Casualties of War

PETER: Well, guys, this really powerful story about smallpox and the Civil War evokes for me, well, the American Revolution. Hey, we had freed people or people escaping slavery to join the counterrevolutionary cause. And the black people who gathered, well, many of them died. In fact, most of them died of smallpox.

And that connection between race, gathering people together, containing them, and death is very powerful. And it suggests to me too that we should not forget how dangerous war is, and not just on battlefields. And it’s really, if you want to know how humans have dealt with disease, well, they’ve been the pathogens’ best friends by creating the optimal conditions for the spread of disease.

ED: That’s great point, Peter, because what we see is that war in many ways is massive, immediate urbanization. Not only the armies are coming together with no real capacity to contain that many people, but now in the Civil War, the contraband camps and the desperate search for freedom that grew up around those armies created a particularly lethal environment. And that doesn’t stop with the Civil War. I believe that goes forward even to the 20th century, doesn’t it, Brian?

BRIAN: That’s right, and what we find in World War I is the very movement of the armies that fought World War I are going to be the carriers of one of the great epidemics of all history, and certainly of the 20th century. That’s the great influenza epidemic of 1918, otherwise known as the Spanish flu. And guys, before we go any further, I want to bring back our friend from earlier in the show, Dr. Robert Gaynes, the epidemiologist at the CDC.

DR. ROBERT GAYNES: And numbers vary a lot on this between, depending on who you talk to, 20, 40, or even 60 million people worldwide in that one year died from influenza. And that makes it in one year the worst epidemic in human recorded history.

BRIAN: Now, normally, the very old and the very young are hit hardest by the flu. You guys know that already. But in 1918, something strange happened. The group hardest hit was healthy young adults. Hospital wards were full of dying 23-year-olds. And that demographic anomaly matters because of what else was going on in 1918, World War I.

DR. ROBERT GAYNES: And if you were the malevolent public health official and wanted to create an environment that would facilitate transmission of influenza, you would create trench warfare. That was an absolutely perfect place for that virus to go.

BRIAN: Those 23-year-olds, not only were they especially susceptible to influenza. They were being concentrated in military barracks, where the disease could easily be passed from one to the next. And they were being shipped from military base to military base, both here in the States and around the world. Dr. Gaynes read to us from a letter written by an Army doctor describing the carnage left by the flu at a military base near Boston.

DR. ROBERT GAYNES: We have lost an outrageous number of nurses and doctors, and the little town around here is a sight. It takes special trains to carry away the dead. For several days, there were no coffins, and the bodies piled up something fierce. We used to go down to the morgue and look at all the boys laid out in long rows. It beats any sight they ever had in France, I’ll bet.