PESTILENCE AND WAR
By EDGAR ASHWORTH
Ia speech in the House of Commons a few days ago the Foreign 1 Secretary emphasised the seriousness of the European situation, and stated that unless some further steps of a more definite nature are taken there is a danger of a terrible epidemic occurring in Europe this winter. While the Channel could be used to stop the Germans it could not stop germs, and the devastation of an epidemic could not be limited by a frontier or a strategic front. It is evident from this statement, and from another passage in the speech, that the anxiety of the Government is in the first place concerning the out- break of serious epidemics on the Continent, and secondly regard- ing the possibility of their spread to this country. No names of diseases were mentioned, but it is fairly obvious that the scourges which are casting shadows over the European Continent today are smallpox, typhus, bubonic plague, and influenza. Let us look all of these in the face indifferently, resolved not to meet trouble half- way, but to do whatever we can as individuals to lessen the risks. In the past all of these diseases have been closely associated with wars and famine.
Influenza, being the infectious disease affecting adults which is best known to us, may be taken first. Outbreaks of mild influenza are quite common, the disease sometimes showing a tendency to attack the lungs and at other times the stomach and the intestinal tract. Influenza was probably known in classical times, and in the Middle Ages it masqueraded under various fanciful names. Between 1173 and 1875 nearly Soo epidemics are known to have occurred in various places. In addition to these local waves of increased inci- dence, influenza also occurs at long intervals in pandemic waves— these outbreaks affecting practically the whole world. Since 1875 there have been many epidemics and two pandemics, in 1889-91 and in 1918-19. -Many will recollect the serious position which arose as a result of the latter pandemic. This scourge probably originated in the United States in the spring of 1918, and was carried from there to Europe, from which it soon involved the whole world except St. Helena and certain islands in the Polynesian group. The disease reached this country in June, and it showed three waves, the third of which did not occur until the spring of 1919. It is not generally realised that this pandemic was one of the three most terrible out- breaks of infectious disease' which have ever occurred in recorded history. During this period the disease caused nearly 200,000 deaths in England and Wales alone. In Europe as a whole over 2,000,000 deaths occurred, and a .tolerable estimate of the total deaths caused throughout the world during this pandemic exceeded 21,000,000. It was most dangerous during the second wave, when fatal cases often showed a peculiar heliotrope colour of the skin.
In the first World War the battle losses in the American Army were 35,000. In a few months the death roll from influenza in United States troops rose to 24,000. It is now well appreciated that influenza is due to an extremely minute virus and that it is spread by "droplet infection " from the respiratory tract of a sufferer directly to any contact who may come within range of his respiratory artillery. It is not so generally known that an epidemic—in contra- distinction to individual attacks of the disease—spreads with a speed equivalent to the fastest means of human travel at that particular
time. The aeroplane has therefore accelerated the dissemination of influenza in its epidemic and pandemic forms.
The famous plague of Athens in 43o B.C., which was described by Thucydides, occurred during the Peloponnesian War. It used to be regarded as an outbreak of plague, but it is now realised that no identification is possible. Two outbreaks of plague, of the many which affected this country, stand out above all others. The Black Death of 1348 caused disintegration in the intellectual, moral, reli- gious and social life of Europe. A brilliant contemporary description was given by Boccaccio in the Decameron. It is variously estimated by competent historians that between a quarter and a half of the population of Europe perished, which means that the number of deaths was at least 25,000,000. The other epidemic which we have cause to remember was the Great Plague of London, which occurred in 1665. Bubonic plague has been frequently associated with wars. The Thirty Years' War saw many widespread outbreaks. During the campaigns of Charles XII of Sweden, Swedish and Polish sol- diers carried the disease to Silesia after the battle of Pultowa (1707). Three years later there were 4o,000 deaths in Stockholm alone. In the Russo-Turkish Wars of 1769 and 1828 the warring armies and the civilian population suffered severely. Plague broke out during Napoleon's campaign in Syria, and a well-known picture by Baron Gros shows him touching plague-sufferers fearlessly in the hospital at Jaffa. There was much controversy over this supposed incident, and there is possibly some truth in the charge that Napo- leon had all the plague cases—about half a dozen in number— poisoned, lest they should infect his whole army.
Smallpox has had a chequered history, and numerous references can be found to its association with wars and armies. A few examples will suffice. In- 1779 the combined French and Spanish fleets sailed into the English Channel without encountering resist- ance. Before a landing could be effected, the crews were attacked with smallpox, and a storm completed the havoc which the disease had started. During the Franco-German War of 1870-1 smallpox raged in the French armies and in those parts of the country in which campaigning had taken place. During the siege of Paris there was a heavy mortaiity from smallpox.
We come now to typhus, which has an even more tragic history than any of the diseases so far mentioned. Hans Zinsser was strongly of the opinion that soldiers rarely win wars ; their duty is more often to mop up after the barrage of epidemics. " Typhus "—as he says—" with its brothers and sisters . . . has decided more cam- paigns than Caesar, Hannibal, Napoleon, and all the inspector- generals of history. The epidemics get the blame for defeat, the generals the credit for victory." Typhus has been prevalent in Europe for at least four centuries, and England has known quite serious localised outbreaks, such as the famous " Black Assizes," when prisoners brought up from the cells infected members of the court. The Thirty Years' War left nests of typhus infection scattered over the whole European Continent. In the Wars of the Spanish and Austrian Successions the disease was rife, and during the siege of Prague it claimed 30,000 victims. In the Peninsular War the British troops lost 8,889 men as a result of battle and 24,930 due to disease, much of which was typhus. A similar but more sombre picture emerges from the later wars of Napoleon. It is estimated, for example, that during 1813-14 a tenth of the whole population of Germany was attacked by the disease, and there were probably over a quarter of a million deaths. In the first World War typhus broke out first in the Serbian Army in November, 1914. The peak period of the epidemic was reached in April, 1915, by which time 2,50o cases a day were occurring, and the mortality was then 6o per cent. of persons affected. The rise of the Soviet Union between 1917 and 1923 was hampered by this loathsome disease, and it is estimated that in these years there were 30,000,000 cases of typhus, with 3,000,000 deaths, in European Russia alone.
Such is a small part of the story, from which the future possi- bilities may be deduced. It should, however, be emphasised that they are not certainties, but at highest probabilities. The epidemio- logical lessons of the war years, when the wide use of air-raid shelters in London and other cities gave conditions extremely favour- able to the spread of epidemics, which never occurred, should not be disregarded. The relief and medical services of U.N.RR.A. will do what is possible to reduce the dire results of epidemics which may arise in the appalling conditions in Europe. The Continent is mentally and morally sick. If physical sickness is added, it is clearly the duty of all in this country to maintain their own health to the best of their ability, so that this sea-girt island may have a chance of remaining a bastion against infection. So far as smallpox is concerned, efficient quarantine and inspection at the ports will remain a fundamental procedure. With reference to vaccination, I confine myself to the expression of my own conviction that in the individual this practice, if effectively carried out, will prevent small- pox. Typhus and plague both depend on insect and animal hosts for their transmission. Quarantine, the prevention of the ingress of the black rat at the ports and air-ports, and the destruction of fleas and lice, are the main measures, and these have been highly effective in the past. In the case of these diseases, therefore, the Channel is a boon which we could ill afford to disregard. Influenza presents a different problem. The aeroplane has overcome the restricting influence of our seas, and during an influenza epidemic so many people are potentially infective that official measures are often impracticable. Then is the time to appeal to the good sense of the people. An infected individual can at least remain at home while he is infectious, and can use common sense in preventing wide dissemination of infective matter when he has to cough or sneeze in public. Special masks were tried out on the London population during the " blitz " period of 1940, but they were never popular. Perhaps now is the time to interest the populaticn once more in their use.
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