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Introduction
Failure is not the usual focus of historical inquiry. As U.S.
President John F. Kennedy remarked in a military context,
“Victory has a hundred fathers and defeat is an orphan” [1].
To paraphrase that: histories of success generate a hundred
historical inquiries, but histories of failure, such as is pre-
sented here, are rare. However, histories of failure clarify
choices and opportunities, and demonstrate how the inad-
equacies of routine and accepted ways of doing things move
us toward creativity and innovation.The history of failure in
this case involves the ancient disease of typhus, the Rockefel-
ler Foundation and Spain in 1940 and 1941.
Typhus was at the time a disease that had been studied ex-
tensively in both its cause and effect. A recent article has
noted that the “two milestone discoveries” regarding typhus
occurred in 1909, when Stanislaus von Prowazek discovered
“the causative agent of epidemic typhus fever,” later named
Rickettsia prowazekii
by S. Burt Wolbach; and when Charles
Nicolle identified of the human body louse as the means of
transmitting typhus from person to person. [2] It also was
known by that time that the human body louse had adapted
not only to human bodies as environments, but also to the
comforts of human clothing.
As a matter of history, typhus was understood to flourish
in dense urban environments, during warfare, and in prison
and refugee situations – any time that people were in pro-
longed close contact and especially when their normal de-
fenses were reduced by other diseases and poor nutrition.
WorldWar I had produced those situations, and typhus had
been
rampant.Atthe onset ofWorldWar II public health of-
ficials and military planners anticipated major typhus out-
breaks, yet in the ensuing twenty years there had been lit-
tle progress in understanding how to control typhus. The
fundamental anti-typhus strategy by the outbreak of World
War II remained sanitation: making the human body louse’s
human environment less hospitable by encouraging physical
cleanliness with soap and hot water; by fumigating infested
clothing and bedding with steam or hot air; and by using
insecticides not toxic to humans, such as rotenone.Although
strategies based on sanitation were effective if consistently
enforced, they were primarily responses to epidemics, and
did not prevent them.
This was the background for the Rockefeller Foundation’s
interest in typhus as it geared up to work in concert with the
United States government to prepare for a global explosion
of typhus after the beginning of WorldWar II. The Founda-
tion was in many respects better prepared to engage the dis-
ease than the U.S. government or any other international
organization, such as the Red Cross. Only the Institutes Pas-
teur had a similar global reach. Created in 1913, the Foun-
dation had from the beginning focused on public health and
epidemic disease. It had established or funded public health
research institutes in North America, Europe, South Ameri-
ca and East Asia, and had conducted disease-control demon-
strations throughout the world. [3]While most of its control
work had focused on hookworm (ankylostomiasis), yellow
fever, malaria, and tuberculosis, the Foundation recognized
typhus as a major
problem.Atthe beginning ofWorldWar II
it established the Rockefeller Foundation Health Commis-
sion as an agency “to render services in the public health field
to regions afflicted with public health problems related to
the war… A study of nutritional problems and control of
possible epidemics are among its chief concerns” [4: 116] At
that time the Foundation revealed that it had “an active inter-
est in typhus,” and that it was testing “seven different types of
typhus vaccine” [4: 116].The Foundation also stated that:
In spite of the fact that it is an age-old problem, our ba-
sic knowledge regarding [typhus] is far from
adequate.Weknow in a general way that it is spread from person to per-
son by means of the body louse and that it develops rapidly
with devastating results when people are crowded together
under unsanitary conditions and when there is a heavy louse
infestation… But we do not know how best to control or
eradicate louse breeding under war conditions
[5:21].
The typhus program of the
Rockefeller Foundation
It is useful to begin the story of the Rockefeller Foundation’s
typhus program with observations and recommendations
made by John H. Janney in December 1941, just after the
United States entered the war. Janney brought to his obser-
vations the perspective of a Rockefeller public health officer
for more than two decades. After remarking that “it is im-
portant that typhus is increasing rapidly in Europe,” Janney
summarized the situation facing the Allies: “the control of
typhus is a responsibility which Great Britain andThe United
States will have to face in winning the war. Neither of these
countries has, at the moment, personnel trained in anti-ty-
phus work with experience more recent than 1921. Little
has been added to the knowledge of the part played by lice
in transmitting the disease and delousing methods are not
improved over those used twenty years ago”. Faced with this
situation, Janney called for an “immediate and serious im-
provement in our epidemiological, entomological, and tech-
nical control knowledge of typhus.” [6]
1
The Rockefeller Foundation had established a modest anti-
typhus program in 1940 by connecting with the Harvard
University laboratory of Hans Zinsser, who had for many
years been investigating the family of
Rickettsia
microbes and
had already published his classic historical work,
Rats, Lice
and History
[7]. In that book Zinsser argued that much of hu-
man history has been shaped by epidemic disease, and that
typhus in warfare had killed more soldiers than were killed
by enemy action [5:20-21]. Zinsser had worked out a meth-
Políticas e redes internacionais de saúde pública no século XX