Epidemics Resulting from Wars

All infectious diseases may spread in consequence of war and develop into epidemics of varying extent. In the next chapter we shall see how the wars at the end of the fifteenth century favoured the spread of an epidemic of syphilis. In the Union Army, during the American Civil War of 1861–5, both measles and typhoid fever were very widespread, and together they were the cause of 4,246 deaths, or about 1·75 per cent of the total enlistment. Scarlet fever, influenza, yellow fever, relapsing fever, and malaria (if the war is waged in countries where this disease is endemic—especially in the Lower Danube region, in the Netherlands, Spain, and Italy) have also played an important rôle in many wars. But we give the name ‘war pestilences’ only to those infectious diseases which in the course of centuries have usually followed at the heels of belligerent armies, such as typhus fever, bubonic plague, cholera, typhoid fever, dysentery, and small-pox; we may also include here scurvy, the etiology of which has not yet been definitely determined.

Typhus fever (spotted fever, exanthematic typhus—called in France and England simply typhus, in Spain tabardillo—formerly called contagious typhus, hunger typhus, camp fever, and Hungarian fever) is an acute infectious disease of cyclic recurrence, which resembles typhoid fever only in name. From the eighth to the tenth day after infection, often somewhat sooner or later, it begins with a chill, accompanied by nausea, vomiting, violent headache, and psychic depression. In the first few days the patient’s temperature rises rapidly, and on the fourth or fifth day a rash in the form of dull-red spots, as large as a pea, breaks out over the entire body. These spots gradually grow larger, and after two or three days, through the appearance of very small haemorrhages, change into petechiae. The apathy of which the patient first gave evidence now gives way to wild delirium. At the end of the second week the temperature falls rapidly, and in one or two days becomes normal; often, however, the fall of temperature takes from six to eight days. The duration of the entire disease, accordingly, is from two to two and a half weeks. Death usually occurs at the crisis of the disease—from the tenth to the twelfth day—rarely between the sixth and ninth days or after the twelfth.

The danger of the disease varies greatly in different epidemics; statements regarding this point diverge according as we refer to the statistical records of hospitals or to the private practice of physicians. With the latter the number of deaths is smaller, since persons suffering from the disease in mild form less often go to the hospitals. Epidemics in which a quarter of the patients, and even more, have succumbed have frequently occurred, especially in war times, during famines, &c. The cause (infective agent) of typhus fever is not known; according to recent investigations it is spread by vermin; Ricketts and others have fixed responsibility for it upon the body louse. The infection is communicated from man to man, and very often it is contracted from the clothes, linen, and other effects of typhus patients. Recovery from the disease usually renders a person immune against a second attack. Typhus fever frequently appears nowadays in the eastern and south-eastern parts of Europe, in Hungary and Galicia, and also in Spain, Italy, and Ireland.

Plague appears in two forms, depending upon the place where the infective agent enters the body: the bubonic plague and the pneumonic plague. In the case of the former the painful plague-sores (buboes) develop, usually two or three days after infection, from the lymphatic glands; these sores,—which appear most often in the region of the groin, less often in the axilla, on the neck, lower jaw, and in other places,—soon suppurate. There is either a development of toxins, which are the cause of the severe general symptoms, or else the bacilli pestis go from the glands into the circulatory system and cause septicaemia, which is quickly fatal. Pneumonic plague takes the form of a catarrhal inflammation of the lungs, causing a profuse and bloody expectoration, which contains large quantities of bacilli. This form of the disease almost always ends fatally in a few days. The mortality of bubonic plague is somewhat lower; the disease has an average duration of eight days, and carries away from fifty to seventy per cent of its victims.

In the Middle Ages an epidemic of plague (black death) ravaged all Europe. At the present time it is still endemic in India, in southern China, in Egypt, in Uganda, and perhaps in other countries, whence it frequently develops into general epidemics.

The infective agent in the case of plague is the bacillus pestis, identified in 1894 by Kitasato, and subsequently, but independently, by Yersin. Rats, which are very susceptible to the disease, play an important rôle in spreading it; in India the outbreak of a plague epidemic is always preceded by the dying of large numbers of rats. Their excrement contains large quantities of bacilli, which may be destructive to human beings. The rat-flea is also known to carry the infection. The infection may be conveyed directly by plague patients, when the buboes suppurate, or when the blood becomes generally infected with the bacilli pestis, which are contained in abundance in the sputum, urine, and excrement, or when the lungs are affected and the patient charges the atmosphere by coughing. One who has recovered from the disease is usually immune for life.