A Fighting Chance: Disease, Public Health, and the Military, Part 1

*The following blog post was written by 2013 Margaret Angus Research Fellow Robert Engen.

When we think about war and health care our imaginations are immediately drawn to ideas of war wounds, amputations, mobile surgical hospitals, and even psychiatric trauma and PTSD. These are among the most visible marks that war can leave on its participants.

But until very recently in human history, war and health care meant something else. Until the twentieth century, the overwhelming majority of casualties in any war did not come from battle wounds, but from disease. Typhus, typhoid fever, malaria, cholera, dysentery, smallpox, and a host of other infectious pathogens thrived in wartime, when soldiers lived packed together in barracks, suffered from fatigue and malnutrition, marched into foreign lands that contained unfamiliar illnesses, and experienced a near-total breakdown in sanitation and hygiene.

Often the epidemiological components of warfare are overshadowed in military history; yet, until halfway through the twentieth century infectious disease was sovereign over the battlefield, determining the success or failure of entire campaigns.   Dr. Hans Zinsser, a prominent American bacteriologist and expert on the typhus bacterium, wrote in 1937 that,

“In point of fact, the tricks of marching and shooting and the game called strategy constitute only a part – the minor, although picturesquely appealing part – of the tragedy of war. They are only the terminal operations engaged in by those remnants of the armies which have survived the camp epidemics.”[i]

Let’s look at some of western civilization’s most important and celebrated wars since the eighteenth century to see how many soldiers died from infectious disease compared to combat. While this is a crude measure, it gives an idea of the intractable problem of disease faced by militaries throughout history.  We’ll examine this as a ratio: the number who died of wounds (soldiers in red) to the number who died of disease (soldiers in black). Note that the images represent rough estimates of only the soldiers who died of disease or of battle injuries. Those who were wounded but lived, and those who were ill, but recovered – the majority in most cases – are not counted.

Engen_MHC_Blog_01 photoThe American Revolution, 1775-1783[ii] (American Colonial Army only)

Ratio of 9:1

Smallpox, thypus, dysentery, fevers.

photo 2

The Peninsular War, 1807-1814[iii] (British Army only)

Ratio of 7.5:1

Typhus, dysentery, yellow fever.

photo 3

The Walcheren Expedition, 1809[iv]

(British Army only)

Ratio of 38:1

Typhus, typhoid, paratyphoid, malaria, dysentery.

photo 4The Crimean War, 1853-1856[v] (Estimates of French, British, Russian armies)

Ratio of 5:1

Cholera, typhus, scurvy.


photo 5The American Civil War, 1861-1865[vi] (Estimates of Union and Confederate armies)

Ratio of 3:1

Dysentery, diarrhea, typhoid.

photo 6Spanish-American War, 1898[vii] (United States Army and Navy)

Ratio of 8:1

Malaria, typhoid, yellow fever.

photo 7South African War, 1899-1902[viii] (British Empire forces only)

Ratio of 2:1;

Typhoid fever.

photo 8First World War, 1914-1918[ix] (British Empire forces only)

Ratio of 1:2

photo 9

Second World War, 1939-1945[x] (Canadian Army only)

Ratio of 1:11

It was only in the twentieth century, over half a century after the widespread acceptance of germ theory, that the number of disease casualties finally dropped below battle casualties. For most of human history, disease has played a pivotal role in the outcome of military campaigns.

The causes of this dramatic reversal are not what you might think. Over the next couple of blog posts I will take a closer look at two extreme examples in a comparative context: the British Walcheren Expedition of 1809, and the Canadian Army’s Scheldt campaign in 1944. Both were fought over the exact same ground in the Netherlands thirteen decades apart, but the results of the campaigns could not have been more different, or more indicative of how disease and public health has shaped modern military history.

Robert Engen is pursing his PhD in military history at Queen’s University. He also teaches at Queen’s and writes extensively about Canadian military history.

[i] Hans Zinsser, Rats, Lice and History (New York: Bantam Books, 1967, c1937), 112.

[ii] Louis C. Duncan, Medical Men in the American Revolution, 1775-1783 (Carlisle Barracks, Pennsylvania: Medical Field Service School, 1931), 369-78.

[iii] Samuel Dumas, Losses of Life Caused by War (Oxford: The Clarendon Press, 1923).

[iv] Papers relating to the Scheldt – Casualty Returns. UK Parliamentary Papers 1810 (14(2)).

[v] Roger Cooter, “Medicine in War,” in: Deborah Brunton (Ed.), Medicine Transformed: Health, Disease and Society in Europe, 1800-1930 (Manchester: ManchesterUniversity Press, 2004), 335.

[vi] Stanhope Bayne-Jones, The Evolution of Preventive Medicine in the United States Army, 1607-1939 (Washington, D.C.: Office of the Surgeon General, 1968), 97-121.

[vii] Donald H. Dyal, et al., Historical Dictionary of the Spanish-American War (Greenwood Press, 1996), 67.

[viii] Cooter, “Medicine in War,” 335.

[ix] Ibid., 335.

[x] William R. Feasby (Ed.), Official History of the Canadian Medical Services, 1939-1945, Vol. 2: Clinical Subjects (Ottawa: Edmond Cloutier, 1953), 423-30.

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