physician, Heinrich Struck. Robert Koch, one of the founders of the germ theory, joined the advisory council in 1880 and served as provisional director from 1884 to 1885. After Koch’s arrival in Berlin, the Office of Imperial Health became a prestigious research facility and a main training center for disease control. It designed programs to educate the overall population in hygienic matters and promote the teaching of experimental science throughout Germany.
The proposal to create the Office of Imperial Health came directly from members of several medical organizations. The project was first proposed in 1869 at the forty-third annual Assembly of German Naturalists and Physicians (Versammlung der deutscher Naturforscher und Ärzte) in Innsbruck and was further developed at the next meeting in Rostock.70 These professional encounters led to the creation of the German Medical Association (Deutsche Ärztevereinsbund), founded in Leipzig in 1872. The association sought to promote and safeguard the professional interests of the medical class. It lobbied for expanded, improved public health regulations and the inclusion of physicians in official matters related to national health care.71 Representatives of the organization considered that the progress of the nation could not be achieved “without the state and science being two of a kind.”72 They advocated for a centralized administration that would work together with local governments and physicians in the institutionalization of health policies for the new empire. The idea of forming an institute in charge of public health arose in response to the political unification of the German lands, the political expansion of the medical class, and two major cholera epidemics that assailed the country in 1866 and 1873. Of the twenty-one scientific organizations that signed the petition to found the Office of Imperial Health in 1875, only one, the Society of Physicians from Upper Silesia, came from the eastern borderlands.
First on the agenda of the Office of Imperial Health was the improvement of statistical methods to enable authorities to enact effective control measures against epidemic threats. Compiling statistical data about disease propagation was confirmed as essential at the many international sanitary conferences on cholera that were held throughout the nineteenth century. The need to count and classify individuals in light of the dangers that a disease posed to the empire had enormous consequences for the Prussian-Polish provinces. The territories were the place where authorities tended to record the highest rates of cholera cases, many of them attributing the disease to insalubrious Polish customs and geographical proximity to the Russian Empire. The drive to count individuals and their diseases contributed greatly to the statistical battles that Germans and Poles engaged in over the national character of the territories in later decades. Judging by the large number of cholera cases attributed to Polish-speaking subjects, it became easy for people to imagine the eastern borderlands as Polish and not German. Similar to typhus, the cholera disease served to point out the lack of Germanization, but also to imprint the territories with a “Polish essence” that troubled many German physicians and nationalists.
Another important point in the agenda of the Office of Imperial Health was the creation of a bill for compulsory autopsies to enable physicians from all over Germany to investigate the specific cause of a disease. The handling of dead bodies was an issue that provoked many religious and political controversies, especially among Jewish and Catholic communities.73 For example, during the cholera epidemic of 1831, many of the regulations enacted were at odds with local customs and conflicted with religious precepts. People protested what they saw as the disrespectful measures that physicians and authorities used when dealing with the bodies of their deceased family members. Therefore, efforts to pass the bill approving compulsory post-mortem examinations were met with great resistance, and the imperial government was never able to approve a uniform regulation that applied to all the German states.74 Only the bill to combat diseases considered dangerous to public safety (Gesetz zur Bekämpfung gemeingefährlicher Krankheiten)—proposed during the cholera epidemic of 1892 but not passed until 1900—allowed physicians to carry out compulsory autopsies in places affected by epidemic outbreaks.
The fact that cholera played a fundamental role in the establishment of the Office of Imperial Health meant that many of the measures created to protect the German Empire were directed against sources of infection in the Prussian-Polish provinces. Since early on in the history of the disease, many Germans tended to associate cholera with Polish subjects, given that infection usually followed an east to west course and the outbreaks coincided with the Polish uprisings throughout the nineteenth century. Also, the first real encounter that German authorities had with the disease was in 1831, as events of the Polish uprising in the Kingdom of Poland were unfolding.75 Therefore, it was easy for many to conflate political and scientific discourses when judging events in the provinces and their neighboring lands. While serious cases of the illness were classified as “Asiatic cholera,” because scientists established the origins of the disease in India, the less-threatening cases were called “cholera nostras” (native cholera) or sporadic cholera.76 Throughout the nineteenth century, cases of Asiatic cholera were frequently located in the eastern provinces.
During the cholera epidemic of 1831, opinions about the transmission of the disease were highly divided. Some physicians and public health authorities believed that the illness was communicated through direct contact with affected people and goods, whereas others considered that cholera was spread through a miasma or polluted air. The immediate official response was to follow the contagionist stance and attribute the main cause to the illegal influx of people from the Kingdom of Poland. Authorities also took into consideration local factors and individual predisposition to the disease. As Peter Baldwin states, “the official Prussian position affirmed cholera’s transmissibility while also insisting that individuals could lessen or increase their predisposition to it.” The predisposing factors included “individual dietary and hygienic habits, states of mind, insanitary and crowded living circumstances and atmospheric conditions.”77 This definition of disease causation gave the government and public health authorities major power over individuals, their cultural behaviors, and, in the context of the Polish uprising, their political associations.
In Posen, the first districts to succumb to cholera were the ones located along the Warthe River.78 Provincial president Flottwell responded to panic about the disease by mobilizing military troops to the border and quarantining the population. Authorities closed down schools, taverns, and theaters. They also tried to shut down some churches, but were unable to do this due to the personal intervention of the king.79 These severe measures caused popular unrest and riots against physicians and public health representatives in general. The attacks from the Catholic Church, especially over the handling of dead bodies, also contributed to the mistrust of government officials and the unity between the Polish lower classes and the clergy. Moreover, the presence of the military in the borderlands and the ineffective control of cholera cases, which kept spreading despite the cordon sanitaire, seemed to reinforce the idea held by supporters of the November Uprising that Prussia was actually containing the fever of the Polish revolution and not the disease.
Over the course of the epidemic, the Jewish community was the least affected by the disease. According to authorities, Jews adhered to hygienic ritual measures, followed the ordinances imposed by state authorities, and practiced a healthy diet.80 The low mortality rate from cholera among Poznanian Jews was mainly due to the successes of the Mosaic Cholera Commission and its leader, Rabbi Aki Eger. The commission taught Jewish families how to fight the disease and raised funds to treat Jewish patients with mild cases of cholera in the synagogue.81 This initiative was of great help to physicians because it allowed them to concentrate on the severe cases. Over the course of the epidemic, Polish Jews were also the ones who suffered most from the segregation policies officials implemented to control the disease, given that commercial relations, the source of income for many of them, were prohibited between Posen and other provinces. In some reports they were also blamed for importing the disease to Prussia, especially in Silesia, by smuggling contaminated goods from Poland.82
Cholera attacked Posen periodically from 1831 to 1873. In his description of the outbreaks, German-Jewish health counselor (Sanitätsrath) Joseph Samter attributed infection to environmental and cultural
