Another Reason To Oppose War

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The current
debate over "Swine flu" brings to mind another negative
aspect of warfare that is rarely discussed. In addition to the obvious
waste of life, consumption of capital and other resources, and expansion
of state power, war can also play a key role in spreading disease.

What’s the
connection with "Swine flu"?

The currently
feared potential pandemic involves a type of Influenza A virus known
as subtype H1N1. H and N refer to the Hemagglutin and Neuraminidase
proteins found on the surface of the virus. H1N1 is the same subtype
of Influenza A that caused the 1918 pandemic. Fortunately, the current
version is, thus far, not as virulent as the 1918 variety. The 1918
flu (commonly called the Spanish flu) was the deadliest epidemic
in the history of the world.

It is estimated
to have infected 1/3 of the world population. This means about 500
million people were infected. An estimated 40–50 million died. This
influenza pandemic had some characteristics that were never seen
before and have never been seen since.

  • Typical
    influenza pandemics have a mortality of less than 0.1% but the
    mortality rate for the 1918 flu was 2.5–3.5%.

  • Mortality
    typically hits the very young and the very old and infirm the
    hardest but the 1918 pandemic killed mostly young adults. 99%
    of the deaths occurred in people less than 65 years old and
    half of all deaths occurred in people 20–40 years of age.

How does this
relate to warfare?

World War
I started in Europe in 1914. By 1917 the nations and armies comprising
the Allied and Axis powers were prostrate, depleted, and near exhaustion.
The stalemate was characterized by the trench warfare known as the
"meat grinder." The horrific conditions there are well
known to even the most casual students of history. In addition,
much of the civilian population of central and eastern Europe were
starving because the British had blockaded the North Sea ports and
prevented the importation of food and medical supplies as well as
military materials.

At this point
the US entered the war. The American Expeditionary Force brought
thousands of young American soldiers and sailors with fresh weapons
and supplies of ammunition to European shores. They also brought
the virus that mutated into the most deadly microbe in the history
of mankind.

Although it
is probably impossible to determine the true origin of the disease,
the earliest outbreak in the US was at Fort Riley, Kansas among
troops training for the A.E.F. The first cases were noted in early
March, 1918. In August a more severe form of the viral illness erupted
in Brest, France. Brest was one of the main ports for the shipment
of men and matriel from the US. From there it quickly spread across
Europe. This more virulent form of the virus was then exported back
to the US. It first arrived in Boston in September, 1918. Boston,
of course, was a port through which large shipments of men and war
supplies passed.

Though the
war was probably not responsible for the extreme virulence of the
disease, it certainly contributed greatly to its spread. Never before
had there been such a massive gathering and transportation of men
from disparate regions. The brutal living conditions in the trenches
and the devastation and malnutrition in the cities and countryside
of Europe no doubt created conditions conducive to the spread of
disease. The lowering of resistance brought about by a reduction
in the efficiency of response of the immune system due to stress
and malnutrition certainly played a role as well.

It is ironic
that one of the early victims was Randolph Bourne who died in December,
1918. He is famous for noting that "war is the health of the
state." Unfortunately the same can’t be said for the health
of the people.

13, 2009

Ernest N.
Curtis [send him mail]
is a cardiologist in practice for thirty years in Long Beach, California.

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