Alls Lousy On The Eastern Front

During World War I, the European continent provided history's largest experiment in entomological warfare tactics. For the first time, scientific understanding of insect-borne diseases allowed these agents to be exploited as "passive weapons," demonstrating that the best offense could be a good defense. Rather than forcing the enemy into infested habitats, science provided the means for military leaders to protect their own forces from the ravages of disease-carrying insects that were part and parcel of war. The advantage of metal armor had been known for centuries, but biological armor now transformed the battlefield.

The grand experiment, however unintentional, allowed military historians to compare the course of war when an army was vulnerable versus when it was protected from the ravages of lice. From 1914 through 1918, the Eastern Front was a worst-case scenario for typhus, while the Western Front was relatively vermin free—an utterly unique experience in the annals of entomological warfare.

If an entomologist were to have written a recipe for a typhus epidemic, no finer list of ingredients and instructions for their mixing could be found than those of Eastern Europe:1

Begin with a population of weakened human hosts. After Archduke Ferdinand was assassinated in July 1914, Austria declared war on Serbia. The Serbs were an exhausted people, having just finished a war with Turkey—the third major conflict in two years.

Next, take the already vulnerable hosts and pummel them thoroughly. The Austrians bombarded Belgrade and smashed their way through the towns and villages of the north. Civilians abandoned their homes and a wave of refugees poured into the countryside.

To the weakened hosts, add a large dash of new blood, so that the population is brimming with defenseless bodies. The fight was not entirely onesided. Earlier conflicts had left the Serbs worn down, but the survivors were battle-hardened. They managed to capture some 20,000 Austrian prisoners.

Make sure to thoroughly crush any semblance of hygiene or medical infrastructure. As the offensive continued, hospitals were destroyed and medicines were impossible to find. There had been only about 400 physicians for all of Serbia, and most of these doctors closed their clinics to defend the homeland, leaving the nation essentially without medical care.

Add a heaping amount of lice and microbes, mix thoroughly, and simmer. By late November, typhus began to spread among the refugees. From there, the disease soon infected the weary Serbian army and their POWs. At first there was little alarm, as typhus had been a part of life in Eastern Europe for centuries. But never before had there been such a bountiful mix of ingredients for brewing an epidemic.

Finally, if the stew is not yet boiling feverishly, dump in fatigued bodies until the pot is overflowing. On December 3, the Serbians launched a fierce counterattack. After three days of bloody fighting, the Austrian invasion force was crushed. More than 40,000 prisoners were taken, burdening the Serbs with one POW for every four of their own soldiers. Between the captives and the depleted supplies of food, water, shelter, and medicine, the nation was strained far beyond its capacity.

The epidemic irrupted almost simultaneously from a constellation of filthy camps, ravaged villages, and war-torn cities. Initially, mortality rates were running at 20 percent. But as the scant supply of medicine was depleted, the rate rose to 60 percent. A shortage of grave diggers—along with doctors and nurses—soon added to the grisly conditions. By April 1915, there were 10,000 new cases each day. With one in six people contracting typhus, more than 200,000 Serbs perished, including 70,000 soldiers. Fully half of all of the Austrian POWs died from the epidemic.2

The battlefield misery led to a bizarre application of entomology: insects were used to produce self-inflicted wounds and provide a reprieve from the front.3 Fearing the horrors of war, soldiers on the Eastern Front collected Paederus beetles, the insects possessing the potent toxin that so intrigued the Romans more than two thousand years earlier. The weary men pulverized the beetles and applied the powder to minor wounds, mucous membranes, or even their eyes. The severe inflammation that followed was often taken to indicate a raging infection, assuring the victim of a medical ticket to the rear. Insects were also generating unexpected events on a national scale.

Paradoxically, louse-borne typhus protected the nation of Serbia. After repulsing the initial Austrian incursion, the country was absolutely helpless to defend itself against another attack. However, the Central Powers (Germany and Austria-Hungary, along with Bulgaria and the Ottoman Empire) knew better than to invade a land in the midst of a raging epidemic. As such, the Allied Powers did not have to contend with their enemy storming through Serbia and establishing a front with Russia—a strategy that might have substantially altered the course of the war. Russia, however, was not spared from a devastating—albeit nonhuman—invasion.

As the First World War was winding down on the Eastern Front, lice and their microbes were just getting started. The war had been hard on Russia, with famine weakening the nation and refugees spreading lice throughout the countryside. And since the overthrow of the tsar in 1917, essential services had utterly disintegrated. Nearly six times more Russians would die of insect-borne disease in the years after the war than died of battle-related trauma during the war.4

In the two decades prior to World War I and the Russian Revolution, the country had suffered about 82,000 cases of typhus each year. This number rose to 100,000 in the early years of the war, climbed to 154,000 in 1916, and thereafter the disease was rampant. Over the next five years, conservative estimates place the number of cases at 20 million, with 3 million deaths. There may have been 30 million infected, with as many as 10 million dead. In 1919, Vladimir Lenin darkly pronounced that "either socialism will defeat the louse, or the louse will defeat socialism." Although the insects lost, the Red Army witnessed the potential of entomological warfare. However, a military must be able to harness a destructive power before it can be exploited. And a critical lesson in this regard came from the trenches of the Western Front.

The British and French knew the phenomenal capacity of typhus to alter the course of war.5 Just 60 years earlier, during the Crimean War, they had allied with the Turks to fight the Russians. Nearly two-thirds of the 167,755 soldiers who died in the conflict succumbed to disease, and the situation was even more skewed in terms of casualties (i.e., those killed, as well as those injured, wounded, or otherwise incapacitated). Bombs and bullets wounded 197,399 soldiers, while typhus debilitated 767,411. The western European nations were horrified by these losses and set out to understand the cause of the disease.

A French scientist, Charles Nicolle, made the breakthrough in 1909. While serving as the director of the Bacteriological Laboratory at Rouen, he definitively linked lice and typhus—a discovery that earned him the Nobel Prize in Medicine in 1928. Once the vector was known, controlling typhus became a matter of suppressing the insect carrier. The military quickly grasped the importance of hygiene—louse-ridden soldiers were casualties-in-waiting. When World War I broke out, the generals on the Western Front were determined to wage a wholesale assault on insects and were poised to accomplish something unprecedented in European history: cause more deaths by combat than by disease.

Shortly after the opening salvos, the two sides bogged down in the grim conditions of trench warfare. The crowded, filthy conditions were ideal for lice, and infestation rates quickly soared to nearly 90 percent.6 With the vectors in place, only the microbe was missing. To prevent infected insectan infiltrators from arriving via the Eastern Front, commanders strictly limited the movement of troops from Serbia and neighboring countries. Having cut the disease's supply line, western forces initiated a two-pronged attack on the lice: prevention and intervention (see Figure 7.1).7

Special Sanitary Units made sure that the British soldiers were keenly aware of the importance of fighting filth. Indeed, one of the greatest insults to be hurled against a battalion by its replacements came to be "they left a dirty trench." But convincing the troops of the value of hygiene was an uphill

Figure 7.1. Dorsal view of a male body louse; the dark mass inside the abdomen is a previously ingested blood meal. The insect's legs and flattened body are well adapted to avoid being dislodged from their hosts, so during World War I entomologists on the Western Front advised the troops to keep their hair short and faces shaved, change clothing often, keep infested uniforms away from their quarters, and wear silk underclothes—all to deny the insects a reliable foothold. (Photo by James Gathany, courtesy of CDC)

battle. The military aspired to substantially higher standards than much of the civilian population—and incoming recruits were woefully uninformed. Some of London's poor still clung to the old notion that healthy children hosted robust lice infestations.

In a remarkably farsighted move, the British Expeditionary Forces added two entomologists to each of their Sanitary Units. These experts provided simple and effective advice to the soldiers on how to keep their six-legged opponents at bay. Eliminating cover for the enemy was an important tactic, so troops were told to keep their hair short and faces shaved (see Figure 7.2). Because body lice live in clothing and use commando raids to grab a blood-meal, another maneuver was to deny them safe haven. Silk underclothes were recommended, as the fine texture made it difficult for the vermin to gain a reliable foothold. Soldiers were also advised to change clothing as often as possible and to keep infested uniforms away from their quarters. The entomologists had found that the adult lice starved within a week without a blood meal.

Figure 7.2. Typhus shaped the course of the First World War on the Eastern Front, where an epidemic of this insect-borne disease in Serbia served to keep the Central Powers from invading Russia. An understanding that lice were the carriers of this disease prevented major outbreaks on the Western Front. Here, members of the 6th Infantry are seen picking "cooties" out of their clothing near Nantillois, France. Such simple practices prevented the vectors from reaching outbreak levels. (Courtesy of Disabled American Veterans)

Figure 7.2. Typhus shaped the course of the First World War on the Eastern Front, where an epidemic of this insect-borne disease in Serbia served to keep the Central Powers from invading Russia. An understanding that lice were the carriers of this disease prevented major outbreaks on the Western Front. Here, members of the 6th Infantry are seen picking "cooties" out of their clothing near Nantillois, France. Such simple practices prevented the vectors from reaching outbreak levels. (Courtesy of Disabled American Veterans)

The eggs were another matter; brushing and ironing were the two best means of removing and destroying nits. In particular, a hot iron applied to the seams of shirts and pants—the bunkers of body lice—roasted the enemy within their emplacements. But such elaborate assaults were beyond the means of the soldiers in the trenches, so special forces had to be deployed.

Generals had long considered the infantry, cavalry, and artillery as the backbone of a winning army, but the lowly Quartermaster Corps was essential to victory on the Western Front. And among these uncelebrated providers of food, clothing, and supplies, the least assuming units proved to be among the most vital: laundry companies. With clouds of chlorine and mustard gas rolling across Europe, the launderers got into the spirit of chemical warfare. Rather than soap and water, dry-cleaning processes with volatile solvents were found to more effectively wipe out the insectan enemy entrenched in folds and seams. Having beaten the insects on the clothing front, the Allied and Central Powers extended the hygienic battlefield to the human body (see Figure 7.3).

Figure 7.3. A delousing station for soldiers after coming from the lines on the Western Front in World War I. These soldiers are from the 125th Infantry, 32nd Division, near Montfaucon, October 22, 1918. Trenches, dugouts, woods—the entire front was vermin-infested. Although infestation rates among the troops initially reached almost 90 percent, British Sanitary Units—which included entomologists—and the American Quartermaster Corps launched an intensive and effective campaign against the vermin. (Courtesy of Disabled American Veterans)

Figure 7.3. A delousing station for soldiers after coming from the lines on the Western Front in World War I. These soldiers are from the 125th Infantry, 32nd Division, near Montfaucon, October 22, 1918. Trenches, dugouts, woods—the entire front was vermin-infested. Although infestation rates among the troops initially reached almost 90 percent, British Sanitary Units—which included entomologists—and the American Quartermaster Corps launched an intensive and effective campaign against the vermin. (Courtesy of Disabled American Veterans)

The account of Private James Brady of the British Army provides a compelling view of the Germans' delousing process:

So far as I recall Nov. 11th 1918 came and went within the dreary confines of Giessen prisoner-of-war camp, without us having the slightest inkling of what was going on in the "free" world outside. . . . Soon after breakfast we were paraded in groups of around fifty men and marched at a hot pace through the camp to the precincts of one of the most comprehensive delousing stations we had ever come across. Fashioned out of some ancient farm-buildings with high-roofed barns on the fringe of the camp, it was manned by a forbidding horde of untidy German soldiery, garbed in long, off-white short-sleeved gowns, each armed with the oddest collection of "toiletry" gadgets—hair-clippers, scissors, razors (safety and otherwise), scrubbers, hand-brushes, loofahs, sponges, rough-haired towels, huge blocks of evil-smelling ersatz soap, and large canisters of equally evil-smelling "disinfectants."

Altogether the joint looked like something designed by a demented Heath Robinson [a British cartoonist with a Rube Goldberg—like sense of humor], peopled by a gang of mentally disturbed sadists intent on inflicting injury to anything in sight. Furthermore, each "torturer" had a horrible grin on his face. We didn't like the look of things one bit. But it turned out to be quite a comedy. Suddenly, a giant of a fearsome-looking Prussian guard-type screamed out one word which we all understood: "STRIP." Then at a signal from the giant, the good-natured torturers descended upon us with something akin to glee—the barbers with their rusty, dull-bladed clippers and shavers first—until, within the swish of a whisker we were reduced to the bald bareness of our birthdays.

The scene was bizarre in the extreme and not lost on those of us with a sense of the humour. But that was only the beginning. A few shouted words of command from the senior NCOs and we were ushered shivering with cold, into the main building and shunted through a badly-lit maze of narrow duck-boarded corridors and cubicles where for a full thirty minutes we were drenched alternately with fountains of hot and cold water assaulting us from every angle, steamed with jets of scalding vapours, scraped, soaked, soaped, submerged in cauldrons of slimy oil, again bombarded with torrents of hot water, battered with rough towels, brushed with canvas sacking, finally propelled head-first into a huge bath of soothing water before being disgorged, pink and panting, into a barn-like room—there to be handed back our very own uniforms, now stiff and hot from dry-heat ovens and stinking of ersatz disinfectant which reminded me of the ablutions at Ripon camp on inspection day.

It may be said that, as we recovered our breath and dressed ourselves in our clean, lice-free uniforms, everybody felt there was a good deal to commend German de-lousing methods. It was the nearest approach to bliss in captivity that we'd ever experienced, and we could but concur when the German orderlies smiled at us and said, "Good, Jah?" We marched back to our billet light of head as well as of foot and empty-bellied, ready to gorge ourselves on our newly-acquired Red Cross parcels.8

Had either side failed to hold the lice at bay, the loss of troops to disease would likely have meant precipitous defeat. Although typhus was largely neutralized, another less virulent disease added misery to life in the trenches. Head, body, and pubic lice found a new rickettsial ally.9 Unknown before World War I, trench fever made its appearance in France and Belgium. Although 800,000 men would contract the disease in the course of the war, there were few fatalities. A victim experiences a sudden fever, loss of energy, dizziness, and headache followed by a rash and severe aching oddly concentrated in the shins, justifying the malady's other name: shin bone fever. The fever, which can reach I05°F, persists for five or six days, then drops for several days only to return in as many as eight cycles.

Trench fever made an encore performance in the Second World War, but it was less prevalent given that soldiers were not massed into filthy ditches for months on end. The disease disappeared for a half-century until irrupting among the homeless population of the United States in what was sardonically called "urban trench fever."10 Epidemiologists are uncertain of where the pathogen had been hiding until the 1990s. However, given the microbe's apparent capacity to lurk in the environment, and the louse's infamous ability to exploit grubby hosts, we might expect further ambushes by trench fever in the coming years as pockets of poverty expand throughout the world.

Trench fever was a pathogenic seed that germinated amid the privation of battle and continues to sprout in unsanitary conditions. But even more invidious seeds were planted in the First World War in the form of novel ideas rather than new illnesses. Military scientists understood the germ theory of disease, the basics of vector biology, and the rudiments of epidemiology. Having used this knowledge to prevent disease, only a malevolent twist of logic was needed to imagine how an army might conscript insects to induce an epidemic in the enemy.

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