Two Faces of Death: Fatalities from Disease and Combat in America's Principal Wars, 1775 to Present

Abstract

Throughout America's first 145 years of war, far more of the country's military personnel perished from infectious diseases than from enemy action. This enduring feature of war was finally reversed in World War II, chiefly as a result of major medical advances in prevention (vaccines) and treatment (antibiotics). Safeguarding the health of a command is indispensable for the success of any campaign. Wars are lost by disease, which causes an enormous drain on the military's resources and affects both strategy and tactics. Disease and combat mortality data from America's principal wars (1775–present) fall into two clearly defined time periods: the Disease Era (1775–1918), during which infectious diseases were the major killer of America's armed forces, and the Trauma Era (1941–present), in which combat-related fatalities predominated. The trend established in World War II continues to the present day. Although there are currently more than 3,400 U.S. military fatalities in Iraq, the disease-death toll is so low that it is exceeded by the number of suicides.

Infection-Associated Clinical Outcomes in Hospitalized Medical Evacuees After Traumatic Injury: Trauma Infectious Disease Outcome Study

“…1, 2 In no setting is this more well-recognized than the challenging environment of combat casualty care. During the current military conflicts in Iraq and Afghanistan, Operations Iraqi and Enduring Freedom (OIF/OEF), major advances resulting in increased survival among wounded personnel have been observed.…”

Antimicrobial Prescribing Practices Following Publication of Guidelines for the Prevention of Infections Associated With Combat-Related Injuries

“…(1–3) Antibiotic prophylaxis (postinjury antimicrobial therapy) has been the focus of extensive research, and the findings of these investigations have led to clinical practice guidance (CPG) for a range of traumatic injuries with endorsement by several civilian organizations. (4–8) Combatrelated traumatic injury in modern warfare frequently introduces greater complexity because of multiple injuries with extensive tissue loss and disruption accompanied by wound contamination.9,10 In addition, the evidence base for antibiotic prophylaxis recommendations is significantly limited compared with civilian trauma settings.…”

Deaths and survivors in war: The Italian soldiers in WWI

“…In terms of cause of mortality, the Great War was also the first conflict in which the number of deaths by injury was higher than the number of deaths from illness. An exception are the deaths in the American army (Cirillo 2008), where illness accounted for more deaths than combat. But this is due to the fact that the US military forces were only deployed on a large scale in 1918, the year of the Spanish flu epidemic (see Byerly 2005).…”