile, turned conquering armies
into panic-stricken rabbles, is briefly dismissed as “a wing-
less insect, parasitic upon birds and mammals, and belong-
ing, strictly speaking, to the order of Anoplura.”

The louse shares with us the misfortune of being prey
to the typhus virus. If lice can dread, the nightmare of
their lives is the fear of some day inhabiting an infected
rat or human being. For the host may survive; but the
ill-starred louse that sticks his haustellum through an in-
fected skin, and imbibes the loathsome virus with his
nourishment, is doomed beyond succour. In eight days he
sickens, in ten days he is in extremis, on the eleventh or
twelfth his tiny body turns red with blood extravasated
from his bowel, and he gives up his little ghost. Man is
too prone to look upon all nature through egocentric eyes.
To the louse, we are the dreaded emissaries of death. He
leads a relatively harmless life the result of centuries
of adaptations} then, out of the blue, an epidemic occurs;
his host sickens, and the only world he has ever known
becomes pestilential and deadly; and if, as a result of
circumstances not under his control, his stricken body is
transferred to another host whom he, in turn, infects,
he does so without guile, from the uncontrollable need


for nourishment, with death already in his own entrails.
If only for his fellowship with us in suffering, he should
command a degree of sympathetic consideration.

The louse was not always the dependent, parasitic
creature that cannot live away from its host. There were
once free and liberty-loving lice, who could look other
insects in their multifaceted eyes and bid them smile when
they called them “louse.” But this was even longer ago
than the Declaration of Independence, for it took the louse
many centuries to yield up its individualism.

It was so long ago that we have no records of any neo-
lithic or even Neanderthal louse from which we can trace
a clear line of descent. Indeed the ancestral problem has
remained an extraordinarily difficult one. Many erudite
students pre-eminently Enderlein have been inclined
to derive the Siphunculata or sucking lice from the Rhyn-
cota or true bugs, largely on the basis of similarities of
the mouth parts. But this idea is rejected as truly prepos-
terous by Professor Handlirsch * and his followers, who

1 Handlirsch (Die Fossilen Insekten) says:

“Was die zuerst genannte Gruff e (Sifhunculata) anbelangt y so
wurde sie ihrer^ saugenden Mundteile wegen von vielen Autoren den
H emifteroiden angegeliedert^ tuobei aber nicht berucksichtigt wurde^
dass diese saugenden Mundteile absolut nicht von jenen der Schna-
belkerje abstammen konnen^ weil sie in manchen Punkten noch ur-
sfriinglicher sind, so zum Beisfiel in den nicht zu einer Russelscheide
verwachsenen, manchmal noch ]rei erhaltenen Tastern des dritten
Kiej erf acres usw. Alle diese Tatsachen wurden von mir in einer gegen
Enderlein gerichteten Schrijt (Zool. Anz. 1905, 664) wohl hin-
langlich erortert^ und ich kann mich hier damit begnugen, noch ein-
mal hervorzuheben, dass sich die Sifhunculatenmundteile nur von einem
kauenden Tyfus ableiten lassen und sich ganz eng an jene der Mallo-
fhagen anschliessen. Nachdem nun auch in Bezug auf die ubrige


trace the descent of our lice from the fur- and feather-
eating Mallophaga (bird lice) for reasons unquestionably
well founded upon considerations far too intricately tech-
nical for superficial discussion. We could not do justice to
a subject so fundamental without extensive citation from
the works of specialists. We desire merely to indicate that
this problem of ancestry has led to dissension among louse
scholars, on occasion not entirely without passion, though,
unlike the question of the descent of man, it has not in-
volved religious feelings.

The opinion of the learned Professor Handlirsch ap-
pears to be the one most generally favoured among louse
scholars. Modern lice consist of two closely related va-
rieties: the biting lice, or Mallophaga; and the sucking
lice, or Anoplura. These orders are parasitic developments,
probably, of the ancient group of pre-cockroaches, from
which are also derived our present cockroaches and ter-
mites. The pre-cockroaches, or Protoblattoidea, are fossil
forms of the upper Carboniferous period, and too far

Morfhologie cine weitgehende tjbereinstimmung zwischen blutsau-
gcnden und felzjressenden Lausen besteht, liegt es allzu nahe, erstere
von letzteren abzuleiten, beziehungsweise durch V ermittelung der Cor-
rodentien (P sodden) von der Blattoidenreihe. Diese Anschauung ent-
hebt uns der gewiss misslichen Notigung, zu einem so unnatiirlichen
und unlogischen Auskunjtsmittel zu greijtn, wie es cine Ableitung der
Pediculiden von der Wurzel des H emitter old enstammes w’dre y denn
toir mussten in diesem Falle bis in das Palaeozoikum hinabsteigen> wo
es bekanntlich noch keine Saugetiere gab, auj denen ausschliesslich die
Pediculiden leben konnen. Fur die Ableitung der Pediculiden von
Mallofhagen ist ubrigens in neuerer 2, tit, gleichzeitig aber ganz un-
abhangig ouch N. Cholodkowsky auf Grund der Embryonalentwicke-
lung dingetreten. Hoffentlich gelingt es unseren vereinten Bemuhungen
dock endlich ouch Enderlein von seiner Ansicht uber die en gen Be-
ziehungen zwischen Pediculiden und Hemifteroiden abzubringen”


removed to concern us. Our own companions, the blood-
sucking ones, are probably derived from the fur-scaveng-
ing insects, through the Psocidse or Corrodentia small
winged or wingless creatures, the best known representa-
tives of which are our common book lice. The latter group
are not the direct ancestors of the louse, but spring with
them from a common stem. The conditions are analogous
to the relationship of the higher apes and man a kin-
ship that is too often misunderstood as a direct descent or
ascent (however one looks at it), like the rungs of a lad-
der, rather than, more properly, like twigs of the same

Ancestral origin from the same stock may be both up-
ward and downward. In the case of the louse, we know
relatively little about the matter, since we must judge
from anatomical data alone} and the evolution of purely
parasitic from free-living forms would seem to be a down-
ward rather than an upward development. In the case of
man, the relationship with the monkeys is surely much
closer than that of the lice with the Psocidae. The anatom-
ical and blood-chemical similarities are exceedingly close
ones and being the arbiters of appraisal we assume
that we are the higher forms, since we include mental and
spiritual qualifications, without really knowing much of
these attributes among the apes. A distinguished biologist
has recently claimed, on the basis of anatomical and phys-
iological studies, that there is a much closer similarity
between man and the young, rapidly developing anthro-
poid than there is between man and the adult ape. Ac-
cording to this, we may be looked upon as arrested or


> maladjusted apes; while the apes, passing through this
stage, go on to adultness, where they cease to struggle
for the things they canrtot achieve and arrive at reason-
able contentment. This is in keeping with Goethe’s view
that man is a permanent adolescent

However this may be, it is likely from evidence that,
somewhere in the legendary past of louse history, an off-
spring of a free-living form not unlike our book louse
found that life could be infinitely simplified if, instead of
having to grub for food in straw, under tree bark, in moss
or lichen, in decaying cereals and vegetables, it could
attach itself to some food-supplying host, and sit tight.
It is one of the few instances in which nature seems ex-
tremely logical in its processes. The louse sacrifices a
liberty that signifies chiefly the necessity for hard work,

, the uncertainty of food and shelter, and exposure to
dangers from birds, lizards, and frogs j loses the fun of
having wings, perhaps ; but achieves, instead, a secure
and effortless existence on a living island of plenty. In a
manner, therefore, by adapting itself to parasitism, the
louse has attained the ideal of bourgeois civilization,
though its methods are more direct than those of business!
or banking, and its source of nourishment is not its own}

Thus, at any rate, arose the parasitic lice, first, per-
haps, the biting ones, the Mallophaga, and there
developed, showing the infinite elasticity of nature:

The chicken louse
Trinoton, the goose louse
The slender duck louse


The pigeon louse

The turkey louse

The biting guinea-pig louse

Trichodectes the horse louse

to mention only a few. Out of these, or parallel with them,
came the animalcules with which we are chiefly con-
cerned. Not content with a diet of feathers, fur, and
dandruff, these varieties cast off by a kind Providence/
upon thin-skinned, warm-blooded animals discovered]
by an incomprehensible cleverness (or perhaps by an ac->
cidental scratch and an occurrence not unlike the dis-
covery of roast pig by the Chinese) that under their
feet ran an infinite supply of rich red food. They de-
veloped boring and sucking structures, and thus arose:

The hog louse

The dog louse

Polyplax, the rat louse

The foot louse of the sheep

The cat louse

The short-nosed ox louse

The monkey louse

Our own fediculi the head

louse and the body louse

of man

It is with the last two that we are chiefly concerned,
and they are so closely related that, even now, by an oc-
casional mesalliance resulting from the meetings of young
people about the neck band, a body louse may go native
and interbreed with a head louse. The crab louse we may


neglect. He is probably of distinct generic origin and a
creature that merits neither respect nor sympathy} not
even terror.

Although the human head louse first came into the
hair of primitive savages from fur-bearing animals, even
in this respect the give-and-take does not appear to have
been entirely one-sided. Ewing suggests that the At-
eles monkeys may have received their lice from natives j
and the similarity between the various monkey lice and
those of man is so close that they can interchangeably
feed on one or the other host without harm. We have
ourselves fed two hundred Arabian head lice on an East
Indian monkey for weeks at a time, with relatively low
mortality. Such interchange of hosts is not usually pos-
sible. A louse fed on a foreign host, in most cases, suffers
a probably painful and fatal indigestion.

Ewing further suggests that the spider monkeys ob-
tained their lice from man when the latter reached tropical
America in his dispersion from the Old World. The fur
of the Ateles monkeys is very similar in coarseness and
abundance to that of the head of man, and the blood of
this monkey is physiologically more nearly like that of
man than that of some other monkeys of the New World.
These reflections of Ewing are of great importance in
connection with our biography, since the question often
arises whether typhus was present in America before the
conquest of Mexico. If, as Ewing states, the phylogeny
of the Ateles-infesting lice has followed that of their
hosts, it is likely that the lice have been in America for a
long geological period. The genus Ateles or spider


monkey we quote Elliott from Ewing has a wide
area of distribution, extending from South-Central Brazil
as far north as the state of Vera Cruz in Mexico, and from
the Pacific coast of Ecuador to the Atlantic coast of Brazil.
There are two distinct American groups of fediculi, ac-
cording to our authority one of them confined to man,
and one to monkeys. “The foremost infesting man are
largely hybrid head lice, the pure strains of which were
originally found on white, black, red, and yellow races
living in their original geographical ranges. The monkey-
infesting lice of America, so far as known, fall into distinct
species according to the hosts they infest, thus indicat-
ing to a certain degree at least a parallel phylogeny for
host and parasite. If the monkey hosts procured their lice
from man, it was not from recent man, but from man that
lived tens of thousands of years ago long enough to
allow species differentiation.”

Once established on the head of a savage, the louse
passed from race to race, acquiring slight changes of
form and feature in the process, so that to-day it would
seem that we can deduce some information as to human
racial relationship from the characteristics of the lice found
in different parts of the world. The Pediculus humanus
nigritarum y or head louse of the African Negro, is slightly
different from the head louse found on European and
modern American heads. The latter appear to be hybrids,
with a strong strain of the nigritarum. The Pediculus
humanus americanus, found on the prehistoric scalps of
American Indian mummies, is again different, and this
ancient parasite has been taken from the scalps of living


Indians, together with the European head louse one
among the many acquisitions of civilization.

Our eminent authority, Ewing, studying large series
of lice from living Americans, has observed that there
was no correlation between louse types and racial types
of the human hosts. It appears that America, the melting
pot of human races, has also become the melting pot of
lice. Ewing became convinced that he was dealing in the
American race largely with hybrids of different racial
types, and this conviction was strengthened by the rela-
tively recent discovery by Bacot that the head lice of
man would intermarry with the body lice and give fertile
progeny. This led Ewing realizing the futility of ob-
taining any information concerning original American
lice from the examination of the heads of our modern in-
telligentsia to search for these insects in the scalps
of American mummies. At first his search was in vain,
because, although he found nits plentiful upon the scalps
of pre-Columbian Peruvian mummies, he found no speci-
mens of mummified adults. Later, however, through
Dr. Lutz of the American Museum of Natural History,
he secured the scalps or hair samples from twenty pre-
historic American Indian mummies. Three of these had
not only nits, but lice in all stages of development. It
was found that the insects from Peruvian mummies were
slightly different from those taken in the Southwestern
United States, and that all the lice from prehistoric
mummy scalps showed differences from some of the lice
obtained from a living Indian. It is probable, according
to Ewing, that our living Indians have acquired the Cauca-


sian and the Ethiopian head louse, and now enjoy hybrids
between these two and the American types. It might be
mentioned, also, that the American mummy type is dis-
tinct from Fahrenholz’s Pediculus hwnanus marginatus>
or Japanese variety.

Shipley tells us that the louse adapts its color to that
of the host, so that we have the black louse of Africa, the
smoky louse of the Hindu, the yellowish-brown louse
of the Japanese, the dark brown one of the North Ameri-
can Indian, the pale brown one of the Eskimo, and the
dirty gray one of the European.

Again, though the evidence is vague, this prehistoric
American louse has been described as quite similar to the
Chinese head louse and to the lice found upon Aleutian
Eskimos another argument for the Volkerwanderung
across the Bering Straits.

From the several head varieties arose the body louse,
when naked man began to wear clothing. Primitive races
as a rule have no body lice. Advancing in civilized habits
with his host, the louse now began to attach its egg co-
coons or nits to the fibres of the clothing instead of to the
hairs of the body thereby gaining a degree of pro-
tection from direct attack and a greater motility.

In the development of the head louse into the body
louse, there are many very interesting changes of habit.
Free lice are not often found on the skin. The insects
remain in the underclothing in contact with the body, ex-
cept when feeding, and even at such times they may re-
main attached by the legs to fibres of the cloth. Soon
after conception, the mother louse begins to lay eggs, at


the rate of five or more a day, and this is kept up for about
thirty days. The eggs are then attached to the fibres of
the clothing by a sort of cement substance which forms
the nit. Hatching occurs at varying periods, according to
the temperature. At normal temperature of the human
body, hatching may occur in a week, but if repeatedly
exposed to cold or kept at a lower temperature, this proc-
ess may be delayed for over a month. In getting out of
its egg, the young nymph shows extraordinary enterprise.
First, it forces open the little lid, or operculum. This
gives it the first fascinating glimpse of freedom; but the
hole is too small to permit escape. With great ingenuity,
the little animal begins to swallow air from in front and
eject it from behind, gradually increasing the pressure
until eventually it pops out into the great world. It is
then a finished little louse, a perfect image of its parents;
but if not fed, it dies within a day or two. If properly
taken care of, it moults, and in from four days to a week
goes into what is spoken of as the second nymph stage,
and from that by a similar process into a third nymphal
stage, throughout this period enjoying all the privileges
of louse existence except the sexual one. It does not be-f
come a sexually mature louse until two or three weeks I
after emerging from the egg. But then . . . Oh, boy! j


More about the louse: the need for this chapter will be
apparent to those who have entered into the spirit of this


ALTHOUGH we are aware of the desirability of making
progress toward our true objective, the discussion of
typhus fever, we may be forgiven if being on the
subject of lice we devote a few additional pages to
these much misunderstood insects. In the study of animal
evolution, there seems to have been an almost complete
neglect of social forces which, if we study Fabre, Maeter-
linck, Wheeler, and others less eminent, appear to play
extraordinary roles in the organization of insect life
particularly. The admirably efficient feudal matriarchy
of the beehive seems quite superior to any comparable
achievement in general contentment developed by man.
And the communistic organization of the termites, as
described by Professor Wheeler, appears to represent the
ultimate perfection of modern Russian aspirations
more perfectly conceived than man seems capable of con-
ceiving them. Yet, in the so-called lower ranges of animal
life, we attribute to “instinct” or evolutionary forces the
results which men struggle toward with what they call
“intelligence.” It is at least reasonable to suppose that
alterations in human society and government are equally


subject to external forces, 1 though man’s greater restless-
ness brings them about with greater speed. In the preced-
ing chapter, we mentioned the possibility that the parasit-
ism developed by the louse was due to the impulse of a
bourgeois desire for easy living on the part of the in-
dividuals carried by chance to a location where food was
simply obtained and life was secure. It is equally possible
that there may have been, among these colonists on an
abundant soil, a growing conviction that all lice were
born equal, that liberty and equality and fraternity should
govern society, and that, in this way, the discouragement
of wings, of independence, of adventurousness, may have
led to a stabilization at the lowest level of louse capacities.
However this may be, the louse like man has, for
one reason or another, failed to develop the highly com-
plex civilization of the bee or the ant. Such development
has perhaps been unnecessary because of the infinite and
ever-renewed supply of abundant territories for explora-
tion. He lives, blissfully irresponsible, like the Poly-
nesians before the advent of Captain Cook, roaming on the
land of plenty, where nature provides warmth, shelter,
the odors he loves best, copses for love, and secure under-
growth to which his chosen mate can attach her nest. Under
his feet is an inexhaustible supply of the food he pre-
fers, and he has but to sink his hollow stylet into a tender
skin to procure his two or three daily meals, with much
less trouble than it takes the aborigines to knock a coco-
nut off a tree. In his unrestrained simplicity, he is much
like Rousseau’s noble savage, so abhorrent to Mr. Bab-

1 Professor L. J. Henderson’s Seminar on Pareto would undoubtedly
prove of invaluable assistance in expanding this idea.


bitt, leading a physically and emotionally unrestricted
life. 2 If, with Mr. Babbitt, we deplore this, we cannot
we regret to say look forward to any changes for the
better in the near future. With us, a spiritual deepening
is imminent, with the complete exploitation of our con-
tinent and the exhaustion of those easy pickings which, for
two hundred years, have allowed us to remain, like the
louse, undisciplined. 8 But the louse seems indefinitely
committed to the materialistic existence, as long as lousy
people exist. Each newborn child is a possible virgin con-
tinent, which will keep the louse a pioneer ever deaf
to the exhortations of his Van Wyck Brookses and Mum-
fords better to “evaluate his values.”

As far as we can ascertain, since man has existed the

2 In one important respect, this accusation of Rousseauism is not
entirely just to the louse. Though in his other appetites leading an
apparently effortless and licentious existence, his sexual arrangements
are uniquely wise. Nature has provided that the nymph that is,
what may be called the high-school or flapper age of the louse is
not yet possessed of sexual organs. These do not appear until the fully
adult form develops, and reproduction is thus postponed until a re-
sponsible age is reached. Adolescent Bohemianism, “living oneself out,”,
“self -expression,” and so forth, never get beyond the D. H. Lawrence
stage among the younger set. How much physical hardship and moral
confusion could be avoided if a similar arrangement among us could
postpone sexual maturity until stimulated by an internal secretion from
the fully established intellectual and moral convolutions of the brain!
The loss of copy this would entail for Theodore Dreiser, William
Faulkner, Ernest Hemingway, and others would be amply compensated
for by gains in other directions.

8 Had the Pacific Ocean extended to the west bank of the Missis-
sippi, we should probably have developed, by this time, what is so
ardently wished for by our younger critics a distinctive American
culture. With us, the latent seeds planted at Concord a hundred years
ago may be expected to burst into flower when the vitality of our race
is driven inward by the failure of external resources for material ex-


louse has been his inseparable companion. Unlike other
parasites, he never leaves his host, except as the conse-
quence of accident or disaster. When he is cast out, or
when his host perishes, he is doomed unless he can
promptly find another. This fact has led many religiously
inclined louse scholars to speculate upon the problem of
whether Adam and Eve were lousy. Cowan quotes a
writer in the Gentleman’s Magazine for 1746 as saying,
in’ regard to this fascinating question: “We can hardly
suppose that it [the louse] was quartered on Adam and
his lady the neatest pair (if we believe John Milton)
that ever joyned hands. And yet, as it disdained to graze
the fields or lick the dust for sustenance, where else could
it have had its subsistence?” The question can never be
settled. We do know, however, as we have elsewhere
noted, that lice are present on the most ancient mum-
mies from many parts of the world, and that these in-
sects were described by early travellers on all savage races
encountered by them. Cowan, in his Curious Facts in the
History of Insects^ quotes Wanley’s story of the eating of
lice by the Budini, a people of Scythia, and the same habit
still prevalent among monkeys is recorded of the
Hottentots and the American Indians. By some of these
peoples, as well as by the mediaeval English, the practice
was supposed to have medicinal value particularly
against the jaundice. In the same extraordinary book, we
find citations from Purchases Pilgrims concerning the
strange habits of the natives of Malabar, who, “if Lice
doe much annoy” them, call upon certain religious and
holy men who “will take upon them all those Lice which


the others can find and put them upon their [own?]
head, there to nourish them” an act of benevolent self-
sacrifice which alone should have served to canonize

Pertinent to the now highly probable assumption con-
cerning the prevalence of typhus among the Aztecs be-
fore the advent of Cortez is the tale cited from Torque-
mada. “During the abode of Montezuma among the
Spaniards, in the palace of his father, Alonzo de Ojeda
one day espied … a number of small bags, tied up. He
imagined at first that they were filled with gold dust,
but on opening one of them what was his astonishment
to find it quite full of Lice!” Ojeda spoke of this to
Cortez, who then asked Marina and Anguilar for an ex-
planation. He was told that the Mexicans had such a
sense of duty to pay tribute to their ruler that the poorest,
if they possessed nothing else to offer, daily cleaned their
bodies and saved the lice. And when they had enough to
fill a bag, they laid it at the feet of their king. Weizl in-
forms us that, when sojourning for a short time among
the natives of Northern Siberia, young women who vis-
ited his hut sportively threw lice at him. On inquiry con-
cerning this disconcerting procedure, he was embarrassed
by learning that this was the customary manner of indi-
cating love, and a notice of serious intentions. A sort of
“My louse is thy louse” ceremony.

It is not necessary, however, to confine ourselves to
the primitive or ancient races to illustrate the important
and intimate role played by lice in the social life of the
human race. Among the unfortunates of our own day,


these little creatures are still sufficiently prevalent in the
most civilized communities, although, in places as decadent
as Boston is said to be by Upton Sinclair, it is often dif-
ficult to find a needed supply of the insects, unless one
knows one’s way about. In our experience, on one occa-
sion when a supply of uninf ected lice was needed im-
mediately for feeding on a suspected case of typhus fever
it became necessary, by appeal to the scientific enthusi-
asm of a municipal police captain, to place under tempo-
rary arrest a coloured gentleman who was the only in-
dividual easily discovered who was in possession of the
coveted insects. It is needless to add that he was, of course,
immediately released after generously supplying us
from his ample store.

Yet, as everyone who has really been to war knows, let
the water supply fail, or soap become scarce, or a change
of clothing be delayed it takes no time at all before
the louse comes back to its own. It was not so long ago,
indeed, that its prevalence extended to the highest orders

j of society, and was accepted as an inevitable part of exist-

i ence like baptism, or the smallpox.

Lice have even been important in politics. Cowan tells
the story of the custom prevailing in Hurdenburg in
Sweden, where in the Middle Ages a mayor was elected in
the following manner. The persons eligible sat around a
table, with their heads bowed forward, allowing their
beards to rest on the table. A louse was then put in
the middle of the table. The one into whose beard the
louse first adventured was the mayor for the ensuing


The manner of living throughout the Middle Ages
made general lousiness inevitable. In England, in the
twelfth and thirteenth centuries, the houses of the poor
were mere hovels, often with only a hole in the roof to
let out the smoke of the central fire} and in cold weather
the families were huddled together at night without
changing the simple garments usually a single shift
which they wore in the daytime. Washing was practically
out of the question, and the better classes not very
much more comfortable in their badly heated domiciles
wore a great many clothes, which they rarely changed.
MacArthur’s story of Thomas a Becket’s funeral illustrates

The Archbishop was murdered in Canterbury Cathe-
dral on the evening of the twenty-ninth of December.
The body lay in the Cathedral all night, and was pre-
pared for burial on the following day. The Archbishop
was dressed in an extraordinary collection of clothes. He
had on a large brown mantle; under it, a white surplice;
below that, a lamb’s-wool coat; then another woollen
coat; and a third woollen coat below this; under this,
there was the black, cowled robe of the Benedictine Order;
under this, a shirt; and next to the body a curious hair-
cloth, covered with linen. As the body grew cold, the
vermin that were living in this multiple covering started
to crawl out, and, as Mac Arthur quotes the chronicler:
“The vermin boiled over like water in a simmering caul-
dron, and the onlookers burst into alternate weeping and

The habit of shaving the head and wearing a wig was


no doubt in part due to the effort to hold down vermin.
Gentlemen and ladies all over Europe resorted to this,
but the wigs they wore were often full of nits. Pepys
speaks of this in several places, complaining about a new
wig he had bought which was full of nits. “Thence to
Westminster to my barber’s j to have my Periwigg he
lately made me cleansed of its nits, which vexed me cruelly
that he should put such a thing into my hands.”

Even in the highest society, the questions of lice and
scratching were serious problems; and the education of
children, even in the highest circles, included a training
of the young in relation to their vermin. Reboux, speak-
ing of the education of a princess of France in the middle
of the seventeenth century, says: “One had carefully
taught the young princess .that it was bad manners to
scratch when one did it by habit and not by necessity, and
that it was improper to take lice or fleas or other vermin
by the neck to kill them in company, except in the most
intimate circles.”

He tells another story illustrative of the universal
lousiness even of the aristocracy. The young Comte de
Guiche had made himself unpopular with the King by
casting amorous eyes upon Madame, the King’s sister-in-
law. He sent the Comte’s father to announce banishment
to the son. The latter was not yet out of bed when his
father arrived. As the old Marshal stood in front of the
bed, a louse crawled out from under his perruque, began
to crawl along the deep furrows on the old man’s fore-
head, skirted the edges of the little thickets made by the
eyebrows, and crawled back under the hair of the wig.


The entire lecture was missed, while the Comte de
Guiche was watching the adventures of the insect.

Even long into the eighteenth century, lice were re-
garded as necessities. Bacteriologists for a generation have
wondered whether the presence of colon bacilli in the
intestines might not, because of their universal occurrence,
have some physiological purpose. For similar reasons, as
wise a man as Linnaeus suggested that children were pro-
tected by their lice from a number of diseases.

In the story of George Washington by Rupert Hughes,
we find the following paragraph on “Rules of Civility,”
copied by Washington in his fourteenth year: “Kill no
vermin, as Fleas, lice, tics, etc. in the sight of others, if
you See any filth or thick Spittle, put your foot Dexteri-
ously upon itj if it be upon the Cloths of your Compan-
ions, put it off privately, and if it be upon your own
Cloths, return thanks to him who puts it off.”

Since Colonial days, these things have changed. The
louse has been banished completely from fashionable so-
ciety, and even though among our middle classes
there may not be a. motor car in every garage, there is al-
most invariably a bathtub in every cottage and flat. And
more and more, the habit of keeping the coal in the bath-
tub is disappearing. The louse is confined, in consequence,
to the increasingly diminishing populations of civilized
countries who live in distress and great poverty. But
there are still many of these with us, and there are re-
gions of the earth where life is still primitive, where
bathtubs remain luxuries and bathing amounts to counter-
revolution. The louse will never be completely extermi-


nated, and there will always be occasions when it will
spread widely to large sections of even the most sanitated

And as long as it exists, the possibility of typhus epi-
demics remains.

Much about rats a little about mice

IT is now quite well established that the subject of our bi-
ography is, in some phases of its adventurous existence,
closely associated with rats. Since it is our purpose to write
a well-balanced account, undistorted by exaggerated em-
phasis or by omissions, it becomes necessary to give some
attention to these rodents, which play a role as important
in the history of mankind as the other hosts of typhus. In
dealing with rats, we must consider as well, though in a
minor way, their smaller brethren, the mice not only
because what rats can do, mice may also accomplish, but
because typhus virus can be kept comfortable and alive in
some mice, which means that they also become subjects for
further epidemiological study. A close relative of our own
typhus, the Tsutsugamushi fever of Japan, is actually
conveyed, from field mice to man, by the harvest mite. 1
In regard to the association of rats with typhus, the
known facts are still, in a degree, rudimentary. All that
we know definitely is that the virus of the typhus fever of
the New World has been found in the rat flea and in the
brains of rats trapped in an epidemic focus in Mexico
City. The disease, in the places mentioned, may be con-

^For the following classification of the rodents, we are indebted to
Professor Paul A. Mood/ (excerpt from Rodent Classification, based on


veyed from the infected rat to man by the flea. We know,
also, that rats in the Mediterranean basin are similarly in-
fected. Studies made within the last few years seem to in-
dicate that the virus of the Mexican-American type of
typhus fever, as well as of the endemic variety in the
Mediterranean basin, is highly adapted to rodents and is
carried in these animals rats during the intervals be-
tween human epidemics; transmitted from rat to rat by the
rat louse (polyplax) and the rat flea (Xenopsylla), and,
on suitable occasions, to man from the rat by the rat flea.
For this reason, Nicolle speaks of this as the “murine”
virus. The virus obtained from cases occurring in the his-
toric Eastern European typhus foci and in Africa is less
virulent for rodents, and there is reasbn to believe, from
observations too technical to be here described, that this
virus has been propagated for centuries, not only in rats,

List of North American Recent Mammals, 1923, by Gerrit S. Miller,
Jr., Bull. 128, U. S. National Museum):
Superfamily Muridae:

Family Cricetidse (New World) :
Subfamily Cricetinse:

Genus Peromyscus, deer mice
Genus Sigmodon, cotton rats
Subfamily Microtinse:

Genus Microtus, meadow mice

(Subfamily also includes lemmings and muskrats, among

Family Muridae (New World) :
Subfamily Murinse:

Genus Micromys, European harvest mice
Genus Rattus:

Rattus rattus, black rat, formerly called Epimys rattus
Rattus norvegicus, Norway or house rat
Genus Mus, house mice


but in human carriers. With infected human beings, the
European infection has been imported to America as
what is known as “Brill J s disease,” so that we now enjoy
both varieties on this continent. It is more than likely that
in both cases the virus comes from a common stock which
originally infected rodents. Hence our preoccupation with
these animals. They become objects of interest in trac-
ing the epidemiology not only of typhus, but also of
plague these two calamities sharing with human fe-
rocity the greatest responsibility for wholesale sorrow, suf-
fering,, and death throughout the ages.

It is a curious fact that long before there could have
been any knowledge concerning the dangerous character
of rodents as carriers of disease, mankind dreaded and
pursued these animals. Sticker has collected a great many
references to this subject from ancient and mediaeval litera-
ture, and has found much evidence in the folklore of
mediaeval Europe which points to the vague recognition
of some connection between plague and rats. In ancient
Palestine, the Jews considered all seven mouse varieties
(akbar) unclean, and as unsuited for human nourish-
ment as were pigs. The worshipers of Zoroaster hated
water rats, and believed that the killing of rats was a serv-
ice to God. It is also significant that Apollo Smintheus,
the god who was supposed to protect against disease, was
also spoken of as the killer of mice, and Saint Gertrude
was besought by the bishops of the early Catholic Church
to protect against plague and mice. The year 1498, Sticker
tfclls us, was a severe plague year in Germany, and there
were so many rats in Frankfurt that an attendant was sta-


tioned for several hours each day on a bridge in the town
and directed to pay a pfennig for every rat brought in.
The attendant cut off the tail of the rat probably as a
primitive method of accounting and threw the bodies
into the river. Heine, according to Sticker, speaks of a tax
levied on the Jews of Frankfurt in the fifteenth century,
which consisted of the annual delivery of five thousand
rat tails. Folklore originating in a number of different
parts of Europe during the great plague epidemics men-
tions cats and dogs, the hereditary enemies of rats and
mice, as guardians against the plague.

Most scholars agree that there is no reliable mention of
rats as such in classical literature. The Greeks had
the word p&. Herodotus mentions the field mouse
jiDs ipovpalos. The expression /uDs tv irlTTij (mouse in a
pickle jar) meant “to be in a bad hole or scrape.” The
Greeks also knew 8po, the later Roman “Sorex,”
which, though not a rodent at all (the shrewmouse),
looked enough like one to get into the literature with the
mouse. Our learned friend Professor Rand tells us of
a story quoted by Keller (Die Antike Thierwelt) about
Heliogabalus, who “staged a fight between ten thousand
mice, one thousand shrewmice and one thousand weasels.”
Needless to relate, the shrewmice “polished off” the mice,
and the weasels got both of them. 2

8 In connection with this story about Heliogabalus, it is particularly
strange that rats were not included in his curious amusement. Accord-
ing to Hamilton and Hinton, the rat was “undoubtedly present in
the East before the time of the Crusaders, and was firmly established
in Europe ihortly after 1095.” Heliogabalus, whose real name was
Varius Avitus, a native of Emcsa, was taken from Rome to his birth-


The Romans knew the mouse well. It was recognized
as a pest, and musculus (little mouse) was even used as a
term of endearment by Martian. The word root (muishi,
Persian; musa y musi y Hindu; musiko, Pali) indicates the
world-wide ancient knowledge of mice.

There is, however, no specific early differentiation be-
tween mice and rats, and authorities seem to agree quite
generally that nothing in the references to mice, at least
among the Greeks and Romans, justifies the assumption
that rats may have been referred to. Yet, in view of the
probable ancient prevalence of rats in Eastern countries,
and the close communications by sea between the Greeks
and the Mediterranean coastal cities, as well as the regular
grain traffic between Egypt and Rome, it is difficult to
credit the complete absence of rats from the European
littoral throughout antiquity.

In regard to mice and rats in the Near East, Herodotus
tells us of Libya that “in this country there are three

place, Emesa, after the murder of Caracala. There he became high
priest of the Syrian sun god, Elagabalus, whose name he assumed. On
his return to Rome as Emperor in 219 A.D., he affronted the com-
munity by, among other things, the “horseplay and childish practical
joking” of which the mouse battle is an example. In attempting to
determine whether rats reached Rome at or about the time when free
communication between Rome and the Levant was habitual, in the
centuries following the year one, it is of interest to note that when the
true black rat surely arrived in Italy after the Crusades, it was known
as “Sorco,” from “Sorex” which justifies the suspicion that the
Sorex of Heliogabalus might have been a rat. This is further encouraged
by the thought that rats might more easily have carried the victory over
the mice than true shrewmice, which are insectivorous and not very
large or powerful. In later literature, according to Hamilton and Hin-
ton, the black rat has figured as “Sorex” (Hoefnagel-Archctypa, 1592),
and is referred to as Mus major seu Sorex in Merrett (Pinax, 1667).


kinds of mice. One is called the c two-legged’ mouse }
another the ‘Zegeris’ [a word that means a hill pos-
sibly a sort of prairie dog] ; a third, the ‘prickly’ mouse.”
Also he recounts that when Sanachrib, King of Arabia and
Assyria, marched a great host against Egypt, on the night
before the battle “there swarmed upon them mice of the
fields, and ate up their quivers and their bows and the
handles of their shields” so that, on the next day, they
fled. This sounds much more like rats than like the
timid field mouse. However, these things are hardly
evidence. 8

It is quite impossible to make a case for the presence of
true rats in Europe proper during classical times, much
as this would clarify the epidemiological situation. It is
conceivable that the manner of transmission of plague and
typhus may have undergone modification since the Pelo-
ponnesian Wars by changed adaptations to hosts, both
insect and rodent. But it would seem much more likely
that the zoological differentiations between rodents so
similar and closely related as mice and rats were inaccu-
rate in ancient records, and that rats may have existed
though undomesticated. This would give us a wider lati-
tude for speculation regarding the nature of epidemics,
which, to be sure, were rarely, under the circumstances of
ancient life, as widespread or deadly as they became with
the later concentrations of population and of urban habits.
At any rate, if rats had been present in those times in any-
thing like the numbers in which they are found to-day, we
should probably have reliable records. It may well be

8 The same story is found in Josephus.


that the frugality of well-run households, like that of
Penelope, gave little encouragement to house rats to be-
come parasitic on man to the extent to which they have

All this is conjecture. According to the wisest students
of the subject, there is no certain knowledge of rats in
Europe, within historic periods, until shortly after the
Crusades. In prehistoric days they certainly existed there

but later disappeared. Fossil remains of rats have been
found in the Pliocene period of Lombardy (the Mastodon
period of Europe) and in the lat^r Pleistocene of
Crete. They were present during the glacial period
with the lake dwellers, whom they pestered in Meck-
lenburg and Western Germany. From that time on,
there were either few or no rats until thousands of years

In regard to the reappearance of rats in Europe, our
industrious colleagues, the zoologists, have gathered an
immense amount of information, much of which has been
interestingly summarized by Barrett-Hamilton and Hin-
ton in their History of British Mammals, and by Donald-
son in his Memoir on the Rat. Before we proceed to this
subject, however, it will be profitable to consider the strik-
ing analogy between rats and men. More than any other /
species of animal, the rat and mouse have become de- \
pendent on man, and in so doing they have developed^
characteristics which are amazingly human.

In the first place, like man, the rat has become practically
omnivorous. It eats anything that lets it and like man { J* d Mou8c -> Mite -+ Man

Spotted Fever Types Tick * Tick Man

Fievre Boutonneuse Tick * Dog? Tick * Man

True Typhus

Murine Type * at f lea }->?! “”*, N I Rat Flea -* Man – Louse -* Man
JV Rat Louse J (Mouse?) \

European (Human) Type Man * Loute * Man

Were we engaged in writing a treatise for technical readers,
this would be the place for emphasis upon the minor
clinical differences between the members of the group
for such differences exist, as, for instance, in the necrotic
local lesions of Tsutsugamushi, the glandular swellings
in this disease, and the occasional raised knobs in Fievre
Boutonneuse. We might also enter upon details of the
methods by which the individual strains of virus can be
differentiated in the laboratory. But this would carry us,
without much gain for our present purposes, too far from
the central theme.

The fact remains that the family resemblances of these
diseases in man are unmistakably close $ are almost in-
distinguishably so in the spotted-fever-typhus relation-
ship} and are demonstrable, as deep-seated biological
kinships, by reactions of the blood of patients and by ex-
perimental observations upon infected animals. More-
over, all of the diseases of the group are caused by the
invasion of the patient’s body by the minute parasites
spoken of as Rickettsiae.



These minute, bacillus-like things belong to a group
which probably acquired its first parasitism on insects
a surmise which is suggested by the frequency with which
similar organisms, incapable of causing disease in the
higher animals, occur in a variety of insects. Thus parasites
of this order have been seen in sheep lice, in dust lice, in
bedbugs, in mosquitoes, in fleas, in mites, and in ticks. The
name was given them by da Rocha Lima in honour of
Ricketts, an American who died of typhus while studying
the disease in Mexico City. The particular variety which
is responsible for typhus proper he called “Rickettsiae
prowaceki,” adding the name of Prowacek, an Austrian
who perished in the same manner. The Rickettsiae needed
a name for themselves, because they cannot be logically
grouped either with the bacteria or with the Protozoa. In
the end, they will probably be found closely related to the
true bacteria. However this may be, for the present they
stand apart sufficiently to render a separate tentative classi-
fication convenient. They differ from true bacteria largely
in their response to ordinary methods of coloration, by
their refusal to grow on artificial media other than those
which contain living cells, and by the fact that in the liv-
ing animal as well as in the tissue culture they multiply
only within the cell bodies themselves.

It is, of course, quite impossible to make even a reason-
able guess regarding the free-living ancestral forms of
the Rickettsiae. No doubt they were closely allied to true
bacteria. Indeed the characteristics by which the Rickettsire


differ from bacteria at present may well have developed
as changes incidental to the evolution of their parasitic
existences. At any rate, at some time in the very remote
past, minute unicellular organisms became parasitic within
a considerable variety of insects. In many cases they in-
vaded the Cells and became so adapted to intracellular
existence that to-day they cannot be cultivated except in
living tissue cultures.

We have few criteria by which we can appraise the
antiquity of any form of parasitism. But in general, as
Theobald Smith states it, pathological manifestations are
only incidents in a developing parasitism. On this basis
Rickettsia infection in the ticks is a very ancient condi-
tion} for in this relationship mutual tolerance has de-
veloped to such perfection that neither partner appears
to be injured, and the parasite is transmitted, without
harm to parent or offspring, from one tick generation to
the next. In the rat flea the condition, though still ages
old, is probably a more recent one; for the flea after
a month or two gets rid of the parasite and recovers.
In the case of the human louse, however, we are led by
the same reasoning to assume a relatively late origin of
the association. For no mutual tolerance has developed
and the louse invariably perishes when infected.

The invasion of insects we may regard as the first step
in that complex evolution which ultimately led to the
human afflictions we are discussing. The next step was the
transmission of the parasites from the insects to some of
the higher animals. Some of the Rickettsia-infected in-
sects belonged to species that had, themselves, become


ectoparasitic upon animals and maintained themselves by
sucking blood. In this manner Rickettsiae gained access to
those animals on which their insect hosts were in the habit
of feeding. It is conceivable that the precise host channels
through which the virus passed from insect to animal were
dependent upon the accidental distribution of fauna in
different parts of the world. Thus in one region it took
the mite-field-mouse route, in another the flea-rat direc-
tion. And since in these two cases the mutual tolerance
between parasites and hosts is still imperfect in both the
insect and the animal phases, the virus is perpetuated
only by an uninterrupted circulation of the parasite be-
tween the two. It is probably a fair guess that the tick-
conveyed virus went through a similar animal-insect cycle
centuries ago. It is even possible that a natural, but still
unknown, animal host of spotted fever exists to-day. But
the perfect adaptation which has made hereditary trans-
mission possible within ticks has removed any necessity for
an animal intermediary.

Thus we have a fairly reasonable basis for the tenta-
tive reconstruction of the natural history of the Rickettsia
diseases. An insect-animal cycle once established, and
given an insect which, in emergency, will feed on human
subjects, the transfer of the parasites to man follows.

Man is, in the biological sense, a recent host, and in
him Rickettsia invasion arouses a physiological resent-
ment. A struggle between invader and host ensues which
manifests itself as disease. One or the other succumbs.
But for the parasite it is a Pyrrhic victory. When the
man dies, the Rickettsiae that have killed him die with


him. Only those survive which can escape into a louse,
or possibly a flea, which happens unwisely to feed upon
the human victim at a time when the Rickettsise are
circulating in the blood. And, of the two, the louse is
by far the more dangerous in relation to epidemic
spread} for although, unlike the flea, it can neither hop
nor live for any length of time separated from its human
host, it possesses qualities of dogged persistence and patient
diligence which arouse that admiration, thinly masked
by a pretense of loathing, which men similarly feel for
competing races whom they fear and, therefore, perse-
cute. 2

To those who are engaged in the technical study of the
typhus group it is apparent that the facts so far ascertained
concerning the insect-animal parasitism of the Rickettsiae
represent only a beginning. Apart from the practical im-
portance of these relations in their bearing on diseases,
they offer to the general biologist a rich field for the
study of parasitic cycles. It is quite likely that Rickettsia
invasions have taken many directions other than those so
far investigated. In the Malay States, Formosa, Sumatra,
and Annam, perhaps also in Japan, the Tsutsugamushi
virus can pass through rats as well as mice} and in the
same places, together with a flea-born true typhus, there
is also a tick disease. These are being unravelled by in-
vestigators all over the globe. It has been shown experi-
mentally that by artificial inoculation virulent Rickettsise
can be kept alive for a week or two in a number of insects
that do not naturally harbour them. Also many species of

2 We refer to the “Blond Aryan” complex.


animals not as yet convicted of being sources of human
disease, such as domestic mice in Europe and America,
New World mice, rabbits, woodchucks, monkeys, and even
horses and donkeys can be inoculated with the Rick-
ettsise and harbor them for varying periods. In many of
them this maintenance of the virus is peculiarly dangerous
because it is what we call “inapparent” that is, the
animal shows no signs of illness, yet retains within its
body a virus capable of transfer to insects or to other sus-
ceptible animals. “Inapparent” infection is beginning to
possess an importance of the first order in epidemiological
reasoning in many fields other than that of typhus fever.
In the Rickettsia problems, however, it has already at-
tained practical significance. A rat inoculated with typhus
virus shows no apparent symptoms except, in some cases,
a little fever. Yet two or three weeks later one can pro-
duce typical typhus reactions in guinea pigs or infect lice
by intrarectal inoculation of the apparently healthy rat’s
brain! But this is again tempting us into discursiveness.
We return to our main theme.


In which we consider the birth, childhood, and adolescence

of typhus

THERE are, as we have stated, two distinct types of true
typhus virus. The diseases they cause in man are identical
and both are transmitted from one individual to another
by human body and head lice. Both in man and in
animals recovery from one type protects against the other,
testimony of their close and fundamental kinship. They
can be distinguished only by relatively slight but definite
differences of behaviour when inoculated into guinea pigs,
rats, and mice, and by reactions, called immunological,
which are far too technical to occupy us here. Before these
distinctions had been recognized typhus had been regarded
all over the world as a single disease perpetuated by man-
louse-man transfer. This observation, however, together
with epidemiological observations in Australia and Ameri-
can case studies, led to an intensive search for virus reser-
voirs other than man. The result was the discovery of
natural rat infection and of rat-flea transmission.

Now in correlating the origin of virus strains with their
manner of behaviour in guinea pigs, it was soon observed
that all the viruses obtained either directly from rats or
from rat fleas, as well as those isolated from human
victims in America and Mexico (regions where the


presence of infected rats and epidemiological circumstances
indicated rat origin), behaved in one wayj while the
strains obtained from man in Southeastern and Eastern
Europe where endemic and epidemic typhus has been
prevalent for centuries behaved in another manner.
For these reasons students of the disease to-day classify
the two varieties as the “murine” type in which the
rat-flea cycle precedes human infection and the classical
or “human” type, for which no rat origin has as yet been
determined. The precise relationship between these closely
allied subvarieties then became the focus of attention, since
it was obvious that comprehension of this would go far
toward explaining the epidemiology of the classical
European disease thereby furnishing new principles for
protective measures. The speed with which things have
been moving in the typhus world may be gathered from
the fact that most of the work we are discussing has been
done since 1928, a good deal is hardly off the presses,
and some of it is not yet in print as these paragraphs are
being written. In its accomplishment, French, Swiss, Amer-
ican, British, German, Mexican, and Polish investigators
have engaged in the sort of exciting, friendly, and eager
competitive collaboration or collaborative competition
which gives our profession a zest and charm and a free-
dom from nationalistic chicane found in few others.

It was necessary, first of all, to determine whether the
two types were permanently fixed in their differential
characteristics or whether they represented temporary
variants or, as they are now called, “dissociations” of
one and the same virus, dependent upon or induced by


the different hosts through which they passed. This ques-
tion has, in our opinion, been answered though in the
interests of an accuracy that is essential even in a superficial
discussion of such things we must add that there is still
an element of speculation in the explanation, and opinions
are not yet entirely unanimous. In approaching the prob-
lem, investigators began to pass both types of virus through
a variety of insects, through guinea pigs, rats, and mice,
and to collect for study all the strains they could get hold
of from rats and from human patients. As the matter
stands, at the end of about five years of such study the
evidence so far accumulated tends to show that the two
varieties are permanently fixed each in its own form.
They have so many overlapping characteristics even
in the animal experiments that it is quite easily possible
to train one of them into a temporary simulation of the
other by special methods of investigation. But as soon as
there is a relaxation of experimental manipulation each
type snaps back into its original condition. There are strains
of the murine and of the European type in American and
foreign laboratories that have been so observed for three,
four, and five years and are still true to type.

We can assume with much confidence, therefore, that the
two varieties are fixed, though very closely related, vari-
ants. But the ease with which one of them can temporarily
be trained in the direction of the other by experimental
manipulation suggests that the differentiation is one
that has come about, biologically speaking, at a relatively
recent period. Some light on this phase of the matter has
come from accidental observations made on strains ob-


tained in Mexico. Now and then, from one and the same
Mexican epidemic, among typical marine strains, a few
aberrant ones have been recovered which act like the
European or human variety. Some of these may retain
their human strain characteristics through many guinea-
pig passages. Eventually, however, all of them, especially
under the influence of rat passage, have “come back” to
tne murine attributes. Since in the Mexican epidemics
the passage from man to man just as in the Continental
epidemics is a louse transmission, the observation just
cited suggests that passage through man and lice tends
to modify the properties of the murine virus into a closer
similarity to those of the European human type.

Since years of animal passage and selective experiment
have failed to produce a reversion of a human virus toward
the murine, whereas passage of a murine through man
rapidly produces an often obstinate, though so far still
temporary, change in the direction of the human, we
have much reason to suspect that the human is an off-
shoot of the former the murine being the original
typhus virus of man, which, after a sufficient number of
man-louse-man passages, becomes stabilized as a slightly
changed but permanent and fixed variety. Under such
circumstances, we may still ask ourselves whether the
classical European virus is renewed, from time to time,
from rat sources and so perpetuated; or whether, on the
other hand, it has become thoroughly and permanently
established in man and is continued between epidemics
by a trickle of man-louse-man cases or by so-called human*
carriers who maintain the virus for long periods, though


appearing completely cured much as in the case of
the “inapparent” animal infections which we have else-
where described.

A partial answer in our view a complete one to
this query has come from the study of European cases
imported to America. There occurs among the crowded
immigrant population of our Northeastern cities an acute
fever called “Brill’s disease,” which is really typhus and
yields a typical European or human virus. When Brill
first described it in 1898 among Jews in New York,
being unfamiliar with typhus, he thought it a “new
disease.” We mention this in no disparagement of an ex-
traordinarily sagacious physician; but rather because, if
errors of this kind are easily made in the present era of
medicine, we must be doubly careful in appraising remote
historical evidence bearing on the antiquity of infectious
diseases. Brill deserves much credit for having dif-
ferentiated these mild cases from similar fevers then pre-
vailing, and calling attention to them. His error, more-
over, has been a common one in the history of medicine.
As Murchison tells us, “So completely did relapsing fever
disappear from Britain after 1828 that when, after an
interval of fourteen years, it again showed itself as an
epidemic in 1843, the junior members of the profession
failed to recognize it and it was regarded as a new disease.”
Many similar instances could be cited.

But to return to BrilPs disease. This, as we have said,

is European typhus brought to America by immigrants

from the typhus regions of Southeastern Europe. It is

not common, but there have been enough cases to permit


profitable study. More than five hundred of them are
on record as occurring in Boston and New York since
1910. Epidemiological analysis has shown that well over
90 per cent of all of these cases occurred in the foreign-
born, although they lived in close association with their
native-born friends and relatives, and had similar cus-
toms. The cases were so distributed in time and place
that louse transmission or contact infection could be ex-
cluded, and the circumstances of over five hundred care-
fully investigated patients showed that no factor common
to the entire population such as rats or fleas or any other
animal or insect vector could be held responsible. To
make a long story short, the investigations showed that
these cases were, almost all of them, recrudescences of
infections acquired in childhood in the native heaths of
classical typhus, and that the classical European typhus
can maintain itself in human reservoirs indefinitely with-
out the intervention of extraneous animal vectors. 1

The situation, in summary, is the following: There are
two very closely related, but nevertheless distinct types of
typhus fever prevalent side by side on both the American
and the European continent. From suggested, but yet
incomplete information, one is inclined to assume that
probably the two types exist in many other parts of the
world. One of these varieties, which we speak of as the
murine virus, is maintained in interepidemic periods in

1 The discussion of the prolonged survival of an infectious agent in
the bodies of convalescent and recovered men and animals would carry
us into a new, long, and complex chapter. And we have set our elf-
control firmly against further digressions.


rats, possibly in mice, where it passes from one animal to
the other by the insects we have named j occasionally it
gets into man with the bite of a rat flea; but it causes group
infection or epidemics only when the circumstances are
such that human lice can transmit it from man to man. The
other type has become solidly established in man. Some
individuals who have recovered from a first attack retain
the virus in their bodies and may have another attack of
the disease many years after the first one, when their
resistance is depressed for reason that it has not yet been
possible to analyze. From these recrudescent cases epi-
demics can start under conditions of general louse infes-
tation. There are quite probably rat and human reservoirs
side by side in many different parts of the world, but a
complete survey of this situation will probably take a good
many years of further study.

We have now reached the point in our biography when
we can speak of the birth of our hero without fear of being
forced into further explanatory digressions. If hitherto j
we have followed the discursive plan of Dr. Sterne in I
Tristram Shandy, we can insist and the reader will.|
agree with us that we were not impelled, as was the
immortal author of that great work, by a desire to be)
humorous, but rather by the nature of our subject. The*
birth of an infectious disease is not as simple a matter as
that of a man. Gestation is not a mere matter of ten
months or so, but represents complex biological inter-
adaptations and interactions which cover thousands of


years. And in this particular case we may say that the
conception of our disease took place when the first Rick-
ettsise became parasitic on insects} and gestation lasted
through the uncertain but undoubtedly centuries-long
period during which the parasitism progressed from insect
to animal, and finally through other insects to man him-

Under the circumstances described it appears probable
that isolated, endemic, rat-to-man or mouse-to-man cases
of typhus occurred centuries before the disease became
epidemic, recognized, and differentiated. It is almost sure
that wild rats and possibly other rodents were infected
in many parts of the world early in the natural history of
this parasitism. In the Malay States to-day there seems to
be a concentration of endemic cases of tropical typhus
among workers on oil-palm plantations, where rats abound.

Although, in attempting to postulate a pre-epidemic
existence of typhus fever before the fifteenth century we
are fishing, to some extent, in speculative waters, there
is still much to support this view in conditions as they
exist in widely separated areas of the world to-day. In
Mexico and in the Southern United States a dribble of
sporadic cases, long unrecognized, are constantly acquired
from domestic rats, which result, in the former country,
in epidemic outbreaks only when the louse takes a hand.
In Malaya where there is an urban and a rural tropical
typhus the diseases are again sporadic and rarely give
rise to group infection. The rural variety wnich attacks
the workers on the oil-palm estates seems to be a danger
chiefly for those labourers who are occupied in the clearing


of the lalang growth and the weeds at the bases of the
trees. They are exposed to some vector possibly wild
rats and their fleas, or some still undiscovered vector which
lurks in the brush. At any rate the virus is here widely dis-
tributed in nature, evolved completely up to the point at
which it is ready to enter man and has probably so ex-
isted for an indeterminably long period. Similar conditions
prevail in regard to Tsutsugamushi. Incidentally, failure
of epidemic outbreak of the typhus in Malaya is probably
due to the fact that, according to Dr. Enid Robertson, the
body louse is almost unseen in Malaya, though head lice
exist. In hot countries, where men are totally unclad, or
are clad lightly, and groups of people are widely scat-
tered in rural settlements, the chances are great that typhus
will remain endemic almost permanently and become epi-
demic only when conditions of living are modified.

In problems concerning the remote origins of diseases
there is little chance of either proving or disproving any
hypothesis. We believe, however, that the biological ob-
servations to which we have devoted much space strongly
suggest the following tentative theory regarding the pre-
epidemic history of typhus.

Typhus fever was born when the first infected rat flea
fed upon a man. This accident probably took place
most likely somewhere in the East centuries before the
disease reached the crowded centres and the armies of
mediaeval Europe. Endemic and usually mild cases oc-
curring here and there, with rarely a group outbreak,
escaped the attention of ancient physicians and historians
or were not differentiated from other febrile diseases.


The marine virus was thus the original typhus. In the
course of time the disease was carried, perhaps repeatedly,
to Western countries chiefly by armies, at first causing
limited outbreaks that perhaps ended with the virus still
remaining largely or entirely murine. Infected rats be-
came established in the Mediterranean basin. Early local-
ized epidemics thus may like those in Mexico to-day
have remained murine in origin for a long time. And
indeed, in these earlier days of its epidemic history, typhus
outbreaks were relatively far apart. In the sixteenth and
seventeenth centuries, beginning with the campaigns of
Maximilian against the Turks and through the Thirty
Years’ War, the disease became an almost incessant
scourge of armies and was scattered far and wide among
the wretched populations under conditions ideal for
typhus of famine, abject poverty, homeless wander-
ing, and constant warfare. The human louse was possibly
the last of the series of hosts to acquire the virus for
it had, long before this time, become inseparably depend-
ent upon man. And this surmise is in keeping with the fact
that in the louse the Rickettsise are more predatory than
parasitic. The infected louse always dies.

Under the conditions which we have described for the
unfortunate centuries it is quite conceivable that typhus
fever may have been almost uninterruptedly propagated
by the man-louse-man route in certain parts of Europe,
with renewal at any time from a rat-flea source (although
endemic rat-transmitted cases may have been occurring at
the same time). And this continued through the eighteenth
century, which is, par excellence, the Century of Typhus,


Thus constantly passing through lice and men, certain
strains became modified even as, in a less permanent
manner, we can observe such changes after a few man-
louse passages in modern Mexican outbreaks. Thus was
born the younger brother the human virus. The two
persist, side by side, in many countries of Europe, and,
as investigations of Brill’s disease have shown, here among
us in America as well the murine brother having its
permanent home in rats and fleas 5 the human, last born,
firmly established in man.

The pre-epidemic history of our disease, the circum-
stances of its birth and adolescence, are and needs must re-
main largely hypothetical. We have constructed a trellis
of likelihood from known facts concerning the natural
history of the virus. What we may call the adult state
of the disease the period at which it became a powerful
factor in the history of mankind began when it ac-
quired epidemic propensities. Then only was it recognized
as an individual and accurately described, and we are again
on the terra firma of reliable information in our next
chapter, which deals with the vigorous young adult phases
of our hero.


In which we follow the earliest epidemic exploits of
our disease

WE assume then that the original Rickettsia parasitism
which led to typhus fever in man was a rat-rat-flea in-
fection, and that this gradually infiltrated into Western
Europe from the East. This parasitism exists to-day in
and around the Mediterranean basin, widely distributed,
and there is no particular reason to believe that it got
there from American foci. At first the disease in man
probably bore the form of the mild, sporadic cases
scattered in time and space, as they occur in the South-
eastern United States to-day.

Considering the state of medicine in the early Middle
Ages (possibly cases appeared as early as the Crusades),
we cannot expect records of any value. For, as we have
seen, the existence of the disease among us was not
recognized until quite recently, and the diagnosis, even
now, calls for considerable skill and experience in these
relatively benign infections, in which the fever is often
short-lived and the rash so insignificant that it may be
overlooked entirely or mistaken for flea bites.

Early group infections, when they occurred at all,
probably did not extend beyond the limited ranges of
family or village association. And when, in its earliest


epidemic appearances, the disease attacked armies or towns,
there is much reason to believe that it was associated with
a number of coincident infections plague, enteric fe-
vers, scarlet fever, measles, and so forth, and was obscured,
in historical records, in the general undifferentiated mess
of “pestilence.” The conditions which let down the bars
for one type of infection usually admit a great many
others j and, except under special conditions, epidemics are
usually composed of a number of different types of trans-
missible disease.

In the East it is probable that typhus had passed from
the endemic to the epidemic state at a period earlier than
it did in Europe, and there is some reason to assume that
the earliest recorded severe European epidemic was trans-
ported with soldiers from Cyprus to Spain. This epidemic
occurred in 1489 and 1490, when the forces of Ferdinand
and Isabella were at grips with the Moors for the posses-
sion of Granada.

Of considerable significance for our view of the gradual
manner in which typhus became epidemic in Europe is
the fact that we have information that can hardly be
questioned of at least one preceding group infection which
occurred some four hundred years earlier in a monastery
near Salerno. It is described in the Cronica Cavetise, which
we have not been able to see in the original, but from
which Renzi, much quoted by medical historians, has
cited the important passages. Through the kindness of
Major Hume of the Army Medical Library, we have been
able to find the following passage taken from the Storia
di Medicina in Italia, Volume 2, Napoli, 1845). “E fra’


tanti esempi ne prescegliero uno abbastanza antico per
potere dissipare ogui dubbiezza. Nella Cronica Cavense
reportata dal Pratillo (torn. 14, pag. 450) leggesi: Anno
1083 in Monasterio Cavensi in mense augusto, et $e$tem~
bri crassavit pessima febris cum Piticulis et farotibus.
Nel che si ravissa chiara la differenza che si metteva fra
la pesti, la febbre di altro genera, e quella accompagnata
da petecchie.” (“In the year 1083, in the monastery of
La Cava in the month of August and September, there
spread a severe fever with peticuli and parotid swellings,
in which one sees clearly the difference which is found
from the Pest, a fever of a different kind and in this
case accompanied by petechial spots.”) From this pas-
sage it seems that a diagnosis is warranted.

It would be strange if there had been no typhus what-
ever between this outbreak and that of 1489. We are al-
most compelled to assume that, during the interval, no
accurate observations were recorded, or that, at any rate,
if made, they have been lost.

The chief source for information of the early epidemics
of Spain is the book by Joaquin Villalba, which bears the
following title: Epedimiologia espanola o historia crono-
logica de las *pestes y contagios, efidemias y epizootias que
h dice Mariana, muy desgraciado.


the year 1570. This new pestilence was believed to have orig-
inated among the Saracens after the war of Granada; that is,
after the King Don Fernando of Aragon and Dona Isabel,
Queen of Castille, conquered that city; and after the Moors had
been dispersed by the decree of Don Felipe II. That this infec-
tion came from the Spanish Arabs can be deduced from the fact
that almost all those who were driven from their homes infected,
by association and contact, the inhabitants of the villages, towns,
and cities, as related by Luis de Toro in his treatise On Shotted
Fever; in this work may be found his description of the character
of the disease as it occurred in the periods 1570 and 1577. 2

In his description of this particular outbreak which is
too long to be quoted in full, Villalba expresses the belief
that the typhus of America originated at this time by trans-
portation from Spain to Mexico. The passage in question
is the following:

This spotted fever which, as we have said, afflicted the people
of Spain was transferred to America with our navy and our
merchantmen and attacked the noble city of Mexico with such
severity that it caused much distress. Dr. Francisco Bravo, native
of Osuna, and physician of that city, wrote an extensive discourse

8 Una nueva enjermedad desconocida de los siglos antiguos hasta las
guerras civile; de Granada afarecio en Esfana el ano 1557, la qual
desfoblo la mayor forte de nuestra peninsula, y no emfezo a corregirse
ni mitigarse tino hatia el ano 1570. Esta nueva fetilencia se cree que
tomo su origen de los sarracenos desfues de la guerra de Granada; esto
es, desfues que el rey Don Fernando de Aragon y Dona Isabel, reyna
de CastiUa, conquistaron die ha ciudad, y desfues de haber sido dis-
fersados los moriscos for decreto del senor Don Felife II. Que esta in-
jection froviniese de los arabes esfanoles, se colige de que casi todos
los que jueron disfersados, inficionaban con su comunicacion y trato a
los habitantes de las aldeas, villas y ciudades, como refiere Luis de Toro
en su tratado “de jebri funticulari” ; a suyo car act er fertenece, y se
hattara su description en la efoca 1570 y 1577.


about this disease, to which he gave the name of “tabardete.” His
rare work is entitled: Opera Medicinalia in quibus quam furima
extant scitu medico necessario, in quatuor tibros digesta, printed
in Mexico by Pedro Ocharte in the year 1570, in octavo. This
work, dedicated to Prince Don Martin Enriques, contained the
description of this disease, causes, signs, and symptoms and cure
together with other considerations to which we shall refer
at the proper time. 8

On this subject we shall have more to say presently.

The disease was thus well launched in an epidemic form
in Europe during the last decade of the fifteenth century
and throughout the sixteenth, but had not yet spread
widely across the Continent. In 1546 Fracastorius pub-
lished his De Contagione, in Chapter VI of the Second
Book of which he gives an excellent description of the
disease in its clinical appearances and has many sagacious
things to say about its nature and the manner of its spread.
The following passage from the beginning of this chapter
is cited after the translation of W. C. Wright:

There are also other fevers, which, in a manner of speaking,
come midway between the truly pestilent and the non-pestilent,
for though many die of them, many recover. They are con-

8 Esta “fiebre funticular, que desolaba los fueblos de Esfana, omo
acabamos de decir, faso a las Americas for mcdio de nuestras naves y
comercio, y acometlo con tanto rigor a la insigne ciudad de Mexico,
que causo en ella no focos estragos. El doctor Francisco Bravo, natural
de Osuna, y medico de aquella ciudad, escribio sobre ella un largo dis-
curso con el nombre de tabardete, que se halla en su rarisima obra
titulada: “Opera medicinalia in quibus quam furima extant scitu medico
necessarie, in quator libros digesta” imfresa en Mexico for Pedro
Ocharte ano 1570, en octavo. Esta obra dedicada al frincife Don Martin
Enriquez, contiene la descrifcion de esta mal, causas, senales, sintom’as
y curacion de el, con otros tratados, de que caremos noticia a su tiemfo.


tagious, and hence partake of the nature of pestilent fevers, but
they are regularly called malignant rather than pestilent. Of
this sort were those fevers which in 1505 and 1528 appeared
for the first time in Italy, and had not been previously known
there in our time. They are, however, familiar in certain parts
of the world, for instance in Cyprus and the neighboring islands,
and were also known to our ancestors. They are vulgarly called
“lenticube” (small lentils), or “puncticulae” (small pricks), be-
cause they produce spots which look like lentils or flea bites. Others
spell the name differently, and call them “peticulae.” We must
study them carefully, because nowadays, too, they are frequently
observed, not only as affecting many at once, but also as special
cases, in individuals. Instances have been observed of persons
who went from Italy to other countries where no fever of this
sort existed, and died of it there, as though they had carried the
infection with them. This happened to that very celebrated and
learned man Andrea Navagero, ambassador from the illustrious
Republic of Venice to the King of France, some years ago. For
he died of this disease in a province where that sort of malady
was not known, even by name. He was a man of such learning
and genius that no greater loss to letters has been incurred for
many a year.

We are quoting copiously from the writers who ob-
served these early epidemic appearances of typhus in
Europe, because we wish to emphasize the fact that it was
regarded, in this form, as a new disease and there was
general agreement that it came to Europe from the East.
Of course, in this respect, they may well have taken their
view from the early opinions expressed by Luis de Toro,
and his opinion concerning the transportation of the dis-
ease from Cyprus may have been wrong. Infected rats
are now present along the southern border of the Mediter-


ranean. Spain may have been the first Continental region
to be attacked because of active communication across Gi-
braltar and the rapid spread of rats from one continent to
the other.

However this may be, before the middle of the sixteenth
century typhus fever had begun to take an active hand
in the politics of Europe. It made its political debut,
as one may call it, by one of the most far-reaching and
profoundly effective strokes of its entire career, playing
the decisive role in the relief of the Imperial army at
Naples when besieged by the French under Lautrec in

We may best appraise the enormous historical impor-
tance of the short and localized epidemic of typhus which
destroyed the French army before Naples by considering
the background of the political conditions. 4 Northern Italy
was the battleground on which Charles V and Francis I
had long disputed the hegemony of Europe. The key to
the situation was alliance with and power over the Pope.
On February 24, 1525, the victorious march of the
French army was turned into utter defeat when the Span-
ish troops and their German allies, led by Pescara,
snatched victory from imminent defeat. Italy fell to the
mercy of the Imperial army and the French King be-
came a prisoner in Spain. The Pope, Clement VII, was in
a difficult position. He feared for the independence of
the Holy See: with Milan and Naples in the hands of the
Emperor, the papacy was completely encircled. Lannoy,
the most energetic of the Imperial generals, was threaten-

4 See Von Pastor, History of the Pofes.


ing to march on Rome. The Pope was forced to advance
huge sums of money and to enter into an alliance with
the Emperor. In 1526, after the Peace of Madrid, Fran-
cis was liberated. The conditions imposed upon the French
King were so severe that historians find it difficult to
understand how so astute a monarch as Charles V could
ever have expected him to remain true to his undertak-
ings. Again, the Pope who was timid by nature
fluctuated between two terrors: one, the immediate fear
of the Imperial power in Italy j the other, apprehension
of the consequences if, having remained true to his alli-
ance with Charles V, he should soon be confronted with
a returning French army. Added to his European diffi-
culties, the rapidly advancing power of the Turks in the
East, with invasion of Italy threatened by way of Apulia,
conspired to confuse the papal diplomacy. In 1522 Rhodes
had fallen to the Moslem power. One of the chief bul-
warks on the Eastern front was thus destroyed, the Turks
were in Belgrade, and in 1526 they had destroyed the
Hungarian army at Mohacs.

Although he desired to establish armistice and to re-
main neutral, the distracted Pope was nevertheless per-
suaded to throw in his lot with Francis I, and the result
was the League of Cognac, formed in May 1526, between
Clement VII, Francis I, Sforza for Milan, and the Re-
public of Venice. Active warfare which, as a matter
of fact, had never entirely ceased flamed almost im-
mediately. Francis I, enjoying his new liberty, was slow
in sending assistance, and the Duke of Urbino, who
commanded the northern armies of the new League, was


excessively timid in his tactics. The consequence was that
Milan and Siena remained in Imperial hands; and while
the Pope was sending urgent messages to Francis I for
assistance, the Colonna fell upon Rome, and with a small
army of 5000 men drove the Pope into the Castello Sant’
Angelo, sacked the city, including the Vatican, whence
they took the papal tiara, broke into the secret chapels
of St. Peter’s, and before retiring inflicted a damage
which is estimated to have amounted to 300,000 ducats.
The Imperial armies under Frundsberg and the Duke of
Bourbon, soon after this, marched southward in Italy
and approached Rome. The first attacks upon the city
were made in May 1527.

There followed the sack of Rome one of the most
dreadful calamities that, in its long history, had befallen
the Sacred City. The Pope was made a prisoner. The con-
ditions in the city were described by a Spaniard, Villa,
as follows: “In Rome no bell sounds; no church is open;
no Mass is read. There are no Sundays and no holidays.
The rich shops of the merchants are used as stables; the
most beautiful palaces are devastated. Houses burn, and
the streets are heaps of manure. The stench of the corpses
is dreadful, and in the churches I have seen dead bodies
gnawed by dogs. Mercenaries are dicing for heaps of
ducats in the streets. I can compare it to nothing that I
know except the destruction of Jerusalem.” The cap-
tivity of the Pope was dreadful, not only for physical
suffering and anxiety, but also because it was aggravated
by an outbreak of plague which came with the summer
and killed enormous numbers of the citizens, including


many of those immediately attached to the Pope’s person.
Two cardinals, imprisoned with him, died of the disease,
which was probably bubonic plague.

The same disease contracted in Rome killed Lan-
noy, the Imperial general. The death of this energetic
leader probably had a good deal to do with the subsequent
initial successes gained by Lautrec, who led the French
troops that were now approaching Northern Italy. At
first, the advance of the French was a triumphal march.
Lautrec, to whose French corps were added mercenaries
from Lorraine and the Rhine, and constant reinforce-
ments of Italians, who regarded him as a liberator, re-
conquered the cities of Lombardy almost without opposi-
tion, and learned of the liberation of the Pope and his
transfer to Orvieto when he reached Bologna. Meanwhile,
the Spanish troops, delayed by the pleasures of sacking
Rome, at last became alarmed. Realizing that a decisive
battle would have to be fought for Naples, they hastened
to fortify the place, largely through the advice of the
Prince of Orange, who foresaw and notified Charles V
of the perilous situation.

The Imperial army, which had taken Rome, had by
this time been reduced, largely by the plague, to less than
1 1,000 men, and was wild and undisciplined. This debris
of the once powerful army was encircled near Naples, at
Troja, by Lautrec, with about 28,000 men. Unfortunately,
Lautrec did not immediately attack, but gave the Prince
of Orange an opportunity to escape during the night and
.fortify the position at Naples. It must be remembered
that, at the time Lautrec’s army arrived before Naples,


war upon Charles V was being carried on in all the ter-
ritories of his possessions in the low countries, in Cata-
lonia, and along the Mediterranean coasts. On April 28,
the Imperial navy was almost destroyed, and by June
10 Genoese galleys completely blocked the harbour of
Naples. On the fourteenth of June, 1528, after a month
and a half of the siege, the Prince of Orange wrote to
Charles V: “For ten days we have been living on bread
and water; meat and wine have failed us, and your
troops have not been paid for a long time.” He added:
“Neither they nor I can accomplish the impossible, and
when another month has passed, we will be near the

It is impossible to estimate the consequences for the
future history of Europe if Naples had fallen at this
time, with Italy and the Pope ready to acknowledge
Francis I as liberator and defender of the faith but
then came Typhus. On July 5, Lautrec had believed
Naples incapable of resisting any longer, but in the marshy,
crowded camps of the French the pestilence was destruc-
tive and rapid. Within thirty days, more than half the
army died; according to some accounts, of 25,000 men
only 4000 remained. Vaudemont, Navarro, and Lautrec
himself were taken sick and died. Their successor, the
Marquis of Saluzzo, realized that the siege must be im-
mediately raised. On a rainy night of the twenty-ninth of
August, the retreat began, closely followed by the ener-
getic Piince of Orange with his cavalry. The remnants
of the French army were cut to pieces. They were mur-
dered or disarmed, to perish later at the hands of the


peasants. A few bands managed to reach Rome, half
naked and sick. The Emperor was completely triumphant,
and Clement VII made overtures. The dependence of
Italy upon Spain and the complete control of the immense
influence of the papal power by Charles V was fully es-
tablished. In 1530 Charles V was crowned ruler of the j
Roman Empire at Bologna, by the power of Typhus |

Villalba, in a passage which has been cited, suggests
that typhus was transported from Spain to the New World
during the first half of the sixteenth century.

Ever since the discovery of the New World by the
Old there has been an interchange of many things, good
and bad, between them. At first it was a very uneven
exchange. The Old World brought culture and small-
pox, the Christian religion and measles, rum, European
quarrels, scarlet fever, sparrows, horses and donkeys,
Anglo-Saxons, Irishmen, Jews, Negroes, trousers, influ-
enza, wheat, brotherly love, gunpowder, and tuberculo-
sis. For all these blessings it received in return at first
only gold, tobacco, syphilis, potatoes, and Indian corn.
As the New World flourished it began to pay a more
adequate interest on the invested capital. At present the
honours are about even. Some ot the things America has
received from her elders, like industry, politics, capitalism,
Communism, alcoholism, methodism, baptism, free verse,
free love, psychoanalysis, educational systems, journalism,
philanthropism, the camera, science, art, literature, foot-


ball, rats, remittance men, gypsy moths, Russian princes,
starlings, macaroni, Wiener Schnitzel, labour troubles,
bankers and brokers, and so forth, and so forth, we repay
either in kind or in a bigger and better way. And we add
for good measure high tariffs, peanuts, gramophones,
chewing gum, moving pictures, breakfast foods, heiresses,
Christian Science, cocktail shakers, efficiency methods, and
the boloney dollar. Yet in many ways we shall always
be a colony of Europe, since in the cultural storehouse of
two thousand years there are gifts for which we have no
coin to pay. But this is again aside from our subject. We
are interested in the present connection in whether typhus
fever existed on the Western Hemisphere before these
regions were discovered by Europe, or whether this too is
an importation.

The disease in a form somewhat different from that
of Europe and of Africa is at present prevalent in Mexico,
Peru, Brazil, Bolivia, Chile, and in the Southeastern and
Middle Eastern United States. Its close relation, Rocky
Mountain spotted fever, is at large as we shall see
in the central plateau and mountain regions of our re-
public, and probably in many of the other countries men-
tioned. In Mexico typhus has existed for several centu-
ries. Was it brought by the conquistador es> or was it there
to meet them? The disease in this hemisphere is kept alive
between epidemics in a reservoir of rats. It passes from
rat to rat by the rat louse and the rat flea, and from
man to man by the human louse. Our inquiry, therefore,
involves, among other things: Were the Aztecs lousy?.


What was the status of rodents of the genus rat in ancient

We are, as a matter of fact, in possession of no trust-
worthy accounts from which we can confidently assert
that recognizable typhus epidemics occurred in Mexico
before the arrival of Cortex. There is a legend, credited
by Bernal Diaz and by Nicolas Leon, that the destruc-
tion of the Toltec city of Tollan, in 1116 A.D., S was due
to a typhus epidemic. This may be but the evidence
is as questionable as that concerning the nature of the
plague at Athens during the Peloponnesian Wars. Fer-
nando Ocaranza has recently reviewed the creditable rec-
ords of epidemics in the Aztec kingdom, which are largely
found in the Chronicles of the Franciscan Order. His
evidence is helpful.

Cortez landed at Vera Cruz on the fourth of March
in the year 1519. 6 In 1520, as we have said, a Negro who
landed from the ship which brought the forces of Panfilo
de Narvaez from Cuba came down with smallpox. The
disease spread from Indian village to village, “until there
was not a single healthy village in New Spain.” Fifty
per cent of the population died. The malady was one

6 About the date of the arrival of the Aztecs in Mexico proper.

6 When I entered the harbour of Vera Cruz and then proceeded, in
a comfortable train, along the trail from which Cortez looked back upon
his burning ships, I reflected upon the sublime valour of this man. Per-
haps one of the secrets of his accomplishment lies in the fact that, un-
like modern explorers, he left his wife at home. Would he have burned
his ships had she been with him? No! He would have got as far as
Orizaba, returned to Spain, and written a book called “Hernando and
“Juana Look at Mexico.”


unknown to the Indians. The Franciscans thought that,
had they only arrived in, time, they could have arrested
the outbreak by stopping the native custom of bathing
when sick, through which “the blood was inflamed.”
Many died of hunger, there being too few unafflicted to
serve the sick. The disease was called, by the survivors,
“the great leprosy.”

In 1531 came a second epidemic, again introduced by
the conquerors, called “Tepitonzahuatl” “the small
leprosy.” Many died, but not so many as in 1520. This
was probably measles.

In 1545 the poor devils had another visitation. Ac-
cording to the Friar Geronimo de Mendieta, 150,000 In-
dians died in Tlascala; 100,000 in Cholula, and in other
provinces numbers in proportion to the population. The
symptoms were congestion ($ujamiento\ fever, bloody
stools, blood from the nostrils. It might have been dysen-
tery or typhoid fever, but the mortality is too high for
these. Only plague or typhus would be likely to account
for the death rate. Plague could hardly have escaped
some recognizable description. Typhus, or tabardillo, if
present, should have been recognized for it was known
in Spain at the siege of Granada, which fell on January
2, 1492. The friars knew no name for the Indian disease
of 1 545. But they may have been as inexperienced as many
good modern doctors. It took several years before BrilPs
disease, seen in New York in 1906, was recognized as
typhus fever first by a Jewish physician from Poland,
who happened to stroll through the wards of a New York-
hospital. The 1545 epidemic might have been typhus.


In 1564 the poor Aztecs were again decimated by a
disease of undeterminable nature.

In 1 576 a disease occurred similar to the one of 1 545
again “pujamiento de sangre” This was recognized as
tabardillo. From this time on typhus epidemics were com-
mon and were definitely diagnosed. In the 1588 outbreak
there was a concentration of cases in the Valley of Toluca.
In this valley the natives were now mixed together, but
only the Matlaxingas were severely attacked a legend
which, if true, may indicate that among the others a de-
gree of immunity existed; and such immunity is the result
of exposure to the disease, with many mild cases, in
childhood evidence of possible epidemic preexistence
of the disease among the two less afflicted tribes.

In 1595, measles, mumps, and tabardillo were ac-
cording to this Friar Mendieta common among all the

Mooser, who was the first to differentiate precisely
between a European and a New World typhus, is inclined
to believe that the disease existed in Mexico before the
arrival of the Spaniards, for the following reasons. He
says: “The Indians of Michoacan called typhus ‘coco-
lixtle meco’ or spotted fever: cocolixtle meaning painful
fever and meco derived from *Chichimecas,* a tribe whose
members painted their bodies with red stripes and spots.”
Torres relates that in some parts of the state of Michoacan
it was not until recent years that the name “cocolixtle
meco” began to be replaced in the language of the people
by the Spanish word “tifo.” The Aztecs called typhus
“matlazahuatl.” Matlatl signifies net, and zahuatl erup-


tion, or spots, which means an eruption arranged in the
form of a net. 7 He adds that there is a hieroglyph pictur-
ing typhus in the form of a man covered with spots like
a net, who is holding his head with both hands, and whose
nose is bleeding. Mooser also observes that in describing
an epidemic of 1573, Diaz says that “the terrible coco-
lixtle broke out in the surroundings of the City of Mex-
ico,” evidence that the Spanish had taken over the Indian
name for the disease before they applied their own. This,
we believe, is of considerable significance since, in the ab-
sence of skillful physicians, it would tend to indicate that
the conquerors assumed they were witnessing an epidemic
of a disease long endemic in the occupied territory, not
identifying it with their own tifo or tabardillo until much

There is much in the historical evidence which suggests
the existence of typhus fever among the South American
nations in pre-Columbian days. That there were no rats
in South America before the time of Blasco Nunez, first
Viceroy of Peru (15441546), is not a decisive argument
against such an assumption. For many other rodents can
harbour the typhus virus in an “inapparent” form that
is, without exhibiting obvious symptoms. 8

The occurrence of typhus in epidemic form, at such a

7 Ocaranza does not agree with this and quotes Robelo to the effect
that none of the Mexican dialects were ever written down correctly,
and that it is quite possible that the Aztec name of the disease may
have been, not matlazahuatl, but matlatzdatl, meaning “ten swellings,”
which could possibly signify smallpox.

8 Guinea pigs, rabbits, and a variety of mice can be infected in the
laboratory none of these animals dying as a result of the infection.
Native Mexican rodents have recently been found susceptible.


period, would, however, be quite out of the question
could it be shown that the Aztecs had no lice. In our dis-
cussion of lice we have referred to the studies of Fahren-
holz and particularly to those of Ewing on the varieties
of these insects found on different races of men. Ewing,
it will be remembered, found lice on the scalps of Peru-
vian and of Southwestern American Indian mummies. He
further mentions the presence, on the widely distributed
South American spider monkeys, of varieties of lice
sufficiently similar to those of man to arouse the specula-
tion that the monkeys may have acquired their infesta-
tions from ancestral human forms some tens of thou-
sands of years ago. However this may be, the mummy
observations establish beyond peradventure that aborigi-
nal Americans had lice of their own.

As for the actual lousiness of the Aztecs themselves,
we can find no data except Ojeda’s story of the bags of
lice offered as tribute to Montezuma by the poor. But
Cowan believes that the supposed lice in the bags were
“cochineal insects,” then unknown to the Spaniards. The
selling of the “long worms and lice” for food in Mexico
recounted in Purchases Pilgrims should also be taken
with more than a grain of salt.

Yet more circumstantial evidence makes it almost im-
possible to doubt that the Aztecs had lice. 9

The nation of the Aztecs arrived on the high plateau

9 To be sure, Mooser writes us that in a village some distance from
Mexico City, where a recent epidemic occurred, the Indians had their
own words for other animals, but used the Spanish words “piojo,”
‘”caballo,” for “louse” and “horse.” This is important enough to war-
rant further investigation among other tribes.


of Mexico probably in the early twelfth century. They
came out of the Northwest from the legendary region
of Aztlan. That is about all we know, and beyond this
their origin is as vague as that of any of the other tribes
inhabiting this hemisphere before the discovery Mayas,
Incas, Northern Indians, and Eskimos. Yet, though these
peoples, as far as we can ascertain, knew nothing of each
other, and neither had contacts nor influenced each other’s
civilizations, they unquestionably come from one and the
same stock, and this is now more than conjecture we
can reliably assert it on the basis of blood groupings.
We need not go into this technically for our present pur-
pose. The facts are that by easily performed experiments
on the interaction of the blood serum of one individual
with the red blood cells of another, we can divide man-
kind into four sharply differentiated groups. Actually
there are more than these, but the four main ones will
do for the moment. The characteristics which determine
this grouping are hereditary and the inheritance follows
definite genetic laws. Consequently the study of the blood
groups has considerable anthropological-ethnological value
in revealing the relationship between different races of
men. Among Europeans, centuries of racial mixture have
obliterated origins as far as the blood groups are con-
cerned. And the same confusion exists among Asiatics.
But among inhabitants of the Western Hemisphere, when-
ever reasonably pure stock has been investigated, it has
been found that a single blood group, namely that spoken
of as “Group O,” predominates. Unfortunately, there
are no pure-line Incas available for study j but Mayas


have shown 97.7 per cent and the Yucatan mestizos 85
per cent Group O. A small group of Aztec descendants,
obviously not pure, studied by Castaneda, were 80 per
cent, and the pure-blooded American Indians are 90 per
cent or over of this group. Baffin Bay Eskimos, if of pure
blood, are entirely “O.”

These facts have many interesting connotations, most
of which have nothing to do with this discussion. The im-
portant point for us is that the similarity of blood group-
ing indicates the close relationship of racial stock among
the inhabitants of the Western Hemisphere. And when
this is considered, together with the fact that lice have
been found on prehistoric mummies on at least two sub-
divisions of American aborigines, it appears more than
likely that the Aztecs as well as the Incas were lousy.

While the historical data which we have discussed
and the probability that the Aztecs were lousy combine
to render likely the pre-existence of typhus on the Western
Hemisphere before the Spanish conquest, it is still im-
portant to examine whether there are any facts from
which we can deduce the possibility of the introduction
of the disease from Europe before the earlier date of a
recognizable epidemic in Mexico.

Typhus was distributed throughout Spain before Cor-
tez landed in Mexico. If the disease was imported by the
voyagers, it could not have come in infected lice. The
Spanish adventurers went first to Cuba, before proceeding
to points on the coast of Yucatan and Mexico. This cross-
ing could never have been accomplished in less than several
months, and the typhus-infected louse dies of the disease


in at most twelve to fourteen days after feeding on in-
fected blood. It is of course possible that the virus might
have passed from sailor to sailor in a succession of typhus
cases during the voyage. But had this occurred it would
have been a serious matter, and it is likely that a record
would have survived. In this connection there is an amus-
ing observation of Oviedo, which we quote from Cowan.
He observed that when the ships entered the tropics on
their way to the Indies, the lice abandoned the sailors
and attacked them again at the same point on their re-
turn. The observation is questioned by one of the supple-
mentary writers in Cuvier’s History of the Insects. Cowan
thinks that there might be a certain amount of apparent
truth in it, since heat and abundant perspiration are un-
favorable to the propagation of the body louse. On the
other hand, it is much more likely that in the hot weather
the sailors took off their clothes, and that thereby the
body louse was largely discouraged j but head lice, also
capable of carrying the disease, would have remained.
We have found head lice plentiful in Arabian populations
in North Africa in the middle of the summer, and while
not as abundant in warm countries as in the colder ones,
head lice may thrive under a variety of climatic condi-
tions. It is, for the reasons mentioned, however, unlikely
that infected lice could have been transported alive on
the first stages of the voyages to America.

While such transportation of the disease could, there-
fore, be questioned, it is not impossible that the virus may
have been imported with ship rats or mice. As we have
seen, the black rat has been present in Western Europe


certainly since the twelfth century. It was present in
France and therefore with all likelihood in Spain in the
early thirteenth century, its presence in France being
clearly set down in the “Roman du Renart” and in the
two similar ballads, “Renart le Nouvel” and “Renart
le Contrefait,” which date from the late thirteenth and
early fourteenth centuries. In rats, the disease can be kept
going indefinitely, and may easily have survived voyages
even longer than those of the Spaniards. If in this way
the disease may have become endemic in Cuba, between
which and many parts of Spain there was frequent com-
munication during the early sixteenth century, it might
readily have been carried from Cuba to the coast of
Yucatan and Mexico. The first real epidemic in Mexico
which was specifically recognized as typhus by the friars
was not until 1576. Bernal Diaz, under Grijalva, left
Havana on February 8, 1 5 1 7, in a ship which took twenty-
one days to reach the coast of Yucatan. This expedition
did not proceed to Mexico proper, but went on to Florida,
where half of the Spaniards were killed by the natives.
Cortez left Havana on February 10, 1519, and arrived
on March 12 at Tabasco, having touched Cozumel in
Yucatan, and then went on to San Juan de Ulua, or Vera
Cruz, where he landed on the day before Good Friday.
After that, frequent voyages were made, and it is not
possible to exclude the transportation of infected rats
and their distribution from the coast to the high plateaus,
where the transmission of the disease to individual human
beings by the first rat flea might easily have started an
epidemic among a lousy population, even as it does now.


in at most twelve to fourteen days after feeding on in-
fected blood. It is of course possible that the virus might
have passed from sailor to sailor in a succession of typhus
cases during the voyage. But had this occurred it would
have been a serious matter, and it is likely that a record
would have survived. In this connection there is an amus-
ing observation of Oviedo, which we quote from Cowan.
He observed that when the ships entered the tropics on
their way to the Indies, the lice abandoned the sailors
and attacked them again at the same point on their re-
turn. The observation is questioned by one of the supple-
mentary writers in Cuvier’s History of the Insects. Cowan
thinks that there might be a certain amount of apparent
truth in it, since heat and abundant perspiration are un-
favorable to the propagation of the body louse. On the
other hand, it is much more likely that in the hot weather
the sailors took off their clothes, and that thereby the
body louse was largely discouraged ; but head lice, also
capable of carrying the disease, would have remained.
We have found head lice plentiful in Arabian populations
in North Africa in the middle of the summer, and while
not as abundant in warm countries as in the colder ones,
head lice may thrive under a variety of climatic condi-
tions. It is, for the reasons mentioned, however, unlikely
that infected lice could have been transported alive on
the first stages of the voyages to America.

While such transportation of the disease could, there-
fore, be questioned, it is not impossible that the virus may
have been imported with ship rats or mice. As we have
seen, the black rat has been present in Western Europe


certainly since the twelfth century. It was present in
France and therefore with all likelihood in Spain in the
early thirteenth century, its presence in France being
clearly set down in the “Roman du Renart” and in the
two similar ballads, “Renart le Nouvel” and “Renart
le Contrefait,” which date from the late thirteenth and
early fourteenth centuries. In rats, the disease can be kept
going indefinitely, and may easily have survived voyages
even longer than those of the Spaniards. If in this way
the disease may have become endemic in Cuba, between
which and many parts of Spain there was frequent com-
munication during the early sixteenth century, it might
readily have been carried from Cuba to the coast of
Yucatan and Mexico. The first real epidemic in Mexico
which was specifically recognized as typhus by the friars
was not until 1576. Bernal Diaz, under Grijalva, left
Havana on February 8, 1 5 1 7, in a ship which took twenty-
one days to reach the coast of Yucatan. This expedition
did not proceed to Mexico proper, but went on to Florida,
where half of the Spaniards were killed by the natives.
Cortez left Havana on February 10, 1519, and arrived
on March 12 at Tabasco, having touched Cozumel in
Yucatan, and then went on to San Juan de Ulua, or Vera
Cruz, where he landed on the day before Good Friday.
After that, frequent voyages were made, and it is not
possible to exclude the transportation of infected rats
and their distribution from the coast to the high plateaus,
where the transmission of the disease to individual human
.beings by the first rat flea might easily have started an
epidemic among a lousy population, even as it does now.


It is quite impossible to decide with certainty whether
typhus was one of the gifts bestowed, with other things,
by Europe upon the Western Hemisphere. But in com-
ing to this conclusion we have learned a number of inter-
esting facts.

Young manhood: the period of early vigor and wild oats


AFTER the wars of Granada, the distribution of typhus
from Spain to Italy, France, and thence northward, con-
tinued in an almost uninterrupted succession of small
outbreaks; and when these were hardly spent, a new
wave started from south to north after the siege of
Naples in 1528. Again in 1552, true to its strategy of
taking advantage of every weakness in the defenses of
mankind, a serious typhus epidemic forced Charles V to
abandon the siege of Metz. The investment of the city
took place in the winter months, and the Imperial army,
which contained Spaniards, German and Italian merce-
naries, began, by early December, to suffer severely from
a combination of diseases, among which were scurvy and,
as usual, the enteric fevers j but the most vicious of them
all was typhus. More than 10,000 men are said to have
died within the month, and before the end of the year
the besiegers fled, leaving the surrounding country thor-
oughly infected. It is perhaps at this time that the term
“Morbus carcerorum” first became common for our dis-
ease, since great numbers died in the military prisons.
In the villages of the countryside the pestilence did not
abate until late in the following summer.

From then on typhus was never absent from the regions


invaded by returning soldiers, who lighted fuses of in-
fection that flickered along through villages and cities
wherever chance sparks lighted on inflammable material.
But of these irregularly scattered and generally small
outbreaks we have little precise information. It is not im-
possible that, without further great conflagrations, the
disease might have died out in succeeding centuries had
not the infection, in these early phases of its Continental
life, been repeatedly renewed from the Eastern front.

The most important episode in the conquest of Europe
by typhus occurred at about this time in Hungary. We
have, in a preceding chapter, alluded to the belief ex-
pressed by de Toro, and repeated by Fracastorius, that
typhus was imported from Cyprus ; and there is much
in the historical records to suggest that the evolution of
the parasitism of Rickettsise was several hundred years
more advanced in the Orient than in Europe proper. It
seems hardly reasonable to accept as an accidental coinci-
dence the fact that the two earliest epidemic waves of
typhus which swept through Europe proceeded from
areas in which Western armies were defending their
frontiers against Oriental powers: the first during the
struggle between the Spaniards and Saracens; and the
second, of which we are about to speak, as a result of
war with the Turks on the Hungarian front.

Since the early Middle Ages, Hungary and the Balkan
Peninsula had been the frontiers of Christianity against
the Crescent. In the early fifteenth century the Turks
made powerful progress and, again and again, defeated
Hungarian armies, making themselves masters of Serbia,


not infrequently of Hungary proper, and, on occasion,
investing Vienna. Eastern Hungary, for over a hundred
years, was thoroughly overrun. At times it could obtain no
help from the Emperors of Austria, and defended itself
as best it could with the meagre forces which the King
of Hungary could raise among his own people. The only
frontier protection consisted of a chain of about fifty-five
castles irregularly scattered along the border, without
organization, fighting as much with one another as with
the Turks. There was a thorough admixture of popula-
tions the Turkish armies containing Christian cap-
tives and renegades, the so-called “matrolosos” or “qua-
stotori”; while Turks similarly joined the Christian forces.
We have no precise knowledge of the nature of the
epidemic which was Hunyadi’s most powerful ally when
he relieved the siege of Belgrade and defeated Moham-
med II in 1456. It might have been typhus it might
have been plague. Whatever it was, the victory was a ster-
ile one for Hungary, for the disease killed Hunyadi him-
self. From that time on, for a hundred years and more,
epidemics, which were probably both typhus and plague,
stepped on each other’s heels, accompanied the incessantly
warring armies, and, during the brief periods of armistice,
were carried, by returning troops, to villages and towns.
But it is not until 1 542 that we have sufficiently precise in-
formation to permit a reliable diagnosis of typhus. In
this year Joachim of Brandenburg was in Hungary with
an army consisting chiefly of Germans and Italians. The
disease which killed 30,000 of his men, spoken of as
“Pestartige braiine,” was undoubtedly typhus fever. For


us, in tracing the wanderings of this infection, it is of con-
siderable interest to know whether the Margrave’s soldiers
brought it with them or whether they acquired it from the
Hungarians and the Turks. For, as we have seen, typhus
had by this time entered Spain and Italy from the West,
and was not unknown in France and Germany. A clue
to the problem is furnished by an observation of great
importance recorded by Gyory. Gyory states that the
Germans suffered severely, whereas the mortality among
the Hungarians and Turks was relatively slight. 1 Ac-
cording to contemporary observers, the mortality among
the Germans was so great that a considerable part of the
army never closed with the enemy, because the “Hun-
garian disease” killed them before the Turks had an op-
portunity to do so. It was for this reason that Hungary
was called the “graveyard of Germans.”

If this is correct, and it is not the sort of thing that
would suggest itself without actual observation, it can
have only one meaning: namely, that our disease was
already well established in Hungary when the Imperial
armies arrived. Typhus confers an immunity which,
though not permanent, may still last for years, and it is
commonly observed that, in endemic regions, newcomers
from countries where typhus is not prevalent are much
more severely attacked than are the native born. The
relative immunity of the Turks and Hungarians, there-
fore, would tend to indicate the existence of a “herd”
resistance among them, a phenomenon which could have
been produced only by prolonged and constant exposure

1 Quoted from Prinzing.


to the disease, a continuity of sporadic cases and small
group outbreaks. With the returning army of the Mar-
grave the disease was again disseminated far and wide in

The episode repeated itself on a much larger scale
shortly after this (1566), when Maximilian II advanced
into Hungary to protect his Eastern marches. The first
passages at arms were favorable to the Emperor, who
might have accomplished his purposes promptly had not
typhus again taken a decisive hand. The Imperials en-
camped along the Danube, large bodies on the island of
Komorn, on the Raab, and at Rabnitz. There was food
shortage, bad water, and, Schnurrer adds with obvious
horror, the beer went sour. Bad and inadequate food led
to scurvyj the weather was intensely hot, dysentery and
enteric fever debilitated the men; and all these things
together prepared an ideal soil for typhus. Thomas Jor-
danus, who was present as expeditionary surgeon, has
left a vivid description which makes the diagnosis un-
questionable. An onset with chills was followed by ab-
dominal pain, unquenchable thirst, delirium, and a petech-
ial eruption which was present in almost all the cases he
saw. From the army the disease spread through the sur-
rounding country, and Maximilian was forced to abandon
his campaign and make an unfavorable peace with the
Turks. Eventually discipline failed and the troops scat-
tered in bands, carrying the disease with them into Italy,
Bohemia, and Germany, thence into France, through
.Burgundy, and northward into Belgium. Wherever these
little rivulets of infection reached towns, epidemics re-


suited. Vienna suffered the most severe typhus outbreak
of its history. Ever since that time typhus has remained
endemic in Hungary, the Balkan States, and the adjoin-
ing territories of Poland and Russia. These are still, at
the present day, the “home stations” from which modern
European epidemics take origin.

As far as historical studies can give us a clue to such
matters, we are inclined to believe that the Hungarian
wars and their consequences created the circumstances
which gave typhus the opportunity of passing from man
to man by lice in uninterrupted cycles, short-circuiting the
rat-flea phase and adapting the parasitism firmly as a man-
louse-man transmission in the form which we now know
as the “classical European type” or “virus humanise.”

In describing the events which permitted typhus fever
to overrun the European Continent during the seventeenth
century we confine ourselves to major episodes. It would
require far greater diligence than we possess and, in-
cidentally, would be excessively dull were we to cata-
logue the almost incessant succession of minor outbreaks
which harassed towns and villages during the intervals
between great epidemics. Once thoroughly established
west of the Balkans by the circumstances described in
the preceding section, typhus began to spread in all di-
rections, not unlike a brush fire, now low and smouldering
and, perhaps, in places almost extinguished; again slowly
burning its way into new regions; at all times ready to .
burst into destructive flame when fuel was available. In


this it was not alone during that century which was, of all
periods of so-called Christian civilization, the most miser-
able for man. Plague, which was then the inseparable,
ferocious companion of typhus, had never been entirely
extinguished since the fourteenth century j smallpox,
diphtheria, the enteric fevers, and all the lesser scourges
were constantly alert; and the chronicles of the years
are pitiful records of famine, pestilence, and unbelievably
savage wars.

The wretchedness of the period is vividly set forth in
the account in which Lammert has compiled, year by
year, from 1600 to the end of the Thirty Years’ War, the
dreadful companionships of pestilence and warfare. Lam-
mert was a Eezlrksarzt (district physician) at Regensburg
who studied the local chronicles of different regions in
Germany. He had the quaint habit of heading the sections
treating of successive years with records of weather condi-
tions, crop reports, and, invariably, with statements con-
cerning the quality of the wine. 2 Thus, in 1602, we find:

2 Lammert’s preoccupation with the weather is quite natural. Earlier
books on epidemic disease are dominated by the idea that natural
phenomena, volcanic eruptions, earthquakes, abnormal weather con-
ditions, eclipses, and so on, were largely responsible for epidemics.
Modern epidemiology recognizes that atmospheric conditions, tempera-
ture, humidity, have distinct effects upon the occurrence and spread
of disease, facts for which there are rational explanations. Lammert’s
attention to the vintage is not so readily explained, but may not be as
illogical as it seems at first sight. The habit of wine drinking may
well have had its origin in a crude public-health conception. Wherever,
in the Middle Ages, people lived together in groups, the water was
contaminated. Men knew by experience that drinking water was apt to
*be dangerous. There is a passage somewhere in Froissart which tells us
that an army marching into Spain was rendered helpless by an outbreak


“There was a severe winter, a cold April, a hailstorm in
the summer. The wine was scarce and of poor quality. In
this year there was plague in the Palatinate, through
Saxony and Prussia. In Danzig 12,000 people died in
one week. There was a smallpox epidemic in Bohemia j
another in Silesia. In Southern Germany there raged the
terrible Bauchkrankheit [probably dysentery or typhoid].
There was a famine in Russia accompanied by pestilences
of plague and typhus, and in Moscow alone [probably a
gross exaggeration] 127,000 people are said to have died
of pestilence.”

Each year repeats the grim story. We choose another
at random. Thus: “In 1613, when the wine was plentiful
but sour, the Hungarian disease [typhus] swept across
Wiirttemberg and the Tyrol. Hauptweh [typhus] reigned
in Magdeburg. There was plague in Regensburg, in Leip-
zig, in Bohemia and in Austria, whence it spread east-
ward.” Such is the story year by year until 1618, when
the Thirty Years’ War began.

The Thirty Years’ War was the most gigantic natural
experiment in epidemiology to which mankind has ever
been subjected. 8 Europe, as we have seen, was a spot map

of dysentery which occurred because the wine gave out and the men
had to drink water. This was an army of 20,000 men, and the implica-
tion is that the entire 20,000 drank no water until they were unable to
get hold of wine.

8 There is a relatively new method of investigating infectious disease
which is called “experimental epidemiology.” It consists in setting up
large colonies of mice, rats, guinea pigs, rabbits, or other animals sus-
ceptible to spontaneous infection with some microorganism, and then
introducing, into such a colony, under a variety of controlled conditions,
one or more infected individuals. In this way the circumstances which


of constant small outbreaks of every conceivable infectious
disease j and through this area, for a little over twenty-
nine years, armies marched and countermarched, and dis-
banded soldiers, fugitives, and deserters vagabonded far
and wide. Famines resulted and populations wandered in
fugitive hordes toward food and protection. Wherever
men travelled, disease followed them.

The history of these epidemics can be fully understood
only against the background of the conditions which gave
rise to them 5 and a conception of these conditions can be
best conveyed by episodes such as those taken by Lam-
mert from contemporary records. There is an embarrass-
ment of choice. The following random example is trans-
lated verbatim from a paragraph included by Lammert
in his account of the year 1632. We might, with equal
illustrative value, have chosen almost any other year:
“When Gustavus Adolphus, after taking Memmingen,
prepared to overrun Southern Germany, he was held
back by the news of Wallenstein’s triumphal progress in
Saxony. Memmingen was soon recaptured by the Im-
perial army. The former ‘Reichstadt,’ Kempten, fell into

favour spread can be observed and much information obtained. The
method has proved useful, but has its inevitable limitations, because a
mouse or guinea-pig colony in a closed compartment can never entirely
simulate the complex conditions of human association. Nature sets up
her experiments of epidemiology in times of war and famine, and
when, as in the wars of the late nineteenth and the twentieth century,
these dreadful experiments can be observed by a competent medical
profession, much of value to mankind may be learned. It can well be
said that nobody won the last war except the medical sciences. The
B profit was not worth the loss, but the increase in sanitary and medical
knowledge was the sole determinable gain for mankind in an otherwise
utterly disastrous catastrophe.


the hands of the Swedes, and the contemporary chronicle
written by Dr. Ph. Jak. Karrer records the revolting oc-
currences in tfiis town.” The good Lammert writes, “Die
Feder straubt sich” the pen revolts against recording
“such bestialization of man.” When women were cap-
tured, their breasts were cut off} mothers, with their
children and servants, were thrown into the river. The
soldiers killed the local surgeon, ravished his daughter,
gouged out her eyes, and threw her out of the window to-
gether with her dead father. In the presence of husbands
and parents, later to be murdered, wives and daughters
were raped. Finding a housewife standing before a kettle
of boiling water, the Swedes cut off her hands, dipped her
head repeatedly into the kettle, and decapitated her.
Six little children were found murdered in a cellar. On
the thirteenth of January the city again fell into the
hands of the Imperial troops. The atrocities which the
conquerors now perpetrated upon what was left of the
population, recorded by Dr. Gabriel Furtenbach in what
he appropriately calls his Jammer chronik> defy all -imagi-
nation. This happened shortly before the march of Gustavus
Adolphus on Nuremberg, where typhus wrought appro-
priate vengeance on both armies.

Prinzing divides the epidemiological history of the
Thirty Years’ War into two main periods: the earlier,
from 1618 to 1630, when typhus was the chief scourge;
and the later, from 1630 to 1648, when plague gained
the ascendancy. It must not be forgotten, however, that
throughout the entire period both diseases raged to-
gether and were sturdily reenf orced by dysentery, typhoid


fever, diphtheria, smallpox, scarlet fever, and a variety
of less deadly confederates.

The very beginning of the war was accompanied by a
severe typhus epidemic. The army of Mansfeld, after
the battle of Weissenburg, marched through the Palati-
nate into Alsace, and everywhere left typhus behind it.
This started a succession of epidemics through Bohemia
and the South of Germany. Thence the disease was car-
ried into the North with the troops of Wallenstein and
Tilly, where in 1625 plague and typhus reached their
culmination. Devastation of the fields drove peasants into
the cities, and the pestilence spread into Strassburg, Mann-
heim, Frankfort, Mainz, Nuremberg, and all the smaller
towns. In Metz, typhus again appeared in 1625, and
then spread through Verdun into France. Saxony suffered
severely from typhus and plague after the battle of Brei-
tenf eld in 1631. Plague now gained the ascendancy and
the two diseases together traveled with the rapidly moving
armies, remaining behind when the soldiers departed,
and spreading from innumerable foci into the surround-
ing country. Bavaria was almost depopulated at this time.

In June of 1632 Gustavus Adolphus besieged Nurem-
berg. An enormous number of fugitives and troops had
congregated in the city. After eleven weeks of stubborn
resistance food and supplies gave out. The Hungarian
disease (typhus) and scurvy spread among besieged and
besiegers alike. In the town some five thousand victims
are inscribed in the church records, and these are only a
-fraction of the dead. The nun, Maria Anna Junius of
Bamberg, writes in her chronicle under the date of No-


vember of this year: “War damals gross e Then/rung und
Sterb zu Niirnberg % doss in 7 Wochen 29,000 Menschen

The Swedish army suffered no less. Hunger and disease
destroyed all discipline, and the impoverished peasants
of the surrounding country fell prey to the ferocity of
the soldiers. After a final unsuccessful attempt to storm
the town on September 3, the Swedish King was forced
to retreat. He left desolation behind him: fields were
devastated 5 villages were heaps of ashes, their streets
foul with the stench of dead bodies j in one district only
a quarter of the original population survived; many of
the few survivors, citizens, peasants, and stray soldiers,
contracted disease by invading the abandoned encamp-
ments of both the Swedish and the Imperial troops in
search of food and plunder. Typhus and plague were
again scattered far and wide. Typhus had raised the
siege and had forced both armies to retreat without

The epidemic disasters of the Thirty Years’ War, how-
ever, were not limited to the actual scenes of struggle.
Infection was constantly carried across national borders.
In 1624 over ten thousand people died in Amsterdam.
France was invaded by typhus at almost the same time.
Western Provence was, at this time, the scene of the
ferocious war waged against the Calvinists. Montpellier
was besieged in 1623, and a disease broke out which is
described by Lazarus Riverius as “febris maligna pesti-
lens.” His description, which Murchison cites in detail, is
unmistakably that of typhus. “The skin was marked by


an eruption of red, livid or black spots resembling flea
bites, which appeared from the fourth to the ninth day,
over all parts of the body, but most frequently on the
loins, chest and neck.” The infection remained in the
district and again became epidemic in 1641. From Mont-
pellier typhus, together with bubonic plague, spread north-
ward. In 1628 (we take our figures from Prinzing),
there were 60,000 deaths in Lyons and 25,000 in Limoges.
It extended to Paris and Avignon, toward the Pyrenees
and along the Mediterranean littoral.

When the Thirty Years’ War was ended, no corner of
the European Continent was left without its foci of in-
fection. And although the dreadful period of this war
overshadows all other events of the century, the subse-
quent years were by no means peaceful ones. The cam-
paigns of Turenne, the wars in the Netherlands and in
Russia, and continued warfare with the Turks, es-
pecially the siege of Vienna in 1683, offered typhus
all the opportunities it needed for continuous activity.
And in Italy especially Sicily famines gave the
disease a free hand in some of the most severe epidemics
of its history. Meanwhile France itself was not spared,
and 1651 and 1666 were calamitous typhus years for
Poitou and Burgundy.

On the Eastern battlefields, where the struggles be-
tween Russia, Austria, and Hungary continued without
respite until well into the eighteenth century, the disease
became more and more firmly implanted, leading to the
establishment of the permanent foci of which we have



In the early epidemiological records of England there
is no evidence that typhus fever existed before it had
become firmly established on the Continent, There were,
of course, many dreadful epidemics such as the “Drif ”
or “famine fever” of 1087, mentioned in the Anglo-
Saxon chronicles: “A.D. 1087 after the Birth of our Lord
and Saviour Christ, one thousand and eighty-seven win-
ters} in the one and twentieth year after William began to
govern and direct England, as God granted him, was a
very heavy and pestilent season in this land. Such a sick-
ness came on men that full nigh every other man was in
the worst disorder, that is in the diarrhoea; and that so
dreadfully, that many men died in the disorder.” This
was quite evidently not typhus possibly dysentery
and enteric fever combined with the deficiency diseases
incident to famine. We are equally in the dark concerning
the nature of the famine fevers of 1 1 96 (described by Wil-
liam of Newburgh), of 1258, and of 1315. Lieuten-
ant Colonel W. P. MacArthur, who has written a
scholarly review of typhus in ancient England, is in-
clined to believe that these epidemics, as well as the
diseases associated with gaols in London in 1414, were,
in part, typhus. But he suggests this only in view of the
circumstances under which the outbreaks occurred, and
admits the complete lack of basis for any specific diagnosis
in the very vague descriptions. In view of the apparent
absence of epidemic typhus from Europe before the
fifteenth century, it would seem far more likely that the


disease, once well established on the Continent by the
middle of the sixteenth century, had then crossed the
Channel and the Irish Sea, where it found a fertile soil
in the crowded and filthy villages and towns inhabited
by thoroughly lousy populations.

In England some of the earliest unmistakable ravages
of our disease were in the prisons, where it became known
as the dreaded “gaol fever” or “jayl fever.” MacArthur
tells us that the English prison system was “thoroughly
rotten from top to bottom. . . . Some gaols were private
property, rented by the gaolers, “who reimbursed them-
selves by fees exacted from the prisoners and their friends.
. . . Prisoners were loaded with chains so that gaolers
could extort bribes for ‘easement of irons.* . . . Prisons
were scandalously overcrowded and indescribably filthy.”
These conditions continued for centuries, until after 1770,
when John Howard, the first great advocate of prison re-
form (who himself died of typhus as a result of his tours of
inspection), wrote his pamphlet on The State of the
Prisons in England and Wales. Typhus flourished in the
gaols and, on occasion, escaped and ran riot in the sur-
rounding country. This it did in particularly dramatic
fashion in what are known as the Black Assizes. There
were a number of these: at Oxford in 1577j at Exeter
twelve years later, and, the last serious one, at the Old
Bailey in 1750. The following facts are largely taken
from MacArthur.

In 1577 there was committed to prison at Oxford a

certain Rowland Jencks, a Catholic bookbinder who was

accused of speaking evil of “that government now set-

T 1


tied,” of profaning God’s Word, abusing the ministers,
and staying away from church. Considering the times,
he appears to have been a fellow of spirit and conviction.
Just before his trial started a number of inmates of the
prison at Oxford had died in their chains. The trial, at
which Jencks was condemned to have his ears cut off,
took place in a court unusually crowded because of the
lively public interest aroused by the Jencks case. Soon
after the trial typhus began to appear among those who
had been present. MacArthur tells us that Sir Robert
Bell, the Lord Chief Baron, and Sir Nicholas Barham
both died, as did the sheriff, the undersheriff, and all of
the members of the Grand Jury except one or two. The
total deaths were over five hundred, of which one hundred
were members of the University. The occurrence created
considerable excitement, and even Sir Francis Bacon took
the trouble to investigate, attributing the disease to the
stinks that “have some similitude with man’s body and
so insinuate themselves.” 4 The theories of the day at-
tributed most of these mysterious infections to’ vitiated
air, a not unnatural assumption under the circumstances.
In this particular case papistical evil magic was suspected
in the form of winds compounded in Catholic Louvain
and secretly let loose at Oxford, diabolicis et papisticis
flatibus. Jencks himself, MacArthur says, though deprived
of his ears, escaped the infection, settled in Douai, where
he obtained employment as a baker in the English Col-
lege of Seculars, and lived thirty-three y^ars after the

4 In the medical jargon of to-day these would be known as “ho-
mologous stinks.”


disastrous Assizes. Reasoning from the manner of spread
of the disease among the learned audience, MacArthur
reaches the conclusion in which facts force us reluc-
tantly to concur that no inconsiderable number of the
faculty of Oxford College were, at this time, lousy.

The Exeter Assizes were, in a general way, similar in
circumstance to those which shortly before had occurred
at Oxford. That the condition of jails nevertheless con-
tinued unchanged is witnessed by the Old Bailey out-
break which came two centuries later (1750) and was in-
vestigated and described with accuracy by Sir John Pringle,
Physician in Chief to His Majesty’s Forces and later
President of the Royal Society.

In England, generally, typhus penetrated all corners
of the Island. The description by Thomas Willis, the
Oxford anatomist, leaves no room for doubt that the
disease which decimated both the Parliamentary and the
Royal armies at the siege of Reading in 1 643 was typhus
(Murchison). And in 1650 an epidemic of the same
character “converted the whole Island into one vast
hospital.” And, just as on the Continent typhus and
plague marched hand in hand at this time, the Great
Plague was accompanied by typhus which preceded the ac-
cumulation of plague cases during the cold winter of 1 665.

Exactly when typhus reached Ireland, which later be-
came and still remains one of the most impregnable
strongholds of the disease, is uncertain. Murchison says
that the first precisely recorded epidemic was that ob-
served at Cork in 1 708, but there is reason to believe that,
as the “Irish Ague,” it had existed long before that time.


Appraisal of a contemporary and prospects of future
education and discipline

WERE we engaged in writing medical history instead of
biography, it would now be our task to describe, chrono-
logically and geographically, the almost uninterrupted
succession of typhus epidemics which spared no byway
and corner of Europe throughout the eighteenth and a
large part of the nineteenth century. Such records, how-
ever, though indispensable to the student of infectious
diseases, would contribute little to our present purpose
of setting forth the character and habits of the subject of
our biography. They are available, moreover, in forms
far more scholarly and thorough than anything we could
achieve, in the treatises of Ozanam, Hirsch, Haeser,
Prinzing, and others, from all of whom we have freely
borrowed. The specialist, in studying the epidemiological
data of former times, not infrequently finds observations
and information which, in the light of modern knowl-
edge, become valuable clues to unsolved problems. From
the biographical point of view, however, circumstantial
accounts of the typhus outbreaks, of which no decade of
the period of which we speak was entirely free, would be
dull with constant repetition. The circumstances of oc-
currence, sequence of events, and manner of spread were


always the same in principle. Typhus had come to be the
inevitable and expected companion of war and revolu-
tion} no encampment, no campaigning army, and no be-
sieged city escaped it. It added to the terror of famines
and floods ; it stalked stealthily through the wretched
quarters of the poor in cities and villages; it flourished in
prisons and even went to sea in ships. And whenever
circumstances were favorable it spread through countries
and across national boundaries. If there were any significant
differences between the eighteenth-century manifestations
of typhus and those of preceding periods, they consisted
in the fact that, in addition to the major epidemics that
regularly accompanied human strife and misfortune, there
were now numerous smaller group outbreaks, scattered
here and there in widely separated regions; and on the
Eastern frontiers, possibly in Italy, Spain, and parts of
Germany as well, the infection was sporadically present at
all times, much as typhoid fever is with us now. The
disease had now become widely disseminated and, in areas
where circumstances were favorable for slow propaga-
tion, firmly implanted.

As a matter of fact, until the last decade of the nine-
teenth century mankind changed very little as concerns
those customs and personal habits which determine its
relationship with typhus fever. The extraordinary po-t
litical, philosophical, and scientific awakenings which shed (
so much lustre over the eighteenth century found no re- j
flection in that fastidiousness of physical living which?
alone can curtail the homicidal aggressiveness of our|
disease. Elegance of manners and dress was never more \


assiduously cultivated, but cleanliness did not keep pace.

Even a superficial survey of the evolution of human
cleanliness a subject which well merits a far more
thorough treatment than we can give it here reveals
that its development has lagged far behind the intel-
lectual, aesthetic, and moral progress of man. Cleanliness
was not akin to intelligence and certainly not akin to
godliness} we have seen many godly people who How-
ever, one must not take these old adages too seriously. This
one like “Honesty is the best policy,” “Virtue is its own
reward,” “Waste not, want not,” and so forth merely
expresses the cherished wish of those who dream of un-
attainable perfections. In a perfect world cleanliness would
be at least akin to intelligence, and virtue would be its
own reward. These proverbs are of the same order of
thought as Keats’s “Beauty is truth,” a postulate about
which in spite of his inexperience of the world his
short service as a medical student might have enlightened

However, we have wandered from our theme, which
was that the development of cleanliness lags far behind
the progress of intellectual and aesthetic attainments. In-
deed, observation, especially of some of our artistic con-
temporaries, has often led us to speculate whether there
might not be something mutually exclusive in the two
tendencies. At any rate, in spite of the extraordinary en-
richment of mankind in other blessings of civilization
during the two brilliant centuries of which we speak,
cleanliness did not make headway until medicine had be-
gun to establish the physical perils of filth on a scientif-


ically demonstrable basis. Thus we learn of the educa-
tion of a princess (of about 1700) that “on lui apprit a se
decrotter les pieds . . . four ne pas polluer sa couche.
. . . Elle savait que lorsqu’on se presse la narine en souf-
flant) il faut incontinent marcher sur ce qui tombe a terre”
… Or “que c’est chose vilaine . . . de prendre au col
les poux, puces et autres vermines pour les tuer devout les
genSy a moins qu y on ne soit dans Vintimite”

The new freedom which was preached by Voltaire and
Rousseau did not include freedom from vermin. The pur-
pose of wigs worn on shaven heads has been dealt with
elsewhere. Cities and villages stank to heaven. The streets
were the receptacles of refuse, human and otherwise. The
triangular intervals which one sees between adjacent
mediaeval houses in streets still inhabited are apertures
through which waste, ‘pots de chambre y and so forth, could
be conveniently disposed of from the upper stories. The
opulent used the chaises percees as the last word in fas-
tidiousness. Baths were therapeutic procedures not to be
recklessly prescribed after October. The first bathtubs
did not reach America we believe until about 1840.
And public bath houses lacking sanitary laundry arrange-
ments were as likely to spread disease as to arrest it.
Schools, prisons, and public meeting places of all kinds
were utterly without provisions which might have limited
the transmission of infection. When the windmill ventila-
tion device was installed on Newgate in 1752, MacArthur
says that it was ” rumoured” that two men fell dead when
the first blasts from the exhaust pipe struck them. This
is probably, as MacArthur says, an exaggeration, but


even the false rumour conveys some idea of the probable

condition within the building.

Considering these circumstances, it is not surprising
that typhus fever ran riot through Europe and, occa-
sionally, reached America during the period of which we
write. The turbulent events of the eighteenth century
had carried the infection into the remotest corners of the
civilized world. No longer was it necessary to seek the
origins of renewed outbursts in the East, though continu-
ing wars with the Turks undoubtedly added occasional
sparks. The wars of the Spanish, Polish, and Austrian
Successions, all of which occurred in the first half of the
eighteenth century, provided the old opportunities never
overlooked by typhus. In all of them, pestilences, some of
which have been discussed in preceding chapters, started in
the armies, spread through Central Europe. At the siege
of Prague alone, 30,000 people including all the
French medical staff died. Another wave, during this
same period, swept through Scandinavia, probably via Rus-
sia, and crossed into Germany. A little later it appeared
with deadly violence in Paris and spread into the provinces.
Its presence in Ireland was first reliably reported early
in the century by O’Connel, and it was widely epidemic
by 1718. As the “Irish Ague” it probably occurred there
much earlier but this cannot be positively determined.
In 1720 famine gave it its opening at Messina; a dis-
astrous outbreak occurred in Moscow in 1735; and in
1740, after a decade of relative quiescence, it suddenly


reappeared almost simultaneously and with renewed
vigor in Central Germany and in Ireland. In Ire-
land the occasion was the potato famine of 1740. It is
noticeable that in this century, with the development of
industry, decline of trade and unemployment began to
play into the hands of typhus fever together with wars
and agricultural disasters. There were severe outbreaks
in connection with difficulties in the textile industry in
Flanders and in Austria, a demonstration of its relation-
ship with purely economic hardship.

From now on typhus again followed the armies. It cam-
paigned with the British in Flanders, after Dettingen
(1743), and again in the Spanish wars in 1762. In the
same year it lighted up in Italy, where, abetted by fam-
ine, it lingered, rising and falling, until 1 769. The Naples
epidemic of 1764, described by Fasano, was the most
dreadful episode of this era. Speaking of the outbreak,
Haeser makes the illuminating remark that mortalities
were lowest wherever there was a shortage of doctors, a
circumstance quite probably true, since the medical con-
ventions of the day favored copious bleeding.

The Seven Years’ War, the French Revolution, and
the Napoleonic campaigns in Europe and in Spain were
all more destructive of life by the activity of our disease
than by the power of cannon, rifle, and bayonet. Toward
the end of the eighteenth century and the beginnings of
the nineteenth, England, which had been relatively spared
by typhus during the Continental wars, was seriously in-
vaded. As the Continental epidemics began to decline,
toward 1798, the infection re-entered England, probably


from Ireland, where poor crops and famine had again
given our disease its opening. The succeeding two decades
were typhus years in both islands. The disease reached its
culmination in 1816 to 1819. During the great Irish
epidemic of these years it is recorded that there were no
less than 700,000 cases among the 6,000,000 inhabitants.
At almost the same time (1818) Italy was the scene of
another wave of infection, which swept southward from
the Alps to Sicily.

“Ship fever” was one of the common popular designa-
tions of typhus throughout the eighteenth century. Next
to battle casualties and scurvy, it was the most dreadful
affliction of navies. Lind was one of that extraordinary
group of physicians which the eighteenth century pro-
duced in all countries of Europe, who reasoned correctly
from circumstantial evidence and predicted from pure
clinical observations a great many things which were
later substantiated by scientific investigation. He was
physician to His Majesty’s Hospital at Haslar, near
Portsmouth, and left two papers on fevers and infection,
an essay on the most effectual means of preserving the
health of seamen, and a small volume on diseases in hot
climates. Among other things, recognizing as many
others did at this time the great importance of fruit,
greens, and vegetables for maintaining health on long
voyages, he developed ingenious methods for the preser-
vation of orange and lemon juice and of vegetables. The
fruit juices were kept from deteriorating by putting them
into small pint bottles and covering the surface with a
layer of olive oil before tightly corking them. Leeks and


other vegetables he cut into short lengths, and sprinkled
them with a thin layer of dried bay salt, packing the
entire mass of vegetables in salt. When the salt was washed
out as much as three months later, the preserves could be
prepared as fresh vegetables and had apparently retained
the properties for which they were valued. His views on
the effects of wine and stronger drinks such as “garlic
brandy” are perhaps not so medically sound, but may have
contributed considerably to his popularity in the navy.
In connection with typhus, his notable contribution con-
sists in the description of the disease as one of the most
disabling scourges of the royal navy, with its dissemina-
tion from the ships to the hospitals on land, and thence
to the surrounding country.

There was at this time in England a lively controversy
concerning the importance of ventilation. In spite of the
popular belief in the dangers of contaminated air, Lind
was quite sure that ventilation and the supply of clean
air had very little effect on the spread of disease. As far
as typhus fever itself was concerned, he was quite con-
vinced that the infection was carried not only on the
bodies of men, but upon clothes, on all kinds of material,
wool, cotton, linen, and might cling for some time
to wooden beams, chairs, bedsteads, and such. He cites,
in defence of his views, many observations, among which
is the death of seventeen of twenty-three people who had
been employed in refitting old tents in which patients
had been cared for. He speaks of the infection of the
sleeping quarters in ships, and advocated fumigation. The
materials used for disinfection were probably not very


effective. They consisted of the burning of tobacco, steam
from charcoal fires, the evaporation of camphorated vin-
egar, and the smoke from pitch tar and gunpowder. How-
ever, combined with these ineffective methods of fumiga-
tion, Lind ordered thorough scouring and cleansing and
the removal of bedding and all clothing to the decks, for
sun and air. Likewise, he recommended that physicians
and nurses change their clothing when leaving the hospital.
Altogether the measures advocated by Lind without
his having any suspicion of insect transmission must
have saved a considerable number of lives.


The last half of the nineteenth century marks a turn-
ing point in the epidemic history of the Western World.
Transmissible diseases were, of course, still plentiful;
and scarlet fever, diphtheria, meningitis, and measles
which had been previously masked to some extent by the
more rapidly spreading and violent contagions now at-
tained greater prominence. Cholera also had penetrated
into Europe on several occasions during this period. But
except for influenza, the pestilences which had, through-
out preceding centuries, caused the most widespread
destruction were distinctly declining and were becoming
more limited in regional distribution. Plague had prac-
tically disappeared. Smallpox, which, after almost com-
plete conquest by Jennerian vaccination, burst into renewed
energy in the thirties, had again to be brought under
reasonable control by the practice of revaccination. This
practice was introduced in 1823 and widely applied before


1850. Typhus was becoming more and more rare and
was limited to restricted areas on the Eastern frontiers
and in Ireland except for the occasional epidemic
recrudescences which, following wars and periods of eco-
nomic depression, proved that the seeds of the disease
had not been entirely stamped out. It reached the United
States early in the century probably in the imported
form, since it remained limited to cities of the Eastern
coast. The Philadelphia outbreak of 1837 was the one
during which Gerhardt and Pennock made their valuable
contributions to differential diagnosis. The outbreak in
Silesia in 1 846 and that in London in 1 862 were the direct
consequences of industrial depression. In Silesia al-
ways in contact with the endemic centres of the East
the collapse of the textile industry was responsible. In
England, according to Murchison, the epidemic was the
result of the great crowds of unemployed that wan-
dered into the cities. Here, also, we may assume that
infection may have been reintroduced some six years
before, with soldiers returning from the Crimea.

During the Civil War in which, in the Federal ar-
mies, 44,238 were killed in battle, 49,205 died of wounds,
‘and 186,216 died of disease typhus was not very im-
portant. And in the relatively short European wars, the
French campaign in Italy, the Austro-German and the
Franco-Prussian wars, typhus played a negligible role.
It is of considerable interest, in anticipation of what we
shall have to say of typhus and the World War, that in
the Franco-Prussian struggle of 1870 there was little
or no typhus in either of the contending armies, except


for a moderate number of cases (252) among the Algerian
troops j furthermore, there is considerable question
whether the disease occurred in any of the besieged cities.
At the same time Prussian troops on the Russian border
were never entirely free from the disease. Smallpox,
dysentery, and typhoid fever had now taken the places of
plague and typhus as the major scourges of armies.

It is not easy to account for the decline of great epi-
demics in Europe after 1850. One might assume an un-
accountable cyclic change in the characters of prevalent
diseases. On the other hand one is inclined to give much
credit to the co-operative forces of modern civilized society
when one considers the immediate calamitous consequences
which followed the temporary return to quasi-mediaeval
conditions in Russia and the Near East during and after
the last war. These forces were manifold and it is im-
possible to give any one of them the first place. Of con-
siderable importance, no doubt, is the fact that wars, during
this period, were of short duration and operations were
within relatively circumscribed areas. Another factor, not
to be underestimated, was the safeguard against famine
provided by the development of intensive agriculture and
the perfection of railroad transportation, which prevented
the former prolonged isolation of famine districts from
supplies of food and succor. Of at least equal importance
was the rise of modern medicine, the development of
methods of diagnosis, rational approaches to prevention,
and the organization of local, national, and military
health supervision which gradually extended into all
ramifications of community life. To describe these in any-


thing like completeness would require another, perhaps
useful, but exceedingly dull volume.

It is a curious and heartening fact that international
co-operation in the prevention of epidemics placidly con-
tinues, however hostile or competitive other relationships
may become. At the present moment, while the world
is an armed camp of suspicion and hatred, and nations are
doing their best, by hook and crook, to push each other
out of the world markets, to foment revolutions and steal
each other’s political and military secrets, organized
government agencies are exchanging information concern-
ing epidemic diseases ; sanitarians, bacteriologists, epidemi-
ologists, and health administrators are co-operating, con-
sulting each other, and freely interchanging views,
materials, and methods, from Russia to South America,
from Scandinavia to the tropics. It is perhaps not gen-
erally known that for several years, during the most
turbulent period of the Russian Revolution, the only
official relationship which existed between that unfortu-
nate country and the rest of Europe consisted in the inter-
change of information bearing on the prevention of epi-
demic disease, arranged in co-operation by the Health
Commission of the League of Nations and the Soviet

It is all a part of the strange contradictions between
idealism and savagery that characterize the most curious
of all mammals. It leads to the extraordinary practice of
what is spoken of as “saving at the spigot and wasting at
the bung.”

Thus, during the decade immediately preceding the


World War, typhus fever was leading the quiet bour-
geois existence of a reasonably domesticated disease. It
was, to be sure, causing its periodic localized epidemics
in China and in Mexico, was sporadically occurring in
North Africa and the Near East, and was continuing
(with a declining rate) in Ireland, where there were
only seventy deaths between 1899 and 1913, although
the “Green Island” was regarded as the only Western
country with any considerable typhus incidence. In Amer-
ican cities the infection was present in a mild form, as
Brill’s disease (about 528 cases in New York and Boston
from 1900 to 1930), and undoubtedly it was occurring
in the same relatively tame manner in many other parts
of the world, in South America, in the Mediterranean
basin, and in remote parts of the Orient, where though
unsuspected at that time it has now been detected.
However, there were no great epidemics, and the only
countries in the world where there were a sufficient num-
ber of annual cases and deaths to justify their designation
as “endemic centres” were Russia, Poland, and parts of
Eastern Austria (Galicia).

In these regions, as well as in the adjacent Hungarian
and Balkan territory, typhus kept claiming its annual toll
of victims though epidemic dimensions were rarely
approached except in the presence of the circumstances of
famine or war. Thus cases in Russia usually averaged
about 90,000 a year: the lowest, 36,887, in 1897; the
highest, 184,000, in 1892, when there was a famine.
In the Balkan countries morbidity rates increased during
the war years, 1 912- 191 3 j but even then no true epi-


demic occurred. Western Europe was practically exempt.
The organization of modern life and the forces which
we have enumerated in a preceding paragraph were hold-
ing typhus to an armed truce. And then, for the first time
in the ages-old struggle between the two enemies, the
strategic initiative passed into the hands of man, with the
discovery, in 1 909, by Charles Nicolle (to whom we have
dedicated this book), of the louse transmission of typhus
fever from man to man. For the first time in all the
centuries of a one-sided warfare, with man forever in
the open and typhus ever in ambush, the victim was in
a position to organize a rationally planned and strategi-
cally sound defense against his historic enemy.

If warriors and politicians and patriots and all the
other people responsible for wars had only left the world
alone for another hundred years this discovery might,
without further scientific advances, have sounded the knell
of epidemic typhus in the West.

But then a Grand Duke was murdered at Serajevo and
everybody lost their heads, ourselves and T. Roosevelt
included except Mr. Wilson, who lost his two years
later; and the bands played the “Wacht am Rhein” and
the “Marseilleise” and “God Save the King” and “Gott
erhalte Franz den Kaiser ” and “Boje tsaria Khrani” and
“Ustaj, ustaj, Srbine” and, several years later, the “Star-
Spangled Banner.” And the barbed-wire kings and the,
T. N. T., corned beef, and ordnance people, and the 1
ship jobbers and the shoe manufacturers and the khaki
pants trade, and so forth, and so forth, laid the foun-\
dation for a new and Hollywoodian aristocracy that lasted l


[until 1929. And God was on everyone’s side. And when
?we had all gone to war and the stage was set, typhus
woke up again.

Not everyone realizes that typhus has at least as just
a reason to claim that it “won the war” as any of the
contending nations. Many a French barroom fight might
have been avoided if this had been clearly understood.


It raised its ugly head first in Serbia. This valiant little
nation had hardly recovered from the Balkan troubles
when, in July 1914, Austria declared war and immediately
attacked. Belgrade was bombarded and the Serbian gov-
ernment retired to Nish. The terrified villagers of the
border regions began to move southward toward safety
with all their portable possessions. Early efforts of the
Austrians to cross the Sava, near Belgrade, were re-
pulsed. But later, attacking from the Bosnian border,
they succeeded, in November (not without reverses in
which 20,000 Austrian prisoners were taken), in captur-
ing Valjevo and Belgrade. On December 2 the Serbian
army counterattacked and the Austrians were driven
back across the Drina and the Sava, and Valjevo and
Belgrade were retaken. As a result of these battles North-
ern Serbia was a shambles. Villages were in ruins and the
noncombatant population was crowding its way toward
the South.

Typhus began to show itself in the Serbian army in
November. It is probable that it occurred, at the same
time, among the invaders. In addition to their own


troubles the Serbs now had about 60,000 to 70,000 pris-
oners on their hands, some of them sick and wounded.
They were short of shelter for their own dispossessed
civilian population} there were no adequate quarters for
their prisoners. Most of their able-bodied adults were
with the colours. There were less than four hundred doc-
tors in the country, almost all of whom sooner or later
contracted the disease, 126 of them fatally. The few
existing hospitals were soon overflowing, and others had
to be improvised in buildings which often lacked sanitary
provisions of all but the most primitive order. There were
practically no nurses. There were no beds, no linen, no
medicines. Eventually there were hardly enough grave
diggers. It is impossible to state, with any accuracy, just
where the epidemic started. The first accumulation of
cases occurred among Austrian prisoners at Valjevo. Dis-
semination to all parts of the country was almost imme-
diate. The infection travelled with the wandering popula-
tion, with prison trains, and with moving troops. Through
February and March the epidemic flared up with a
speed and violence never equalled in any typhus out-
break of which we have reliable record. In April when
it reached its culmination the new cases per day ran
into many thousands. For a time 2500 were daily ad-
mitted to the military hospitals alone. The mortality
ranged from approximately 20 per cent during the rise
and decline to 60 and even 70 per cent at the height of
the epidemic. In less than six months over 150,000 people
died of typhus. Not less than one half of the 60,000 Aus-
trian prisoners succumbed.


During all this time Serbia was practically helpless.
Yet Austria did not attack. Military operations were
largely confined to a short bombardment of the railroad
station in Belgrade at about four o’clock in the afternoon,
during which everyone stayed away from the trains. Aus-
trian strategists knew better than to enter Serbia at this
time. The probable results were obvious. Typhus
while scourging the Serbian population was holding
the border. The Central Powers lost six months during
the most critical time of the war. It is anybody’s guess
as to the effect which this delay may have had on the
early Russian and even on the Western campaigns. It is
at least not unreasonable to believe that a quick thrust
through Serbia at this time, with its reactions on
Turkey, Bulgaria, and Greece, the closing of Salonika,
and the establishment of a Southwestern front against
Russia might have tipped the balance in favour of the
then very vigorous Central Powers. Typhus may not
have won the war but it certainly helped.

Typhus from now on took over its historic role along
the entire Eastern front. It flourished as usual in all the
Eastern armies, but was kept, by extraordinarily effective
sanitary measures, bathing and delousing, within
reasonable bounds among the Austrians and Germans.
Though it penetrated into the prison camps in Central
Europe, it was successfully prevented from spreading
to the civilian populations. Among the most remarkable
phenomena of the war is the total absence o r typhus from
the Western front. No completely satisfactory explana-
tion for this can be offered. Soldiers in the trenches on


this front were as universally lousy as soldiers have al-
ways been. And a louse-borne disease, Trench fever, closely
allied to typhus, was common. We can attribute it only
to the fact that the armies were on both sides
more afraid of typhus than they were of shot and shell.
The Central Powers, realizing that a typhus epidemic,
introduced with troops transferred from the East, would
lose them the war, took the utmost precautions to avoid
this. And army sanitary organizations, in all the forces,
were ever conscious of the possible peril, alert for
suspicious cases, and usually quick to resort to wholesale
delousing. The mortality of lice in this war must have
been the greatest in the history of the world.

In Russia alone did typhus attain its mediaeval ascend-
ancy. During the first year of the war only about 100,000
cases occurred in Russia. After the retreat of 1916 the
recorded number rose to 154,000. From then on, for
obvious reasons, figures are unreliable, but there is no ques-
tion that the disease increased steadily and rapidly. Revo-
lution, famine, epidemics of cholera, typhoid, and dysen-
tery, helped. There are no words to record the dreadful
sufferings of the Russian people from 1917 to 1921.
We are concerned with typhus alone. And from the care-
ful and conservative calculations of Tarassewitch, it is
likely that, during these years, there were no less, and
-probably were more than twenty-five million cases of
typhus in the territories controlled by the Soviet Repub-
lic, with from two and one-half to three million deaths.

We have said nothing of the epidemics in Poland,
Rumania, Lithuania, and the Near East, but we are

surely is weary with horrors. Moreover
f they begin to approximate those of Presi-
It’s expenditures) begin to anaesthetize the

records of the World War are reassuring
STfar as occurrences in the West are concerned. But the
Serbian and Russian epidemics have shown that the hero
of our biography has lost none of his vigour, cruelty, and
stealth, and will take prompt advantage of any relaxa-
tion of vigilance and preparedness. There is no hope that
he will reform or “get religion.”

Although partially and temporarily triumphant dur-
ing the last war, he drew down upon himself the renewed
and intensified curiosity of those who crave this kind of
excitement. Not infrequently he has turned upon a pur-
suer and has stopped him in his tracks. But the pursuit
goes on. He has been traced to all corners of the world
and we know almost, though not yet completely
where his tribe is established. His hiding places in rats,
fleas, and lice have been uncovered, and if there are any
further ones, still unknown, they will not remain long
undetected. His methods of attack are being revealed and
appropriate weapons to repulse him are being forged.
In this unlike most other matters of international in-
terest the whole world has co-operated against the com-
mon enemy. French, Swiss, American, British, German,
Brazilian, Japanese, Chinese, Russian, and Mexican in-
vestigators have worked together, cheered each other
on and helped one another in friendly rivalry. To describe
their work belongs to technical literature. To attempt to


do so in this book would lead us into “popular science/ 1
a form ot production which we detest and have endea-
voured to avoid.

Typhus is not dead. It will live on for centuries, and
it will continue to break into the open whenever human
stupidity and brutality give it a chance, as most likely
The book on other site


Published on February 11, 2009 at 5:42 am  Comments (1)  

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