Hans Zinsser argued that pathogenic co-infectivity during a protracted conflict exhibited enormous complexity and variation over time. He argued that it is possible to divide the biological history of the Thirty Years' War (1618-1648) into two distinct epidemiological periods, with typhus reigning from 1618 to 1630. Thereafter, from 1630 to 1648, bubonic plague rose to become the premier scourge of those countries party to the conflict. On an epidemiological level this succession of contagion makes sense as those exposed to typhus would either have been killed, or thereafter acquired some immunity to the pathogen, clearing the way for the ascension of a pathogen to which they had little or no prior immunity (Yersiniapestis). However, during this epic era of societal chaos and inter-state war, various and diverse pathogens; dysentery, typhoid fever, smallpox, and scarlet fever, all interacted with typhus and plague.
Once again soldiers proved to be highly efficient vectors of pathogenic distribution. After the return of bubonic plague in 1630, it "traveled with the rapidly moving armies, remaining behind when the soldiers departed, and spreading from innumerable foci into the surrounding country."53 It is noteworthy that even into the nineteenth century, the disease continued to be problematic for military forces, and the conduct of martial campaigns. August Hirsch observed that the conflict between Russian and Turkish forces in Wallachia in 1828-29 generated the last significant outbreak of Bubonic Plague in the European theatre.54
Thereafter, the incidence of plague in the European population diminished markedly as sanitary measures improved. Yet Yersinia pestis would continue to afflict societies in East Asia for some time to come. Hays notes that the armed rebellion of 1855 in Yunnan province of China facilitated the spread of the pathogen throughout the entire region: "The great Muslim rebellion that began in 1855 resulted in nearly two decades of internal turmoil in Yunnan, in which plague epidemics coincided with military massacres, famine, and considerable emigration. . . . Troop movements and emigration may have spread plague to other areas of China."55 This association between war and plague continued into the twentieth century as a significant outbreak of plague struck down thousands of Vietnamese citizens from 1966 to 1974, primarily as a result of the atrocious conditions associated with the war; including the destruction of health infrastructure, and breakdown of hygiene and sanitary measures.56 Antibiotic prophylaxis has proved to be crucial to the containment of Yersinia pestis, yet the pathogen remains endemic at low levels throughout some regions of the world, including the American Southwest.
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