Throughout human history there have been major epidemics that lead to the massive losses of life. These two major killers include war and disease. Both often coincide with one another and influenced further breakthroughs in not only the outcomes of war, but the continuation of advancements in the medical field. They often fuel each other in a vicious cycle that doesn’t seem to have an end in sight. While wars in the combative sense affect people’s lives up until the fighting has stopped, infectious disease however is an often-unrecognized weapon of war. It silently claims millions of lives throughout a conflict and long after a cease fire has been signed. While devastating, there can exist positive impacts such as the pressures to expand healthcare and create tools to treat communicable diseases as they run rampant in war zones. A push for new technologies to combat the devastating diseases help to establish our current forms of modern medicine. It brings into question that in times of war, when the incidence of disease often increases dramatically, do nations with appropriate resources have the responsibility to share their knowledge, technology, and money to help alleviate or eliminate many of the illnesses? This answer should be a resounding yes and often times there is aid from nations to fund the research and tools to stop the spread of disease. Examples of wars inspiring the creation of new tropical disease treatments through post-colonial African history include the South African war, World War I, and World War II.
During the years 1899 to 1902, war was rampant in the country of South Africa. The British Empire was in a vicious battle between the South African Republic and the Orange Free State. Much of Britain was against this war and propaganda was often used to display the horrors that existed such as disease ridden concentration camps. “During the first half of the war, that is, until the concentration camp issue attracted popular interest, it was around the Army Medical Department that most controversy swirled. A tremendous number of sick and an alarming rate of mortality from typhoid fever combined to spark a public debate which culminated in the appointment of a Royal Commission to look into the care of Britain's sick and wounded soldiers in the war” 1 . Thousands succumbed to the fevers of typhoid while inside the camps. Many pictures taken then published in British newspapers to show the devastating effects of typhoid on the soldiers and civilians. The publicized photos included those who were inches from death and children to further persuade citizens to take a stand against the war and push for medical treatment. At its peak outbreak of spring 1900, typhoid claimed the lives of 600 men with 3,250 being admitted to the hospital 2 . This dramatic outbreak was mostly caused by poor conditions as well as a lack of sanitary regulations throughout the army. “There was a tendency in the officer corps to regard disease as an unfortunate visitation rather than as a direct consequence of ignorance, negligence, and a lack of professionalism. According to PMO of the South African Field Force William Wilson, the senior officers had no real knowledge of sanitation nor did they have any appreciation of its far-reaching importance. The details of personal and camp health were consequently "slurred over." This was confirmed by Director-General Jameson who later admitted that ‘If sanitation had been understood, not alone by our own officers, but by the rank and file of the military officers, commanding officers, I think it would have saved thousands of lives” 3 .
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Although an immunization against typhoid existed at the time of the war it was on a volunteer basis only in which approximately 95% of the soldiers refused. This created breeding grounds for typhoid and it spread like wildfire with severe outbreaks creating devastation. The lack of immunization and sanitary regulations allowed for future commissions to reassess the procedures of dealing with illness. “What was required was that they be vested with executive authority which would enable them to go beyond the mere making of recommendations. Even more importantly, the regular officers and men of the army needed not only careful training in sanitation and hygiene, but mandatory immunization as well. The Commissioners, by focusing on inadequate staff and on minor equipment improvements, tried to ensure future medical success by dealing, not with the source of the problem, but with its surface manifestation” 4 . In a hopeful yet morbid afterthought, the British government had come to the realization that without the horrific outbreaks of typhoid, there would have been no call to attention of their lacking disease prevention techniques in their military.
World War I was deemed “The war to end all wars”. Instead, thousands died across the globe, not only from the fighting but from disease, specifically The Spanish Influenza. This deadly and rampant disease claimed more lives than any battle fought in World War I. It vast numbers reaching well over thirty million people world-wide. “Undoubtedly the influenza pandemic of 1918-19 was the most devastating infectious disease to affect the world since the Black Death ravaged much of Asia and Europe in the mid-fourteenth century” 5 . The disease often struck those between ages 20-40 which made its prime targets the soldiers fighting in the war and civilians.
The effect of the inflection was quite devastating since literature reports that it result in the loss of close to 2 percent of the entire population of Africa just in six months 6 . The pandemic struck in three waves, but most of the sub-Saharan Africa was hit by the second and most lethal wave. Sub-Saharan Africa was most affected since the regions that had been hit by the first wave of the pandemic had developed a form of immunity against the infection while those in the most affected region had not. The only part of Africa that escaped the onslaught, at least only partially, was the one that had been touched by the first wave of the occurrence. Specifically, the Maghreb and Egypt as well as the southeastern part of the continent are the only regions that were unaffected by the most deadly wave of the outbreak. The Natal Province of South Africa and adjoining territories are among the regions in the southeastern part of the continent that were not affected by the third wave of the outbreak.
The administrative and medical authorities were overwhelmed by the outbreak of the infection in Africa. Because of the fact that no influenza medical antidote or that related to the complications it caused, the doctors only resorted to the prescription of supportive or palliative of natural recovery that was complemented by good nursing 7 . As often the case, in the wake of a lack of a credible biomedical cure, there was a proliferation of quack remedies designed to substitute the anguished large-scale demand for a biomedical antidote. Where they had the appropriate and adequate resources, governments of the affected parts of the continent acted according to the expert advice they received from their medical officers. In such cases, the governments engaged in the distribution of leaflets that gave hints on the manner in which the Spanish Influenza would be prevented, distributed hurriedly-concocted vaccines to their populace, planned home visits aimed at the provision of food as well as succor to the sick 8 . Literature still indicates that the governments dispatched army nurses and doctors that could be spared and opened emergency hospitals that would help provide care to the worst hit areas. In a few cases, especially those that were extremely dire such as Port Louis, Windhoek, and Kimberly, the governments dissected towns into fixed medical districts in addition to allocating a single doctor to each of them that would treat all the patients 9 . However, it should be understood that no such targeted relief existed in most of the places, specifically in the remote regions in which most of the African population lived. In such regions, the families and individuals were abandoned to take care of themselves in the event that their communities were themselves too stricken to offer help.
Panic spread across the entire continent with most of the Africans thinking that it was a supernatural attack that had targeted to wipe out the Black race. However, the biomedically orientated governments thought and understood that the disease was vested in natural world, in the germs and the unhygienic environments that were breeding grounds for the germs. For such a reason, public health and sanitary reforms were the primary responses. In each of the territories, the attack was followed by short-term, but energetic clean-ups of the villages and towns. A Freetown newspaper that preached, “Praying minus proper sanitation availeth naught, echoed such efforts… 10 ” however, only Mauritius, Kenya and South Africa went that far in ensuring comprehensive reforms of the public health systems which had failed greatly during the outbreak of the flue in 1918. In the mentioned nations, the control and preventive measures entailed construction of houses that are more salubrious and hospitals and the development of early warning measures over telegraph and radio that would alert health authorities of the presence of such an infection.
The Second World War (WWII) also saw more people die of disease, especially malaria, than they did from combat 11 . Many troops that fought in the war suffered great numbers of casualties by the disease. For instance, Gen. Douglas MacArthur commented on his predicament in 1943 indicating that the war would live on as long as he did not confront the second enemy 12 . For instance, he claimed, “This will be a long war if for every division I have facing the enemy I must count on a second division in hospital with malaria and a third division convalescing from this debilitating disease! 13 ” From this statement, it is apparent that the general’s fear was not in overrunning the Japanese forces, but in the failure to control the Anopheles mosquito, the carrier of the disease. The deadly outbreak of the disease during the war led to the death of some 60,000 US soldiers in the South Pacific and Africa 14 . The US forces could only realize success following their successful fight against the disease. In the South Pacific Theater for instance, the conditions were harsh because the mountainous terrain, excessive mud, swamps, heavy rainfall, high temperatures and thick jungle formed perfect breeding grounds for the mosquitoes 15 . It then meant that malaria was rampant, and even though other infections such as beriberi and dysentery took their toll, malaria that caused the most devastating effects since it killed more soldiers than the enemy did. In fact, the US and other armies would defeat their enemies if they managed to keep their troops free from malaria.
Before the outbreak of the war, the armies had mastered the art of using preventive measures that included a regular use of Atabrine or quinine treatments, a careful selection of their camp bases, and the use of mosquito nets. However, the implementation of such measures at the time of the war proved a difficult task. First, there was the problem of insufficient supply of the malarial drugs; their supply was more than 100 percent less than the demand since the tropical regions were rich with the mosquitoes that bread all year round 16 . In some of the cases, the troops were invaded at a time when they had been greatly affected by the disease, which caused large numbers of their soldiers to die from the attack. However, the war prompted the development and the utilization of drugs against the disease as well as the residual insecticides such as DDT, which were among the greatest contributions to the malariology at the time of the Great War. Before then, most of the population in Africa and other regions had depended on quinine as the only antimalarial drug in existence. The arrival of new drug forms such as pyrimethamine, proquanil, primaquine, amodiaquin, and chloroquine relived the troops and the populace. The emergence of more drugs meant that malaria would be controlled to a greater extend since they complimented preventive measures that were adopted such as the use of treated nets and proper public health reforms 17 .
In conclusion, as much as the wars had adverse effects on the populations in Africa and the rest of the world, their emergence caused improvements in public health. As this paper has reported, the war in South Africa, and consistent with all the other wars, the post war eras were followed by quick public health reforms that targeted to eliminate the major diseases that had afflicted the populations at the time of the war. Specifically, the malaria, typhoid fever, and Spanish Influenza afflicted Africans during WWII, the South African War, and WWI respectively. However, their attacks taught the African governments the importance of proper public health measures that have contributed to the control of the infections that killed more people than the battles did.
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Killingray, David. “A New 'Imperial Disease': The Influenza Pandemic of 1918-9and Its Impact on the British Empire.” Caribbean Quarterly , vol. 49, no. 4, 2003, pp. 30–49. JSTOR , www.jstor.org/stable/40654422.
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Stephen A. Pagaard, ‘Disease and the British Army in South Africa, 1899-1900, Military Affairs, 50(1986), 71-76
1 Stephen A. Pagaard, ‘Disease and the British Army in South Africa, 1899-1900, Military Affairs, 50(1986), 71-76.]
2 Ibid.
3 Ibid.
4 [Stephen A. Pagaard, ‘Disease and the British Army in South Africa, 1899-1900, Military Affairs, 50(1986), 71-76.]
5 Killingray, David. “A New 'Imperial Disease': The Influenza Pandemic of 1918-9and Its Impact on the British Empire.” Caribbean Quarterly , vol. 49, no. 4, 2003, pp. 30–49. JSTOR , www.jstor.org/stable/40654422.
6 Phillips, Howard. "Influenza Pandemic (Africa)." International Encyclopedia of the Frist World War (2014): 174-75.
7 Phillips, Howard. "Influenza Pandemic (Africa)." International Encyclopedia of the Frist World War (2014): 174-75.
8 Ibid.
9 Ibid
10 Phillips, Howard. "Influenza Pandemic (Africa)." International Encyclopedia of the Frist World War (2014): 174-75.
11 Srinvas, Jacob. "Malaria in Wars And Victims – Malaria Site". 2015. Malariasite.Com . Accessed June 30 2017. http://www.malariasite.com/wars-victims/.
12 Ibid
13 Ibid
14 Ibid
15 Hawks, Jeff. 2017. "Malaria In World War II - Army Heritage Center Foundation". Armyheritage.Org . Accessed June 30 2017. https://www.armyheritage.org/75-information/soldier-stories/292-malaria-in-world-war-ii.
16 Srinvas, Jacob. "Malaria in Wars And Victims – Malaria Site". 2015. Malariasite.Com . Accessed June 30 2017. http://www.malariasite.com/wars-victims/.
17 Srinvas, Jacob. "Malaria in Wars And Victims – Malaria Site". 2015. Malariasite.Com . Accessed June 30 2017. http://www.malariasite.com/wars-victims/.
