Typhus in 1915

December 2015
 December 2015
Typhus in 1915

Museum of Science and Technology – Belgrade | Gallery AD

Author of Exhibition
Jelena Jovanović Simić
Author of Display
Svetlana Jovanović
Publication issued by
Museum of Science and Technology –
Belgrade

Exhibition Organizer For the Publisher

Marina Milenković Sonja Zimonić, director of the Museum Proofreading
Miloš Luković
Conservation and Restoration Editor
Zoran Lević Marina Đurđević Translation
KAUKAI
Public Relations Author of Text
Ivan Stanić Jelena Jovanović Simić Photographer
Miloš Jurišić
Technical realization Graphic Design
X-tim Marko Jovanović Printing
Branko Davidović X-tim, Belgrade
Reviewers
Exhibition Insurance Dr. Zoran Vacić Print run
Dunav Insurance Company Dr. Jasmina Milanović 300
Realization of the exhibition was financed by the Ministry of Culture and Information
of the Republic of Serbia
Museum of Science and Technology thanks to the loaned material for the exhibition to:
The Archives of the Serbian Academy of Sciences and Arts, the Archives of Serbia, the Belgrade City
Library, the Archives "Veroslava Veljašević" in Smederevska Palanka, the Medical High School in
Belgrade, the National Museum Valjevo, Imperial War Museum in London, Prof. Dr. Milan Radovanovic,
Prof. Dr. Zelimir Mikic, Dr. Zoran Vacić, Mr. Miroslav Aleksandric, Mr. Zoran Trtica, Mr. Milos Jurisic and
Mr. Branko Kuzmanovic.
Cover photo:
The nurses and patients in Nis District Hospital 1915.
(From the Collection of FotoMuzej, ownership of Mr. Zoran Trtica)
 Content

10 Circumstances prior to the outbreak of the epidemic

11 Three types of typhus –characteristics of the diseases

17 The cause of the onset and the spread of the epidemic

30 Help from Serbian Humane Societies and medical help from abroad

35 Suppressing the epidemic

54 S o u r c e s , L i t e r at u r e and comments
 7

I found out that my aunt Kasija Miletic, who was always there for me in all three wars, worked as a
volunteer nurse at the Military hospital for typhus patients in Valjevo. I received a special permit to go
to Valjevo...

It was a sunny day; a flock of storks was flying across the transparent blue sky covered with pink
morning reflections and I was almost jumping across the wide furrows hardened by the Sun that
intersected the rutty road. All around me there were green plum orchards. You could feel the breath of
sprouting in the plowed fields. Everything was growing, blooming and giving fruit. This symphony of
spring and life was suddenly corrupted by the black flags. On every other house there was a big or a
small black cloth hanging, like a sign of death that visited it.

Stanislav Krakov1
8
 9
Epidemic of typhus, or to be more precise –
epidemics of three types of typhus – typhus,
typhoid fever and relapsing fever that simulta-
neously broke out during the First World War
in 1914/1915 in Serbia, still attract the atten-
tion of historians of medicine and historians,
almost a century later. The tragic proportions
of the epidemic are reflected in the number of
the dead and the infected in only six months: it
is estimated that between 135.000 and 150.000
died and between 500.000 and 600.000 peo-
ple, soldiers, prisoners and civilians, contract-
ed the disease.2 On the other hand, we are still
searching for the answers to a lot of questions
regarding the epidemic.
First of them refers to the number of victims,
which was never determined because there are
no complete statistical data. The data regard-
ing the soldiers, officers and prisoners who
got infected and died are partially saved, in
records kept by some of the physicians that
were published after the First World War, while
the Archive of the Medical Corps had been de-
stroyed in Kraljevo just before the Army re-
treat began across Albania and Montenegro
towards Greece. The morbidity and mortality
of the civil population hasn’t been studied in
detail to this day.3
The second question that arises is this: Could
the epidemic have been avoided or at least sup-
pressed before it took so many lives? Numer-
ous works of literature have been investigat-
ing the “weak links” that, individually or com-
bined, led to the tragic outcome, and which are
related to problems in the organisation of the
Medical Corps at the time, number and exper-
tise of the medical staff and the impact made
by the living conditions in a country destroyed
and exhausted by war. Third question refers to
the outbreak of the epidemic itself.
The epidemic of typhus in Serbia in
1914/1915 has a special place since, as dr. Wil-
liam Hunter (1861–1937), Head of the British
Army Medical Mission in Serbia and one of the
people who were the most responsible for its
arrest, said, it was “the most sudden in origin,
 10
most rapid in rise, greatest in extent, and most
quickly arrested of any epidemic of a like kind
in history.“4
Beside the characteristics of the disease,
the way the patients were treated, conditions
that led to the outbreak of the epidemic and
the measures applied to suppress it, the goal
of the exhibition Typhus in 1915 is to present
personal experiences, feelings and destinies of
the people who contracted it: physicians, med-
ics, nurses, soldiers and civilians.
Circumstances prior to the outbreak
of the epidemic
After the brilliant victories of the Serbian
Army against the Austro-Hungarians on Cer
and Kolubara, Serbia was, next to Montenegro,
the only country that managed to preserve the
integrity of its territory in the first year of war.
It began in 1915 as a free, but in every way
exhausted country. Apart from losing around
70.000 soldiers who died or disappeared in bat-
tles, around 5.000 civilians also died or disap-
peared. Around 50.000 wounded and sick re-
mained in hospitals. Great problems with the
lack of accommodation and food were affect-
ing not only hospitals, but the civilian popula-
tion as well. Besides that, there were around
50.000 Austro-Hungarian prisoners that had
to be accommodated and fed too.
A consequence of the military operations, in
which the Army went from retreating in a hur-
ry to attacking without any rest, was an enor-
mous exhaustion of the people. “The organism
of an Army”, wrote dr. Lazar Gencic, “that
leads a third war in a short period of time,
after all those operations and movements,
which our army performed during the last
operations, must eventually lose the greatest
part of its resistive strength and succumb to
illnesses more than ever, and especially to in-
fectious diseases that it already made contact
with, while mixing with the troops sent from
new territories...”5 A break in the war activi-
ties should’ve been used to accommodate the
Army in cantonments where they could’ve re-
 11
covered, filled up their ranks and renewed the
military equipment. However, the winter had
already begun and there was a shortage of ev-
erything: food, warm cloths and fuel. During
1914 the production of food decreased by two
thirds because the harvest was interrupted due
to mobilization (83% of the male population
capable of military duty had been mobilized).
In these conditions, infectious diseases that
were the main problem even during the time
of peace, both among the civilians and in the
army, found a fertile soil.
An increase in morbidity from infectious
diseases was noted in October 1914, during
the Battle on Drina. The cause was the density
of ranks in trenches in unhygienic conditions,
which gave rise to massive lice infestation,
as well as cold and damp weather and food
shortage.6 People first started contracting ty-
phoid fever and dysentery, and then smallpox,
relapsing fever and typhus. The notes of Col-
onel Dusan Stojanovic, Minister of Defence
at the time, tell us that on October 31, 19147
the number of sick was higher that the num-
ber of wounded patients in hospitals in Val-
jevo.8 Over the next few months the number
of sick people, especially those suffering from
all three types of typhus would increase pro-
gressively. Relapsing and typhoid fever were
spreading more rapidly until December, while
typhus, which occurred only sporadically since
the end of October, broke out at the start of
1915. According to the records made by med-
ical corps colonel dr. Sima Karanovic, Head of
the Medical Corps department of the Ministry
of Defence, number of patients suffering from
typhus, which was 123 on December 24, 1914,
increased tenfold during the next month, and
reached its maximum of 8.124 cases on March
24, 1915.9
Three types of typhus –characteristics
of the diseases
The word typhus comes from Greek (τύφος)
and it means „smokey“ and „hazy“. It is
thought that Hippocrates first used the word
 12

to describe “the state of confusion of the in- la typhi) was discovered by a German bacte-
tellect with tendency towards stupor” of the riologist, Karl Joseph Eberth (1835–1926) in
infected, but the term wasn’t connected to ty- 1880.12 During the 19th century the aetiology
phus before the 18th century.10 and epidemiology of typhus (typhus exanthe-
maticus) were extensively researched. Typhus,
Although all three types of typhus are sepa-
still considered to be typhoid fever, was distin-
rate entities and have specific causative organ-
guished as a separate disease by an American
isms, there are numerous similarities between
physician, William Wood Gerhard (1809–1872)
them, which is the reason why in course of
in 1837.13 First person to state the opinion that
history the physicians couldn’t clearly sepa-
protection against lice is an important preven-
rate them. Erroneous diagnosis, however, hap-
pened even after their separation and descrip-
tion. Relapsing fever (febris reccurens) was
first described by an Irish physician, John Rut-
ty (1697–1775), and its causative organism,
spiral-shaped bacteria of the genus Borrelia
(first named Obermeier’s spirillum, and later
Borrelia) was discovered by Otto Hugo Franz
Obermeier (1843–1873) in 1868.11 Typhoid fe-
ver (typhus abdominalis) was first described
as a separate disease by French physician
Pierre Charles Alexandre Louis  (1787–1872)
Charles Jules Henry, 1866–1936, French doctor who discovered
in 1829, while the causative organism (first in 1909 that cause of typhus is transferred to humans by
white louse. For this discovery he was awarded Nobel Prize
named Eberth’s bacillus, and later Salmonel- 1928. Source: https://upload.wikimedia.org/wikipedia/commons/2/26/
Charles_Nicolle_at_microscope.jpg
 13

tive measure against typhus was an English

physician, Charles Murchison (1830–1879).14
Half a century later, in 1909, a French physi-
cian, Charles Jules Henry Nicolle (1866–1936),
proved in his experiments that body louse
(pediculus humanus corporis, pediculus vesti-
menti, human louse) is the transmitter of a yet
unknown disease causative agent. For this dis-
covery Nicolle received Nobel Prize in 1928.
Among the numerous scientists who searched
for the causative agent during the first two
decades of the 20th century, the most import-
ant were Howard Taylor Ricketts (1871–1910),
Stanislaus von Prowazek (1875–1915) and
Henrique da Rocha Lima (1879–1956). A new
group of microorganisms living inside the host’s
cell (Rickettsia) was named after Ricketts, who
himself fell ill and died during his research.15
Prowazek, a Czech born scientist, was also a
victim of typhus. His colleague Da Rocha Lima
continued the research and in 1916 he finally
identified the causative agent. In honour of his
colleagues, he named it Rickettsia prowazekii.
Rickettsia prowazekii , photos under electronic microscope.
Rickettsia are wine red and are inside cell nucleus ( fibroblast)
Letter “n” defines cell nucleus. Source: http://www.ppdictionary.
com/bacteria/bwum/prowazekii_files/prowazekii_growing.jpg
All three types of typhus are severe infectious
diseases and they have a similar onset, except
that the symptoms of typhoid fever develop
more slowly. Typhoid fever transmits through
food or water polluted with feces or urine of
the diseased or the germ carrier. Transmission
of typhus and relapsing fever requires a vector.
Human body louse is the main transmitter of
typhus and relapsing fever. Besides that, re-
lapsing fever can also be transmitted by ticks,
while the causative agent of typhus, although
 14

less frequently, can be transmitted by head

louse (pediculus capitis), through conjunctiva
(if, for example, one rubs the eyes with hands
that he previously used to squash the lice) or
by inhaling the dust contaminated by louse fe-
ces. Even though the transmission process for
typhus and relapsing fever is the same, the way
in which a person gets infected is different. In
both cases the louse sucks the blood of the dis-
eased. The causative agent of typhus, Rickett- Body louse (white louse, clothes louse – pediculus corporis
humanus; pediculus vestimenti) Source: http://getridofnits.co.uk/
sia prowazekii is found in the louse’s intestines, wp-content/uploads/2014/10/body-louse-pediculus-humanus.jpg
and it is excreted in feces, while Borellia, the
causative agent of relapsing fever, is found in from the louse’s body when it gets squashed by
the hemolymph and it is released by damag- scratching, also gets inside the host through
ing the louse. One louse can infect only one the microlesions on the scratched skin. In both
person with relapsing fever, but several with cases the entrance point for the causative
typhus.16 Infection mechanism of typhus is as agent can also be the small wound made by
follows: while sucking the blood, the infected the louse bite.
louse defecates; a person feels an itch at the
All three diseases – typhus, typhoid and re-
bite site and scratches, thus making small le-
lapsing fever– begin with signs characteristic
sions on the skin and simultaneously rubbing
for general infections: high body temperature
in the feces filled with Rickettsia. In case of
(that stays for days), headache, physical and
relapsing fever, the causative agent, released
psychological exhaustion, and in case of ty-
 15

phus and relapsing fever, there is also distinctive joint and muscle pain.

In the second stadium, in a case of both typhoid and typhus, delirium, or the so-called “typhoid
state”, occurs. And while the person suffering from typhoid is mostly sleepy, confused, dazed
and has slow reactions, a person suffering from typhus is restless, agitated and disobedient,
often uncontrolable and aggressive. Descriptions of
the clinical picture for persons suffering from relaps- On November 18, [1914] – I feel heavy and exhausted
ing fever state that the patient’s consciousness is pre- – but I have to work, how can one think of oneself in
this moment when 200 of poor people are waiting for
served, but clouding of senses is certainly possible as help from your hand and for words of comfort coming
an individual reaction to high body temperature. from your lips. May good Lord Help us, we will rest,
there will be time, let us first chaste the enemy from our
country.
In a case of both typhoid fever and typhus, a skin
rash occurs. In case of typhoid fever the rash occurs On November 28, – I am not feeling myself today. I
feel pain all over my body, I can’t stop coughing, and
in 30% of patients. It is shaped like pale rose spots sleep is restless full with bad dreams. I must have
(maculla) the size of lentils that appear on the chest, temperature. It won’t be worst.
abdomen and upper arms. At that time the rash was November 29, – I feel rather bad today. I have some
the most important diagnostic sign of typhus. Even kind of fever! I would lie down but I can’t, everybody
is looking at me and expecting me to help! Well, I have
though it also starts with the appearance of rose to to think about everything but about myself and it is
red spots the size of millet or a lentil, the spots are possible only if I have time! [last note in the diary]
unevenly distributed and after a few days they change From the Diary of Doctor Zivan Vlajic (1864–1914),
Commander of The First Field Hospital of Timok Division
their appearance: spots become areas of tinny red II class
dots, which are actually minor bleeds from broken
skin capillary blood vessels (petechia). These chang- Copy of the diary is preserved in the Museum of the Science and
Technology – Collection of the Museum of Serbian Medicine of
es, which occur everywhere except on the face, soles the Serbian Medical Society)
 16
and palms, are also the reason why this dis-
ease is called spotted typhus in some countries,
but there are also variations of the disease in
which the skin rash does not occur. 17
In the second stadium of typhoid fever intes-
tinal disorders occur, such as three to six stools
a day, which have a characteristic appearance
described as pea soup. Even though this type
of typhus is also a generalized disease, the at-
Torso mold – skin changes with typhus (Medical School,
Belgrade)
tribute abdominal indicates the site of prima-
ry pathological changes (intestinal tract) ex-
pressed in the clinical picture of the disease.
Recovery period for typhoid fever is between
one and two weeks, and it is slightly longer for
typhus because the changes on blood vessels
disappear in one to two months. As a conse-
quence of these changes untreated typhus had
complications that are very rare today: inflam-
mation of blood vessels and gangrene (often
symmetrical gangrenes on extremities and
peripheral body parts); inflammation of the
heart muscle; pneumonia and hearing loss. In
persons who recovered from typhus, relapse of
the disease is possible after several years, due
to the reactivation of Rittsketsia from a focal
point somewhere in the body. This delayed
relapse of typhus, which shows mild clinical
symptoms, is called Brill-Zinsser disease.18
The main features of the relapsing fever are
the repeated attacks of high body temperature
that stay for several days, and are followed by
a sudden return to normal. First attack is usu-
 17

ally the longest, and every subsequent attack is shorter and the periods of normal body tempera-
ture between them grow longer. Most often there are two attacks after which a relatively fast
recovery ensues.

Of these three diseases, typhus had the highest mortality rate, which was between 30% and
60% in Serbia. Antibiotics, which were first brought into use after the Second World War, sig-
nificantly alleviated the symptoms, prevented the complications and changed the course of the
disease, for all three types of typhus.19
They dressed my wound and took me out. Two of them.
As we have come half way – I fainted. I got fever and
typhus. The cause of the onset and the spread of the

What is going to happen.. as soon as they have laid me
down I had a dream burning in fever:
As …I am, at noon, looking right at the sun. And I
have turned into a sparrow a bird. I want to fly out,
but because of the whole glass – I can’t. I tried left to
the glass door, want to go out through the window… A
man is standing there; Big whip over his shoulder, big
beard… but he says: “Jump! Or you want me to whip
you?”
Then I woke up – two doctors: one of them is holding
my hand and the other one puts his head on my
forehead and says:
“Typhus, Infectious Ward, room number nineteen.”
Ljubomir Batinic,soldier from Azanja
Dragutin Paunic i Milija Djordjevic, Tri sile pritisle Srbijicu – price
Solunca (Beograd: Narodna knjiga, 1988), 52
epidemic
Unlike the typhoid fever, which was present in
Serbia even during the time of peace, typhus and
relapsing fever were much less known to the phy-
sicians at that time. Both of these diseases ap-
peared during the Balkan wars, but the epidem-
ics were on a smaller scale that the ones during
1914/1915.
At the beginning of the 20th century two small-
er epidemics were recorded: During 1901/1902 in
Cacak County, where six prisoners and 47 civilians
from 13 villages contracted the disease (53 in to-
tal, out of which 5 died)20 and during 1906/1907 in
 18
a prison in Topcider.21 During the Balkan Wars
the epidemics broke out in garrisons engaged
in areas where typhus was endemic: In the First
Balkan War, in 1912, during the besiege of Ed-
irne; in the Second Balkan war in Bitolj, where
43 of the 500 diseased soldiers died22; then in
1913 in garrison in Debar, where 650 people
contracted the disease.23 In March 1913, there
were 100 officially registered cases in Serbia,
13 in Belgrade, 5 in Valjevo, 25 in Zajecar, 10
and Jagodina, 11 in Knjazevac, 18 in Negotin,
Typhus Hospital with its doctors, Bitola, 1913 (Source: Zdravlje, 1913)
one in Cacak, six in Pirot and one in Paracin.24
Based on the information that in the summer
of the same year Stanislaus Prowazek studied
the disease in Belgrade based on 51 cases, it
can be concluded that the number of people
suffering from this disease by the end of 1913
was certainly higher.25 Finally, just before the
outbreak of the First World War in May 1914,
the epidemic was registered again in Debar.26
It is thought that in the autumn of 1914
typhus appeared in several focal points. Ac-
cording to dr. Vladimir Stanojevic “first cases,
even before the typhus appeared on the battle
fields, were officially recorded in South Serbia
as well”, which was reported by the “Head of
the Medical Corps of the Ministry of Defence
to the Supreme Command on October 10, 1914
with no.368, stating that there are only three cas-
es of typhus in Serbia, one in the hospital in Debar
and two in Mitrovica, of which one had died.”27 Af-
ter the battle of Kolubara the contagion spread
along the line front Uzice-Mladenovac-Val-
jevo-Lazarevac-Belgrade. One of the focal
 19

points on that line was among 3.500 wound-

ed and sick that Austro-Hungarian army left
before their retreat. Among them were those
suffering from typhus and relapsing fever. The
second focal point was among the troops mo-
bilised in the newly-liberated territories (Old
Serbia, Macedonia) in order to fill up the Ser-
bian Army’s military ranks for fightings on Dri-
na.28 Epidemic continued to spread, as testified
by Stanojevic, “using directions and roads that
everybody was using to get to and retreat from Patients affected by typhus in Valjevo Hospital, 1915. Arrow
points at the skin area with rush (Source: Arius van Tienhoven,
the battlefields, where, like through the main Strahote rata u Srbiji)

arteries, coursed the blood of the entire army
and where endless caravans of army, people,
refugees, wounded, sick, prisoners, etc. passed
by day and night. Through these arteries the
army’s contagion was injected into the entire
population in the background.”29 The very hos-
pitals that accommodated wounded next to the
sick patients were the ones who contributed
the most to the spreading of the epidemic. Due
to the overload of the hospitals both wound-
ed and the sick were discharged home before
time. Infectious patients, still not recovered
properly, and those who had smaller wounds
and caught the infection in the hospital, but
the disease hadn’t manifested itself, carried
the contagion to their homes. The other link in
this chain was the railway. “In the trains”, said
Dr. Stanojevic, “you could see all sorts of peo-
ple. There were naked and diseased refugees,
both the carriers of the disease and those who
had already been ill. There were recovered sol-
diers, discharged home. Next to these disease
 20

From the war diary of Doctor Svetislav Barjaktarovic

(Archives of Serbian Academy of Sciences and Arts, Historic
carriers were the ones who were still healthy Collection 14.476/III)
but already in the incubation period, i.e the
period when the infection starts growing and
spreads to the others. There were various cou-
riers and their kind, who, prior to getting on
the train, already visited all the places suspi-
cious for infection and lice... “30

Between December 1, 1914 and January 1,

1915 the number of people suffering from in-
fectious diseases in hospitals in the war zone
increased threefold – from 3.152 to 10.816. On
December 13 in hospitals all over the country
there were 33.370 wounded and 10.732 sick
patients, and after a month, on January 13,
the number of wounded persons was 22.017
(of that 4.248 prisoners), while the number of
sick grew to 29.503.31 Quarter of the sick pa-
tients suffered from typhus, while the prefera-
nce was given to relapsing fever.

Not even the rapid increase in the number of

the diseased that Head of the Medical Corps
Colonel Lazar Gencic and Head of the Medical
Temperature Chart with values recorded by medic, later on
Professor at Belgrade University School of Medicine, Svetislav
Barjaktarovic, affected by typhus 1915 (Archives of Serbian
Academy of Sciences and Arts, Historic Collection 14.476/III)
 21
February 1, [1915] Vlaska. This other hospital
[The Second Field Hospital of Morava Division]
has around 200 patients all of them suffering from
infectious diseases such as Febris exanthematica,
Febris reccurenss, variolla vera. My special request
was to work in this hospital because of typhus in
order to get to know this disease as well as relapsing
fever. 32 patients suffer at the moment from typhus
and 70 of relapsing fever.
February 12, Vlaska. Today I feel that I have
temperature, 37, 3°C
February 14, Vlaska. Illness overcomes me,
temperature goes high, I feel much worse. I have
moved again to the “pharmacist” and Christodoulou.
February 15, Vlaska. Today they are going to move
me to the room with Andra [Nikolic], Djura and
Major Gvozden Ristanovic. That means that my
illness is typhus.
February 16, Vlaska. Today I have got freckles all
over my body. They change compresses every half
hour […] I lie in the house of Randjel Lukic […] The
room is nice, spacious and bright. It is rather clean,
orderlies from II Regiment Unit nurse me, those that
Doctor Sekulic has sent to nurse Doctor Andra, their
(Archives of Serbian Academy of Sciences and Arts, Historic Collection 14.476/III)
names are Milan Petkovic and Aleksandar Rancic.
February 17–26, Vlaska. The disease is at its height.
But I yet feel pretty good. Orderlies take a good care
of me.
February 27, Vlaska. It was critical tonight. It turned
out well.
February 28, Vlaska. Dr. Pajic has told me today
that the crisis has gone and that situation is
improving. This good news made me cry.
March 1, Vlaska. It is nigh and it is already March.
I have temperature 37.7°C today and 36.8°C. I feel
better but I am extremely exhausted.
March 4-8, Vlaska. My disease is now quite good. I
already eat all the food.
March 14, Vlaska. Today they have sent me home
and put me on a sick leave.
From the Diary of Svetislav Barjaktarovic, medic and
later on Professor at Belgrade University School of
Medicine.
 22
Corps Department at the Ministry of Defence
Colonel Sima Karanovic knew about, nor the
insight into poor conditions in all of the hos-
pital, that Colonel Dr. Roman Sondermayer,
Inspector for the military medical institutions,
had the chance to see for himself during su-
pervisions between December 21 and January
12 1915,32 – were recognised in time as signs
for alarm. We can see what were the opinions
of the physicians in those day from an article
by Dr. Toma Leko, published on January 12:
“Sights we can see these days on the streets
of Valjevo, and even more so in the hospitals,
remind me somewhat of that masterful de-
scription by Manzoni, in which this Italian poet
paints an epidemic in his famous work The Be-
trothed. However, the epidemic present today
in one part of our Army and country is in no
way such that it could become a great worry
for us, even though from time to time a per-
son can see some very dramatic and horrible
sights. Perfecting the organisation of our Med-
ical Corps will provide that this street drama
of our epidemic disappears, and the Medical
Corps and natura magis medicatrix will un-
doubtedly make this epidemic fades away.“33
The events that followed showed how errone-
ous was this attitude: Serbian Medical Corps
wasn’t able to combat the epidemic and the
healing power of nature – natura magis med-
icatrix – proved to be an unreliable ally. Toma
Leko, who, while serving as the Head of the 6th
Reserve Hospital in Valjevo contracted and re-
covered from typhus, died of typhoid fever in
June 1915.34
The question of responsibility for the cata-
strophic consequences of the epidemic was
posed during the war, and it remained open
until today. It is still argued whether the State
and the management of the Medical Corps did
all they should’ve and could’ve done, as well as
the question whether the physicians knew the
epidemiological characteristics of the three
diseases; more specifically, were they aware
that typhus and relapsing fever are transmit-
ted by lice? Other than these questions, we
 23

Hallucinations are so strong so

that patients should be protected
from committing suicide, especially
from jumping from the window.
Third Reserve Hospital in Valjevo
where I was nursed, by night
looked more like a madhouse than
regular hospital. Some patients
were singing, some commanding,
the others talked to dead and
were calling the roll. Everybody
hallucinated on its own way and
hasn’t disturbed one another.
Doctor Dragutin S. Petkovic,
Medical Corps Officer of Morava
Division II Class

Museum of Science and Technology –

Collection of the Museum of Serbian
Consecration of the monument to the patients died from typhus in Morava Permanaent Military Medicine of the Serbian Medical Society
Hospital by Cele-kula in Nis, 1915 (Museum of Science and Technology – Collection of the Museum of
Serbian Medicine of the of the Serbian Medical Society)

should also bear in mind the following important facts: the number of physicians and para-
medical staff that Serbia had at the beginning of the war was not sufficient; the Medical Corps
was inadequately and insufficiently equipped; there was no causal treatment since this was the
pre-antibiotic era, and there was a general weakness of the entire population, which also con-
tributed to the mass morbidity and mortality.
 24
It is known that the entire Serbian Medical
Corps entered the war inadequately organised:
even though they were prepared for surgical
work, there was a lack of bacteriologists and
hygienists and preventive medical institu-
tions.35 Not even the small number of ten spe-
cialist bacteriologists and hygienists that were
in the country was properly assigned during
the war to work in their own specialty field, but
instead they worked as unit physicians, heads
of hospitals and medical officers. Only after
the epidemic flared two of them – dr. Bozidar
Zanft (who died as a typhus victim in Febru-
ary 1915) and dr. Moric Buli – were assigned
to their posts according to their professional
qualifications.36
Ever since 1910 Gencic, as the Head of the
Medical Corps department at the Ministry of
Defence, tried to establish a preventive service
in the Medical Corps, warning the authorities
that “without bacteriology there is no hygiene,
and without the hygiene there is no health in
the army.“37 However, it was all in vain, may-
be mostly because of the slow administration
and the tendency to save funds in every way
possible. It appears that slow decision mak-
ing had not a little an impact when it comes
to epidemic. This is also indicated by a severe
criticism made by Vladimir Stanojevic in 1922:
“Our negligence and Eastern slovenliness, hid-
den behind the phrase incapabilities of the bud-
get“, as well as our misunderstood frugality
and stinginess had to lead to an epidemic [...]
The battle with the contagion that had already
arisen is hard and complicated. Our special
conditions and our passive and inexperienced
epidemic measures only made things worse.
We were so unprepared, so ignorant and un-
skilled to take actions against the epidemic
that any serious fight was out of the question.
We were such passive observers of everything
that happened to us and around us, that the
things followed its own course...“38
The events that followed confirmed that
there was a delay in the decision making, and
therefore the validity of Stanojevic’s claims.
 25

On January 15 Colonel Gencic informed the Head of the Supreme Command Headquarters Vo-
jvoda Putnik that “relapsing fever and typhus are transmitted by lice that are now present in our
army in the highest degree” and that “therefore, the lice should be destroyed.”39 He also gave
the comparative information regarding the number of the people suffering from all three types
of typhus in military hospitals for December 15, 1914 and January 13, 1915: typhoid 486: 1,491;
typhus 96 : 730 and relapsing fever 1129 : 5.233. It was also stated that it is necessary to look for
physicians abroad, not just for the army, but to satisfy the needs of the civilian population as
well, since the epidemic among the civilians will last longer than among the army.“40

Convalescents recovered from typhus in the hospital room no. 19 of Nis District Hospital and back of the photo with their
signatures, March 1915. (Museum of Science and Technology – Collection of the Museum of Serbian Medicine of the of the Serbian Medical
Society)
 26
In the meantime, the physicians who were
also getting ill and dying in large numbers,
continued to fight in hospitals that were short
of everything, starting from the space to ac-
commodate patients, through personnel, beds,
beddings, blankets and change of clothes for
the patients, to quality food and medications.
However, were they aware that their main ene-
my was body louse? “And even though in 1909
Nicolle and Conseil determined that typhus is
transmitted by lice”, wrote in 1925 dr. Dimi-
trije Antic, Head of the 1st Reserve Hospital in
Kragujevac during the epidemic, “we entered
the World War in 1914 uninformed of that im-
portant fact. The authorities that didn’t spare us
with their endless orders, with or without value,
sadly missed to inform us, in a form of a simi-
lar order, that typhus is transmitted by lice.“41
A great number of physicians might have been
uninformed, but certainly not all of them. There
were certainly those who still remembered dr.
Jovan Kujacic’s work Typhus Fever (Typhus), first
published in Public Health, addition to Serbi-
Room with those that recovered from typhus, respectively
those “commuted a death sentence“ had more than thirty
beds every bed radiating childish happiness of those that
were coming back to life. The patients were mostly on their
feet; some were sitting at the table in the middle of the
room, some were reading, writing letters while the others
talked vividly (jokes were present) and few of them in order
not to discontinue old Serbian tradition played preferans.
Everywhere witty words, laughter, bright remarks. Young
and old coming from the various branches of the army in the
civil world being artists, doctors, topologists, lawyers and
tax collectors. This many-colored world was moved by the
same power: “happiness for being alive.”
Aleksandar Dj. Kostic, medic, later on Professor at the
Belgrade University School of Medicine.
Aleksandar Dj. Kostic, “Tifuske zgode i nezgode”, 13
an Archives of Medicine from May till October
1913,42 and then a separate edition in the first
half of 1914, where he literally stated: “it has
been accurately determined, and in general it
is considered to be most reliably proven that out
of all the stated insects louse is the only one that
transmits and takes the infected blood from the sick
to a healthy person.“43 It had to be known to at
least some of the younger physician who grad-
 27

uated at foreign universities after 1909, and also to a number of foreign physicians who came
to aid Serbia. Finally, it is hard to believe that doctors Milan Radovanovic, Roman Sondermayer,
Eduard Michel and Milan Jovanovic Batut, who were in close contact with Stanislaus Prowazec
during his research in Belgrade in 1913, and whom he mentions with gratitude by name in his
paper published in November the same year.44 However, even though it was known, it was mostly
not believed in. “I remember a
colleague”, Antic wrote, “who We, that were upstairs on the first floor of the barracks, were sitting in our medic
himself barely survived typhus room, we had lunch there, slept there, talked there and very often sang there. I was
not able to sing, since two of my brothers had already died from typhus, being on
in 1915, and after that insisted military duty. When I came back to my work to Nis after I had buried my second
that it is not true that lice are brother in Kragujevac I lied down to bed with already high fever. That was the first
typhus in our medic room. That was by the end of January 1915. I remembered my
the transmitters of this horri- friends putting on me cold Priessnitz compresses and lice from my hair leaving my
ble disease.“45 So there were warm skin. I don’t know if I can call that bad omen for close death; at the clouded
state of mind as some kind of visual hallucinations I saw beautiful illuminated and
those physicians who knew, colored cascades as some kind of firework looking like range of rainbow colors.
heard but doubted, and there
Milorad Dragic, medic, later on respectable doctor,medical historian and the Chief of
were certainly those who were the Department of Science of the Institute for Health Education
completely uninformed. But the
Dragic, “Secanja na medicinski rad u Provom svetskom ratu”, u Zbornik
knowledge itself, even when Milorad
neobjavljenih radova saopstenih u Sekciji, knjiga II u spomen pedesetogodisnjice albanske
it existed, couldn’t have been Golgote, pet godina rada Sekcije 1960–1965, ur. Vladimir Stanojevic (Beograd: 1965),
97.
enough since there was a lack
of means to suppress the infestation with lice. Serbia didn’t have nearly enough necessary dis-
infection devices, and some of those that existed remained unused whether because they were
not functioning or because there was no one who could handle them.46 Boiling the laundry – dis-
infection method generally used in hospitals – was also unavailable due to several reasons: there
 28

Medical Corps
Captain Doctor
Vladimir Stanojevic,
Head of Morava
Permanent Military
Hospital in Nis,
receives morning
report, 1915.
(Museum of Science and
Technology – Collection
of the Museum of
Serbian Medicine of the
Serbian Medical Society)

were not enough clothes, they took a long time to dry and there was no staff to do the job.47
In those conditions in order to protect the body from lice and to destroy them, various agents
were applied, such as naphthalene dissolved in alcohol or petrol, camphor, petroleum, turpen-
tine oil, mercury preparations (sublimates and ointment), tobacco leaves, garlic... It turned out
that these were not efficient weapons for fighting the epidemic since the mortality rate grew
every day. In Valjevo, Kragujevac, Nis and other cities more than one hundred people died each
 29

The situation in the hospitals was not only inadequate, but horrible. There were scenes from the hospitals reminding of the
most terrible days of massive death caused by typhus in Napoleon’s Army in 1813, Crimean Wars or Russian-Turkish War in
1878. The number of patients was far above the number of beds so that all the patients, the most serious one those that were
delirious, that urinated in bed and those who were at one’s last gasp, all of them mixed up, lied in the beds that were put
together, under the beds, on the floor even in the corridors.

There was no one to nurse since both nurses and elderlies had already died or lied in beds with the diseased patients.
Prisoners who were unfamiliar with the language of the patients and who themselves looked as a ghosts being also the
patients who had just got up and could barely stay on their feet, played a role of elderlies. There were no doctors, since they
got affected most easily and died most frequently in the largest percentage […]

The chaos was in the hospitals everywhere in all segments. At Morava Hospital near “Cele-Kula” in Nis, laundry didn’t work
properly in February and March as well as cemetery. Patients did not have clean underwear for dirty one was piled up in two
big rooms up to the ceiling, the laundry did not work and the hospital was crawling with lice. The dead hadn’t been buried
for several days, since there was certain confusion among those making coffins, driving to the cemetery, digging the wholes
and those that buried dead bodies. The chaos was also in the kitchen. Food was given to the patients at random and roughly
and was served by prisoners who on their way to the wards drink up, eat up and even sell the food! But at the admission
ward there were more and more seriously ill, already dead and half dead. They were brought primitively on one peasant
horse cart or oxen cart, piled up and crowded like sardines without straws or any other floor covering. They pulled them up
and down in the carts, to the hospital through town , all day around on the bumpy road.
Medical Corps Captain Doctor Vladimir Stanojevic, Commander of the Permanent Morava Hospital from March 1915 to 1916,
later on Medical Corps General, medical historian and the founder of two institutions within Serbian Medical Society: Section
for the History of Medicine and the Museum of Serbian Medicine.

Vladimir Stanojevic, “Pegavi tifus u srpskoj vojsci 1914 and 1915”, Istorija srpskog vojnog saniteta: nase ratno sanitetsko iskustvo, ur. Vladimir
Stanojevic (Beograd: Stamparija “Zlatibor”, 1925), 333-335.
 30

Help from Serbian Humane Societies and

medical help from abroad

At the beginning of the war in order to serve

the needs of an army that counted around
500.000 people in Serbia, 409 physicians and
203 medical students were mobilised.50 Stu-
dents who participated in previous wars as vol-
Products used for protection against lice (naphthalene, unteers, were called to serve for their country
alcohol, tobacco leaves) (Museum of Science and Technology –
Collection of the Museum of Serbian Medicine of the of the Serbian for the first time. Medical units also included
Medical Society)
paramedics, people who carried the wounded
day. On February 23, 1915 Politika announced
that since the beginning of the war 69 physi-
cians died, mostly from typhus.48 According to
the research so far, the number of physicians
(serving in the Serbian Medical Corps, foreign
physicians and prisoner physicians) and med-
ics who died is 170, and that is probably not
the final number.49

Transportation of dead, who died from typhus, Nis, march 1915

(from the Collection of Mr. Branko Kuzmanovic)
 31

Sick leave document and

death certificate of III Reserve
Hospital of Morava Division
II Class; Valjevo, April15,
1915 (Museum of Science and
Technology – Collection of the
Museum of Serbian Medicine of the
of the Serbian Medical Society)

I have been deadly sick for sixteen days. On the seventeenth day I didn’t have temperature anymore. I couldn’t
believe it. And doctor Djordjevic [Selimir – author. remark] who had cured me so well to my thirteenth day of
illness, died shortly from typhus. When temperature was over 40°C, Sister De Hrote wrapped me in cold wet sheet
that she had wetted every two hours even every hour. In the morning and in the evening they gave me 4 grams of
quinine and eggs with brandy as stimulus for heart that suffered a great deal.

Fourteen doctors died in Valjevo in a course of ten days. Colleagues that we had good time together and worked
together, as that Serbian woman doctor who anesthetize my patients during major surgery …All of them, really
all of them when I asked for them – the answer was they had died, all of them had died. I remembered them with
sorrow. Especially two Croatians, Kovrec and Milota [Vaclav Milota was Czech, author.remark]…After that Miss.
Babic and colleague Vojteh and friend Kuk.”
Arius van Tienhoven, Chief of Medical Mission from Holland who worked in Valjevo from August 1914 till the end of
February 1915.

Arius van Tienhoven, Strahote rata u Srbiji: dnevnik ratnog hirurga (Beograd: Utopija, 2005), 94-95
 32
and medical second lieutenants, trained to
perform this duty during the compulsory mil-
itary service. At the time Serbia didn’t have
an education system to educate nursing staff,
but there were, the same as in previous wars,
volunteer nurses, members of various humane
societies: Serbian Red Cross Society, Circle of
Serbian Sisters, Knjeginja Ljubica Society, Bel-
grade Women’s Society, Jewish Women’s Soci-
ety, National League of Serbian Women, War
Women’s Society and others. Members of
the women’s humane societies, besides their
Thermometer, the beginning of XX century
(Museum of Science and Technology – Collection
of the Museum of Serbian Medicine of the of the
Serbian Medical Society)
Stethoscope, monoauricular, XX century (Museum of Science and Technology –
Collection of the Museum of Serbian Medicine of the of the Serbian Medical Society)
work in hospitals, also organised accepting
the wounded soldiers from the front, sewed
clothes and gathered food and medical sup-
plies for the hospitals, army and the refugees.
Many of them, including painter Nadezda
Petrovic, president of the Circle of Serbian Sis-
ters Ljubica Lukovic and Kasija Miletic – Serbi-
an Florence Nightingale, became victims of the
epidemic.
Serbian Red Cross Society was a great sup-
port to the Medical Corps. At the beginning of
the war the Society procured a large number
of beds for the hospitals and stretchers for
medical trains, and then continuously supplied
the hospitals with medical supplies, beddings,
change of clothes for the patients, as well as
beverages that were, at the time, considered
to be important therapeutic agents (milk, vine,
cognac and tea).51 The Society helped the Gov-
ernment in engaging and financing the work
done by physicians and medical missions from
abroad. Even though further mobilisation of
physicians and medics from newly-liberated
 33

Patients’ food

Milk was main and the best food for the patients affected by typhus. The patient should drink two liters of good cow milk
and 1 liter of tap or boiled water. Besides milk, patient could have beef soup or thick chicken soup with egg yolk, lemonade,
raspberry juice with water, orange juice and some glass of wine, pure or with water. If a patient can take it, it is good to give
him one uncooked egg. During illness, patient should urinate as much as possible in order to purify blood, so one should be
offered milk, tea or herbal tea frequently. In the second week or rather in the second half of the second week, crises occur and
that is when the patient is in the most danger for his heart can lose vitality. That is why it is so important to feed the patients
with good and heavy food: give them plenty of milk and soup as frequent as possible, some glasses of red wine 1-2 black coffee
and punch. After 10-20 days when fever gets lower and treat disappears and when a patient himself starts feeling better, soft
boiled egg, rice pudding, smashed potatoes with milk, sponge cake, cream desert or switched egg may be offered to him. Only
after several days when patient feels good with this food, solid food can be given to him.

From the Typhus – the manuscript of anonymous doctor

Archives of Serbia, Miscellaneous, 1158

Nis District Hospital 1915. (From the

Collection of FotoMuzej, ownership of Mr. Zoran
Trtica)
 34

territories, as well as employment of physi- break of the epidemic, equipped with surgical
cians from allied and neutral countries, in- equipment. They were not informed about the
creased the number of physicians by Mid-Oc- epidemic because Serbian Government didn’t
tober 1914 to 828,52 that number was still in- mention it in their appeals for help due to po-
sufficient. Therefore, the Government, at the litical and military reasons. Despite that, the
initiative of the Supreme Command’s Medical medical staff adapted to the conditions thanks
Corps, tried to employ additional physicians to their professionalism and conscientious-
from abroad several times, under the following ness, working relentlessly day and night with
conditions: monthly salary between 500 and their Serbian colleagues. Among them, the
600 dinars (which was the amount of monthly
salary of county physicians and heads of hos-
pitals in Serbia); per diem in the amount of 3
dinars (if the food is not provided) and accom-
modation in the hospital.53 Starting in summer
1914, medical unit began to arrive, and they’ve
been organised and completely equipped by
the humane societies from Greece, Russia,
Great Britain, Netherlands, Switzerland, USA
and Denmark. Beside them, there were also
individually employed physicians from Greece,
Great Britain, Belgium, France, Netherlands,
Switzerland...
Patients bathed, changed into clean clothes sitting on a bench
waiting for their beds to get clean linen. Hospital in Valjevo,
The units were arriving, even after the out- 1915. (Source: Arius van Tienhoven, Strahote rata u Srbiji)
 35

first victims of typhus were Dr. Theofanos Dz-

agris, physician from Greece and dr. Eva Mit-
nicka from Switzerland, who died in November
1914. 22 female members of the British units
died, and their units mostly consisted of wom-
en. Several heads of the foreign medical units
also suffered from typhus: Lady Louise Mar-
garet Leila Wemyss Paget (1881–1958), Head
of the First Unit of the Relief Fund in Skopje;
dr. Eduard W. Ryan (1883–1923), Head of the Syringe according to Pravaz, the beginning of XX century
(Museum of Science and Technology)
American Red Cross Unit in Belgrade; dr. Ar-
ius van Tienhoven (1886–1965), Head of the
private medical unit from Netherlands, which
operated in Valjevo and Main physician in the
Sank Peterburg’s Slavic Humane Society Mis-
sion, dr. Nikolay I. Sychev (Николай Иванович
Сычев, 1878–1954). 20 foreign physician died
of typhus while one was a victim of typhoid fe-
ver.

Suppressing the epidemic

Serbian Government faced the fact that the

Medicaments used in treatment of typhus – Electrargol and
epidemic got completely out of control at the Neosalvarsan (Museum of Science and Technology – Collection of the
Museum of Serbian Medicine of the Serbian Medical Society)
 36
Regarding insufficient number of doctors and orderlies as well as
lack of apparatus, linen and other material in the height of epidemic
of typhus, curing as well as nursing of the patients was rather poor.
Administered for use were: Digitalis, Caffeine and Camphor that
were given to all the patients without distinction. Whenever it was
possible injections were administered of : camphor, caffeine and
adrenalin. Antipyretics were rarely used. There were attempts with
intravenous injections or Electrargol (10ccm several times) or
just Neosalvarsan (no 0.45 pro dosim) or simultaneous combined
treatment with Electrargol and Neosalvarsan. Some special effect
was not noticed.
We gave subcutaneously serum of convalescents 2–10 ccm several
times…It is obvious that convalescent serum didn’t have reliable
specific effect, the same as any other tried cure.
In curing typhus the greatest attention should be paid to the
hygiene and nursing. Ventilation of rooms, if possible curing to be
outside, as much air as possible, cleanliness of body, clean linen,
clean mouth, febrile diet, bag with ice on a head, eventually on
a heart. From medicaments and symptomatic cures – drugs for
strengthening and stimulating heart.
Dr. Dimitrije Antic, Head of the First Reserve Hospital in Kragujevac,
later on Professor at the Belgrade University School of Medicine.
Dimitrije Antic, “Pegavi tifus u Kragujevackoj rezervnoj bolnici 1914-1915,
u Istoriji srpskog vojnog saniteta: nase ratno sanitetsko iskustvo, ur. Vladimir
Stanojevic (Beograd: Stamparija “Zlatibor”, 1925), 328.
meeting held on January 26, 1915. The deci-
sion was made to ask officially, through Em-
bassies in Great Britain, France and Russia, for
immediate help in the form of 100 physicians
to suppress the epidemic.54 Great Britain was
first to respond, and their Government made
a decision to send a mission to Serbia com-
prising 25 military medical officers. The British
Military Hospital attached to the Serbian Armies,
being the official name of the unit, was given
assignment to analyze the epidemic, make a
plan and determine the measures for its sup-
pression. The first and the most important task
for the Mission was to improve the health of
the Serbian Army so that they could be ready
for further military actions, and also to clean
the country from the disease that could pass
on to allied troops in case they needed to be
engaged in Serbia.55 The Mission started its
journey on February 2, 1915.
At that time, finally faced with the dangers
of the epidemic, physicians in Nis held meet-
ings in which they discussed all three types of
 37
typhus and the ways to fight them. From the
beginning of January until the end of Febru-
ary six meetings were held, out of which three
were devoted to typhus, two to typhoid fever
and one to relapsing fever. The Government
established the State Board for suppression of
infectious diseases,56 which included dr. Roman
Sondermayer and dr. Svetislav Moacanin, per-
sonal physician of the Crown Prince Aleksan-
dar, and parliament members Velisav Vulovic
(Chairman of the Board), dr. Dragoljub Pav-
lovic and Miloje Jovanovic. The first actions of
the Board were to build isolation wards in mil-
itary zones and in the background, construct
two large disinfection furnaces in Nis, procure
mobile steam disinfection devices and medi-
cations from abroad.57 By the middle of Feb-
ruary Medical train no.1, under the command
of Dr. Milan Petrovic, was turned into a disin-
fection train. Using “strong disinfectants and
naphthalene”, by February 19, all the stations
from Belgrade to Veles were disinfected.58 The
Board managed to bring the decisions to close
the schools, prohibit hospital visits and for-
bid the civilians to move around the military
zones. Since there was a lack of disinfection
devices (that arrived in March, and in an insuf-
ficient number)59, improvised methods were
recommended in order to fight pediculosis.
Supreme Command advised the use of locomo-
biles to produce water steam, but it was rarely
possible.60 “Disinfection furnaces” that used
dried, overheated air, were more widely used.
They were recommended by the physicians
stating that they can be made in the ground,
by making a small pit with a chimney, where
you first make the fire, and then take out the
ashes and put the clothes in.61 Disinfection
(depediculation) in them was performed at the
temperature between 110 and 120 0C, for 15
to 20 minutes. Depending on the skillfulness
of the operator and the size of the furnace, be-
tween 70 and 300 pieces of clothing could’ve
been disinfected in them each day.62
These measures still didn’t give results in
suppressing the epidemic, so they were rad-

Colonel Doctor William
Hunter (1861–1937), Chief of
The British Military Hospital
attached to the Serbian
Armies (Source: Ljubomir Vuksic,
“Istorisjki osvrt na prestanak
pegavca (typhus exanthematicus)
1914–1915 u Srbiji”, Arhiv za
istoirju ydravstvene culture Srbije
18, 1989)
38
icalized and improved by the arrival of the British
Army Medical Mission. On February 19, 1915 the Mis-
sion arrived in Nis, headed by Colonel William Hunt-
er, Head of the London Fever Hospital. The Mission
included: Lieutenant Colonel Dr. Georg Еlliott Frank
Stammers (1873 – after 1940), second commander
and epidemiologist with a wast experience gained in
India and South Africa;63 Captain Dr. William W. C.
Topley, bacteriologist, and 22 medical lieutenants.64
It was the first official state mission that the Allies
sent to help the Serbian Army. They were welcomed
in Nis by Serbian and British state officials. After the
reception with the Prime Minister Nikola Pasic, the
Mission met with the members of the State Board for
Suppression of Infectious diseases. In a very short pe-
I was unconscious for several days. They have been giving me aspirin, coffee and
brandy and I was recommended to take hot bath. That’s how they cured me as well.
Military doctors came to see me since I was a soldier but it was hard to get a doctor
these days, because complete Valjevo was ill and number of doctors was limited.
My family hasn’t informed me about my disease, or what has been happening in the
town in order not to make me afraid.
From the manuscript Jedna tuzna prica Radovan Draskovic, soldier, later historian and
publicist and Director of the Historical Archives of Valjevo.
Museum of Science and Technology – Collection of the Museum of Serbian Medicine of the
Serbian Medical Society
 39

riod of time they received all the necessary information regarding

the epidemic. A visit to the hospitals in Nis assured the members
of the Mission that they need to act quickly. Hunter stated that
in one of the hospitals that had the capacity of 200 beds, he’d
seen 700 patients; that several of them were lying on joint beds or
on the floor, practically without the covers; that only two young
physicians were taking care of them; that there were no nurses,
and that their duties were performed by Austrian prisoners; that
the conditions in the hospital were unsanitary in every regard,
and that there were no disinfection devices, only a small furnace
where it was possible to disinfect only two pieces of clothing at
the same time...65 After he got acquainted with the situation, dr.
Hunter pointed out that the problem is twofold: both hospital and
preventive (emergency protection of the public health).

The rate at which the Mission acted is reflected in the fact that
on the third and the fourth day after their arrival Lieutenant Colo-
nel Stammers made seven reports on the epidemiological situation
in Serbia, together with a proposal for preventive measures. These
reports are titled as follows: 1) Note on the possibility of chol-
era outbreak in Serbia during future operations; 2) Simple method
for water purification using “chlorine”; 3) Potable water: several

Lieutenatn-Colonel George E.F. Stammers (1873–after 1940), Second Commandeer of Britain Military Hospital that joined Serbian
Armies (Photograph taken in 1899 during the Second Bulgarian War. Property of Imperial War Museum, London © IWM Q 72354 (detail))
 40
notes on water supply; 4) One simple, cheap,
improvised steam disinfector; 5) Ways to stop
the spreading of relapsing fever and typhus; 6)
Suggestive booklets and posters – calls. War
against the contagion: to all the men, women
and children in Serbia; 7) Chlorination meth-
od for sterilization of water for active service
troops.66
The measures for suppressing relapsing fe-
ver and typhus were determined together since
these diseases had the same transmitter.67 The
first of them was an instruction for construc-
tion of an improvised water steam disinfection
device for which Stammers stated that it was
used in India during the cholera epidemic. The
device had a firebox and a reservoir above it,
containing boiling water with added formal-
dehyde. Over the reservoir one would install a
wooden or an iron barrel with holes on the bot-
tom, so the water steam can go through. The
material that needs to be disinfected would
be inserted into the barrel and the top open-
ing would be closed with a hatch, over which
a large rock would be placed. The disinfection
process would last for one hour. This simple
device, which was widely applied in Serbia, and
then in other fronts during the First World War
(for example, on Salonika front and in Afri-
ca), was also known as “Serbian barrel”, “En-
glish-Serbian barrel”, “barrel disinfector” and
„Serbian barrel delouse”.
Based on these reports, submitted to the
Head of the Medical department at the Min-
istry of Defence, Colonel Karanovic, and then
later to the State Board for Suppression of In-
fectious Diseases, the Mission made a propos-
al titled “Measures that the Government, City
and Hospital administrations need to adopt in
order to stop the spreading of typhus and re-
lapsing fever”. The Proposal had nine items:
1. Compulsory notification, isolation, and
disinfection, in the case of hospitals.
2. System of notification in towns and villag-
es-and by householders.
3. Personal cleanliness of patients and of de-
 41

Report of Lieutenant-Colonel Stammers no. 4: One Simple, Cheap Improvised Steam Disinfector (Archives of Serbia, MUD – S,D.o. –
12/1915)
 42

struction of vermin in all bedding, cloth-

ing, bedsteads.
4. Removal to hospital where possible.
5. Personal interest of each individual in
combating these diseases.

“Reserve Hospitals “arose like mushrooms, but without

any hospital equipment, without enough linen, change
of underwear, soaps, without disinfectant apparatus.
The Danube Cavalries Regiment I Call was first to use
“Serbian Barrel” for disinfection, even before Hunter.
Over big boiler of boiled water, barrel with the pierced
bottom was fixed protected with asbestos from burning Poster about typhus, 1915 (Archives of Serbia, ZP – 179)
.The only thermometer was one of 100°C bought at
the Chemist’s Cecelski mounted on the lid and after
it was used for some time it was broken, then all the 6. Public interest to be aroused by pamphlets
cleverness of Artillery Sergeant, chemist, Dr. Sinisa and newspapers.
Djaja hadn’t help to fix the thermometer, the apparatus
was definitely deprived from thermometer. Inventive 7. Supplies of disinfectants and arrange-
cavalries placed on the place of thermometer a whistle ments for disinfection by public authori-
and when strong jet of steam caused whistling, the
apparatus was under sufficient steam. ties.
Dr. Kosta Todorovic, later on Professor at the Belgrade
8. Formation of public disinfecting stations;
University School of Medicine.
9. The formation of the newly improvised
steam or “ barrel disinfector” devised by
Kosta Todorovic,”Uspomene o epidemiji pegavca iz 1914/1915” Lieutenant-Colonel Stammers, so simple
Zbornik neobjavljlenih radova saopstenih u Sekciji, knjiga II u
spomen pedesetogodisnjice, albanske Golgote, pet godina rada Sekcije in character, so inexpensive, and so easi-
1960-1965, ur. Vladimir Stanojevic i dr. (Beograd: 1965), 63.
ly made, that they could be formed in any
 43

number required in every village, and even

in every household in the country.68

State Board for Suppression of Infectious

Diseases, which had significant available
funds, accept the proposed measures within
seven days and began their application.

The Mission continued their work in Kragu-

jevac, where the Government and the Medical
Corps had their headquarters. A laboratory run
by Captain Topley was established there, and
it also conducted, besides the usual analyses,
research on the typhus causative agent. On
February 25 the Mission submitted a new set
of measures to the Government, which includ-
ed: suspending all railway traffic (which came
into force on March 3 and lasted for a month);
prohibiting soldiers to take leave of absence;
establishing quarantine for soldiers and con-
valescents on a railway junction in Mladenovac
(began operating on April 9, after railway traf-
fic was re-established); formation of a special
train for disinfection and vaccination.
Poster Announcement for People,1915 (Archives of Serbia, ZP – 177)
 44

Other innovation implemented by the Mis-

Soldiers preparing and handing over their uniforms, which
are going to be disinfected in the disinfection and vaccination
train, 1915. (From Mr. Branko Kuzmanovic’s collection)
sion was the train for disinfection and vacci-
nation. Hunter stated that the train built in
Serbia was the first of its kind employed in an
army, while Richard P. Strong (1872–1948)
gives an information that the same type of
train was first used in Manchuria in 1910, and
then in Germany at the beginning of 1915.69
According to Lieutenant Colonel Stammers
“Serbian train” was build in ten days, by alter-
ing the existing railway cars in a railway work-
shop in Nis. It had a section for disinfection

The quarantine in Mladenovac, which had

two large disinfection devices and 25 “Serbi-
an barrels”, was at the same time serving as
the disinfection station. This was a place where
soldiers took a bath and cut their hair while
their clothes were being disinfected. After that
they would receive a vaccine against typhoid
fever and cholera. Passangers would remain
there for 12 to 24 hours after which they could
Train for disinfection and vaccination, 1915 (Source: Richard P.
continue their journey. Strong et alt, Typhus Fever with Particular Reference to the Serbian Epidemic.
American Red Cross at the Harvard University Press, 1920)
 45

of clothes (water steam was supplied by the locomotive); bath-wagon

with showers; three wagons for vaccination, six wagons for train staff
accommodation and three for storage. Main Commander of the train
was Stammers, and on the Serbian side Nikola Hristic, Captain of the 1st
class, was assigned as the Commander.70 Since April 6 until the Mission
left Serbia on May 28, 1915, around 300.000 people were vaccinated in
the train.

The Mission cooperated with British medical units that were present
in Serbia at the time, first of all Scottish Women’s Hospitals and legend-
ary dr. Elsie Maud Inglis (1864–1917). After the arrival of the French
Mission headed by Colonel M. Jaubert and Medical Corps Commission
of the American Red Cross and Rockefeller Foundation, headed by dr.
Richard Strong, professor of Tropical medicine at the Harvard Univer-
sity, an International Medical Corps Commission was formed and it in-
cluded representatives of all the units and missions working in Serbia,
as well as Serbian Chiefs of Medical Corps.71 Honorary President of the Sir Thomas Johnstone Lipton
(1848–1931), the benefactor
Commission was Crown Prince Aleksandar, and the Vice president was of the Serbian people and an
honorary citizen of Nis and
Sir Ralph Paget (1864–1940), head of all the British units in Serbia and Professor Richard Strong,
head of the Commission of
a former British Envoy to Serbia. Commission coordinated operations the American Red Cross and
of all the units that worked together, while dividing the assignments the Rockefeller Foundation,
Niš, 1915 (from the Collection of
Mr. Branko Kuzmanovic)
with the Serbs in order to supress the epidemic. It was agreed that the
French mission would act within the borders of Serbia before the Bal-
kan Wars, American mission was assigned to newly-liberated territories
 46
and Russians and Swiss were included in the
operations in the big hospitals.72 British units
continued to operate in the areas they were
already assigned to (in both Serbia befor the
Balkan Wars and “South Serbia”).
I stared at the ceiling; always at the same crack that spread
over my head and to the corner ending in the big whole. I
was wrapped up in various thoughts. Fever of over 40°C
burned my weak body. It looked like I was steaming…
With great difficulty I moved my head towards window;
in front of the chapel I saw them unloading coffins. They
echoed being empty. I felt a sudden pain. For whom were
those coffins? There would be enough of them for all of
us lying down there. Maybe one of them was for me? I
remembered that shortly I comforted seriously ill patients for
it was my duty. Just to make things easier for them– not to
tell them that the end is inevitable. The doctor told me “Be
brave”! It’s true he didn’t say “Brave for life” nor did he say
“Brave for Death”
Aleksandar Dj. Kostic, medic, later on Professor at the
Medical Faculty at Belgrade University
Aleksandar Dj. Kostic, “Tifuske zgode i nezgode”, U vedrini oluje
(Beograd: Partizanska knjiga, 1984), 9-10.
French mission arrived in March and it in-
cluded 101 physicians. There were divided in
seven sectors with seats in Belgrade, Uzice,
Valjevo, Krusevac, Kragujevac, Zajecar and
Nis. Their main operations included treat-
ing the sick and implementing the preventive
measures against the infectious diseases. The
mission established a hospital in Belgrade for
treatment of typhus, organised a course for
voluntery nurses and within the scope of pre-
ventive work in the sectors, it solved sanitary
issues in cooperation with Serbian authorities
and conducted vaccination against cholera, ty-
phoid fever and smallpox.73
American mission, headed by professor
Strong, which included around one hundred
members, also worked on treating the sick and
protection of public health. The operations in-
cluded medical inspection of the houses and
public buildings, identification of the new-
ly-diseased people and their isolation, securing
and implementing disinfection, preparation of
vaccines and implementation of vaccination
and improving the hygienic living conditions.74
Due to the insufficient number of doctors
on its own fronts, Russia wasn’t able to send a
 47
Austro-Hungarian prisoners disinfect a coach, Nis, 1915 (from
the Collection of Mr. Branko Kuzmanovic)
military medical mission to Serbia, but Russian
Volunteer Missions that already operated in
Serbia joined the battle against the epidemic.
These included Mission of the St. George’s Com-
munity of the Russian Red Cross, also know as
A.P.Hartwig’s Mission (Александра Павловна
Гартвиг, 1863-1944), headed by a private doc-
tor Sergei Kvintilianovich Sofoterov (Сергей
Квинтилианович Софотеров, 1879–1949) and
Russian Society and City of Moscow Unit and
Moscow Mission, also known as Duchess Maria
Trubetskaya’s Mission (Мария Константиновна
Трубецкая, 1881–1943). Moscow mission
was headed by Dr. Sergei I. Sirotin (Сергей
Иванович Сиротин). Upon the proposal by Dr.
Sofoterov, who presented the plan to solve
the sanitary issues in Nis to the Serbian Gov-
ernment on February 8, a City Council was
formed, which included representatives from
both military and civil authorities. The Coun-
cil’s task was to supervise the implementation
of the proposed measures. The city was divided
into four sectors, and supervision over each of
the sectors was assigned to one physician and
one assistant. Their duties included sanitary
inspection of the city, isolation of the diseased
and management of a disinfection team. Each
sector had a pharmacy and an infirmary, and
vaccination brigades were also formed. New-
ly-established public kitchens significantly
contributed to the improvement of the public
health and immunity.75 A special medical ep-
idemiological mission for fighting infectious
diseases called Mission of the Alexandria Com-
munity of the Russian Red Cross arrived in Nis on
May 28, 1915, when the epidemic was already
starting to wane. The mission consisted of
 48

anthologist, who was at the time working at

I am on my way all alone, with strong desire to fight and sacrifice,
without any missions, without help without any material resources.
the University in Zurich, arrived in Valjevo as a
Laboratory should be waiting for me in Valjevo. I am going to the volunteer. His modest laboratory became “the
hospital for infectious diseases that is located on the hill outside
the town, I got one room and the narrow hall as well as a small
center of medical life” and the first School
chest that was proudly called bacteriological laboratory. It consists of Bacteriology for Serbian physicians.77 In
of small test tube heater for a few test tubes, about fifty test tubes
and small number of reagents. With these weapons I have to attack
March Ernest Conseil (1879–1930), an asso-
one of the largest epidemics of typhus. ciate of Charles Nicolle, also arrived in Val-
Ludwik Hirszfeld, Polish doctor – bacteriologist and immunologist, jevo.78 In May, at the Sixth Reserve Hospital
who came to Serbia as volunteer in February 1915. near Skopje, also known as Typhus colony, a

Ludvik Hiršfeld, Istorija jednog zivota (Beograd: Srpska knjizevna

zadruga, kolo LV knjiga 377, 1961), 55.

eight doctors and 44 nurses, and the Chief phy-

sician was Professor Nikolay Spassky (Николай
Сергеевич Спасский, 1867–after 1924). This
mission’s hospital was the only hospital in Nis
where civilians suffering from infectious dis-
eases: dysentery, typhus, typhoid, malaria, in-
fluenza, scarlet fever, syphilis and tuberculo-
sis, were treated.76
During the epidemic, some world famous
scientists came to Serbia to research the ty-
Laboratory utensils from the First laboratory of Serbian Army
phus. In February 1915 Dr. Ludwik Hirszfeld headed by Doctor Ludwig Hirszfeld, Thessaloniki, 1916–1918
(Museum of Science and Technology – Collection of the Museum of
(1884–1954), Polish bacteriologist and sero- Serbian Medicine of the of the Serbian Medical Society)
 49
well-equipped laboratory began to operate.
The hospital was under the management of
one of the Lady Paget's units. After the arrival
of prof. Strong’s mission an existing hospital
laboratory was reorganised thanks to the joint
efforts of Serbian authorities and American
and British physicians. Until the end of June
laboratory was headed by Dr. Hans Zinsser
(1878–1940), and he was later replaced by dr.
Aldo Castellani (1874–1971).
***
Joint efforts made by the foreign medical
missions, first of all Colonel Hunter’s mission,
Serbian authorities, Serbian humane societies
and the whole nation resulted in suppression
of the epidemic in an incredibly short period of
time. Morbidity and mortality rates suddenly
began to decrease by the end of March, and
continued to decrease in the following months.
By the end of 1915 individual cases of typhus
were recorded but there was no epidemic. Even
though pediculosis was also present during the
retreat across Albania, the epidemic didn’t
break out. At the Salonika front only 18 cases
of the disease were identified among the sol-
diers, of which seven died (in 1916 and 1917),
while in 1918 there wasn’t a single recorded
After ten, fifteen days, typhus prevailed: every morning from
our company – and it had about two hundred soldiers – ten,
fifteen of them used to go to see a doctor for a checkup and
from there they were put on a train for Pristina to get to the
hospital.
I have got typhus myself and went to Pristina to the hospital.
I stayed there for several days and I noticed soldiers coming
to the hospital and dying. Six of my friends died there and
were buried there. Six out of eighteen of us stayed forever in
Pristina. I told them that I wanted to go back to my company
and they sent me back to Ferizovic. I stayed there in barracks
just for overnight, in the morning they sent me back to the
hospital in Pristina. I stayed in the hospital for ten days this
time. We lied on the floor covered with straws, there were
beds as well but not enough for everybody. This place was
just for dying, eleven more soldiers from my company died
there…
I was there for five weeks and I was well again, but my skin
was completely pilled, I had both typhus and typhoid.
Zivojin Jovanovic, soldier from village Sepci
Dragutin Paunic i Milija Djordjevic, Srbijico, duso gorka – price solunaca
(Belgrade: Narodna Knjiga, 1988), 163
 50

case.79 Thanks to the vaccination, the Army

and the people were protected from typhoid
fever and cholera.

The causes of the tragic outcome of the epi-

demic were multiple: inadequate organisation
of the health service, slow decision making,
insufficient number of doctors and medical
staff, physician’s inexperience in battling ty-
phus and relapsing fever, lack of equipment

Chart prepared by Dr. William Hunter showing the number of

people suffering from typhus and relapsing fever in correlation
to the measures used to contain the epidemic. (Source: William
Hunter, “The Serbian Epidemics of Typhus and Relapsing Fever in 1915,
Their Origin, Course and Preventive Measures employed for their
Arrest“)
Dr. James Francis Donnelly, a member of the unit of the
American Red Cross, the victim of typhus in 1915, with Sir
Thomas Lipton in addition to improvised disinfection appliance
in Gevgelija, 1915 (from the Collection of Mr. Branko Kuzmanovic)
 51

for preventive medical work, shortage of med-
ical supplies, and then the overall poor resis-
tance of the population in war conditions and
absence of causal treatment.
The experience gained in the First World War,
in which 12% of the population that died con-
sisted of victims of the epidemic, brought on a
change in the organisation of the health ser-
vice. New Health Policy no longer gave priority
to curative medicine. Preservation of the hu-
man health and prevention of diseases, from
conception of the human being until the end
of life, became the most important.80 In the
newly-founded Kingdom of Serbs, Croats and
Slovenes a network of preventive medical in-
stitutions across the country began to emerge
in 1919. First of these institutions was the
Permanent Epidemiological Commission, es-

Only after liberation, the hospital for military patients

and civilians was established in Lazarevac, but it was in
shortage of medicaments and other equipment. The whole
neighborhood was without doctors, pharmacies without
drugs. The enemies spent up everything but also took it away.
In the city there was not a single house without a patient.
Besides measles, whooping cough, diphtheria, relapsing fever
and typhoid fever, typhus was most numerous. Indescribable
fear overcame everybody, especially when hysterical patients
in delirium started running away and attacking other people.
One man from Podrinje in delirium jumped into a well in
front of the frightened refugees.
Dr. Kosta Todorovic, later on Professor at the Belgrade
University School of Medicine.

Kosta Todorovic,”Uspomene o epidemiji pegavca iz 1914/1915” Disinfection of laundry with improvised apparatus (type:
Zbornik neobjavljlenih radova saopstenih u Sekciji, knjiga II u spomen Serbian barrel), Thessalonica Front 1916-1918. (Archives of
pedesetogodisnjice, albanske Golgote, pet godina rada Sekcije 1960-1965, Serbian Academy of Sciences and Arts, Historic Collection, 14.559/IV-
ur. Vladimir Stanojevic i dr. (Beograd: 1965), 61 19)
 52

I was surprised with great number of surgical complications

from typhus. I have seen 130 cases of parotitis as consequence
of typhus, this parotitis in most cases was serious with abscesses
and gangrenes; I have seen patients dying from it…This parotitis
could be result of not kept mouth clean enough. In 124 cases I saw
gangrene of leg toes even calves. Just once it was penis gangrene;
partly gangrene of auditory system happened as well.
Dr. Vojislav Subbotic, the founder of modern surgery in Serbia,
later on one of the founders of the Belgrade University School of
Medicine.

Report “On Typhus in Serbia” that doctor Vojislav Subbotic, Deputy of the
Serbian Royal Government submitted at the Medical Conference of the Allied
Governments in Paris on March 15 – April 6, 1916 (transcript); Museum of
Science and Technology – Collection of the Museum of Serbian Medicine of
the Serbian Medical Society.

Report On Typhus in Serbia that doctor Vojislav Subbotic,

Deputy of the Serbian Royal Government submitted at the
Medical Conference of the Allied Governments in Paris on
March 15 – April 6, 1916 – transcript. (Museum of Science and
Technology – Collection of the Museum of Serbian Medicine of the
Serbian Medical Society)
 53
tablished in 1919 as an expert advisory body
with the Ministry of Public Health for all ques-
tions regarding prevention and supression of
acute infectious diseases.81 It was merged with
Permanent Bacteriological Station in Belgrade
(1922), Laboratory for Tropical and Parasit-
ic Diseases in Belgrade (1922) and Institute
for Social medicine in Belgrade (1923) and
so the Central Hygienic Institute in Belgrade
was founded in 1924, as the Center of Hygiene
Service for the entire country. Along with the
civil health service, new principles of operation
were also adopted in the Army Medical Corps,
which began the construction of Military Hy-
gienic Institute in Belgrade in 1919.
By 1925 in Kingdom of Serbs, Croats and
Slovenes there was a network of 250 hygienic
institutions,82 consisting of hygienic institutes,
public health clinics and health stations. Their
scope of operation included study of popula-
tion in all the areas of life connected to health,
health – educational work and supression of
mass infectious diseases.
When the infection was near the end, I went one day to visit a
family ill with typhus; only mother was on her feet, father and the
five children were ill. During my last visit they were on the ground
all of them were laying on the beaten earth floor in the one room
Serbian home. In the corner through one whole in the roof smoke
coming from several burning twigs in the ashes bellow one black
pot was going out. I came across six patients laying down on the
floor hardly covered by the rags of shirts […] This time I brought
them sheets, shirts and some clothes – present from the French -
Serbian Committee […] I have shown them riches that I brought, I
dressed up my patients and I put in one pot with hot water all the
clothes that I could find in the house. Father was at death’s door
and as I was ready to leave those miserable people and to mount
the horse I caught a sight of some kind of a ghost resting on very
bad branch taken out from fireplace entering the house. That was
my patient, dressed up in long shirt that I have just given him,
he walked with grimaces stretched to the utmost. He approached
slowly ordinary flowers by the wall: marigold, balm and
delphinium with light bunch-like flowers. Dying man, bent picked
up one flower and after bringing it close to his mouth handed it to
me. I still have that flower and tormented face and love of that man
will always remain in my heart.
Dr. Charles Garin, Member of the French Medical Mission that
operated in Serbia between April and September 1915
Source: Dragoljub N. Bakic, transl. U Srbiji april - septembar 1915.
(Kragujevac, 1965),4. Translated from French: J. Colombani et Charles Garen,
En Serbie (Avril – Septembre 1915) (Salonique: 1916), 25.
 54

Sources, Literature and comments

1
Stanislav Krakov, Život čoveka na Balkanu (Belgrade, Naš dom; Lausanne: L’age d’Homme, 2009),
76.
2
Literature offers different information. For example, the number of 150.000 diseased is given by:
Radovan Čekanac et al (Istorijski osvrt na epidemiju pegavca 1914-1915. godine u Srbiji, 220);
135.000 dead and 500.000 to 600.000 diseased is stated by Kosta Todorović (Uspomene o epidemiji
pegavca iz 1914/1915, 60); William Hunter stated that there were „at least“ 120.000 dead and „a little
less than“ 500.000 diseased (The Serbian Epidemics of Typhus and Relapsing Fеver in 1915, 39) etc.
(full references for the above mentioned works are given in further notes).
3
Ljubomir Vukšić studied the epidemic among the civilian population based on the death certificates
from eight cities (Ljubomir Vukšić, „Istorijski osvrt na prestanak pegavca (typhus exanthematicus)
1914–1915. godine u Srbiji“, Arhiv za istoriju zdravstvene kulture Srbije, 18 (1989 ): 45–57). In recent
years, this subject was treated by Zoran Vacić, (Zoran Vacić, „Tifusne epidemije u Srbiji 1914-1915.
godine – rad civilnog saniteta na suzbijanju epidemija“ (this paper was presented at the 49th Meeting
of the Section for History of Medicine of the Serbian Medical Society in Belgrade, April 30, 2015). The
author would like to thank dr. Zoran Vacić for making the manuscript of the paper available.
4
William Hunter, “The Serbian Epidemics of Typhus and Relapsing Fever in 1915, Their Origin,
Course and Preventive Measures employed for their Arrest“, Proceeding of the Royal Society of Med-
icine, XIII, 2 (1919): 75.
5 Report by dr. Lazar Genčić to the Head of the Supreme Command Headquarters, Con. L. No. 8257
from 15. 01. 1915. (Archive of the Military History Institute). The author would like to thank dr. Zoran
Vacić for making the copy of the document available.
6 Aleksandar S. Nedok „Srpski vojni sanitet na početku rata u velikim bitkama 1914. godine“, in Srps-
 55

ki vojni sanitet 1914-1915. godine, editors Aleksandar S. Nedok and Branislav Popović (Belgrade:
Ministry of Defence of the Republic of Serbia, Academy of Medical Sciences of the Serbian Medical
Society, 2010), 54.
7 Dates are given according to Julian calendar, which was in use in Serbia at the time. The difference
in relation to the Gregorian calendar used today, but also used by the members of the foreign medical
units and missions, is 13 days for the 20th century. 13 days should be added to the stated dates.
8 Aleksandar S. Nedok „Srpski vojni sanitet na početku rata u velikim bitkama 1914. godine“, 56.
Dušan Stefanović (1870–1951), Minister of Defence from January 4 until November 22, 1914, later a
Division General, downloaded on 10. 10. 2015, http: //bit.ly/1W0P7bn.
9 Vladimir Stanojević, Istorija ratnih zaraza (Belgrade: Štamparija „Zlatibor“, 1924), 40.
10
Radovan Čekanac et al, „Istorijski osvrt na epidemiju pegavca 1914-1915. u Srbiji“, in Srpski vojni
sanitet 1914-1915. godine, editors Aleksandar S. Nedok and Branislav Popović (Belgrade: Ministry of
Defence of the Republic of Serbia, Academy of Medical Sciences of the Serbian Medical Society, 2010),
211. Stupor is a condition in which the sufferer is conscious, but doesn’t have voluntary activities and
responds only to pain stimulus.
11
Desanka Kosanović-Ćetković, Akutne infektivne bolesti (Gornji Milanovac: Dečje novine, 1990),
243.
12 Ibid., 120.
13
„William Wood Gerhard (1809-1872)“, downloaded on 19. 10. 2015, http://archives.dickinson.edu/
people/william-wood-gerhard-1809-1872.
14
Richard P. Strong et al, Typhus Fever with Particular Reference to the Serbian Epidemic (Cam-
bridge: American Red Cross at the Harvard University Press, 1920), 42.
15
Until the invention of electron microscope it was uncertain if Rickettsia should be classified as bacte-
ria or viruses since they exhibit the characteristics of both types of microorganisms. Using the electron
microscope it was determined that they are bacteria living inside the host’s cells.
 56

16
Čekanac et al, „Istorijski osvrt na epidemiju pegavca 1914-1915. u Srbiji“, 244.
17
The Latin name of the disease (typhus exanthematicus) also relates to the wide-spread skink changes
called exanthem (exanthema – eruption).
18
The disease was named after the American physician Nathan Edwin Brill (1860–1925), who was the
first to describe the symptoms and Hans Zinsser (1878–1940), who connected them with typhus in
1934.
19
The medications of choice for treatment of relapsing fever are penicilin and tetracyclines, and for
treatment of typhus and typhoid fever chloramphenicol was introduced in 1948.
20
Jovan Kujačić, Pjegava groznica (pjegavi tifus) (Belgrade: State Printing Office of the Kingdom of
Serbia, 1914), 18; Jaroslav Kuželj, „Rasprava o tifu“, Srpski arhiv za celokupno lekarstvo, IX, 6 (1913):
258–260; Jaroslav Kuželj, „Rasprava o tifu“, Srpski arhiv za celokupno lekarstvo, IX, 7 (1913): 307.
21
Zoran Vacić, „Tifusne epidemije u Srbiji 1914-1915. godine – rad civilnog saniteta na suzbijanju
epidemija“ (this paper was presented at the 49th Meeting of the Section for History of Medicine of the
Serbian Medical Society in Belgrade, April 30, 2015).
22
Vojislav Kujundžić, „Pegavi tifus u Bitolju“, Zdravlje – lekarske pouke i obaveštenja o zdravlju i
bolesti, 8, 5 (1913): 136, 138.
23
Čekanac et al, „Istorijski osvrt na epidemiju pegavca 1914-1915. u Srbiji“, 216.
24
Vladimir Stanojević, „Pegavi tifus u srpskoj vojsci 1914 i 1915“, in Istorija srpskog vojnog saniteta:
naše ratno sanitetsko iskustvo, editor Vladimir Stanojević (Belgrade: Štamparija „Zlatibor“, 1925),
330.
25
Strong et al, Typhus Fever with Particular Reference to the Serbian Epidemic, 77.
26
Report by dr. Lazar Genčić to the Head of the Supreme Command Headquarters, Con. L. No.
8257 from 15. 01. 1915. (taken from: Aleksandar Nedok, „Vojni sanitet neposredno posle Kolubarske
bitke“, in Srpski vojni sanitet 1914-1915. godine, editors Aleksandar S. Nedok and Branislav Popović
(Belgrade: Ministry of Defence of the Republic of Serbia, Academy of Medical Sciences of the Serbian
Medical Society, 2010), 163.
27
Stanojević, „Pegavi tifus u srpskoj vojsci 1914 i 1915“, 330.
 57

28
Lazar Genčić, „Zašto je došlo do epidemija i pomora u našoj vojsci i narodu u vreme ratova 1912-
1918“, in Istorija srpskog vojnog saniteta: naše ratno sanitetsko iskustvo, editor Vladimir Stanojević
(Belgrade: Štamparija „Zlatibor“, 1925), 780.
29
Vladimir Stanojević, „Pegavi tifus u srpskoj vojsci 1914 i 1915“, 340–341.
30
Ibid., 341–342.
31
Milan Grba, Britanske sanitetske misije i Srbija u Prvom svetskom ratu (Magisterial thesis, Faculty
of Philosophy, University in Belgrade, 1995), 25.
32
Archive of Serbian Academy of Sciences end Arts (hereinafter refered to as: ASASA), Historical
Records, Dr. Roman Sondermayer’s Fund, 14559/I–1 и 14559/I–2.
33
Toma Leko, „Nekoliko reči o povratnom tifusu kao zarazi“, Ratni dnevnik II, 171 (1915).
34
Radoje Čolović, ed., Pomenik poginulih i pomrlih lekara i medicinara u ratovima 1912–1918,
[fototipsko izdanje] (Belgrade: Infinitas, 2012), 56.
35
More precisely, there was (since 1900) only one institution of that type in the country: Pasteur’s
Institute in Nis, whose main scope of activities included preparation of vaccine against smallpox and
rabies using the imported vaccine.
36
Nedok, „Vojni sanitet neposredno posle Kolubarske bitke“, 154.
37
Ibid., 155.
38
Stanojević, „Epidemija pegavog tifus u našoj vojsci 1914 i 1915“, 336, 340. The article was first
published in a magazine Ratnik in 1922.
39
Report by dr. Lazar Genčić to the Head of the Supreme Command Headquarters, Con. L. No. 8257
from 15. 01. 1915. (taken from: Aleksandar Nedok, „Vojni sanitet neposredno posle Kolubarske bitke“,
159)
40
Report by dr. Lazar Genčić to the Head of the Supreme Command Headquarters, Con. L. No. 8257
from 15. 01. 1915.
41
Dimitrije Antić, „Pegavi tifus u Kragujevačkoj rezervnoj bolnici 1914-1915“, in Istorija srpskog
 58

vojnog saniteta: naše ratno sanitetsko iskustvo, editor Vladimir Stanojević (Belgrade: Štamparija
„Zlatibor“, 1925), 322.
42
Jovan St. Kujačić, „Pjegava groznica (pjegavi tifus)“, Narodno zdravlje, lekarske pouke narodu,
dodatak Srpskom arhivu za celokupno lekarstvo, , XVIII (1913), 5:100–113, 6:121–125, 7:139–146,
8:159–165, 9:180–187, 10:204–210.
43
Kujačić, Pjegava groznica (pjegavi tifus), 34.
44
See endnote no. 21.
45
Antić, „Pegavi tifus u Kragujevačkoj rezervnoj bolnici 11914-1915“, 323. This was also testified by dr.
Moric Buli and dr. James Berry (1860–1946), Head of the British Mission, which operated in Vrnjačka
Banja in 1915. See: Moric Buli, „Moja bakteriolška iskustva u ratovima 1912-1918“, in Istorija srpskog
vojnog saniteta: naše ratno sanitetsko iskustvo, editor Vladimir Stanojević (Belgrade: Štamparija
„Zlatibor“, 1925), 520; James Berrry, Frances May Dickinson Berry and Walter Lyon Blease, The Story
of a Red Cross Unit in Serbia (London: J.& A. Churchill, 1916), 57.
46
Strong et alt, Typhus Fever with Particular Reference to the Serbian Epidemic, 28; ASASA 14559/I.
47
ASASA, 14559/I.
48
„Dnevne vesti: Umrli lekari“, Politika, 23. 02. 1915, 9.
49
The number of dead was obtained by comparing the data from: Pomenik poginulih i pomrlih lekara
i medicinara u ratovima 1912–1918, 128–129, and Aleksandar S. Nedok, „Sanitetsko osoblje koje je
izgubilo živote tokom ratnih događaja od 15. 7. 1914. do 30. 09. 1915“, in Srpski vojni sanitet 1914-
1915. godine, editors Aleksandar S. Nedok and Branislav Popović (Belgrade: Ministry of Defence of the
Republic of Serbia, Academy of Medical Sciences of the Serbian Medical Society, 2010), 367–368 and
the data obtained from daily newspapers published during the period January-March 1915 (Politika,
Pravda and Srpske novine).
50
Nedok, „Srpski vojni sanitet na početku rata i u velikim bitkama 1914. godine“, 31.
51
Hranislav M. Joksimović, Život i rad Srpskog društva Crvenog kstra i Društva Crvenog krsta S.H.S
od 6. februara 1876. god. do 6. februara 1926. god. (Belgrade: Grafički institut „Narodna misao“ A.D.,
1926, 62.
 59

52
Ibid., 53.
53
Grba, Britanske sanitetske misije u Srbiji u Prvom svetskom ratu, 22.
54
Ibid., 38.
55
Hunter, The Serbian Epidemics of Typhus and Relapsing Fever in 1915, 35.
56
Decision by the Minister’s Council to establish the State Board was made on March 8, and published
in Srpske novine on March 10, 1915. In the Archives of the State Board in the Archives of Serbia, the
oldest document is dated January 21 (MUD – S, D.o. – 1/1915), which implies that the Board was
active even before it was officially established. The same thing is indicated by the news about the State
Board’s activities, published in daily newspapers.
57
„Državni odbor za suzbijanje zaraze“, Pravda, XII, 47, 16. 02. 1915, 2.
58
„Borba protiv zaraze: dezinfekcija na železnicama“, Pravda, XII, 50, 19. 02. 1915, 1.
59
„Dnevne vesti: Aparati za dezinfekciju“, Dnevne vesti, Politika, 21. 03. 1915, 4.
60
Kosta Todorović, „Uspomene o epidemiji pegavca iz 1914/1915“, in Zbornik neobjavljenih radova
saopštenih u Sekciji, knjiga II u spomen pedesetogodišnjice albanske Golgote, pet godina rada Sekcije
1960–1965, ed. Vladimir Stanojević et al (Belgrade: Serbian Medical Society, Section for History of
Medicine and Pharmacy, 1965), 63.
61
Vojislav Subotić, „O predohrani od pegavca“, Ratni dnevnik, II, 202, 12. 02. 1915, 2.
62
„Peći za dezinfekciju“, Srpske novine, LXXXII , 55, 26. 02. 1915, 1–2.
63
Stammers was promoted to lieutentant colonel on March 1, 1915 (Gregorian calendar), which means
that he left England as a major, and arrived in Serbia as a lieutentant colonel.
64
Other than dr. Hunter, who was a colonel in Army Medical Service, other members (26 in total)
came from the Royal Army Medical Corps.
65
Hunter, The Serbian Epidemics of Typhus and Relapsing Faver in 1915, 49.
66
Archives of Serbia, МUD – S, D. о. – 12/1915. Translation of the Stammer’s report made available
to the State Board by the Medical Corps department of the Ministry of Defence Con. L. no. 834, 18.
 60

03. 1915. in Nis).

67
It is interesting that in Report no. 5 flea is also mentioned as one of the transmitters of the typhus,
while fleas and bedbugs are also mentioned as transmitters of the relapsing fever.
68
Hunter, The Serbian Epidemics of Typhus and Relapsing Faver in 1915, 54–55.
69
Hunter, The Serbian Epidemics of Typhus and Relapsing Faver in 1915, 142; Strong et alt, Typhus
Fever with Particular Reference to the Serbian Epidemic, 33.
70
Hunter, The Serbian Epidemics of Typhus and Relapsing Faver in 1915, 145.
71
Medical Director of the Commission was prof. dr. Richard Strong, Secretary lieutenant Petronijević,
and the members were: Colonel Hunter (Great Britain), Colonel Jaubert (France), Colonel Sofoterov
(Russia), Colonel Karanović, dr. Mita Nikolić, Head of the Medical Corps department at the Ministry
of Internal Affairs, and Colonel Sondermayer.
72
Dragoljub N. Bakić, transl., U Srbiji april – septembar 1915. (Kragujevac, 1965), 4. translated from
French: J. Colombani et Charles Garen, En Serbie (Avril – Septembre 1915) (Salonique: 1916), 4.
73
Bakić, trans., U Srbiji april – septembar 1915, 6.; Serbian Archive, MUD – S, D.o. – 19/1915 (Minutes
of meeting of the Board for Protection of Public Health held on 22. 06. 1915).
74
Strong et alt, Typhus Fever with Particular Reference to the Serbian Epidemic, 23.
75
Galina Igorevna Ševcova, Ruska dobrotvorna pomoć u Srbiji u ratovima 1912-1917 (Belgrade: Infini-
tas, 2010), 102–106.
76
Ibid.,157–161.
77
Ludvik Hiršfeld, Istorija jednog života (Belgrade: Srpska književna zadruga, kolo LV, knjiga 377,
1962), 58. When Crown Prince Aleksandar’s Serbian Hospital was opened in Thessaloniki in May
1916, Serbian Army’s First Laboratory was established inside it. Dr. Hirszfeld, who run the laboratory,
held bacteriology courses for Serbian physicians and medics.
78
François Boudier, Vie et оuvre du Docteur Ernest Conseil, Human health and pathology, down-
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loaded 13. 8. 2015, http://dumas.ccsd.cnrs.fr/dumas-00913354.

79
Vukšić, „Istorijski osvrt na prestanak pegavca (typhus exanthematicus) 1914–1915. godine u Srbiji“,
56.
80
Uroš Krulj, „Principi zdravstvene politike“, Glasnik Ministarstva narodnog zdravlja, 1–2 (1919): 9.
81
Jelena Vasiljević, „Osnivanje Centralnog higijenskog zavoda u Beogradu i njegov rad u periodu
između: dva rata (1919–1941)“, in Zbornik radova Dvanaestog naučnog sastanka Naučnog društva
za istoriju zdravstvene kulture Jugoslavije (Beograd: Naučno društvo za istoriju zdravstvene kulture
Jugoslavije, 1964), 159-161. Work performed by the Permanent Epidemiological Commission was le-
galised in 1921.
82
Andrija Štapar, Pet godina socijalno medicinskog rada u Kraljevini Srba, Hrvata i Slovenaca (Za-
greb: Institut za socijalnu medicinu, 1925), 7.