In September of 1939, Nazi Germany invaded Poland, marking the beginning of World War II in Europe. By the war’s end in 1945, Poland had suffered the deaths of more than five and a half million citizens – a fifth of her pre-war population – with the majority of these the victims of war crimes at the hands of the Germans. A large community in southeastern Poland, however, escaped persecution and the horrors of deportation and death thanks to an ingenious ruse employed by two Polish physicians. With the help of a sham “vaccine,” Drs. Eugene Lazowski and Stanisław Matulewicz fabricated a fictional epidemic that would save the lives of thousands.
Epidemic typhus is a disease of war, of prisoners and refugees, and it spreads like wildfire in places congested with humanity and lacking in sanitation. Disease relies on a variety of pestiferous vectors for the transmission of infective bacteria. In the case of Rickettsia proawazekii, the agent of epidemic typhus, mice and rats serve as the reservoir, allowing the bacteria to replicate and proliferate before its transmission to bloodfeeding insect vectors such as rat fleas and lice.
For centuries, possibly for millennia, typhus epidemics have laid waste to prisons, refugee camps, and military barracks. The disease has long been feared due to its high mortality and difficulty in containment. Furthermore, it is difficult to quickly diagnose, its clinical presentation non-specific and characterized by fever and chills, a wretched headache, and skin rash, eventually causing death due to dehydration and shock.
The disease’s mark can be found throughout the pages of history. Researchers have suggested epidemic typhus as the cause of the plague that, according to Thucydides, killed as much as two-thirds of the Athenian population as citizens crowded the city during the Peloponnesian War.(1) More recently, DNA testing has revealed that many of the thousands of French soldiers of Napoleon’s Grand Army that filled a mass grave in Vilna in Lithuania had succumbed to epidemic typhus.(2) Epidemics struck during the Great Irish Famine of the 1840’s, in the prison camps of the American Civil War, and caused more than three million deaths in Russia alone during the First World War.
It was during the outbreaks of the First World War that Arthur Felix and Edward Weil, two eastern European microbiologists, devised a method to diagnose Rickettsia in a surreptitious manner, exploiting the cross-reactivity of Rickettsia with the molecular marker OX 19 found on another bacteria altogether, Proteus vulgaris. This humdrum, mostly benign organism can cause the rare urinary tract infection, but fortuitously happens to have the unusual trait of evoking the same bacteria-killing antibodies as R. proawazekii.
The Weil-Felix test exploits this phenomenon and relies on killing Proteus with formalin, and then injecting the mixture into a blood sample from an ill patient. If the patient is indeed infected with typhus, anti-Rickettsial antibodies that have been generated to fight the typhus infection will zero in on Proteus, recognizing structurally similar proteins on the Proteus surface.(3) The blood sample will visibly clump or agglutinate due to the effects of the existing antibodies on the new bacteria, and the patient is thus diagnosed with R. proawazekii. However! If the patient is already infected with Proteus, then the same agglutination will occur when the Weil-Felix test is administered, and the patient will naturally test positive.
The mechanics of the Weil-Felix test were certainly known to two young Polish physicians, Eugene Lazowski and Stanisław Matulewicz, who had been taught this important piece of Polish history in their medical school. In 1942, both doctors worked with the Polish Red Cross in the small village of Rozwadow, 150 miles south of Warsaw, in a region whose many citizens were in immediate danger of deportation to Nazi camps or summary execution at the hands of the occupying Germans.(3)
The two doctors devised a ruse to protect their countrymen, capitalizing on the Weil-Felix parlor trick. Any febrile patients that they encountered received a shot of dead Proteus vulgaris. Samples of their blood were then sent to German-run laboratories, which, of course, identified the patients as infected with R. proawazekii. Soon it seemed as if the entire southeastern region of Poland was infected with louse-born typhus.(4)
Germany hadn’t seen epidemic typhus for over 25 years. With German troops lacking natural immunity to the bug, the army feared any exposure to the disease, whether through contact with infected persons or through travel in infected regions, as an outbreak among the troops would jeopardize their show of force in Europe.(3) A massive quarantine of the region was quickly declared, the Germans contending that nearly all population centers in the region were ridden with louse-born typhus. Posters declaring “Achtung, Fleckfieber!” (“Warning, Typhus!”) were tacked along the perimeters of the villages.(5)
The ruse lasted for two years, during which the region remained relatively free from German oppression, the local population safeguarded against deportation to labor camps. In late 1943, however, the Germans heard from an informant that there was, in fact, no epidemic of typhus. Coupled with the suspiciously low mortality rate due to this enduring “epidemic,” a medical delegation was sent to investigate the situation in southeast Poland. An article published in the British Medical Journal describes their close call with the authorities,
A Nazi deputation consisting of an elderly doctor and two younger assistants was sent to investigate the results sent by Drs. Matulewicz and Lazowski. They were cordially received and in the traditional Polish manner given food and vodka. The senior doctor did not personally inspect any of the village, but remained to be entertained, dispatching his juniors. They made a cursory examination of the buildings but, being aware of the risks of infection, were easily dissuaded from closer inspection. An old man dying of pneumonia was brought in for the senior doctor and with much drama shown to be severely ill with, it was claimed, typhus fever. As Goethe said, “We see what we know.” They saw, were convinced, and left.(6)
The Germans were successfully duped for three crucial reasons: their unshakable faith in the results of the Weil-Felix test, their fear of spread of typhus infection in Germany, and their failure to properly diagnose the infection clinically in the 1943 visit.(4) It was to the Poles’ advantage, as the fictional epidemic would continue successfully until the war’s end.
“I was not able to fight with a gun or a sword,” Eugene Lazowski would later say, “but I found a way to scare the Germans.”(4) Though the fictional typhus epidemic came too late to save many of the Jewish citizens of Rozwadów, Tarnobrzeg, or the surrounding shtetls, an estimated 8,000 Poles were spared the horrors of the Nazis thanks to the scientific knowledge and the courage of Drs. Lazowski and Matulewicz and the microbiological quirk of Proteus vulgaris, a sheep in wolf’s clothing.
Learn more about epidemic typhus by visiting this factsheet by the Center for Food Security & Public Health.
1) RJ Littman (2009) The plague of Athens: epidemiology and paleopathology. Mt Sinai J Med. 76(5): 456-67
2) D Raoult et al. (2005) Evidence for louse-transmitted diseases in soldiers of Napoleon’s Grand Army in Vilnius. J Infect Dis. 193(1): 112-20
3) Y Goor. (2013) When the test tube was mightier than the gun: a Polish doctor out-frightens the Nazis. Isr Med Assoc J. 15(4): 198
4) B Dixon. (1990) Scientifically Speaking: Mimicry and more. BMJ. 301(6762): 1210
5) Sun Times Company (2004) “He duped Nazis, saved thousands.” Sun Times Company. Accessed online on May 30, 2016 at http://www.stjoenj.net/lazowski/lazowski.html
6) JDC Bennett & L Tyszczuk. (1990) Deception By Immunisation, Revisited. BMJ. 301(6766): 1471-1472