The Disease of War

I recently read a disintegrating little paperback on my bookshelves.  It probably belonged to my father, who was a public health doctor, with a masters in public health from Columbia University.  The book, Eleven Blue Men, consists of twelve stories about mysterious cases of sickness and death that came under the New York City Public Health Department’s purview in the mid-1940s.  The stories were originally serialized in The New Yorker magazine.  My edition of the book, by Berton Roueche, was published in 1955.

The stories involve cases of superlative medical detection, and they describe the extensive efforts exerted by epidemiologists and other investigators to identify and contain the culprits.  Cases of botulism, tetanus, smallpox, psittacosis, leprosy, typhoid fever, and others are described in detail.  There is a chapter on antibiotics, including the discovery of penicillin from mold, and the methods by which it was mass produced during World War II.

The outbreak of smallpox in New York City in 1947, a most contagious and deadly disease, led to the most massive emergency vaccination program in history, with 6,350,000 people being vaccinated, including the mayor of New York, within 28 days.

A new disease, which came to be named ricksettialpox, began striking inhabitants of a specific apartment complex in the borough of Queens in 1946.  It took significant sleuthing and the inspiration of an exterminator to discover the vector, a mite that fed on mice.

In the case of leprosy, the author goes into the historical discrimination and cruel torture of lepers, and the Bible-based fear of the disease, even though it is extremely sluggish and only marginally contagious.

While the stories are dated, and many of the diseases now rare in the US because of better sanitation, nutrition, and vaccinations, the afflictions themselves still exist and crop up from time to time.  The World Health Organization officially declared smallpox eradicated worldwide in 1980.  Other killer diseases like polio or tetanus now are virtually absent from the US and other developed countries.  Antibiotics like penicillin have completely changed the face of bacterial diseases and their treatments.

Medicine has made extraordinary strides in the past century, but I wonder about diminishing returns.  I read in newspapers about the starving children in Yemen and Ebola in the Congo, where there are also ongoing armed conflicts.  I think about microbiologist Hans Zinsser’s 1934 book Rats, Lice, and History, in which the author claims the bacteria win every war.  Zinsser was the original author of the microbiology text still used in medical schools today.

So, while medicine may have advanced, the social disease known as war has not, and it’s as deadly as ever, if not more so.  The starving children in Yemen are civilian victims caught in the proxy war between Saudi Arabia and Iran, with the US assisting the Saudis through arms sales and military cooperation.  There’s no medicine that cures starvation or unsanitary conditions.  Malnutrition, impure water, and stressful living conditions are breeding grounds for diseases like cholera, which, like Ebola, is transmitted through contaminated bodily fluids.

Eleven Blue Men softened my views on vaccines.  I can’t argue with vaccines for polio, smallpox, or tetanus, but I wonder about the proliferation of vaccines for an array of milder diseases, like influenza, which are generally self-limiting.  Vaccines themselves cause risks.  American children receive some 70 vaccines before they are 18 years old.

The medical clinics in Yemen are full to overflowing, but there’s little they can do for starvation.  Clinics in war-torn or infection-ridden areas may have vaccines or medicines, too, but they can’t provide the food, sanitation and clean water that do a longer-lasting and more effective job of preventing and healing disease.

When it comes to public health, the simplest measures are usually the best.  They have to do with sanitation, nutrition, and clean water.  In the case of civilian victims of war, the “collateral damage”–as the military likes to rationalize it–most of the trauma comes not from the bombs and bullets, but from the diseases that meet no resistance in debilitated populations.  It’s no wonder that the Spanish flu epidemic of 1918, at the heels of World War I, was the deadliest epidemic in history, killing more people in one year than the bubonic plague killed in the four years of the Black Death.  The flu epidemic killed ten times more people than the war itself.  The flu has not been that deadly since, but neither have the people been so lacking in resistance.

We don’t think of war as a disease, but maybe we should.  It’s a social disease, and no one is immune.