On Mortality from CoInfection

As was noted above, one analytical problem is the issue of the co-infection of troops and civilian populations by multiple pathogens. It is certainly reasonable to assume that over the span of an attenuated conflict (such as the Thirty Years' War) that the forces and populations involved experienced a succession of epidemics, often with multiple sources of infection. World War I saw the infection of German and Austrian populations by influenza, which then opened the way for subsequent epidemics of pneumonia and tuberculosis. This makes any such strict accounting of influenza-induced mortality rather problematic, in that the secondary effects of the pandemic persisted for some time. This reinforces the position taken by the political scientist Hazem Ghobarah et al. that the public health costs of wars (and complex emergencies) are likely complex, attenuated, and difficult to estimate.

Disease-induced mortality data from the US Civil War provide us with some idea of the relative aggregate mortality from disease vs. battlefield injuries. The mortality statistics on Union troops compiled by US Surgeon-General Barnes in 1870-1888 are the best available data on causes of death during that conflict.85 The data indicate that deaths from infectious diseases vastly exceeded battlefield deaths and deaths from wounds suffered in action. (See figure 7.5.) It is instructive to compare aggregate battlefield and wound-induced mortality (93,443) against deaths from infectious disease. The ratio of disease-induced mortality to battlefield/ wound-induced mortality is a significant 1.9928:1, suggesting that disease was very much a security issue to American forces during this era. But such data were not disaggregated into mortality by specific pathogen,

350,000 300,000 250,000 200,000

J 150,000 100,000 50,000 0

Suicide, Unknown Killed in Died from Infectious Total murder, battle wounds disease execution

Figure 7.5

Causes of death, American Civil War. Source: J. Barnes, The Medical and Surgical History of the War of the Rebellion (1861-5), vols. 1-3 (US Army, 1870-1888).

Suicide, Unknown Killed in Died from Infectious Total murder, battle wounds disease execution

Figure 7.5

Causes of death, American Civil War. Source: J. Barnes, The Medical and Surgical History of the War of the Rebellion (1861-5), vols. 1-3 (US Army, 1870-1888).

and so (aside from anecdotal records) we have little empirical evidence to indicate which specific pathogens accounted for what proportion of that aggregate mortality.

Such problems of co-infection persist into the modern era. According to Grant and Jorgenson, who studied the mortality patterns of Soviet troops in Afghanistan during the 1980s, disease played a significant role in mortality. Specifically, they report that less than 3 percent of casualties resulted directly from combat, yet approximately 76 percent of Soviet casualties resulted from infectious diseases, including malaria, plague, typhus, hepatitis, and various forms of dysentery.86

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