The International Community Battles the Typhus Epidemic – Serbia 1914-15

While the Influenza Pandemic of 1918-20 is well known and much discussed, few remember the Typhus Epidemic that preceded it in Serbia. The country had just emerged from the Turkish and Bulgarian wars of 1912 and 1913, before being plunged in 1914 into World War I. Resources were stretched and resistance low, Serbia begged for help and the response of the international community was heroic. The effort to contain the disease was partly humanitarian – the situation in Serbia was beyond horrifying – but also practical: the Serbians were allies and their army was completely paralyzed by disease; there was also fear that the epidemic could spread anywhere that soldiers were fighting in unhygienic conditions. There was an estimated 30%-60% and even 70% mortality, with 150 000 deaths in the first six months.

One remarkable aspect of the international response was the number of women medical personnel, especially from Scotland and England, who answered Serbia’s call. They had been contemptuously rejected by the British military on the western front, but were enthusiastically received in the Balkans and in Italy. The movement was led by Dr Elsie Inglis, who set up 14 Scottish Women’s Hospitals, including four specifically for nursing typhus cases. Some 600 women medical volunteers went out primarily to Serbia, including Dr Elizabeth Ross, who died there. They are not forgotten and in 2015, on the 100th anniversary, a set of stamps commemorating them was issued. 

Sir Thomas Lipton – as in Lipton’s Tea – worked very hard organizing and financing the volunteers and hospitals, and himself visited Serbia in March 2015, endearing himself to the medical missions by living and eating in the same conditions as everyone else. He wrote:

I met on the country roads many victims too weak to crawl to a hospital. Bullock-carts were gathering them up. Often a woman and her children were leading the bullocks, while in the cart the husband and father was raving with fever. Scarcely enough people remain unstricken to dig graves for the dead, whose bodies lie exposed in the cemeteries. The situation is entirely beyond the control of the present force, which imperatively needs all the help it can get – tents, hospitals, doctors, nurses, modern appliances…… and clothing to replace the garments filled with typhus-bearing vermin.……

He goes on to describe the hospital at Ghevgheli, in Northern Macedonia, where Dr James Donnelly of the American Red Cross died, one of the numerous doctors and nurses, many foreign, who had perished in the effort to ameliorate a disastrous situation:

The place is a village in a barren uncultivated country, the hospital an old tobacco factory, formerly belonging to [Sultan] Abdul Hamid. In it were crowded 1400 persons, without blankets or mattresses, or even straw; men lying in the clothes in which they had lived in the trenches for months, clothes swarming with vermin, victims of different diseases – typhus, typhoid, dysentery and smallpox – were herded together. In such a state, Dr Donnelly found the hospital, where he had a force of six American doctors, twelve American nurses and three Serbian doctors. When I visited the hospital, three of the American doctors, the three Serbian doctors, and nine of the nurses were themselves ill. The patients were waited on by Austrian prisoners. The fumes of illness were unbearable. The patients objected to the windows being opened, and Dr Donnelly was forced to break the panes. One of the first things he did on his arrival was to test the water which he found infected. He then improvised boilers of oil drums in which to boil water for use and he built ovens in which to bake the clothes of the patients, since the hospital was not provided with proper sterilizing apparatus. The street cleaning and hospital waiting was done by Austrians, whose numbers were rapidly thinning from typhus and other diseases.

Dr M. Jeanneret-Minkine of the French Mission writes on the dangers, and also the attitudes of the medical community, emphasising, among other points, the enormous importance of sterilizing clothes and bedding – something which he himself studied and refined – as the mortality rate rose from 15% to 50%:

At the end of January, the surgeon of the hospital developed typhus, whilst in the next room his Austrian colleague was becoming convalescent. He however recovered. The same day, a Czech doctor was taken ill and died. Within the next few days, the Superintendent of the hospital, a young physician who worked under my supervision in an improvised hospital, a Polish surgeon whose room I had just moved into, the Chief Administrator of Sanitation, and later, a Roumanian doctor who had taken his wife and children with him to Pirot, became infected. All died one after another. I myself contracted typhus in March.

In short, out of the 13 physicians working in the town when I arrived, 2 were immunised by a  previous attack of typhus, 2 were taken ill at the outbreak of the epidemic and recovered, 8 contracted typhus when the epidemic was at his height, and 6 died within a month. Only one escaped unscathed…..

The civilian population did not suffer much from the epidemic, with the exception of the refugees and those in communication with the hospital. Even the peasant women who, although they should have been forbidden to do so, visited their sick husbands on market days, rarely carried infection to their villages as they were clean and fought the vermin. In the town, at the sight of workmen busy painting names on new coffins, the women outside their doors did not stop weaving and spinning the many coloured tapestries which are the glory of their town. And when a group of Czech prisoners organised a concert at which, after the Russian anthem, the Serbian anthem and the Marseillaise, music by Wagner was played, the hall was crowded.

I have already mentioned the very important part played by fear in the prognosis of typhus exanthematicus, so will not refer to it again. I wish however to say how much I was impressed by the ease with which one became accustomed to the idea of death, even of death without glory, from infectious disease. We watched our group of physicians and hospital employees rapidly diminish; the merry party round the dining room table was reduced to three, but nevertheless remained optimistic. Without any effort we had become used to danger threatening us and faced it, smile on lip and joke ever ready, like soldiers at the front. It is a curious psychological phenomenon that the fact of seeing so many people die, causes one to regard death as a very common event, even when it is a question of one’s own death. Life is very busy and there is an adversary to be fought; the situation may be likened to an exciting game of checkers which absorbs you and makes you forget all the rest. Also one has faith in one’s good star. The reason for that man’s death was no doubt because he was afraid; the one over there was no longer young; that one had over-disinfected himself with alcohol, another was too thin or too fat, etc. One even went so far as to believe that typhus would not be dangerous to one’s self and was almost glad to contract it in order to find out what it is like!

And meanwhile, the epidemic continued its ravages. By the end of February, the number of physicians who had died from typhus in the Serbian reserve hospitals exceeded 100, representing almost a third……

At Uskub [Skopje], I at last saw a hospital free from typhus. It belonged to an English mission, with a well-trained personnel, beds, sufficient quantity of linen, and which above all accepted only a limited number of wounded per room and per doctor.”

There are numerous first person accounts of the battle against the epidemic, by American, British, European and Serbian doctors. All praise the extraordinary courage and stoicism of the Serbians. The second text here is from a major work on the subject:

Richard P. Strong, Typhus fever with Particular reference to the Serbian Epidemic, Harvard University Press, 1920

Of considerable interest is the account of a woman who went to Serbia as a nurse, but left to join the army, subsequently writing of her experiences:

Flora Sandes, An English Woman-Sergeant in the Serbian Army, London 1916

There is also a book by a couple who went out to work distributing Red Cross stores to the hospitals, in particular the Women’s Hospitals. In spite of the cheerful tone – the book is amusing – the horror that lies behind their experiences is very clear:

Jan and Cora Gordon, Two Vagabonds in Serbia and Montenegro – 1915, London, 1916 (Penguin 1939)

V. Subbotitch (Surgeon Colonel, Serbian Army), A Pandemic of Typhus in Serbia – 1914-15, sheds light on the efforts to halt the spread of the disease, by every means available, including removing all upholstered seats from the trains, because they could not be adequately disinfected.

All these books and papers are available on

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