War Epidemics: An Historical Geography of Infectious Diseases in Military Conflict and Civil Strife, 1850-2000 (review)

War as a causal agent in fomenting and spreading epidemic diseases has been examined, primarily by physicians-historians, for over 150 years. The authors treated here are British geographers employing very modern statistical and mapping technologies. They discuss ancient war—the Plague of Athens, etc., and attend to medieval and early modern data, but have primarily studied American and British nineteenth and twentieth century events where reliable data are most available. They are mainly concerned with the great epidemic diseases—cholera, influenza, measles, smallpox, and typhoid, as well as malaria and sexually transmitted diseases.

Using cluster maps, graphs, tables, regression analysis, etc., they describe how the spatial-temporal dynamics of epidemic diseases are influenced by military operations and war. Where appropriate, civilian and peacetime data provide comparisons to military events. Only ground forces are examined.

The major modern wars studied include the Crimean War, the U.S. Civil War, the Franco-Prussian War, the Anglo-Boer War, World Wars I and II, Korea, Vietnam, and the Rwandan Civil War. The categories of study are recruit epidemics, troop mobilization and movement, population displacements (refugees), POW camps, and emerging diseases (AIDS).

The authors attend to civilian populations often ignored in previous military studies such as postwar epidemics (cholera in the Philippines in 1902); measles in concentration camps in the second Anglo-Boer War (1902); and cholera, typhus, and AIDS in various African civil wars (1970–94). The change in warfare modes from formal state on state to primarily civil and guerrilla/insurgent wars tends to produce displaced populations, breakdown of public health measures, and an increase in epidemic diseases. Refugees from such struggles are especially susceptible to cholera, typhoid and disentry (fecal-oral transmissions), influenza and pneumonias (respiratory transmissions), and malaria, typhus, and plague (vector borne). The authors touch upon public health and preventive measures—immunization, sanitation, and camp hygiene—but their emphasis is on disease spread.

There are a few very limited attempts to discuss the impact of disease on military operations or outcomes. Some analyses are new and striking. The study of the spread of cholera in British forces in the Crimea is the best I have seen. Few military histories of the Franco-Prussian War note that good German and failed French military smallpox immunization programs resulted in 25,000 dead French soldiers and only 297 German deaths. However, infected French POWs (about 268,000) spread smallpox to German towns near POW camps, causing about 180,000 civilian deaths.

There are no acknowledgements to assistance from military or medical historians who could have prevented some modest missteps. Napoleon did not "personally cure" plague (p. 103); U.S. disease deaths in Vietnam should be 1,000, not 10,000 (p. 34). There are six, not seven, volumes in the official U.S. medical history of the Civil War and Woodward did not edit all of them (p. 352). Other readers will probably find other slips. They do not detract from the book's value.

The extensive references are essentially to secondary sources. However, Cosmas is not cited for the Spanish-American War, nor Reister or Cowdry for the Korean War nor Linn for the Philippines. The magisterial two volumes of the U.S. Army in World War II (1992 and 1998) were not used nor was the infectious disease history of the Vietnam War (1982). Twentieth century authors on the disease and war topic—Garrison, Ashburn, and Duncan—are ignored.

Is this book useful to military historians? For the wars discussed and perhaps for inroducing them to topics seldom considered as part of "war": the health of refugees, POWs, and recruits. And for noting that the health of a command is militarily important and the responsibility of the commander—and giving some specific examples. Military...