The Viennese Disease
Wartime analogies in the Covid-19 pandemic are commonplace. Western governments and journalists, in particular, have reached for the stories of national solidarity, resilience and rivalry cast during and after the Second World War, as the first peak of the pandemic in Europe coincided with the 75th anniversary of the Allied victory.
It makes more sense, though, to compare 2020 to the First World War. Conscripts in the fight against Covid-19 know little about the enemy (though they’re learning), and don’t know how long they will need to fight. States struggle to formulate shared aims across international alliances. Then, as now, we are using age-old weapons as well as new ones: quarantine, plague-masks and handwashing.
The Hungarian physician Ignáz Semmelweis first predicted in the mid-19th century that medical students transferred small particles (what we now know to be germs) from diseased patients to previously uninfected people. Semmelweis instructed those around him to wash their hands with a form of lime disinfectant. He is not only the father of hand hygiene: his expression of the medical practice ‘recognise-explain-act’ remains the base model of strategies to prevent infection promoted by the World Health Organisation.
The First World War and the disintegration of the Austro-Hungarian Empire brought an end to Central Europe’s place at the forefront of biomedical science. As the Allies’ wartime blockade continued into the peace, hunger and disease gripped Central and Eastern Europe. Vienna, Berlin and Moscow saw a dramatic spike in deaths after 1918. The Spanish flu has received a great deal of attention recently. At the time, people were just as – if not more – preoccupied by the risks posed by typhus and tuberculosis.
In Vienna, one in every four deaths was caused by TB. Dr Siegfried Rosenfeld, of the Austrian Department of Health Statistics in the Volksgesundheitsamt, called it the ‘Viennese Disease’. Rosenfeld recognised that poor nutrition and living conditions were behind death rates high enough to rival the Black Death. He would not have agreed with 20th-century historians’ later conclusion that the 19th century marked the end of the great plagues.
Revolution, civil war and nation-building drove mass population displacement, at the same time that Central European armies weren’t demobilising so much as disintegrating. Moshe Fuchs, a Yiddish writer and journalist in Vienna, described the way the end of the war transformed the railway lines and stations of Central Europe into vectors of disease. Densely packed trains, platforms and concourses were filled with the bodies of the exhausted, injured and dying, the uniforms of the doctors and nuns who attended them stained red and black with blood and sweat.
Fuchs vividly captured the way soldiers and civilians suffered together. Contemporary science backed up him up. In 1916, the first major study of epidemic disease in wartime showed that soldiers were more likely to die of contagious disease than through enemy action, at least until the Russo-Japanese War of 1904, when war was more effectively mechanised. Crucially, in Epidemics Resulting from Wars, Friedrich Prinzing demonstrated that epidemic disease among soldiers sparked greater epidemics among the civilian population.
The Carnegie Endowment for Peace translated and syndicated the book. It influenced the idea that the League of Nations, as well as promoting international peace, should improve world health and economic stability. This agenda emerged more because of the chaotic aftermath of the war, and problems with the peace settlements, than from any grand designs articulated by Woodrow Wilson.
In October 1920, the International Union against Tuberculosis and Lung Disease was founded. It still exists today. Its founding figures included Professor Léon Bernard, who was instrumental in creating a League Epidemic Commission in 1920, and the League of Nations Health Organisation the following year.
As with the WHO, ‘great’ power politics always shaped, and limited, the activities of the LNHO. The challenges faced by the League are a reminder that arguments for or against international co-operation and organisation are often rival attempts to find solutions to common problems. For all leaders – whether the states they govern are ‘powerful’ or not – the realm of international relations is where they have least control.
The League’s fight against epidemic disease also demonstrates the need for a global commitment to supporting local, community-based schemes, which include economic and financial support as well as better healthcare.
After the Second World War, new institutions of global governance were founded, not only the WHO, but the Food and Agriculture Organisation and the International Monetary Fund, bridging health, hunger and the economy. The end of this Western-made system, centred on the United Nations, now seems irreversible. Relations between states are changing, with new powers emerging – notably China and India – and the structures of global capitalism and communication in flux. The history of the world wars and the Covid-19 pandemic are a reminder that we should still take seriously the League’s crisis call ‘for a much larger degree of international collaboration than anything yet achieved’.