The Viennese Disease

Patricia Clavin

Wartime analogies in the Covid-19 pandemic are commonplace. Western governments and journalists, in particular, have reached for the stories of national solidarity, resilience and rivalry cast during and after the Second World War, as the first peak of the pandemic in Europe coincided with the 75th anniversary of the Allied victory.

It makes more sense, though, to compare 2020 to the First World War. Conscripts in the fight against Covid-19 know little about the enemy (though they’re learning), and don’t know how long they will need to fight. States struggle to formulate shared aims across international alliances. Then, as now, we are using age-old weapons as well as new ones: quarantine, plague-masks and handwashing.

The Hungarian physician Ignáz Semmelweis first predicted in the mid-19th century that medical students transferred small particles (what we now know to be germs) from diseased patients to previously uninfected people. Semmelweis instructed those around him to wash their hands with a form of lime disinfectant. He is not only the father of hand hygiene: his expression of the medical practice ‘recognise-explain-act’ remains the base model of strategies to prevent infection promoted by the World Health Organisation.

The First World War and the disintegration of the Austro-Hungarian Empire brought an end to Central Europe’s place at the forefront of biomedical science. As the Allies’ wartime blockade continued into the peace, hunger and disease gripped Central and Eastern Europe. Vienna, Berlin and Moscow saw a dramatic spike in deaths after 1918. The Spanish flu has received a great deal of attention recently. At the time, people were just as – if not more – preoccupied by the risks posed by typhus and tuberculosis.

In Vienna, one in every four deaths was caused by TB. Dr Siegfried Rosenfeld, of the Austrian Department of Health Statistics in the Volksgesundheitsamt, called it the ‘Viennese Disease’. Rosenfeld recognised that poor nutrition and living conditions were behind death rates high enough to rival the Black Death. He would not have agreed with 20th-century historians’ later conclusion that the 19th century marked the end of the great plagues.

Revolution, civil war and nation-building drove mass population displacement, at the same time that Central European armies weren’t demobilising so much as disintegrating. Moshe Fuchs, a Yiddish writer and journalist in Vienna, described the way the end of the war transformed the railway lines and stations of Central Europe into vectors of disease. Densely packed trains, platforms and concourses were filled with the bodies of the exhausted, injured and dying, the uniforms of the doctors and nuns who attended them stained red and black with blood and sweat.

Fuchs vividly captured the way soldiers and civilians suffered together. Contemporary science backed up him up. In 1916, the first major study of epidemic disease in wartime showed that soldiers were more likely to die of contagious disease than through enemy action, at least until the Russo-Japanese War of 1904, when war was more effectively mechanised. Crucially, in Epidemics Resulting from Wars, Friedrich Prinzing demonstrated that epidemic disease among soldiers sparked greater epidemics among the civilian population.

The Carnegie Endowment for Peace translated and syndicated the book. It influenced the idea that the League of Nations, as well as promoting international peace, should improve world health and economic stability. This agenda emerged more because of the chaotic aftermath of the war, and problems with the peace settlements, than from any grand designs articulated by Woodrow Wilson.

In October 1920, the International Union against Tuberculosis and Lung Disease was founded. It still exists today. Its founding figures included Professor Léon Bernard, who was instrumental in creating a League Epidemic Commission in 1920, and the League of Nations Health Organisation the following year.

As with the WHO, ‘great’ power politics always shaped, and limited, the activities of the LNHO. The challenges faced by the League are a reminder that arguments for or against international co-operation and organisation are often rival attempts to find solutions to common problems. For all leaders – whether the states they govern are ‘powerful’ or not – the realm of international relations is where they have least control.

The League’s fight against epidemic disease also demonstrates the need for a global commitment to supporting local, community-based schemes, which include economic and financial support as well as better healthcare.

After the Second World War, new institutions of global governance were founded, not only the WHO, but the Food and Agriculture Organisation and the International Monetary Fund, bridging health, hunger and the economy. The end of this Western-made system, centred on the United Nations, now seems irreversible. Relations between states are changing, with new powers emerging – notably China and India – and the structures of global capitalism and communication in flux. The history of the world wars and the Covid-19 pandemic are a reminder that we should still take seriously the League’s crisis call ‘for a much larger degree of international collaboration than anything yet achieved’.


  • 1 September 2020 at 10:40pm
    Dale Lowery says:
    As with the League of Nations, so the United Nations. Powerful nations have little incentive to put the common good ahead of narrow parochial interests, while the lessor nations never miss a chance to overplay whatever momentary advantage they may from time to time inherit from History's ebb & flow -- each bit player imagining that surely _this_ is the moment when they ascend from minor regional power to lead the world towards a Future with themselves firmly at the forefront. How pitiful, sad, predictable, & seemingly unnecessary. Surely SOON some insightful scholar will arise to bless us with a system of thought & a program of key actions to put behind us our ironic, worldwide, plague of provincialism.
    It cannot come too soon. Much later & it may not be able to come at all.

  • 2 September 2020 at 8:38am
    Joe Morison says:
    Different times, different diseases. In the medieval period dysentery was the disease that most shaped conflict. Sieges were more important than set battles, and once a siege had been set up the twin problems were victualling the besieging forces and keeping off dysentery - if the first could be overcome, the second usually brought things to an end unless a speedy victory was achieved.

    The biggest difference between our struggles in either of the World Wars and this one against Covid 19 is the prevalence of appeasers. Everywhere, from the White House to Downing Street at the beginning and the right wing media to the LRB blog comments, people are suggesting we just give in to the virus while doing our best to protect the most vulnerable. Sweden’s disastrous following of this strategy and the appalling death toll in the US where this attitude seems to hold almost half the population have done little to curb its adherents enthusiasm. It’s as if Halifax had succeeded Chamberlain instead of Churchill, and that had done nothing to slow down Hitler but almost half the allies still thought it was a great thing. Careless talk costs lives was a popular slogan then, today it’s not careless talk but shoddy thinking that is our greatest threat.

    • 3 September 2020 at 10:39pm
      Bob Beck says: @ Joe Morison
      Or, in the alternative: maybe the biggest difference between the World Wars and this pandemic is that they were wars, while this is a pandemic.

      Does war, in fact, supply a good metaphor for a public-health crisis? To me, it seems worse than useless: a positive hindrance to both understanding, and effective action.

    • 4 September 2020 at 8:05am
      Joe Morison says: @ Bob Beck
      You’re right, of course, in many ways they are very different and require different approaches. However, there are quite big areas of overlap: in each case governments are required to lead their populations into making difficult and self-sacrificing changes to their lives, in each case the solution (for us now, a vaccine and new forms of treatment) requires governments to make huge investments in expertise and money alongside private industry, and in each case success requires everyone to come together in a spirit that we are all in it together. It’s this latter part that is so sadly lacking at the moment. In the US, the abominable Trump is leading his supporters to view those taking the recommended precautions with the same sort of contempt that conscientious objectors received during the World Wars - that really is irony. And the same poison is taking root here: the Telegraph comment boards, for example, are full of people boasting about never wearing masks and urging others to do the same.

    • 6 September 2020 at 12:43pm
      Nicholas Benda says: @ Joe Morison
      I don't think your concession to Bob Beck is quite sufficient. Your "appeasers" analogy doesn't map onto the way Nazism was a force in plain sight whereas the virus is beset with a mass of unknowns, starting with the question of its origin and the refusal of the Chinese government to allow its investigation. I also think that Sweden's current death toll of around 6,000 doesn't allow you to call its policy disastrous. As far as I can see the US death toll is not proportionately far off the UK one. A lot of my friends, as you do, regard the purportedly science-led advice (and laws) as unassailable and incumbent on all. But I have to say, at the risk of all kinds of reprimand, that I remain a sceptic and I think this kind of scepticism shouldn't be silenced.

    • 7 September 2020 at 1:44pm
      Joe Morison says: @ Nicholas Benda
      I don’t see what debate about Covid 19’s origins has to do with the issue of how we deal with it; and I certainly don’t think scepticism should be silenced as long as it’s coming from genuine sources such as yourself as opposed to Russian and other provocateurs (but then I wouldn’t have wanted sincere arguments for appeasement silenced - open debate is the best way to reach the truth).

      I would say that the Swedish approach has undoubtedly been a disaster. Despite similar epidemic start dates, population densities, and cultures; Sweden has reported seven times more COVID-19 deaths per person than Finland and Norway, and three times more than Denmark. And for what gain? It’s economy seems to be just as fucked as everyone else’s.

      And saying that the US’s death rate is not proportionally far off ours is no recommendation at all. The UK government may have come to its senses eventually, but at the start Johnson was all for keeping the economy up and running while eschewing what he saw as continental lily-liveredness; that’s why we have one of the highest deaths per head of the population in the world. It’s the death rates in mainland Europe that you should be comparing the States’ death toll with. But, at least the UK has come to its senses, and the rate of infection and deaths has dramatically fallen; in the US it is still climbing fast, and many reputable bodies are predicting it could double by the new year.

    • 8 September 2020 at 5:48pm
      Maurice Herson says: @ Bob Beck
      The ways in which the 'fight' against the pandemic is not a war. In a war there is an enemy
      which has a strategy
      and tactics
      with a political dimension that can be approached via diplomacy
      and a psychology that can be strengthened or demoralised
      with a fighting force that is separate from the entire population
      that can be intimidated, beseiged, bombed, won over.
      An enemy that can surrender, be forced into submission.
      Our corona virus 'enemy' has none of these characteristics and to characterise our response to it as a war on the virus is entirely misleading, and probably leads us to tackle it wrongly. Sadly, it also reveals the human weakness for violence as a default response, even in metaphor.

    • 8 September 2020 at 10:32pm
      Bob Beck says: @ Maurice Herson
      Yes, exactly. And in warfare, governments send troops off to fight in the certainty that some will be killed or incapacitated. If these are volunteers, they face such risks knowingly (though of course nothing can really prepare a person for warfare), hence could be said to be self-sacrificing. If they're conscripts, they're simply forced into the machine that grinds them up.

      And here the war metaphor, applied to the pandemic, becomes indecent: even obscene. I have heard people blithely describe as "acceptable" the "risk" (which is really a certainty) that, as lockdown restrictions are lifted, there will be more infections, and therefore more deaths, mostly among those with preexisting health problems. ("If they be like to die, they had better do it, and decrease the surplus population").

      Asked by what right, and on whose behalf, they choose to "accept" the "risk" of others' premature deaths (not to mention the anguish experienced by those others' families, by health-care workers and so on), they either fall silent, or come out with a fusillade of rubbish, the defensiveness and special pleading of which is a dead giveaway.

  • 9 September 2020 at 7:58pm
    Eamonn Shanahan says:
    Great blog, thank you. Alas, the League's crisis call that 'a much larger degree of international collaboration than anything yet achieved' seems more than ever unlikely in a culture of power doubling down on the ludicrous notion that the interests of a nation state are somehow discrete from the interests of us all. Until we learn that 'us and them' has become 'us only', we will continue to compete rather than cooperate.

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