Was typhoid inoculation safe and effective during World War I? Debates within German military medicine

Journal of the History of Medicine and Allied Sciences

Volumn 55, Issue 2, 2000, Pages 101-133

  Linton, Derek S ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

TYPHOID PARATYPHOID VACCINE;

ARTICLE; GERMANY; HISTORY; HUMAN; MILITARY MEDICINE; TYPHOID FEVER; VACCINATION; WAR;

GERMANY; HISTORY, 20TH CENTURY; HUMANS; MILITARY MEDICINE; TYPHOID FEVER; TYPHOID-PARATYPHOID VACCINES; VACCINATION; WAR;

EID: 0034167641     PISSN: 00225045     EISSN: None     Source Type: Journal    
DOI: 10.1093/jhmas/55.2.101     Document Type: Article

References (112)

1. Two recent collections of articles that take up military medicine during World War I are Wolfgang U. Eckart and Christoph Gradmann, eds., Die Medizin und der Erste Weltkrieg (Pfaffenweiler: Centaurus-Verlagsgesellschaft, 1996) and Roger Cooter, Mark Harrison, and Steve Sturdy, War, Medicine and Modernity (Phoenix Mill: Sutton Publishing Ltd., 1998).
2. Two recent collections of articles that take up military medicine during World War I are Wolfgang U. Eckart and Christoph Gradmann, eds., Die Medizin und der Erste Weltkrieg (Pfaffenweiler: Centaurus-Verlagsgesellschaft, 1996) and Roger Cooter, Mark Harrison, and Steve Sturdy, War, Medicine and Modernity (Phoenix Mill: Sutton Publishing Ltd., 1998).
3. Some of the exceptions include several works on sexually transmitted diseases, among them: Allan M. Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States since 1880 (New York: Oxford University Press, 1985); Claude Quetel, History of Syphilis (Baltimore, Md.: Johns Hopkins University Press, 1990) and Lutz Sauerteig, "Militär, Medizin und Moralität: Sexualität im Ersten Weltkrieg" in Eckart and Gradmann, (n. 1) Medizin, pp. 197-226. Paul Weindling has written several articles on epidemic typhus, Journal of the History of Medicine : Vol. 55, April 2000 including "The First World War and the campaign against lice: Comparing British and German sanitary measures," pp. 227-40, ibid. A number of articles on malaria and on the 1918 influenza epidemic have also appeared.
4. Some of the exceptions include several works on sexually transmitted diseases, among them: Allan M. Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States since 1880 (New York: Oxford University Press, 1985); Claude Quetel, History of Syphilis (Baltimore, Md.: Johns Hopkins University Press, 1990) and Lutz Sauerteig, "Militär, Medizin und Moralität: Sexualität im Ersten Weltkrieg" in Eckart and Gradmann, (n. 1) Medizin, pp. 197-226. Paul Weindling has written several articles on epidemic typhus, Journal of the History of Medicine : Vol. 55, April 2000 including "The First World War and the campaign against lice: Comparing British and German sanitary measures," pp. 227-40, ibid. A number of articles on malaria and on the 1918 influenza epidemic have also appeared.
5. Some of the exceptions include several works on sexually transmitted diseases, among them: Allan M. Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States since 1880 (New York: Oxford University Press, 1985); Claude Quetel, History of Syphilis (Baltimore, Md.: Johns Hopkins University Press, 1990) and Lutz Sauerteig, "Militär, Medizin und Moralität: Sexualität im Ersten Weltkrieg" in Eckart and Gradmann, (n. 1) Medizin, pp. 197-226. Paul Weindling has written several articles on epidemic typhus, Journal of the History of Medicine : Vol. 55, April 2000 including "The First World War and the campaign against lice: Comparing British and German sanitary measures," pp. 227-40, ibid. A number of articles on malaria and on the 1918 influenza epidemic have also appeared.
6. Some of the exceptions include several works on sexually transmitted diseases, among them: Allan M. Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States since 1880 (New York: Oxford University Press, 1985); Claude Quetel, History of Syphilis (Baltimore, Md.: Johns Hopkins University Press, 1990) and Lutz Sauerteig, "Militär, Medizin und Moralität: Sexualität im Ersten Weltkrieg" in Eckart and Gradmann, (n. 1) Medizin, pp. 197-226. Paul Weindling has written several articles on epidemic typhus, Journal of the History of Medicine : Vol. 55, April 2000 including "The First World War and the campaign against lice: Comparing British and German sanitary measures," pp. 227-40, ibid. A number of articles on malaria and on the 1918 influenza epidemic have also appeared.
7. Wolfgang U. Eckart, '"Der grösste Versuch, den die Einbildungskraft ersinnen kann' - Der Krieg als hygienisch-bakteriologisches Laboratorium und Erfahrungsfeld" in Eckart and Gradmann, (n. 1) Medizin, pp. 299-319.
8. Ibid., p. 313.
9. Frederick P. Gay, Typhoid Fever Considered as a Problem of Scientific Medicine (New York: Macmillan, 1918), pp. 180-81.
10. John Andrew Mendelsohn, "Cultures of bacteriology: Formation and transformation of a science in France and Germany 1870-1914" (Ph.D. diss., Princeton, N.J.: Princeton University, 1996), p. 764.
11. Thomas McKeown, The Rise of Modern Population (New York: Academic Press, 1976) and The Origins of Human Disease (Oxford: Blackwell, 1988). For a recent critical assessment, see Anne Hardy, Epidemic Streets: Infectious Disease and the Rise of Preventive Medicine 1856-1900 (Oxford: Clarendon Press, 1993), pp. 1-3, 289-94.
12. Thomas McKeown, The Rise of Modern Population (New York: Academic Press, 1976) and The Origins of Human Disease (Oxford: Blackwell, 1988). For a recent critical assessment, see Anne Hardy, Epidemic Streets: Infectious Disease and the Rise of Preventive Medicine 1856-1900 (Oxford: Clarendon Press, 1993), pp. 1-3, 289-94.
13. Thomas McKeown, The Rise of Modern Population (New York: Academic Press, 1976) and The Origins of Human Disease (Oxford: Blackwell, 1988). For a recent critical assessment, see Anne Hardy, Epidemic Streets: Infectious Disease and the Rise of Preventive Medicine 1856-1900 (Oxford: Clarendon Press, 1993), pp. 1-3, 289-94.
14. Ernst Friedberger, Zur Entwicklung der Hygiene im Weltkrieg (Jena: Verlag Gustav Fischer, 1919), p. 13.
15. For the work of Budd and the early bacteriology, see W. Kolle and H. Hetsch, Die Experimentelle Bakteriologie und die Infektionskrankheiten, 2 vols. (Berlin: Urban & Schwarzenberg, 1922), 1, 305-6. The bacteria was often called the Eberth-Gaffky bacillus before the turn of the century.
16. A good account of early work on agglutination as well as the numerous debates about its interpretation can be found in Hans Zinsser, Infection and Resistance, 2nd ed. (New York: MacMillan, 1918), pp. 218-21, 234-41. Most German researchers soon interpreted agglutination within Ehrlich's side chain theory as a chemical union of agglutin (a haptaphore group) and bacteria.
17. Prof. Dr.Vagedes, "Fortschritte in der Bekämpfung der Heereskrankheiten in den Heeren europäischer Grossstaaten," Dtsch. Mil. Aerztl. Z., 1913, 42, 1-26.
18. For deaths in the military, see "Vorläufiger Jahreskrankenrapport für 1911/12," Dtsch. Mil. Aerztl. Z., 1913, 42, 229, and "Vorläufiger Jahreskrankenrapport für 1912/13," 1914, 43, 470, ibid.
19. For deaths in the military, see "Vorläufiger Jahreskrankenrapport für 1911/12," Dtsch. Mil. Aerztl. Z., 1913, 42, 229, and "Vorläufiger Jahreskrankenrapport für 1912/13," 1914, 43, 470, ibid.
20. Mendelsohn, (n. 6) pp. 568-79, 590-613, 633-44.
21. Ibid., pp. 672-79.
22. Dr. Loesener, "Die Bedeutung der Keimträger fur die Truppe," Dtsch. Mil. Aerztl. Z., 1911, 40, 185-206; Dr. Huene, "Der Einfluss gesunder Keimträger in der Verbreitung der Seuchen, mit besonderer Berücksichtigung der Truppen im Frieden und Kriege," Dtsch. Mil. Aerztl. Z., 1913, 42, 103-16.
23. Dr. Loesener, "Die Bedeutung der Keimträger fur die Truppe," Dtsch. Mil. Aerztl. Z., 1911, 40, 185-206; Dr. Huene, "Der Einfluss gesunder Keimträger in der Verbreitung der Seuchen, mit besonderer Berücksichtigung der Truppen im Frieden und Kriege," Dtsch. Mil. Aerztl. Z., 1913, 42, 103-16.
24. Bavarian State Archives (hereafter MKr) 10109 Bd. I Typhus: Berlin 23 April 1913, Generalstabarzt der Armee v. Schjeming an die Königliche Kaiser Wilhelms Akademie für das militäraerztliche Bildungswesen und sämtliche Sanitätsämter, Preisausschreiben. The prize was never collected.
25. MKr 10109 Bd. I Typhus: Kriegsministerium No. 26278 München, 5 Feb. 1914, Betreff: Friedensverpflegungsvorschrift, Frh. von Kress.
26. MKr 10109 Ud. I Typhus: Kriegsministerium Medizinalabteilung Berlin, 8 April 1914, v. Schjerning.
27. For the discovery of the first typhoid vaccines and the priority dispute associated with it, see Dieter H. M. Groschel and Richard B. Hornick, "Who introduced typhoid vaccination: Almroth Wright or Richard Pfeiffer?" Rev. Infect. Dis., 1981, 3, 1251-54. For an excellent contemporary analysis of the British and German testing, see Frederick F. Russell, "Antityphoid vaccination," Am. J. Med. Sci., 1913, 146, 803-9.
28. For the discovery of the first typhoid vaccines and the priority dispute associated with it, see Dieter H. M. Groschel and Richard B. Hornick, "Who introduced typhoid vaccination: Almroth Wright or Richard Pfeiffer?" Rev. Infect. Dis., 1981, 3, 1251-54. For an excellent contemporary analysis of the British and German testing, see Frederick F. Russell, "Antityphoid vaccination," Am. J. Med. Sci., 1913, 146, 803-9.
29. Sanitätsbericht über das Deutsche Heer im Weltkriege 3 vols. (Berlin: Verlag E.S. Mittler & Sohn, 1934), III, 107. For Koch's doubts about a vaccine, see A. von Wassermann and P. Sommefeld, "Experimentelle Untersuchungen über die Wirksamkeit der Typhus-und Choleraschutzimpfung," in Kriegsaerztliche Vortrage, vol. III, C. Adam, ed. (Jena: Verlag von Gustav Fischer, 1916), 42-44.
30. Sanitätsbericht über das Deutsche Heer im Weltkriege 3 vols. (Berlin: Verlag E.S. Mittler & Sohn, 1934), III, 107. For Koch's doubts about a vaccine, see A. von Wassermann and P. Sommefeld, "Experimentelle Untersuchungen über die Wirksamkeit der Typhus-und Choleraschutzimpfung," in Kriegsaerztliche Vortrage, vol. III, C. Adam, ed. (Jena: Verlag von Gustav Fischer, 1916), 42-44.
31. MKr 10109 Bd. I Typhus: "Aufzeichnung über die am 24 April 1913 im Kaiserlichen Gesundheitsamt abgehaltene Beratung, betr. die Schutzimpfung gegen Unterleibtyphus und die Ausdehnung der systematischen Typhusbekämpfung auf alle Kreise der Ober-Elsass."
32. Ibid. The introductory report by Dr. Haendel that surveyed recent foreign research and testing is on pp. 4-16.
33. See Ibid., pp. 18-20, for the criticisms of the tests conducted in Southwest Africa, and pp. 23-25 for Gaffky's critique of the British statistics. All participants regarded controlled trials as desirable, as did their British counterparts including Alinroth Wright, although, of course, not double-blind trials and with rather relaxed notions of statistical significance. For a discussion of Wright's views of antityphoid testing procedures in the British context, see J. Rosser Matthews, Quantification and the Quest for Medical Certainty (Princeton, N.J.: Princeton University Press, 1995), pp. 98-99.
34. "Aufzeichnung," (n. 21) pp. 7-8, 39-40. See also Russell, (n. 19), pp. 809-12 for a discussion of contemporary debates and evidence about the negative phase, which Russell also believed to be disproven.
35. Ibid. "Aufzeichnung," (n. 21), pp. 20-23.
36. Ibid. "Aufzeichnung," (n. 21), pp. 20-23.
37. Ibid., pp. 17-18, 30, 36-37. Fornet, who closely followed French research at the Pasteur Institute, probably based his position on the work with live bacilli vaccines by Metchnikoff and Besredka. For this research, see Russell, (n. 19) p. 828, and for Fornet's French connections, see Mendelsohn, (n. 6) Cultures, pp. 732-38.
38. Ibid., pp. 17-18, 30, 36-37. Fornet, who closely followed French research at the Pasteur Institute, probably based his position on the work with live bacilli vaccines by Metchnikoff and Besredka. For this research, see Russell, (n. 19) p. 828, and for Fornet's French connections, see Mendelsohn, (n. 6) Cultures, pp. 732-38.
39. "Aufzeichnung," (n. 21), p. 16 and especially the comments by Martin Kirchner, pp. 24-27, and Paul Uhlenhuth, p. 29.
40. Ibid., p. 26 for Pfeiffer's comments and p. 30 for Fornet's.
41. MKr 10109 Bd. I Typhus: Kriegsministeriuin Mediżinalabteilung, München, 25.7.1914 and das K. Sanitätsamt II A K betreff: Festungssanitätsdepots-Dr. von Seydel.
42. For difficulties with the typhoid statistics, see Richard Pfeiffer, "Typhus" in Hygiene Bd. VII, Handbnch der Aerztlichen Erfahrung im Weltkriege 1914/18, Wilhelm Hoffman, ed., (Leipzig: Verlag von Johann Ambrosius Barth, 1922), 328-30; Alfred Goldscheider, "Typhus Abdominalis" in Innere: Medizin Bd. III, Handbuch der Aerztlichen Erfahrung im Weltkriege 1914/18 Ludolf Krehl, ed., (Leipzig: Verlag von Ambrosius Barth, 1921), 88. For the official statistics, see Sanitätsbericht, (n. 20), III, 99-104.
43. For difficulties with the typhoid statistics, see Richard Pfeiffer, "Typhus" in Hygiene Bd. VII, Handbnch der Aerztlichen Erfahrung im Weltkriege 1914/18, Wilhelm Hoffman, ed., (Leipzig: Verlag von Johann Ambrosius Barth, 1922), 328-30; Alfred Goldscheider, "Typhus Abdominalis" in Innere: Medizin Bd. III, Handbuch der Aerztlichen Erfahrung im Weltkriege 1914/18 Ludolf Krehl, ed., (Leipzig: Verlag von Ambrosius Barth, 1921), 88. For the official statistics, see Sanitätsbericht, (n. 20), III, 99-104.
44. For difficulties with the typhoid statistics, see Richard Pfeiffer, "Typhus" in Hygiene Bd. VII, Handbnch der Aerztlichen Erfahrung im Weltkriege 1914/18, Wilhelm Hoffman, ed., (Leipzig: Verlag von Johann Ambrosius Barth, 1922), 328-30; Alfred Goldscheider, "Typhus Abdominalis" in Innere: Medizin Bd. III, Handbuch der Aerztlichen Erfahrung im Weltkriege 1914/18 Ludolf Krehl, ed., (Leipzig: Verlag von Ambrosius Barth, 1921), 88. For the official statistics, see Sanitätsbericht, (n. 20), III, 99-104.
45. See, for example, Ernst Romberg, "Die Behandlung des Unterleibtyphus," Feldaerztl. Beil. Muench, Med. Wochenchr., 22 Sept. 1914, 38, 1981.
46. MKr 10109 Bd. I Typhus: Nr. 48831 Kriegsministerium Medizinalabteilung, München, 6.11.1914. An den K. stellv. Korpsarzt I. II. III. A.K. Betreff: Vorsichtsmassregeln gegen Übertragung von Typhus, Nachstehender Erlass des Chef des Feldsanitätswesen zur Kenntnis gebracht. Dr. v. Seydel.
47. B. Moellers, "Abschliessender Bericht über die in den Jahren 1903-1918 unter Mitwirkung des Reiches erfolgte systematische Typhusbekämpfung im Südwesten Deutschlands," Arbeiten ans dem Reichsgesundheitsamte, 1926, 56, 261-73.
48. Pfeiffer, (n. 30), p. 332; Dr. Uhlenhuth, Dr. Olbrich, and Dr. Messerschmidt, "Typhus-verbreitung und Typhusbekämpfung im Felde," Med. Klinik, 7 Feb. 1915, XI, 149-58.
49. Sanitätsbericht (n. 20) III, 107-8; MKr 10109 Typhus: Chef des Feldsanitätswesens, Berlin, 9.8. 1914, and the accompanying "Gebrauchsanweisung"; Kriegministerium Medi-zinalabteilung, Berlin, 22.8.1914, An sämtliche Königlichen Sanitätsämter und die Herren Garnisonaerzte . . . gez. Paalzow.
50. For the preparation of vaccines and problems with suspensions, see Pfeiffer, (n. 30), pp. 335-36; Dr. H. Stieve, "Beobachtungen bei der Typhusschutzimpfung mit dem Russelschen Impfstoff," Feldaerztl. Beil. Muench. Med. Wochenschr., 16 Feb. 1915, 7, 236; Eugen Schlesinger, "Die Begleiterscheinungen der Typhusschutzimpfung auf Grund von 1340 Impfungen," Muench. Med. Wochenschr., 20 Maerz 1915, 13, 431-32; see especially p. 432 under the rubric "Impfstoff".
51. For the preparation of vaccines and problems with suspensions, see Pfeiffer, (n. 30), pp. 335-36; Dr. H. Stieve, "Beobachtungen bei der Typhusschutzimpfung mit dem Russelschen Impfstoff," Feldaerztl. Beil. Muench. Med. Wochenschr., 16 Feb. 1915, 7, 236; Eugen Schlesinger, "Die Begleiterscheinungen der Typhusschutzimpfung auf Grund von 1340 Impfungen," Muench. Med. Wochenschr., 20 Maerz 1915, 13, 431-32; see especially p. 432 under the rubric "Impfstoff".
52. Stieve, (n. 36) p. 236.
53. Ibid.
54. S. Oberndorfer, "Plötzlicher Tod nach Typhusschutzimpfung," Dtsch. Mil. Aerztl. Z., August 1918, 47, 286-88.
55. MKr 10110 Typhus Bd. IV 1915-1917: Divisionarzt 2 Landwehr Division 25.8.1915 an den Königl. Bayer. Kriegsministerium and the follow-up report of 27.18.15.
56. Stieve, (n. 36) pp. 237-38.
57. Schlesinger, (n. 36) pp. 431-33; Ernst Laqueur, "Über die Unschädlichkeit der Typhuschutzimpfungen," Fcldacrztl. Beil. Muench. Med. Wochenschr., 21 Sept. 1915, 38, 1295-97.
58. Hugo Kammerer and Wilhelm Woltering, "Typhusschutzimpfung und Milzschwellung," Feldaerztl. Beil. Muench. Med. Wochenschr., 11 Jan. 1916, 2, 37-38.
59. Pfeiffer, (n. 30) p. 337.
60. Sanitätsbericht (n. 20) III, 109. For the Austro-Hungarian army, see I. Kaup, "Erfahrungen und Untersuchungen über den Wert und die Wirkungsdauer der Typhusschutzimpfung," Feldaerztl. Beil. Muench. Med. Wochenschr., 5 Sept. 1916, 36, 1302. The Kaup article was in two parts. The second part, subtitled "Serologischen Untersuchungen im Handlaboratorium," appeared in the same journal on 12 Sept. 1916, 37, 1343-45.
61. Sanitätsbericht (n. 20) III, 109. For the Austro-Hungarian army, see I. Kaup, "Erfahrungen und Untersuchungen über den Wert und die Wirkungsdauer der Typhusschutzimpfung," Feldaerztl. Beil. Muench. Med. Wochenschr., 5 Sept. 1916, 36, 1302. The Kaup article was in two parts. The second part, subtitled "Serologischen Untersuchungen im Handlaboratorium," appeared in the same journal on 12 Sept. 1916, 37, 1343-45.
62. Sanitätsbericht (n. 20) III, 109. For the Austro-Hungarian army, see I. Kaup, "Erfahrungen und Untersuchungen über den Wert und die Wirkungsdauer der Typhusschutzimpfung," Feldaerztl. Beil. Muench. Med. Wochenschr., 5 Sept. 1916, 36, 1302. The Kaup article was in two parts. The second part, subtitled "Serologischen Untersuchungen im Handlaboratorium," appeared in the same journal on 12 Sept. 1916, 37, 1343-45.
63. Erich Toenniessen, "Längerdauerende Krankheitserscheinungen in zeitlichen Zusammenhang mit der Typhusschutzimpfung," Muench. Med. Wochenschr., 30 März 1915, 13, 429-31.
64. Schlesinger, (n. 36) p. 433. See also the comments of Pfeiffer, (n. 30), pp. 338-39.
65. Dr. Hünermann, "Über Typhusschutzimpfung," in W. His and W. Weintraud, eds., Verhandlungen der ausserordentlichen Tagung des deutschen Kongresses für innere Medizin in Warschau am 1. und 2. Mai 1916, pp. 212-13.
66. A. Goldscheider and K. Kroner, "Über den Einfluss der Typhusschutzimpfungen auf die Erkankungen bei der. . . Armee im Herbst und Winter 1914/15," Berl. Klin. Wochenschr., 13 Sept. 1915, 37, 970-71. The article appeared in three parts 6 Sept. 1915, 36; 13 Sept., 37; and 20 Sept. 1915, 38.
67. Ibid., 6 Sept. 1915, 36, 933-34.
68. Ibid., pp. 940-41; see p. 935 for fever curves.
69. Ibid., 13 Sept. 1915, 37, 968 (emphasis in original).
70. Ibid., 20 Sept. 1915, 38, 1003.
71. Hünermann, (n. 48) pp. 208, 215-23.
72. Ibid., p. 228.
73. Ibid., pp. 225-29.
74. Kaup, (n. 45) 36, 1301-4.
75. Ibid., 37, 1343-45.
76. Jan Karolček, Problems of Anti-typhoid Immunity and Protective Vaccination against Typhoid (Flushing: Medical Examination Publishing Co., 1969). Wassermann and Sommerfeld, (n. 20), pp. 42-54, had shown that when the bactericidal properties of the blood of mice were reduced, typhoid bacilli could still penetrate their stomach linings. Because mice were normally immune to typhoid, they believed that this established a clear relationship between the bactericidal titer of the blood and typhoid immunity.
77. Kaup, (n. 45), 37, 1344.
78. Ibid., 37, 1344.
79. Ibid., 37, 1345.
80. A brief report of Friedberger's talk to the Berlin Medical Society on 2 May 1917 was printed in Muench. Med. Wochenschr., 22 May 1917, 21, 686. For Friedberger's difficulties with military censorship during the war, see Friedberger, (n. S) Zur Entivicklung, pp. VII-VIII.
81. A brief report of Friedberger's talk to the Berlin Medical Society on 2 May 1917 was printed in Muench. Med. Wochenschr., 22 May 1917, 21, 686. For Friedberger's difficulties with military censorship during the war, see Friedberger, (n. S) Zur Entivicklung, pp. VII-VIII.
82. E. Friedberger, "Zur Frage der Typhus-und Choleraschutzimpfung," Z. Immunitätsforschung, 1920-1921, XXVIII, 177-78. Friedberger argued that precisely because the value of the vaccine was unproven, there could be no ethical objection to not inoculating some troops.
83. Friedberger, (n. 8) Zur Entivicklung, pp. 104-5. See also pp. 26, 109-13 for his position on the role of nutrition, especially pp. 26 and 112, where he claims that improved nutrition was the primary reason for the decline of enteric diseases during World War I.
84. Ibid., pp. V-VII, 14-18.
85. Ibid., pp. 24-25.
86. Ibid., pp. 28-36.
87. Ibid., pp. 38-46.
88. Ibid., pp. 33-39.
89. Ibid., pp. 65-69.
90. Ibid., pp. 70-78.
91. Ibid., pp. 78-83.
92. Ibid., p. 80.
93. Ibid., pp. 46-64, especially pp. 54-56, where he provides his key explanations for the declines in morbidity and mortality.
94. Ibid., pp. 59-64. He also discusses the same issue in relation to cholera and the cholera vaccine.
95. Ibid., see pp. 91-92, where he discusses the infrequency and milder character of bacterial dysentery during World War I compared to previous wars. Zur Entwicklung had initially been written during the war, but could only be published afterward. Consequently, in light of the increasing number of cases and severity of dysentery in the last two years of the war, Friedberger added an appendix in which he put forth the argument about epidemic displacement (pp. 99-100). The appendix was a counter critique of an article by the military doctor and hygienist Musehold's "Zur Typhusschutzimpfung des deutschen Feldheeres," Dtsch. Mil. Aerxtl. Z., Okt. 1918, 47, 356-66. Musehold emphasized the difference in incidence and severity of dysentery and typhoid during the last two years of the war and polemicized against what he perceived as Friedberger's advocacy of vaccines made of attenuated live bacilli.
96. Ibid., see pp. 91-92, where he discusses the infrequency and milder character of bacterial dysentery during World War I compared to previous wars. Zur Entwicklung had initially been written during the war, but could only be published afterward. Consequently, in light of the increasing number of cases and severity of dysentery in the last two years of the war, Friedberger added an appendix in which he put forth the argument about epidemic displacement (pp. 99-100). The appendix was a counter critique of an article by the military doctor and hygienist Musehold's "Zur Typhusschutzimpfung des deutschen Feldheeres," Dtsch. Mil. Aerxtl. Z., Okt. 1918, 47, 356-66. Musehold emphasized the difference in incidence and severity of dysentery and typhoid during the last two years of the war and polemicized against what he perceived as Friedberger's advocacy of vaccines made of attenuated live bacilli.
97. Alfred Goldscheider, "Typhoid-und Choleraschutzimpfung auf Grund der Kriegserfahrungen," Dtsch. Mil. Aerztl. Z., Jan. 1918, 47, 21-22.
98. Ibid., p. 22.
99. Wilhelm Hoffmann, "Hygienische Erfahrungen, Infektionskrankheiten und Schutzimpfung im Weltkrieg," Dtsch. Mil. Aerztl. Z., Okt. 1919, 48, 217-19. It is notable that Hoffmann also refers to the brevity and limited character of Friedberger's military medical experience. There was a strong undercurrent of ad hominem invective to many of the replies to Friedberger. In part, Friedberger had opened himself up to this by providing numerous examples from his own experience as a hygienist in Flanders in 1914-1915.
100. Pfeiffer, (n. 30) pp. 342-44.
101. Kolle and Hetsch, (n. 9) Bakteriologie, I, 325-31; see especially the passage on p. 328 that is clearly directed against Friedberger. Obviously Kolle, the co-author of this text, was not a neutral observer because he had been the co-discoverer of the first vaccine along with Pfeiffer. It is also notable that in Britain, where vaccination had not been obligatory during the war, Sir William Leishman, who, along with Almroth Wright, had been the leading proponent of typhoid vaccine, made no effort to disentangle the contributions of vaccine, hygiene, and tracking carriers, all of which he simply touted as effective complementary measures. For his account of the effectiveness of vaccination within the British forces, see William B. Leishman, "Enteric fevers in the British Expeditionary Force," J. R. Anny Med. Corps, July 1921, XXXVII, 1-22.
102. Kolle and Hetsch, (n. 9) Bakteriologie, I, 325-31; see especially the passage on p. 328 that is clearly directed against Friedberger. Obviously Kolle, the co-author of this text, was not a neutral observer because he had been the co-discoverer of the first vaccine along with Pfeiffer. It is also notable that in Britain, where vaccination had not been obligatory during the war, Sir William Leishman, who, along with Almroth Wright, had been the leading proponent of typhoid vaccine, made no effort to disentangle the contributions of vaccine, hygiene, and tracking carriers, all of which he simply touted as effective complementary measures. For his account of the effectiveness of vaccination within the British forces, see William B. Leishman, "Enteric fevers in the British Expeditionary Force," J. R. Anny Med. Corps, July 1921, XXXVII, 1-22.
103. During the 19205 Friedberger became the editor of the Zeitschrift für Immunitätsforschung, and from 1926 he was the director of the Prussian Research Institute for Hygiene and Immunology. He died in 1932.
104. For some of the general reasons for the decline of interest in immunology, see Arthur M. Silverstein, A History of Immunology (San Diego: Academic Press, 1989), pp. 328-30. For some of the research that was done on typhoid immunity and vaccines between the war, see Karolček, (n. 59), Problems, pp. 15-18, 29-34. Among the major advances in the interwar era were the identification of the O, H, and Vi antigens and animal protection tests.
105. For some of the general reasons for the decline of interest in immunology, see Arthur M. Silverstein, A History of Immunology (San Diego: Academic Press, 1989), pp. 328-30. For some of the research that was done on typhoid immunity and vaccines between the war, see Karolček, (n. 59), Problems, pp. 15-18, 29-34. Among the major advances in the interwar era were the identification of the O, H, and Vi antigens and animal protection tests.
106. For a summary of research on the Kolle-Pfeiffer vaccine during this post-war epidemic, see Karolček, (n. 59) Problems, pp. 19-21.
107. Division of Immunology, Walter Reed Army Institute of Research, "Preparation of dried acetone-inactivated and heat-phenol-inactivated vaccines," Bull. World Health Org., 1964, 30, 635-46.
108. Yugoslav Typhoid Commission, "A controlled field trial of the effectiveness of acetone-dried and inactivated and heat-phenol-inactivated typhoid vaccines in Yugoslavia," Bull. World Health Org., 1964, 30, 625-27. Reactions to the vaccines for all the trials are summarized in Myron M. Levine et al., "Progress in vaccines against typhoid," Rev. Infect. Dis., May-June 1989, 11 (supplement 3), 8552-53.
109. Yugoslav Typhoid Commission, "A controlled field trial of the effectiveness of acetone-dried and inactivated and heat-phenol-inactivated typhoid vaccines in Yugoslavia," Bull. World Health Org., 1964, 30, 625-27. Reactions to the vaccines for all the trials are summarized in Myron M. Levine et al., "Progress in vaccines against typhoid," Rev. Infect. Dis., May-June 1989, 11 (supplement 3), 8552-53.
110. Karolček, (n. 59), Problems, pp. 37-38.
111. Levine et al. (n. 87), 8553-54; M.T. Ashcroft et al., "A seven-year field trial of two typhoid vaccines in Guyana," Lancet, 18 Nov. 1967, 2, 1058.
112. L.B. Hejfec et al., "A controlled field trial and laboratory study of five typhoid vaccines in the USSR," Bull. World Health Org., 1966, 34, 336-38, p. 338.