1 Introduction
âCountless people owe their lives and health to vaccination! ⦠Vaccination is a great blessing for all soldiersâ1 proclaimed a military poster in 1916 calling soldiers of the Imperial and Royal 10th Army for vaccination, a practice which it praised to the highest degree. However, the military did not have this positive attitude towards vaccination from the beginning.
At the start of the First World War in 1914, medical research had already developed several effective strategies for dealing with epidemics,2 including disinfection procedures and strict quarantine regulations. These were part of the learning processes from earlier wars (e.g. the Russo-Japanese War and the Balkan Wars),3,4 but were also goals of institutionalized scientific research during times of peace.5 Due to mass mobilization, poor hygiene, adverse climate conditions, and the general chaos of war, the threat of diseases like cholera, typhoid fever, smallpox, and dysentery soon became real and urgent when
Using the example of cholera vaccination, the following chapter deals with the long path to establishing prophylactic vaccination practices within the Imperial and Royal Army on the Eastern Front of the First World War. The focus is more specifically on the region of Galicia, where the Russian and Austro-Hungarian armies not only clashed in numerous battles with huge losses of life but where the medical troops had to contend above all with recurrent flare-ups of cholera infections.8 The âGalician Eastern Frontâ thus offers a special object of study, as it in turn presented a complex space for medical learning processes, in which the relationship between medicine and the Austrian-Hungarian military unfolded amid several influencing factors, for example, the specific environmental and climatic situations, and the resident multi-ethnic Galician population, as well as their colonial hierarchical relationship with the Austro-Hungarian troops mobilized there.9
2 Disagreement on Health Care
More recent studies have long since refuted the positivist view of the traditional medical historical reception of the First World War on the former eastern periphery of the Habsburg Empire, including that specifically of Austrian medicine, once hailed as âgloriousâ.10 In this context, the numerous hurdles,
The continuing disagreements about the correct use of prophylactic measures among military decision-makers as well as (military) doctors seemed to be symptomatic of the organizational chaos. Although vaccinations in general were by no means an exceptional medical treatment in peacetime and within civilian spheres of the Habsburg Monarchy,12 the implementation of the various vaccinations of mobilized soldiers at the most favourable time seemed to be a frequently discussed topic within various institutions of the Imperial and Royal Army. This circumstance has already been addressed in research by the Austrian historians Brigitte Biwald,13 Daniela Angetter-Pfeiffer,14 Elisabeth
During the war, the medical professionals deployed on the Eastern Front had to fight hard against cholera. The outbreaks flared up again and again among both the troops and the civilian population.18 Cholera is an acute, highly contagious diarrhoeal disease caused by infection with Vibrio cholerae bacteria. The infection occurs if contaminated food or water is swallowed. It often runs a mild course or is asymptomatic, but even today it can be life-threatening.19 Cholera patients can experience severe symptoms, such as profuse watery diarrhoea, vomiting, thirst, leg cramps, restlessness, or irritability. It can even lead to severe dehydration, which in turn can lead to kidney failure, shock, coma, and, ultimately, death within hours.20 The cause of cholera among soldiers on the Eastern Front was considered to be the widespread consumption of unripe fruit, mouldy food, or spoiled meat among the often starving soldiers.21 Above all, however, contaminated drinking water led to a rapid spread of the disease. Troops often fought and camped in open fields or crowded into damp, muddy trenches, where they were additionally exposed to harsh weather conditions.22
According to contemporary military statistics, around 78,300 members of the entire army got infected with cholera between 1914 and 1917. Of these, approximately 16,270 died.24 Within the context of the warfare that further exacerbated the precarious situation back then, cholera posed an immense challenge to medical professionals. As this disease caused a great number of casualties among soldiers, it developed into a prominent problem for the military leadership. Although cholera vaccination was officially approved in the army in October 1914,25 its effectiveness was heavily discussed again and again over the following period of about two years by leading military members and doctors. But why exactly?
The debate and the actors involved were complex, as the dividing line cannot always be clearly drawn between military and (scientific) medical interest groups. Different convictions ran through military and civilian as well as scientific institutions. The actors, proponents as well as opponents of cholera vaccination, utilized different narratives based on mostly completely contradictory arguments in order to push through their respective interests. A close reading of army communications from the War Archive in Vienna dealing with the discourse about cholera vaccination and related health measures contributes to the understanding of the construction of arguments for or against vaccination as a protective mechanism against the disease. A comparison of different orders of the War Ministry and the Army High Command, the Army Rear Command, and reports of sanitation chiefs and military as well as civilian doctors exposes the different narratives that were used to build those arguments back then. By using specialized research literature and reports from the interwar period for contextualization, a deeper hermeneutic approach can provide revealing insights on the following question: how exactly were these narratives constructed, legitimized, and used for different kinds of interests?
In the following, using the example of cholera vaccination, an exemplary selection of commands and reports will be used to show how narratives interact and can influence the process of medical learning. Against the background
3 Cholera and Cholera Vaccination: A Polarizing Issue
At the beginning of the war, the Austro-Hungarian troops were first sent to the Eastern Front with almost no preparation for epidemic outbreaks. According to retrospective reports from 1926, the Imperial and Royal Army went to war without specifically established epidemic hospitals.28 Until 1915, if epidemics occurred, regular hospitals were converted into epidemic hospitals.29 Moreover, the doctors who were suddenly mobilized en masse were either not or only inadequately prepared for the treatment of epidemics, and were often randomly assigned to serve in Galicia.30
This approach by the military leadership (especially within the War Department) suggests that the threat of disease outbreaks was not necessarily seen as a priority. Dietrich-Daum, in particular, drew attention to this: although the empirical findings of research as well as the practical experience already gathered by the Imperial and Royal Army on the eve of the war suggested the need for comprehensive, forward-looking, and strictly implemented disease control in armed conflicts, this was neglected.31 This was evident, for example,
In retrospect, the militaryâs actions in the specific case of cholera protection measures also appear incomprehensible. Although catastrophic hygiene conditions could be assumed in Galicia due to mass mobilization and flight movements alone, most soldiers in the army were not vaccinated against cholera when they were mobilized.33 However, the fact that the cholera vaccine was still in an early stage of development34 favoured anti-vaccination approaches of the military at the beginning of the war. The representatives of this group mainly relied on the argument that the expected side effects of vaccination (fever, etc.) would impair the soldiersâ fighting ability, and thus the armyâs effectiveness, too much35âabout which, above all, the widespread narrative was constituted that âcholera vaccination (sometimes vaccinations in general) weakens the armyâ.
On the other side, from the beginning, there were convinced doctors in research who recommended vaccination as protection, as well as high military institutions that tried to follow this advice. With the counter-argument that the danger of cholera (and the troop losses to be expected as a result) was too great to let the troops go into the field completely unprotected, they used the opposite narrative that, rather, âcholera weakens the armyâ. Initially, however, fear of the unknown and admittedly little-researched substances (with possible negative consequences for health and striking power) outweighed fear of the very probable infection with the contagious disease (with a proven morbidity rate of around 20 to 70 per cent, if not treated properly).36 âCholera
In view of the imminent danger of cholera ⦠it is once again ordered that the garrison should only eat cooked food and drink boiled water, possibly with the addition of coffee or tea. Where practicable, the garrison is to be instructed to wash their hands with soap and clean water before eating. Every case of diarrhoea, especially vomiting and diarrhoea, must be brought to the attention of the doctor immediately, and the person suffering from vomiting and diarrhoea must be strictly isolated and his or her belongings disinfected with milk of lime. For this purpose, an adequate supply of lime is to be kept in each ward.
The garrison shall be instructed by the doctors on the nature of cholera and on the preventive measures against it; the officers shall strictly supervise the implementation of these measures.38
In this respect, the military leadership seemed to be rather cautious and to adopt a wait-and-see attitude in the first months, while the cholera vaccination practice was not really considered seriously. Since the massive spread within the army and into the hinterland was not yet too acute at this point, it was apparently assumed that âlightâ measures would suffice to get cholera under control, although the hygiene conditions on the Eastern Front were already inferior in the autumn of 1914 and the conservative measures applied soon failed miserably.39
Beyond content-related aspects, the debate on cholera vaccination additionally became the arena for disputes over competences and power struggles between different military institutions. The Army High Command and the War Ministry, for example, tried to oppose each other by ordering completely contradictory measures: initial efforts by vaccination advocates of the Army High Command to order cholera (and also typhoid fever) vaccines from the Sero-Therapeutic Institute in Vienna40 were prevented by the War Ministry.41 With the main argument or narrative that the armyâs power would suffer too much42 from the vaccination side effects (i.e. fever), vaccination opponents within the military were able to prevail at first.
In approx. 25% of vaccinations a fever occurs, which in some cases can reach temperatures of up to 40°C. ⦠These reactions generally take two days; this is true for typhoid fever vaccination, with cholera [vaccination] ⦠the temperature hardly ever rises above 38°C. Both vaccinations should be repeated at intervals of six to eight days. This means that these vaccinations can only be given to troops who will certainly not be used in any action for three to four days after each vaccination. It must therefore be described as more or less impracticable during mobilization.43
It cannot be assumed that the military approached a medical expert here without bias. Retrospective reports suggest that the War Ministry rather put pressure on the institute to justify its planned course of action.44 Medical
For this reason, the militaryâs initial reticence regarding vaccination is probably due not least to the general shortage of time. The widespread assumption that the First World War would only last a few months or weeks45 from the point of view of the Central Powers seems to have led the military and politicians to allot far too little time and too few resources for their operations. According to this thinking, any kind of delay was therefore, indeed, as Paltauf stated, impractical for military interests. As a result, vaccination advocates were initially unable to convince decision-makers to reconsider the prevailing narrative that âcholera vaccination weakens the armyâ.
Of course, this perspective was rather short-sighted, both from a medical and a military point of view, since, contrary to expectations, the First World War lasted for several years. Due to the poor hygiene conditions, cholera and other epidemic outbreaks occurred after only a few weeks,46 causing high losses among the troops, which actually damaged the armyâs striking power. Nevertheless, the War Ministry kept the upper hand in the autumn of 1914, hoping that the army would succeed before the cholera outbreak got too bad.47
Typhoid fever vaccination is theoretically well-founded, in practice often carried out many times, in some armies, however, in small proportions compared to the large colonial armies (English and German) or the French troops in Morocco (approx. 20,000 men), even in the army of the United States (approx. 50 000â60 000 men), and it has shown positive
results. Cholera vaccination is theoretically less well-founded, but has been practised in India, Japan and Russia, mainly among the civilian population, sometimes also among troops; mainly in the last Balkan War (favourable reports from the Greek army).48
The consideration of vaccinating mobilized troops against cholera therefore lost its appeal from a military point of view, and not only because of the time factor: Paltauf described cholera vaccination itself as being theoretically less sound49 compared to the already known typhoid vaccine. Via this statement, a new narrative was constructed, namely that âthe cholera vaccine was unpredictableâ, which fulfilled an additional legitimizing function for military interests: the narrative justified the armyâs preferential action of remaining cautious about vaccination and waiting because medical experts said that the cholera vaccine was not yet âsufficiently researchedâ.50 This counsel not only made sense in the militaryâs mindset but above all could scientifically validate their short-term interests.
It is also interesting to note that Paltaufâs advice was based on the experience of other countries that had already gained more experience with cholera vaccination. Thus a categorization of âvalidâ and âinvalidâ results emerged based on their âoriginâ: while the âwell-knownâ and âreliableâ typhoid vaccination practice was linked to Western nations in a military context, the âless reliableâ cholera vaccine was linked to Eastern countries in a mostly civilian contextâa circumstance that could well suggest a colonial perspective on the East. So far, this hypothesis cannot be fully substantiated from the official command correspondence, which is rather subtle in this respect; however, a look at retrospective reports by former Austrian military doctors on epidemiological learning processes on the Eastern Front can be quite revealing.
Not infrequently, these reports communicated a strong sense of âcultural superiorityâ with regard to Eastern European countries, even within the sphere of medicine and hygiene.51 For example, their authors, like many Austrian and German scientists, repeatedly used directly formulated chauvinistic,
Ultimately, of course, we cannot know for certain what personal attitudes individual medical experts held toward scientific research from the Eastern European countries. What can be gleaned from Paltaufâs statement above, however, is that according to his expertise, the experience of Eastern countries was not sufficient to classify the cholera vaccine as safe for oneâs own army at the time. This was another useful counter-argument which continued to reinforce the âcholera vaccination weakensâ narrative.
5 Vaccination as the Very Last Resort
However, the hygiene situation on the Eastern Front deteriorated drastically within only a few weeks of the beginning of the war.54 The initially preferred non-invasive methods of disease control, such as disinfection of hands, disinfection of food and water by cooking, isolation of the sick55 etc., could not effectively halt the spread of several epidemics. Additionally, adequate treatment of the sick was often not possible simply due to a lack of personnel, equipment, and treatment options.56 Cholera alone claimed the lives of more and more soldiers who were urgently needed for the fighting. By the end of October 1914, some 3,642 Austro-Hungarian soldiers had died because of infection with cholera,57 a circumstance that the military could not ignore and
The cholera vaccination in contrast to the smallpox vaccination, does not provide unconditional but only relative (not yet ensured) protection. It should be considered as an individual protective measure according to the experience gained so far, which has not yet been concluded ⦠in general only under certain conditions. These conditions can be considered met, if under very bad hygiene conditions ⦠the implementation of the otherwise necessary measures for the control of cholera ⦠is impossible.60
The anti-vaccination attitude in this case was constituted by the same arguments and narratives that were used in the intra-military debate. This time, the still relatively unknown cholera vaccine was compared with the well-researched smallpox vaccine, which was rated as âmore trustworthyâ. Interestingly, the order went one step further and additionally questioned the reliability of the vaccineâs efficacy, which constructed an even stronger argument against
The 4th Corps, in order not to lose its ability to act due to cholera infection, had the most severely infected infantry regiments vaccinated on its own responsibility. The experience gained from about 9,000 such cases showed that the ability to act ⦠was not affected at all. The team completed a seven-hour march on the day following the vaccination without any ⦠vaccination damage occurring ⦠1,000 cholera deaths have occurred in the entire army since September ⦠and the strictly implemented sanitary measures have not been able to achieve any effective success due to the unfavourable weather conditions and partly also to inadequate equipment of the garrison. It is necessary to vaccinate the entire army.62
In this context, some completely contradictory arguments came into play, the purpose of which was, of course, to undermine the arguments of the other side. Initially, the âcholera weakensâ argument was deliberately made explicit as the dominant narrative. This set the scene for all the following arguments,
6 Civilian Health: Something âCompletely Differentâ63
On the basis of theoretical considerations and according to the experience of animal experimentation, the possibility cannot be dismissed that, in cases of severe cholera infection, these vaccinations might constitute a
dangerous experiment under certain circumstances. ⦠Cholera death [is] ultimately caused by so-called bacterial endotoxins that are released by the decay of cholera bacteria in the infected body.66
Dr Julius Maldovan, President of the 2nd Sanitary Commission, performed therapeutic vaccinations with the cholera vaccine on about 300 bacteriologically secured cholera patients. He observed a strikingly favourable mortality ratio. Even though the experts consulted were of the opinion that the vaccination of infected patientsâin the case of a disease that kills in a few hoursâis theoretically unsound, the procedure should be re-examined under the necessary controls, since its previously claimed dangerousness has not been proven.67
Although there was a determined effort to push the pro-vaccine narrative that cholera vaccination is safe, citing a concretely observed improvement in mortality rates, opponents of vaccination in the military and the medical community remained adamant. The argument that vaccination was a last attempt in a desperate situation to save the lives of infected people who were already dying could not convince the opposing side in the long term. The very negative, even âdeathlyâ, image of cholera vaccination remained.
But exceptions may exist here too, e.g. in the case of occupation of fixed places ⦠after the completion of certain operations [or] after ⦠a longer period of rest. The situation is, of course, quite different in the case of troops who have been wounded, traumatized, or [have] venereal infections, or those who are already incapacitated. Here, in order to protect these people from typhoid fever and cholera, vaccination could be carried out without hesitation ⦠the medical staff and waiting staff should also be vaccinated on a regular basis.69
Taking into account Paltaufâs previous lines from the same report, his advice was certainly initially geared towards military interests. But it seems that as a medical expert with extensive knowledge of epidemiology, Paltauf could not deny the danger of cholera altogether. Due to the hierarchy, in which the military clearly had the upper hand, it seems that he tried to propose a compromise: on the one hand, epidemiologically urgent actions should not be completely disregarded, on the other, military operations should in no way be endangered. Therefore, Paltauf tried to encourage the military to vaccinate as many non-combatants as possible, i.e. mainly civilians. Paltaufâs partial concession therefore attempts to subtly address a common functionalist, military practice at the time: to regard actively fighting combatants as urgently needed âhuman materialâ.70 Interestingly, however, soldiers were perceived in this context less as âcannon fodderâ than as an enduring resource who should on no account be exposed to risky medical treatments.
This approach was of course favoured by central findings of the armyâs medical learning system. As the war progressed, the army commands recognized the importance of the state of health of the civilian population for that of their own troops.71 This included monitoring the epidemiological situation of the civilian population in areas that had already been abandoned by troops. Cholera apart, increasing importance was attached to disease control through the sanitation of the staging area and various vaccinations (against smallpox
The main point is that the military decided which narrative was the dominant one for each group and regulated the bodies of bothâeven by force: civilians, all kinds of staff, and armies not actively fighting were occasionally forced to get vaccinated,74 to keep the danger of âweakening due to choleraâ away from the troops, who should be ready for fighting at any time,75 but also to avoid the risk of spreading cholera into the hinterland.76 This was done from the beginning of the war and despite the âdeathlyâ image of the cholera vaccine.
7 The Turn
Regardless of anti-vaccination beliefs among doctors and the military, cholera continued to spread, putting more and more soldiers out of action, and the armyâs striking power actually began to suffer.77 Military leaders eventually realized that the disease could no longer be contained without broader
Infectious diseases claim a particularly large number of victims ⦠Now we already know a lot of ways to protect ourselves against these contagious diseases. Among them, vaccination has a prominent place. Millions of people were vaccinated during the war without any bad consequences or even deaths. On the contrary, countless people owe their lives and health to vaccination! ⦠In the Austro-Hungarian army, cholera, which had only just broken out, was cut off in 5â8 days after vaccination, mortality was incomparably reduced ⦠These facts show that vaccination is a great blessing for all soldiers. â¦Soldiers! Support all health measures for the good of the fatherland and your own good.81
From then on, the narrative âcholera vaccination strengthensâ became the preferred one. It was also clearly based on all the arguments that supported this one and invalidated earlier counter-arguments: for example, that vaccination was definitely safe, effective, and reliable. This time, the military went a step further: the decision to vaccinate was even portrayed as a âservice to the fatherlandâ, adding a dutiful, patriotic component to the whole debate. Soldiers should now do everything possible not to hand victory
Basically, the two narratives âcholera weakensâ AND âinoculation strengthensâ were both enforced and from now on could work together. Conviction of the efficacy and benefits of cholera vaccination gradually spread and improved the image of vaccination to such an extent that it was able to be established as a standardized, proven method in disease control. From the end of the war at the latest, it was retrospectively regarded in the mainstream of medical research as part of meaningful and significant modernizations of the sanitary system.83
8 Assessments from Todayâs Perspective
How should the actions of the Imperial and Royal Army in the First World War against cholera and the cholera vaccination debate be assessed in the context of todayâs knowledge and on the basis of the available source material? Even now, cholera has not been eradicated and occurs worldwide in places with insufficient access to clean water and sanitation, due to natural and humanitarian disasters such as refugee movements.84 Areas affected include the Indian subcontinent, Central Africa, and South and Central America.85 Based
From this current standpoint of knowledge, it seems justified that during the First World War in those western parts of the Habsburg Monarchy that were largely spared from military operations, and where favourable hygiene conditions and extensive access to medical care could be guaranteed, vaccination against cholera was not standard practice. However, the fact that the vaccination of soldiers was not carried out at a time close to mobilization (in some units it was delayed for months) cannot be justified epidemiologically.
In addition, difficulties also lay in the severely limited treatment options at that time. The danger of infection with cholera lies primarily in the rapid loss of fluid from the body through vomiting and diarrhoea. The most important component in the treatment of cholera is therefore the restoration of fluids, sugars, and salts to the patient as quickly as possible (today ideally with the help of an intravenous infusion)92 in order to avoid organ failure and to remove the risk of deathâan option that was not available to the large number of infected people on the Eastern Front in the First World War. The medical staff were often completely overwhelmed by the onslaught of sick peopleâin addition to the wounded.93 The necessary rapid treatment of cholera required the continuous oral administration of sufficient fluids over several days to the patients who were falling ill in droves at the same time.94 For the understaffed medical personnel, the (prophylactic) vaccination against cholera at the
Of course, given these events took place more than a hundred years ago, further considerations are speculative. An analysis that combines scientific methods with those of historical research could lend more depth to the context of the cholera vaccine debate and allow more reliable statements about the facts. For example, complementary tools from statistics, cell and microbiology, virology, historical meteorology, and archaeology definitely offer enormous potential in this regard. Without their contributions, however, the question of the scope of the epidemic in the context of the war, or how its course might have been changed had decision-makers and doctors reacted differently, must remain open.
9 Conclusion
As regards the analysis of dominant narratives in medical discourse, using the example of the cholera vaccination debate of the Imperial and Royal Army, this study can certainly provide an insight into the distribution of power between medicine and the military and argumentation strategies of the two groups for asserting their own interests in the context of the armed conflict of the First World War.
Thus, several orders indicate that medical reports were predominantly used to legitimize military interests and to construct targeted arguments to justify actions that had already been determined and to enforce the constantly changing military interestsâan observation that confirms the current state of research and the âalliance between medicine and the militaryâ95âwith supremacy of the militaryâin the First World War, generally and also for epidemiology.
Additionally, as far as the learning process with respect to vaccinations during the First World War is concerned, a change in narratives did not simply happen rationally in accordance with facts or scientific knowledge. Rather, change was more likely to happen when facts and scientific knowledge fitted the ever-shifting interests of military leaders, who played out different
Using the specific example of cholera, it has been possible to observe that when the military realized that the containment of the infectious disease ultimately involved vaccination, they presented it in retrospect as an effective weapon against the âenemy withinâ.96 In this sense, the touting of the âvictoryâ over cholera points to the armyâs attempt to present itself as a modern and progressive army equal to the difficult situation,97 although research has long since shown that neither the military nor medicine were sufficiently prepared for the unknown, catastrophic dimensions of the First World War98ânor against the cholera epidemic on the Eastern Front.
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Steffen, Katrin. âExperts and the Modernization of the Nation: The Arena of Public Health in Poland in the First Half of the Twentieth Centuryâ. Jahrbücher für Geschichte Osteuropas, Vol. 61, 4 (2013): 574â90.
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Taddei, Elena. âAspekte von indirektem Impfzwang im Rahmen der Pockenschutzimpfung im Tirol des 19. Jahrhundertsâ. In VIRUS. Beiträge zur Sozialgeschichte der Medizin 20. Schwerpinkt: Kulturgeschichte(n) der Impfung, edited by Elisabeth Dietrich-Daum, Marina Hilber, Elisabeth Lobenwein, and Carlos Watzka, 131â46. Leipzig: Leipziger Universitätsverlag, 2021.
ThieÃen, Malte. Auf Abstand: Eine Gesellschaftsgeschichte der Coronapandemie. Frankfurt am Main: Campus Verlag, 2021.
UNAIDS, Fact Sheet, 2023. Available online at https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf. Accessed 14 July 2023.
Vasold, Manfred. Die Pest: Ende eines Mythos. Stuttgart: Theiss, 2003.
Watzka, Carlos. âPockensterblichkeit und Pockenimpfung in der Peripherie: Die Zurückdrängung der Blattern in der Bukowina während des 19. Jahrhunderts im Kontext der Gesundheitspolitik in der Habsburgermonarchieâ. In VIRUS. Beiträge zur Sozialgeschichte der Medizin 20. Schwerpunkt: Kulturgeschichte(n) der Impfung, edited by Elisabeth Dietrich-Daum, Marina Hilber, Elisabeth Lobenwein, and Carlos Watzka, 167â88. Leipzig: Leipziger Universitätsverlag, 2021.
World Health Organization on CholeraâGlobal situation. Available at https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON437. Accessed 14 July 2023.
World Health Organization on Cholera. Available at https://www.who.int/news-room/fact-sheets/detail/cholera. Accessed 11 July 2023.
AT-OeStA/KA FA AOK QuAbt Akten 2239, K.u.k. San-Chef der 10. Armee, Die Schutzimpfung.
Daniela Angetter, Krieg als Vater der Medizin. Kriege und ihre Auswirkungen auf den medizinischen Fortschritt anhand der 2000-jährigen Geschichte Ãsterreichs (Vienna: Ãsterreichsicher Kunst â und Kulturverlag, 2004), 102.
Brigitte Biwald, Von Helden und Krüppeln: Das österreichisch-ungarische Militärsanitätswesen im Ersten Weltkrieg. Teil 1 (Vienna: öbv & hpt, 2002), 42 ff.
Ernst PÅibram, âDie Bedeutung des staatlichen Serotherapeutischen Institutes in Wien während des Weltkriegesâ, in Volksgesundheit im Krieg, II. Teil, ed. Clemens Pirquet (Vienna: Hölder-Pichler-Tempsky A. G., 1926), 282â330, here 287.
Daniela Angetter-Pfeiffer, Pandemie sei Dank! Was Seuchen in Ãsterreich bewegten (Vienna: Amalthea Verlag, 2021), 70â77.
Brigitte Biwald, Von Helden und Krüppeln: Das österreichisch-ungarische Militärsanitätswesen im Ersten Weltkrieg. Teil 2 (Vienna: öbv & hpt, 2002), 532 f; Katrin Steffen, âExperts and the Modernization of the Nation: The Arena of Public Health in Poland in the First Half of the Twentieth Centuryâ, Jahrbücher für Geschichte Osteuropas 4, no. 61 (2013), 574â90, here 575.
Angetter-Pfeiffer, Pandemie, 80â84.
Elisabeth Dietrich, âDer andere Tod. Seuchen, Volkskrankheiten und Gesundheitswesen im Ersten Weltkriegâ, in Tirol und der erste Weltkrieg, ed. Klaus Eisterer and Rolf Steiniger (Innsbruck: Studien Verlag, 1995), 255â76, here 256.
WÅodzimierz Borodziej and Maciej Górny, Der vergessene Weltkrieg: Europas Osten 1912â1923. Bd. 1 Imperien (Darmstadt: wbg Theiss, 2018), 336â70.
Recent research confirms that the First World War resulted in certain modernizations in epidemic control, from which European medicine was able to benefit after the end of the war. Elisabeth Dietrich-Daum points to general useful modernizations, such as the establishment of basic military principles like standardization or increased efficiency in different hygiene or treatment practices. However, these advances were made possible by âmedical experimentation on human beingsâ. Elisabeth Dietrich-Daum, âMedizin und Gesundheitâ, in Katastrophenjahre: Der Erste Weltkrieg und Tirol, ed. Herman J. W. Kuprian and Oswald Ãberegger (Innsbruck: Wagner, 2014), 195â216, here 213â214. With the increasing focus on the ethical issues of war medicine, overly positive receptions from the past have since been put into perspective. The military and medical treatment of soldiers as âhuman materialâ has long since been exposed, as well as war crimes against civilians. Hermann J. W. Kuprian and Oswald Ãberegger, âKrieg als gesellschaftliche Grenz â und Gewalterfahrung,â in Katastrophenjahre. Der Erste Weltkrieg und Tirol, ed. Hermann J. W. Kuprian and Oswald Ãberegger (Innsbruck: Wagner, 2014), 10â20, here 12; Borodziej and Górny, Weltkrieg, 95â111, 291â307.
Angetter, Krieg; Biwald, Helden 1; Biwald, Helden 2; Thomas Edelmann, âVon Impfaktionen und medikamentöser Behandlung. Die k. u. k. Armee im Kampf gegen Cholera, Blattern und Malaria im Ersten Weltkriegâ, HGM-Wissens-Blog, 19 November 2020, https://blog.hgm.at/2020/11/19/von-impfaktionen-und-medikamentoeser-behandlung/, accessed 11 July 2023; Tamara Scheer, âÃsterreich-Ungarns Besatzungsregime im Ersten Weltkrieg zwischen Medizin, Moral und Kriegsnotwendigkeitâ, ÃT KONTINENS 1 (2010), 365â80.
For recent studies, see: Andreas Golob, âDie präventive Blatternbekämpfung im Spiegel des Wiener Zeitungswesen. Sondierungen von 1722 bis 1812â, in VIRUS. Beiträge zur Sozialgeschichte der Medizin 20. Schwerpunkt: Kulturgeschichte(n) der Impfung, ed. Elisabeth Dietrich-Daum, Marina Hilber, Elisabeth Lobenwein, and Carlos Watzka (Leipzig: Leipziger Universitätsverlag, 2021), 55â78; Elena Taddei, Aspekte von indirektem Impfzwang im Rahmen der Pockenschutzimpfung im Tirol des 19. Jahrhunderts, 131â46; Carlos Watzka, Pockensterblichkeit und Pockenimpfung in der Peripherie: Die Zurückdrängung der Blattern in der Bukowina während des 19. Jahrhunderts im Kontext der Gesundheitspolitik in der Habsburgermonarchie, 167â88.
Biwald, Helden 2, 533â39.
Angetter, Krieg, 104â105.
Dietrich, âTodâ, 258â259.
Edelmann, âImpfaktionenâ.
Angetter-Pfeiffer, Pandemie, 84â88; Edelmann, âImpfaktionenâ.
There have been seven cholera pandemics worldwide since 1817, affecting Asia, Europe, Africa, and the Americas. In the 19th century, cholera was considered the ultimate urban disease, linked to the unhygienic living conditions of workers and sailors in the growing cities and capitals. Port cities and metropolises such as Hamburg, New York, London, and Naples were particularly hard hit, but cholera also spread overland, reaching Moscow and Berlin. The cholera outbreaks discussed in this article belong to the sixth pandemic, which flared up mainly in Russia, which was devastated by revolution and war. Valeska Huber, âPandemics and the Politics of Difference: Rewriting the History of Internationalism through Nineteenth-Century Choleraâ, Journal of Global History 15 (2020), no. 3, 394â407, here 394. The seventh has been ongoing since 1961 and, according to the World Health Organization, is the longest-running pandemic to date. World Health Organization on CholeraâGlobal situation. Available online at https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON437, accessed 14 July 2023.
World Health Organization on Cholera. Available online at https://www.who.int/news-room/fact-sheets/detail/cholera, accessed 7 July 2023.
Centers for Disease Control and Prevention on CholeraâVibrio cholerae infection. Available online at https://www.cdc.gov/cholera/illness.html, accessed 11 July 2023.
Biwald, Helden 2, 539.
Angetter-Pfeiffer, Pandemie, 77.
Oksana Nagornaia and Yaroslav Golubinov, âEmbattled Nature: Men and Landscapes on the Eastern Front of the First World Warâ, in Science, Technology, Environment, and Medicine in Russiaâs Great War and Revolution 1914â22, ed. Anthony J. Heywood, Scott W. Palmer, and Julia A. Lajus (Bloomington: Slavica Publishers, 2022), 333â51, here 341.
Salomon Kirchberger, âBeiträge der Sanitätsstatistik der österreichisch-ungarischen Armee im Kriege 1914â1918â, in Volksgesundheit im Weltkrieg, I. Teil, ed. Clemens Pirquet (Vienna: Hölder-Pichler-Tempsky A. G., 1926), 47â77, here 53.
Edelmann, âImpfaktionenâ.
The currently still rampant AIDS pandemic should also be mentioned in this context. After all, in 2022, about 39 million people worldwide were living with HIV and about 630,000 people died of AIDS-related diseases, UNAIDS, Fact Sheet, 2023. Available online at https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf, accessed 14 July 2023. By 2020 at the latest, however, it seems to have been pushed to the margins of media attention by the COVID-19 pandemic.
For new approaches in the debates on health interventions and vaccination in the context of the COVID-19 pandemic, see Malte ThieÃen, Auf Abstand: Eine Gesellschaftsgeschichte der Coronapandemie (Frankfurt am Main: Campus Verlag, 2021).
Wilhelm Raschofsky, âMilitärärztliche Organisation und Leistungen der Epidemiespitäler österreichisch-ungarischen Armeeâ, in Volksgesundheit im Weltkrieg, I. Teil, ed. Clemens Pirquet (Vienna: Hölder-Pichler-Tempsky A. G., 1926), 122â33, here 122â123.
Dietrich, âTodâ, 257. Only in the course of the first year of the war did the army have about 40 mobile and eleven stable epidemic hospitals. Clemens Pirquet, âEinleitungâ, in Volksgesundheit im Weltkrieg, I. Teil, ed. Clemens Pirquet (Vienna: Hölder-Pichler-Tempsky A. G., 1926), 1â13, here 5.
Dietrich, âTodâ, 257.
Research evaluates the organization of the German armyâs defence against epidemics as significantly better than that of the Austro-Hungarian army, also with regard to cholera. Thus they recorded only one-tenth of the cholera deaths of the Imperial and Royal Army. Biwald, Helden 2, 536. Biwald refers here to studies of Manfred Vasold, Die Pest: Ende eines Mythos (Stuttgart: Theiss, 2003), 267.
Dietrich, âTodâ, 257.
Within the Habsburg Monarchy, there was a clear eastâwest divide, as infectious diseases with high mortality rates occurred endemically mainly where climatic and sanitary conditions were most unfavourable. Strict hygiene measures (organized sewerage, waste disposal, etc.) ensured that outbreaks of cholera in the west of the monarchy became exceptional cases and compulsory vaccination of the civilian population was not considered necessary, Dietrich, âTodâ, 256.
PÅibram, âSerotherapeutisches Institutâ, 289; Biwald, Helden 2, 536.
Dietrich, âTodâ, 259.
âCholera als Blaupause für Pandemienâ, interview with Vivek Neelakantan and Eva-Marie Knoll, Austrian Academy of Sciences on Medical History. News of the Austrian Academy of Sciences, 24 May 2023, https://www.oeaw.ac.at/news/cholera-als-blaupause-fuer-pandemien#, accessed 7 July 2023.
Edelmann, âImpfaktionenâ.
AT-OeStA/KA FA NFA HHK AK 3. Armee EKdo 299/ 1174, Op.Nr. 814, k.u.k. AK Grybow, am 24. 9. 1914.
Edelmann, âImpfaktionenâ.
The Sero-Therapeutic Institute in Vienna produced vaccines but also did scientific research and provided educational programmes for doctors, PÅibram, Serotherapeutisches Institut, 282â330.
Dietrich, âTodâ, 259.
PÅibram, âSerotherapeutisches Institutâ, 289.
AT-OeStA/KA FA AOK QuAbt Akten 1347/ 408, k.u.k. Kriegsministerium Abt. 14 Nr. 4661 an das k.u.k. EOK in Wien, am 18. August. Cholera und Typhusschutzimpfung. Prof. Rich. Paltauf. Leiter des k.k serotherapeutischen Institutes in Wien.
PÅibram, âSerotherapeutisches Institutâ, 289.
Sabine Mischner, âTagebuchschreiben als Zeitpraxis. Kriegstagebücher im Ersten Weltkriegâ, Traverse: Zeitschrift für Geschichte/Revue dâhistoire 23 (2016), no. 3, 77-90, here 80â81.
Dietrich, âTodâ, 259 ff.
Edelmann, âImpfaktionenâ.
AT-OeStA/KA FA AOK QuAbt Akten 1347/ 408, k.u.k. Kriegsministerium Abt. 14 Nr. 4661 an das k.u.k. EOK in Wien, am 18. August. Cholera und Typhusschutzimpfung. Prof. Rich. Paltauf. Leiter des k.k serotherapeutischen Institutes in Wien.
AT-OeStA/KA FA AOK QuAbt Akten 1347/ 408, k.u.k. Kriegsministerium Abt. 14 Nr. 4661 an das k.u.k. EOK in Wien, am 18. August. Cholera und Typhusschutzimpfung. Prof. Rich. Paltauf. Leiter des k.k serotherapeutischen Institutes in Wien.
Biwald, Helden 2, 536.
Borodziej and Górny, Krieg, 336â70.
Reports about the fight against epidemics among the civilian population of Galicia contained, for example, the opinion that âthe hygienic requirements could not be metâ because âthe areas where the war took place were for the most part very basic in terms of their cultureâ, or that âthere was no talk of cleanliness, of the appropriate disposal of wasteâ, Raschofsky, âEpidemiespitälerâ, 126. Others wrote about the âunspeakably primitive living conditions of the small peasant population in Galicia ⦠[and] the associated low level of hygienic conditionsâ, Rudolf Stiglbauer, âReport on Frontline Doctorsâ, in Ãrzte und ihre Helfer im Weltkriege 1914â1918, ed. Burghard Breitner (Vienna: Göth, 1936), 93â99, here 94.
Elisabeth Haid, âIm Blickfeld zweier Imperien. Galizien in der österreichischen und russischen Presseberichterstattung während des Ersten Weltkriegs (1914â1917)â, in Studien zur Ostmitteleuropaforschung 43, ed. Herder-Institut für historische OstmitteleuropaforschungâInstitut der Leibniz-Gemeinschaft (Marburg: Verlag Herder-Institut, 2019), 264.
Edelmann, âImpfaktionenâ.
Ibid.
Biwald, Helden 2, 540.
Biwald, Helden 1, 535.
AT-OeStA/KA FA AOK QuAbt Akten 1353/ 5202, k.k. Minister des Inneren an das kuk AOK/EOK, Wien am 9.11.1914. Cholera Schutzimpfung. Abschrift eines Erlasses des k.k. Ministers des Inneren vom 9. November 1914, Zl.7.832/S, an die k.k. Statthalterei in Galizien.
The ministry was reluctant to recommend vaccination to civilian authorities and initially shared similar concerns about cholera vaccination to the military. Research has shown, however, that within the civilian sphere, the Galician population was vaccinated on a broad basis much, more quickly and earlier. Edelmann, âImpfaktionenâ.
Edelmann, âImpfaktionenâ.
Edelmann, âImpfaktionenâ.
AT-OeStA/KA FA AOK QuAbt Akten 1350/ 2695, k.u.k. 2 AK Res Nr/40 S.R an das AOK in Neusandez, Bartfa am 1. Oktober 1914. Cholera-Schutzimpfung.
AT-OeStA/KA FA AOK QuAbt Akten 1347/ 408, k.u.k. Kriegsministerium Abt. 14 Nr. 4661 an das k.u.k. EOK in Wien, am 18. August. Cholera und Typhusschutzimpfung. Prof. Rich. Paltauf. Leiter des k.k serotherapeutischen Institutes in Wien.
Edelmann, âImpfaktionenâ.
Ibid.
AT-OeStA/KA FA AOK QuAbt Akten 1463/ 13716, k.und k. 4. Armee-Etappenkommando Op.Nr. 11524 an das k. und k. Etappenoberkommando Teschen, Standort des AEK am 8. Dezember 1914.
AT-OeStA/KA FA NFA HHK AK 3. Armee EKdo 303/ 1953, k.u.k. 3.AK/AEK Choleraschutzimpfung.
AT-OeStA/KA FA AOK QuAbt Akten 1347/ 408, k.u.k. Kriegsministerium Abt. 14 Nr. 4661 an das k.u.k. EOK in Wien, am 18. August. Cholera und Typhusschutzimpfung. Prof. Rich. Paltauf. Leiter des k.k serotherapeutischen Institutes in Wien.
AT-OeStA/KA FA AOK QuAbt Akten 1347/ 408, k.u.k. Kriegsministerium Abt. 14 Nr. 4661 an das k.u.k. EOK in Wien, am 18. August. Cholera und Typhusschutzimpfung. Prof. Rich. Paltauf. Leiter des k.k serotherapeutischen Institutes in Wien.
Kuprian and Ãberegger, âKriegâ, 12.
Edelmann, âImpfaktionenâ.
Ibid.
Particularly on the Eastern Front and in Galicia, the narrative of âthe unhygienic Eastâ was also often used from a German-speaking, Austrian perspective, which attributed the âmain blameâ for the cause and spread of infectious diseases mainly to the equally unhygienic, primitive, and basically living people and civilians âfrom the Eastâ, Raschofsky, âEpidemiespitälerâ, 126.
Edelmann, âImpfaktionenâ; Borodziej and Górny, Krieg, 363â364.
Recent studies on public health in Eastern Europe found that the German army acted in a similar way. The focus was on protecting their own troops against epidemics; civilians in (now) Polish areas were perceived and treated as âinferior human beingsâ. The chosen sources from the Austro-Hungarian army point to a similar view, Steffen, âModernizationâ, 575.
Edelmann, âImpfaktionenâ.
Biwald, Helden 2, 537.
Edelmann, âImpfaktionenâ.
Edelmann, âImpfaktionenâ.
Ibid.
AT-OeStA/KA FA AOK QuAbt Akten 2239, k.u.k. San-Chef der 10. Armee, Die Schutzimpfung.
Biwald, Helden 2, 523.
This extremely positive reception, as pushed by the military and medicine in a joint alliance, was ultimately able to prevail beyond the end of the war. Assessments of the cholera vaccination and its âinnovativeâ effect by medical experts from the interwar period were often correspondingly favourable and liked to emphasize the progressive thinking and abilities of former Austrian front-line doctors, who perpetuated the narrative that vaccination against cholera was quickly declared standard procedure, without addressing the preceding two-year discussion. Sporadically, however, there seem to have been dissenting voices, even after the end of the war: in this context, the conviction is often expressed that it was not the vaccination but the cold climate that killed the pathogens of the disease and that cholera thus finally extinguished itself. Interesting here are isolated, retrospective reports from which it emerges that the conviction about the ineffectiveness of the vaccination had reached such a point that some doctors felt compelled to disregard the armyâs instructions and issue cholera vaccination certificates to soldiers without vaccinating them against the disease, in other words, falsifying them, Rudolf Rauch, IV. Das Feldspital auf der Jankuhöhe, in Ãrzte und ihre Helfer im Weltkriege 1914â1918, ed. Burghard Breitner (Vienna: Göth, 1936), 148â55, here 154. The mainstream of the medical scene, however, considered the cholera vaccination a positive achievement by the end of the war, Pirquet, âEinleitungâ, 8.
WHO, Cholera.
Austrian Federal Ministry. Social Affairs, Health, Care and Consumer Protection on Cholera. Available online at https://www.sozialministerium.at/Themen/Gesundheit/Uebertragbare-Krankheiten/Infektionskrankheiten-A-Z/Cholera.html, accessed 11 July 2023.
WHO, Cholera.
About 2â3 cases per 1,000,000 travellers, German Society for Tropical Medicine, Travel Medicine and Global Health e.V. on Cholera. Available online at https://www.dtg.org/index.php/empfehlungen-und-leitlinien/empfehlungen/impfungen/impfrisiko-aufklaerung/uebersicht-der-reiseimpfungen/247-cholera.html, accessed 11 July 2023.
Today, the vaccination is usually administered as two oral vaccinations at intervals of one to six weeks and, according to the Styrian epidemic plan, has a protection rate of 90 per cent, Odo Feenstra, ed., Steirischer Seuchenplan (Graz: Classic Verlag, 2016), 95. Available online at https://www.gesundheit.steiermark.at/cms/dokumente/11681099_72561200/51debcea/SP2016final.pdf, accessed 11 July 2023.
German Society for Tropical Medicine, Cholera.
Austrian Federal Ministry, Social Affairs, Cholera.
Dietrich, âTodâ, 256. Within the British and Ottoman armies, for example, cholera broke out in war zones in Mesopotamia and the Near East, due to similar, unfavourable conditions. Although research here also indicated similar problems in disease control, it described the control of typhoid, cholera, and also plague by British armed forces as successful, Mark Harrison, âWar, Epidemics and Empire: British Military Government in the Middle East, 1914â18â, Journal of the Society for Army Historical Research 18 (2018): 33â55.
During a cholera outbreak, rapid access to adequate treatment, which can reduce the mortality rate to less than 1 per cent, is essential. The WHO more specifically states that the majority of infected people can be successfully treated by immediate administration of oral rehydration solution (ORS) (WHO/UNICEF ORS standard sachet is dissolved in 1 litre (L) of clean water). Adult patients need up to six litres of ORS for moderate dehydration on the first day. Severely dehydrated patients are at risk of shock and require rapid intravenous fluid administration. They are also given appropriate antibiotics to shorten the duration of diarrhoea, reduce rehydration fluids, and shorten the amount and duration of cholera virus excretion in the stool. Mass administration of antibiotics is not recommended by the WHO as it has been shown to have no effect on the spread of cholera and may contribute to antibiotic resistance. For children under five years of age, zinc is recommended as an effective adjunctive therapy as it can shorten the duration of diarrhoea and prevent future episodes of other causes of acute watery diarrhoea, WHO, Cholera.
Angetter, Krieg, 89.
Biwald, Helden 2, 540â541.
Dietrich-Daum refers here to Mark Harrisonâs review of publications in the field of the history of medicine in 1996 under the title âThe Medicalization of WarâThe Militarization of Medicineâ, Dietrich-Daum, Medizin, 195; Mark Harrison, âThe Medicalization of WarâThe Militarization of Medicineâ, Social History of Medicine: The Journal of the Society for the Social History of Medicine, vol. 9, 2 (1996), 267â76.
Michaela Scharf, âMedizin im Ersten Weltkrieg. Der Krieg als Laboratoriumâ, Der Erste Weltkrieg, https://ww1.habsburger.net/de, accessed 5 February 2023.
Of course, this new view was also sufficiently instrumentalized. The topos of the âvictory marchâ of (military) medicine against infectious diseases was frequently taken up by the medical scene far beyond the end of the First World War, often also to compensate for the unpleasant role of the war loser and to strengthen national and professional self-confidence with the narrative that âat least one had won against the enemy withinâ and had at least advanced the progress of medicine, Stiglbauer, âReportâ, 93â99; Breitner, Ãrzte.
Dietrich, âTodâ, 257.