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Report on the Typhus Epidemic in Upper Silesia
VOICES FROM THE PAST
American Journal of Public Health |December 2006, Vol 96, No. 122102 |Voices From the Past
Report on the Typhus Epidemic in Upper Silesia
| Excerpted from Virchow RC. Archiv für pathologische Anatomie und Physiologie und für klinische Medicin. Vol 2. Berlin, Germany: George Reimer;
1848;143–332. For an English translation, see Virchow RC. Collected Essays on Public Health and Epidemiology. Vol 1. Rather LJ, ed. Boston,
Mass: Science History Publications; 1985:204–319.
AT THE BEGINNING OF THIS
year reports on the outbreak of a
disastrous disease in Upper Sile-
sia . . . increased in frequency
and urgency. . . . [W]hen the
press published increasingly hor-
rible details on this so-called
hunger-typhus . . . and when fi-
nally even the Ministry of the In-
terior was forced to emerge from
the apathy with which it had so
far met the demands of the civil
authorities, the Minister of Edu-
cation finally ordered . . . Dr.
Barez “to travel to Upper Silesia
Rudolf Carl Virchow, MD, as a young man.
Source.
Prints and Photographs Collection, History of Medicine Division,
National Library of Medicine, Bethesda, Md.
so as to obtain detailed informa-
tion regarding the outbreak of
the typhus epidemic, and the
measures taken against it, and to
assist the authorities concerned
in word and deed whenever nec-
essary.” On the 18th of February
the writer of this report was also
commissioned by the Minister of
Education to visit the area rav-
aged by typhus.
The present report will have
provided the reader with a fairly
comprehensive though not alto-
gether complete picture of condi-
tions in Upper Silesia. A devastat-
ing epidemic and a terrible
famine simultaneously ravaged a
poor, ignorant and apathetic pop-
ulation. In a single year 10% of
the population died in the Pless
district, 6.48% of starvation
combined with the epidemic,
and, according to official figures,
1.3% solely of starvation. In 8
months, in the district of Rybnik,
14.3% of the population were af-
fected by typhus, of whom
20.46% died. . . . At the begin-
ning of the year, 3% of the popu-
lation of both districts were
orphans. . . .
Never during the 33 years
of peace in Germany had even
remotely similar conditions
been seen. No one would have
thought such a state of affairs
possible in a state such as Prus-
sia, which took so much pride
in the excellence of its institu-
tions . . . these enormous compi-
lations of misery cannot be dis-
avowed and we must not hesitate
to draw all those conclusions that
can be drawn. . . . I myself had
drawn the consequences when I
returned from Upper Silesia, and
was determined, in view of the
new French Republic, to help
in the demolition of the old
edifice of our state. I later had
no qualms in making known
these conclusions. . . . They
can be summarized briefly in
three words: Full and unlimited
democracy.
Prussia was proud of its laws
and its civil servants. . . . Accord-
ing to law the proletarian was en-
titled to demand every means
that would preserve him from
death by starvation; the law
guaranteed work, so that he
should earn the wherewithal; the
schools, those so much glorified
Prussian schools, had been cre-
ated in order to secure for him
the education necessary to his
standing; the sanitary police, fi-
nally, had the worthy task of
watching over his housing and
his way of life. And what an
army of well-trained civil ser-
vants was ready to enforce these
regulations! . . . The law existed,
the civil servants were there—and
the people died in their thou-
sands from starvation and dis-
ease. The law did not help, as it
was only paper with writing; the
civil servants did no good, for the
result of their activity again was
only writing on paper. The whole
country had gradually become a
structure of paper, a huge house
of cards, to be toppled in a con-
fused heap when the people
touched it. . . .
VOICES FROM THE PAST
December 2006, Vol 96, No. 12 |American Journal of Public Health Voices From the Past |2103
The bureaucracy would not,
or could not, help the people.
The feudal aristocracy used its
money to indulge in the luxury
and the follies of the court, the
army and the cities. The plutoc-
racy, which draw very large
amounts from the Upper Silesian
mines, did not recognize the
Upper Silesians as human beings,
but only as tools or, as the ex-
pression has it, “hands.” The cler-
ical hierarchy endorsed the
wretched neediness of the people
as a ticket to heaven.
Any nation that still possessed
inner strength and an urge to lib-
erty would have risen up and
thrown from its temples all the
rubbish of hierarchy, bureau-
cracy and aristocracy, so that
only the sacred will of the people
should reign there. In Upper
Silesia it was not so. Accustomed
for centuries to extreme mental
and corporal deprivation, poor
and ignorant to a degree rarely
found in any other nation of the
world . . . the Upper Silesian
had lost all energy and all self-
determination and exchanged for
them indolence, even indifference
to the point of death. In Ireland
the people rose in arms, and
even with the unarmed hand,
once its misery had exceeded the
limits of tolerance, the proletariat
appeared on the battlefield, re-
bellious against law and prop-
erty, threatening, in great masses.
In Upper Silesia the people
silently died of starvation. . . .
Just as the English worker, in
the depths to which he had sunk,
in the extreme deprivation of the
spirit, ultimately knew only two
sources of enjoyment, drunken-
ness and cohabitation, the Upper
Silesian population likewise, until
a few years ago, had concen-
trated all its desires and all its
striving on these same two
things. The consumption of hard
liquor and the satisfaction of the
sexual impulse reigned supreme,
and this explains why the popula-
tion increased in numbers as rap-
idly as it lost its physical power
and moral content. . . . But now
there occurred the unheard of
phenomenon that one of these
two sources of pleasure yet re-
maining open to them was
blocked by the church when it
forbade the consumption of spir-
its. The people suffered it and ac-
cepted this blow in silence also.
Its consequence was as strange
as it was psychologically impor-
tant. While one might have
thought that now the last source
of material enjoyment, i.e., sexual
gratification would be more art-
fully exploited, the opposite oc-
curred; the number of births
steadily decreased. In their own
way the people had become tran-
scendental, like the Christian as-
cetics of the first centuries; but
they did not neglect the body be-
cause of spiritual elevation but
due to spiritual depression. The
bonds which link man, that bod-
ily lump of matter, to the earth,
were loosened in the conscious-
ness of the people; they had be-
come listless to the point of
death, by starvation.
This population had no idea
that the mental and material im-
poverishment to which it had
been allowed to sink, were
largely the cause of its hunger
and disease, and that the adverse
climatic conditions which con-
tributed to the failure of its crops
and to the sickness of its bodies,
would not have caused such ter-
rible ravages, if it had been free,
educated and well-to-do. For
there can now no longer be any
doubt that such an epidemic
dissemination of typhus had
only been possible under the
wretched conditions of life that
poverty and lack of culture had
created in Upper Silesia. If these
conditions were removed, I am
sure that epidemic typhus would
not recur. Whosoever wishes to
learn from history will find many
examples.
The logical answer to the ques-
tion as to how conditions similar
to those that have unfolded be-
fore our eyes in Upper Silesia can
be prevented in the future is,
therefore, very easy and simple:
education, with its daughters, lib-
erty and prosperity. . . . Medicine
has imperceptibly led us into the
social field and placed us in a po-
sition of confronting directly the
great problems of our time. Let it
be well understood, it is no longer
a question of treating one typhus
patient or another by drugs or by
the regulation of food, housing
and clothing. Our task now con-
sists in the culture of 11
/2millions
of our fellow citizens who are at
the lowest level of moral and
VOICES FROM THE PAST
American Journal of Public Health |December 2006, Vol 96, No. 122104 |Voices From the Past
physical degradation. With 11
/2
million people, palliatives will
no longer do. If we wish to take
remedial action, we must be radi-
cal. . . . If we therefore wish to in-
tervene in Upper Silesia, we must
begin to promote the advance-
ment of the entire population, and
to stimulate a common general
effort. A population will never
achieve full education, freedom
and prosperity in the form of a
gift from the outside. The people
must acquire what they need by
their own efforts. . . .
The people must be taught on
the broadest basis, on the one
hand by means of adequate
primary trade and agricultural
schools, by popular books and
popular journals, and on the
other hand there must be free-
dom to the greatest extent, espe-
cially complete liberty of commu-
nal life. . . . The absolute
separation of the schools from
the church, necessary as it is
everywhere, nonetheless is
nowhere more urgent than in
Upper Silesia. . . .
. . . The earth brings forth
much more food than the people
consume. The interests of the
human race are not served when,
by an absurd concentration of
capital and landed property in
the hands of single individuals,
production is directed into chan-
nels that always guide back the
flow of the profits into the same
hands.
Constitutionalism will never
wipe out these abuses, since it is
itself a lie . . . [which] can never
truly draw the conclusions to be
drawn from the principles of gen-
eral equality before the law.
Therefore, I abide by the doc-
trine which I have placed at the
head of this discussion: Free and
unlimited democracy. . . .
The next task will be the im-
provement of agriculture, horti-
culture and animal husbandry. . . .
These men [small landholders]
can only be assisted by popular
instruction, by the introduction of
better plant strains and better
breeds of domestic animals. . . .
The people must be made to un-
derstand that, when exclusively
cultivating potatoes, they will al-
ways be exposed to the threat of
similar crop failure and that only
a certain variety of crops can
protect them from a total failure.
The more widespread cultivation
of maize, legumes, pot-herbs and
fruit could give them a better
chance of yield. . . .
While the state as such should
never be a permanent employer,
Rudolf Carl Virchow
Medical Scientist, Social Reformer, Role Model
GENERALLY REGARDED AS
one of the most brilliant and
influential biomedical scien-
tists of the 19th century,
Rudolf Carl Virchow was, re-
markably, also one of the
most courageous and inspir-
ing proponents of social medi-
cine.1He was born on Octo-
ber 13, 1821, in Schivelbein,
Pomerania, then in eastern
Prussia, but since 1945, part
of northwestern Poland. Re-
bellious and intellectually
gifted, in 1839 Virchow won
a scholarship in 1839 to the
Friedrich-Wilhelms Institut in
Berlin, Germany, where he re-
ceived his medical education.2
After obtaining his MD in
18 43, he was appointed to an
internship at Berlin’s Charite
Hospital where he began his
clinical career.
He also initiated chemical
and microscopic research,
which led to his first publica-
tions and bold proclamations of
the need for a drastic overhaul
of medical research. In 1847,
the 26-year-old Virchow co-
founded a new journal, Archives
for Pathological Anatomy and
Physiology and Clinical Medicine
(later Virchow’s Archives), which
became a major force in the
modernization of medical
science. In 1849 he left Berlin
for Würzburg to accept Ger-
many’s first chair in pathological
anatomy. Soon after launching a
comprehensive, 6-volume Hand-
book on Special Pathology and
Therapeutics in 1854, Virchow
returned to Berlin to head a
new pathological institute and
in 1858 published his classic
Cellular Pathology. In the 1870s,
while remaining a prolific bio-
medical scientist, Virchow also
turned his attention increas-
ingly to anthropology and
archaeology. He died on Sep-
tember 5, 1902, much honored
worldwide as one of the tower-
ing scientists of his era.
Virchow’s career in social
medicine was equally remark-
able. His most famous contribu-
tion was his “Report on the Ty-
phus Epidemic in Upper Silesia”
excerpted here. The report origi-
nated when Virchow was asked
by the Minister of Education to
help investigate scandalous con-
ditions in this poor rural area
under Prussian control, with a
large population of “ethnic Poles.”
Although he studied many di-
mensions of the epidemic, his
19 0-page report is best remem-
bered for its final 30 pages.3,4
Here Virchow applied ideas on
the social causation of disease,
derived from French and English
sources, to conditions in Silesia
and showed a close and sympa-
thetic familiarity with Friedrich
Engels’ stirring indictment, Con-
dition of the Working Class in
England (1844). Caught up in
the heady atmosphere of his rev-
olutionary times, Virchow enthu-
siastically endorsed what he
proudly labeled “radical” political
recommendations: introduction
of Polish as an official language,
democratic self-government, sep-
aration of church and state, and
the creation of grassroots agricul-
tural cooperatives.
After returning to Berlin in
March 1848 to participate in
“revolutionary” political action on
the streets, in July, Virchow
helped found Medical Reform, a
weekly newspaper that promoted
the cause of social medicine
under the banners “medicine is a
social science” and “the physician
is the natural attorney of the
poor.” He continued until June
1849, when increasingly reac-
tionary political pressures forced
VOICES FROM THE PAST
December 2006, Vol 96, No. 12 |American Journal of Public Health Voices From the Past |2105
him to suspend publication. He
became politically quiet in the
early 1850s (as did many Euro-
pean radicals). When he re-
turned to Berlin later in the
decade, he again became active,
although now in more moderate
ways. In 1859 he was appointed
to Berlin’s City Council, a posi-
tion he held until his death, and
there worked on sanitary and
other public health reforms.5In
18 61 he helped found the Ger-
man Progressive Party and was
elected to the Prussian diet as a
leader of the constitutional forces
opposed to Otto von Bismarck.
Virchow later continued that
fight as a member of the German
Reichstag from 1880 to 1893.
Virchow’s dual career has been
widely inspirational. He is often
credited for being one of the first
to make the case for the social
origins of illness and the multifac-
torial etiology of epidemics.6,7 But
beyond that he has also served as
a powerful icon, hero, and role
model because he was both a
leading scientist and an insistent
proponent of the social grounding
of medicine, public health reform,
and political engagement.8,9
Theodore M. Brown, PhD
Elizabeth Fee, PhD
About the Authors
Theodore M. Brown is with the Depart-
ments of History and the Department of
Community and Preventive Medicine, Uni-
versity of Rochester, Rochester, NY. Eliza-
beth Fee is with the History of Medicine
Division, National Library of Medicine,
National Institutes of Health, Bethesda, Md.
Reprint requests should be sent to
Theodore M. Brown, PhD, History Depart-
ment, University of Rochester, Rochester,
NY 14627 (e-mail: theodore_brown@
urmc.rochester.edu).
This contribution was accepted Septem-
ber 11, 2005.
doi:10.2105/AJPH.2005.078436
References
1. Risse GB. Virchow, Rudolf Carl. In:
Gillispie CC, ed. Dictionary of Scientific
Biography. XIVVol 14. New York, NY:
Charles Scribner’s Sons; 1976:39–44.
2. Ackerknecht EH. Rudolf Virchow:
Doctor, Statesman, Anthropologist. Madison,
Wis: University of Wisconsin Press; 1953.
3. Pridan D. Rudolf Virchow and So-
cial Medicine in Historical Perspective.
Medical History. 1964;8:274–278.
4. Azar HA. Rudolf Virchow, not just a
pathologist: a re-examination of the Re-
port on the Typhus Epidemic in Upper
Silesia. Ann Diagn Pathol. 19 97;1:65–71.
5. McNeely IF. “Medicine on a Grand
Scale”: Rudolf Virchow, Liberalism, and the
Public Health. London, England: The
Wellcome Trust Centre for the History of
Medicine at University College London,
Occasional Publication, No. 1; 2002.
6. Waitzkin H. The social origins of
illness: a neglected history. Int J Health
Serv. 19 81;11:77–103.
7. Taylor R, Rieger A. Medicine as
social science: Rudolf Virchow on the
typhus epidemic in Upper Silesia. Int J
Health Serv. 19 85;15:547–559.
8. Eisenberg L. Rudolf Ludwig Karl
Virchow, where are you now that we
need you? Am J Med. 1984;77:524–532.
9. Silver GA. Virchow, the heroic model
in medicine: health policy by accolade.
Am J Public Health. 19 8 7;77:82–88.
since this would gradually lead to
a new despotism . . . what is nec-
essary and desirable is above all
the association of the unproper-
tied, so that through these associ-
ations they can join the ranks of
those citizens who are enjoying
the bounties of life and thereby
at last cease being mere ma-
chines for others. . . . People only
count as hands! Is this the pur-
pose of machines in the cultural
history of nations? Shall the tri-
umphs of human genius serve no
other aim than making the
human race miserable? Certainly
not. . . . Man should work only as
much as is required to wrest
from the soil, from that crude
substance, as much as is needed
for the comfortable existence of
the whole race, but he should
not squander his best powers to
amass capital. . . .
Capital and labor must at least
have equal rights and the living
force must not be subservient to
non-living capital. . . . In every
case the worker must have part
in the yield of the whole, and as,
moreover, with reduced taxation
and with better education, his
will be a happier lot. . . .
These are the radical methods
I am suggesting as a remedy
against the recurrence of famine
and of great typhus epidemics
in Upper Silesia. Let those who
are unable to rise to the more
elevated standpoint of cultural
history smile; serious and clear-
thinking persons capable of ap-
praising the times in which they
live will agree with me. . . .
