The first of the recorded "war pestilences" was the "plague" of Athens18 (430-425 BC), which arose in Piraeus during the second year of the Peloponnesian War, shortly after the Peloponnesian invasion. According to Thucydides, trade and the conditions of war—particularly the flows of war refugees who were driven into Athens (and the resulting exceptional population densities)—played pivotal roles in the rise of the epidemic.19 Ergo, a contributing factor to the outbreak of contagion would seem to be massive population movements from rural to urban centers (in this case Athens), generating exceptional population densities that were epidemiologically permissive to the pathogenic colonization of the population. Zinsser concurs, and attributes the pathogen's emergence directly to the conditions associated with the ongoing conflict, such as dense military encampments and the movement of materiel from Africa.20 Moreover, once the contagion was established within Athens, the Athenian military apparently served as an efficient vector for diffusion of the pathogen, even as it was simultaneously depleted by the disease. Zinsser notes that "the pestilence followed the Athenian fleet, which was attacking the Peloponnesian coast, and prevented the carrying out of the objectives for which the expedition had been organized."21

Notwithstanding the nascent body of genetic evidence that typhus visited Greece during the Peloponnesian War, it appears to have burned itself out or gone into hibernation, as it was some time before it revisited European societies. Hays argues that the next confirmed appearance of typhus on European soil (after the Peloponnesian War) occurred in 1489-90, during (and perhaps resulting from) the Spanish conflict with the Moors over the possession of Granada.22 The historian William McNeill concurs with the temporal frame of typhus' introduction into European societies (circa 1490), but he offers a different explanation of the pathogen's geographic origins. Typhus, he writes, "made its debut on European soil in 1490, when it was brought to Spain by soldiers who had been fighting in Cyprus. Thence it came into Italy with the wars between Spaniards and French for dominion over that peninsula. Typhus achieved a new notoriety in 1526 when a French army besieging Naples was compelled to withdraw in disarray due to the ravages of the disease."23 From this point on, typhus became endogenized within the European human ecology, and its proliferation became associated with violent conflict.

Persistent conflicts between European forces and the Ottoman Empire facilitated the spread of typhus throughout Europe during the 1500s.

Prinzing argues that in the latter years of the fifteenth century Hungary was destabilized by typhus, which had been brought to that country as a result of the protracted conflict with the Ottoman Empire:

. . . hitherto prosperous Hungary, by endless wars with Turkey . . . was brought to the very edge of ruin. . . . the utter lack of sanitation, increased the baneful effects of camp life. Dirt and refuse accumulated in heaps, vermin multiplied so rapidly that it was impossible to get rid of them, corpses were inadequately buried, while enormous numbers of flies and gnats molested the soldiers and did a great deal toward spreading infectious diseases. The hospitals were in a pitiable condition . . . [and] the soldiers . . . gave themselves over to a most dissolute life. . . .A large part of the German troops never once faced the enemy, for the reason that they succumbed beforehand to "Hungarian disease" (i.e. typhus), which killed more of them than the swords of the Turks. Hence Hungary was called at that time the "Cemetery of the Germans."24

The war-induced diffusion of typhus facilitated the first pan-European epidemic of the pestilence in 1566, as the disease became ubiquitous during the war between Maximilian II and the Turks, then spread into western lands. "After the dispersion of the (Habsburg) army," Prinzing writes, "the discharged soldiers carried the disease in all directions. Vienna was hit very hard. . . . The returning Italians brought the disease first to Carinthia . . . and then to Italy. In the same way it was carried to Bohemia, Germany, Burgundy, Belgium, and Spain."25

In the seventeenth century the spread of typhus was also greatly facilitated by the horrid conditions of the Thirty Years' War (1618-1648), by troop movements, and by the widespread conflict-induced famine that eroded the immunological vigor of affected populations. "In the history of this calamitous war," the Prussian historian Friedrich Seitz wrote, "we see typhus fever like a malignant specter hovering over the armies wherever they go, in their camps, on their marches, and in their permanent quarters, and preparing an inglorious end for thousands of valiant warriors. Its ravages among the non-belligerent population in town and country caused the inhabitants of many provinces to remember with hatred and loathing the departed soldiers. . . ."26 Prinzing concurs: ". . . epidemics of dysentery, typhus fever, and bubonic plague followed at the heels of armies (and thus) were borne from place to place, . . . the great depopulation of Germany during the Thirty Years' War was chiefly caused by epidemics of typhus fever and bubonic plague."27 Typhus would also seem to have contributed to the destruction of French forces during Napoleon's withdrawal of the Grand Armée from Russia in

1812.28 Indeed, typhus was one of the numerous infections that beset Napoleon's forces as they marched toward Moscow from their bases in Central Europe during the summer of 1811:

After the battle of Smolensk (August 14-18, 1811) . . . typhus fever and other diseases . . . continued to spread throughout the army. The most common disease even in Moscow was typhus fever. . . . When Napoleon's army withdrew from the city it left behind several thousand typhus fever patients, almost all of whom died. . . . The horrors of the return march are well known. . . . The number of sick soldiers was enormous, and typhus fever raged more and more extensively. In pursuing the French army the Russians also suffered severely from diseases. . . . between October 20 and December 14, 1812, they lost 61,964 men, most of whom died of "nerve fever" (typhus fever).29

Thus, both the Napoleonic and the Russian army served as primary vectors of contagion, and their movements subsequently generated epidemic typhus in the cities that lay in the path of the combatants (e.g., Vilnius, Warsaw, and St. Petersburg). According to H. A. Goden, a physician in the French forces, the military hospitals (lazarets) of the time also functioned as effective nodes of pestilential diffusion in the wake of the dispersing Grand Armée.30 The Prussian physician Heinrich Haser corroborates this description of disbanded troops, and their military hospitals, serving as highly effective vectors of transmission throughout Central Europe:

French soldiers returning from Russia . . . spread the contagion of various diseases over a large part of Central Europe. Almost naked, or clothed in . . . rags, without shoes . . . and their frozen limbs covered with festering sores, they marched through Poland and Germany. Typhus fever and other diseases . . . marked their course. The inhabitants of the country were forced to house the sick; but teamsters also conveyed the infection to villages which the soldiers did not visit. The disease raged most furiously in the hospitals.31

The contagion also appears to have visited the Americas, and it became particularly pernicious during the hostilities associated with the American Revolutionary War (1775-1783). The US medical historian Ted Woodward noted that during the American Revolution typhus infected, and debilitated, approximately one-third of the New York Army of General Nathaniel Greene in 1776, immediately before a confrontation with British forces.32

Modern skeptics may certainly argue that much of this argument is based on anecdotal evidence, or may otherwise question the validity of such accounts. However, the German medical archives of World War I, as prepared by German military physicians, provide us with solid empirical data to support the hypothesis that conflict can act as a mechanism of transmission of epidemic typhus. In this case the onset of the war initiated a massive outbreak of typhus among the German armed forces in the months immediately after the initiation of hostilities. (See figure 7.1.)

During the years 1916-1918, medical innovations resulted in the reduction of incidence and typhus-induced mortality. Despite the increasing capacity of the Germans to control the spread of typhus, it spread inexorably eastward in the months that followed the formal cessation of hostilities in November 1918. Consequently, the pestilence infected millions throughout Eastern Europe and Russia, with estimated civilian and military mortality exceeding 100,000. The military physician Brown notes that during this period approximately one-third of physicians in the Soviet Red Army contracted typhus, and 20 percent of those perished of the disease.33 This dynamic of post-conflict diffusion followed the pattern of earlier epidemics as demobilizing forces again served as agents that transmitted the louse vector, and therefore Rickettsia, throughout a vast area.

During World War II the incidence of typhus in European forces declined dramatically as military units made hygiene a priority. However, that war temporally coincided with epidemic outbreaks in those geographic regions where public health capacity was greatly diminished as a result of the hostilities. Specifically, the physician Bavaro notes that "during and immediately after the war hundreds of thousands of cases of typhus, with up to 10 percent mortality rates, appeared in civilian populations in Egypt, French North Africa, Naples, Germany, Japan, and Korea."34 The manifestations of the illness, and the impact on both military and civilian populations were far more pronounced in the Pacific theater of operations. "In that preantibiotic era, the disease sometimes caused more casualties than actual combat, with mortality rates exceeding 27 percent. There were more than 20,000 cases among Japanese forces and 16,000 cases among Allied troops, including more than 7,300 cases and 331 deaths among US troops."35 The last major recorded outbreak of conflict-induced typhus occurred during the Korean War. Although typhus was largely contained within the military populations of the UN alliance, the material deprivation and destruction of public health infrastructure resulting from the war spawned an outbreak of typhus that resulted in approximately 32,000 cases and 6,000 deaths among South Korean military and civilian populations.36

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