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  • War Epidemics: An Historical Geography of Infectious Diseases in Military Conflict and Civil Strife, 1850–2000
  • Vincent J. Cirillo
M. R. Smallman-Raynor and A. D. Cliff. War Epidemics: An Historical Geography of Infectious Diseases in Military Conflict and Civil Strife, 1850–2000. New York, Oxford University Press, 2004. xxxiv, 805 pp., illus. £100.

Disease is the demonic consort of war. From time immemorial, more soldiers have died from infectious diseases than from enemy action. Not until the major advances in prevention (vaccines) and treatment (antibiotics) in World War II was this enduring feature of war finally reversed. Thereafter, bombs and bullets supplanted disease as the leading cause of military deaths. However, as this intensive study underscores, war-related epidemics continue to claim the lives of countless civilians displaced by conflicts around the globe.

In War Epidemics, part of the Oxford Geographical and Environmental Studies series, Smallman-Raynor and Cliff bring the perspective of geographers to our understanding of how the spatial dynamics of epidemics are influenced by military operations and the directives of war. They address key issues, such as the geographical corridors that diseases follow when [End Page 90] spreading from one area to another and the rapidity with which diseases move. The authors focus on the period 1850 to 2000, for reliable war-related morbidity and mortality statistics were not available prior to the Crimean War (1853–56). Fourteen wars, viewed through regional lenses, illustrate major themes in the geography of war and disease: military mobilization, camp epidemics, emerging and reemerging diseases, sexually transmitted diseases, and island epidemics.

The authors make effective use of the American experience in the Spanish-American War (1898) to show the epidemiological hazards of rapid military mobilization. The concentration of tens of thousands of raw recruits, with different patterns of immunity, in a few overcrowded and unsanitary assembly camps fueled epidemic typhoid.

When thousands of enlistees from disparate epidemiological backgrounds were confined without proper drainage or sewerage systems, the likelihood of infectious disease transmission increased exponentially. Military camps of all kinds—assembly, field, siege, prisoner of war (POW), and concentration—provide a setting for intense population mixing that can supercharge an epidemic. Moreover, camps often act as epidemic seeds from which diseases spread to civil populations, as illustrated by the spread of smallpox from French POWs to Prussian civilians in the Franco-Prussian War (1870–71).

Wars create physical conditions (poverty, famine, destruction of public health infrastructure, large population displacements, and ecological changes) that are conducive to the emergence of seemingly new diseases and the reemergence of classical diseases. An example of a significant new disease is the scrub typhus outbreak among Allied forces in the Burma-India Theater (1942–45) during World War II. Malaria resurfaced as the major medical problem of American personnel in the Vietnam War (1964–73); bubonic plague devastated Vietnamese civilians.

The active role of soldiers in the propagation of sexually transmitted diseases is a persistent theme in the epidemic history of war. Human immunodeficiency virus (HIV) and acquired immuno-deficiency syndrome (AIDS) have added a new dimension to the problem. Civil war in Uganda (1980s) resulted in a million cases of HIV and over 12,000 cases of AIDS. The Ugandan National Liberation Army was implicated as the cause.

Island epidemics have special interest, because they are in effect natural laboratories for the study of the epidemiological processes apparent in the continental landmasses of the Americas, Europe, Asia, and Africa.

Caveat lector. War Epidemics is not for the fainthearted. Staggering amounts of data are presented in 131 tables and 202 figures. Perplexing graphs and mathematics—familiar to epidemiologists—may discourage many readers. [End Page 91] Notwithstanding, a clearer picture of the war–disease nexus will reward those having the fortitude to wrestle with the numbers.

Not unexpected in a work of this magnitude, numerous mistakes escaped detection. Most are minor, such as the use of "vaccination" instead of "variolation" (p. 117) and a jumbled acronym (p. 280). Others are more serious: incorrect graph ordinates (pp. 204, 318) and abscissa (p. 207), and an erroneous compulsory antityphoid inoculation timeline (p. 396). These mistakes do not, however, detract from the impressive scholarship that will make War...

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