Chapter 14Tuberculosis in Hungary before, during and after World War II
Kovács, G.; Gaudi, I.; Horváth, I. (Budapest)
Chapter 15Tuberculosis in the Soviet Union before and during World War II
Shulgina, M.V. (Saint-Petersburg); Vasilyeva, I.A. (Moscow)
Chapter 16Tuberculosis in the United States before, during and after World War II
Hopewell, P.C. (San Francisco, CA)
Chapter 17Tuberculosis in Japan before, during and after World War II
Mori, T.; Ishikawa, N. (Tokyo)
Chapter 18Tuberculosis in Korea during the Japanese Occupation in World War II
Choi, E.K. (Seoul)
Chapter 19Tuberculosis in China before, during and after the Sino-Japanese War
Murray, J.F. (San Francisco, CA)
Conclusion
Chapter 20Tuberculosis and War: Lessons Learned From World War II
Loddenkemper, R. (Berlin); Murray, J.F. (San Francisco, CA)
Tuberculosis and War – Lessons Learned from World War II
For centuries, tuberculosis (TB) has remained the largest cause of adult deaths from any single infectious disease, and still ranks among the top 10 causes of death worldwide. When TB and war overlap, their partnership spreads disease, heightens misery, worsens suffering, and intensifies mortality. Accordingly, TB is one of the most frequent and deadly diseases to complicate the special circumstances of warfare.
In Tuberculosis and War – Lessons Learned from World War II, the impact of war on TB is investigated using the example of World War II (WWII), the worst man-made disaster in history with its 60 million military and civilian casualties. In his post-war summary in 1949, Daniels concludes that TB was the major health disaster of the war years, but notes that not all belligerent countries sustained the same pattern of TB mortality during the war years, 1939 to 1945. Three variations were observed: (1) countries in which there was virtually no wartime increase (e.g., Denmark and Norway); (2) countries in which TB mortality increased during the first few years of the war but then decreased (e.g., England and Wales, Belgium, and France); and (3) countries/cities in which death rates increased from the beginning to after the end of the war (e.g., especially in capital cities like Berlin, Warsaw, Budapest, Vienna, Rome, and Amsterdam). Furthermore, it became unquestioned that the increase of TB during WWII was closely related to the severity of war conditions.
Written by internationally acclaimed experts, this book provides for the first time a comprehensive analysis of the status of TB before, during, and after WWII in the 25 belligerent countries that were chiefly involved (chapters 5–19). In the first of the 4 introductory chapters, chapter 1 summarizes the 70,000-year-old history of TB up to the present. In even earlier times, our hunter-gatherer kindred survived for 2–3 million years of peaceful life before wars began during the Neolithic Revolution. The downside to the amenities of civilization – wars with their human butchery and property destruction – were already taking place before written languages were available to document their existence. The escalation of weapons and means of killing people in the race to annihilation seems to have currently reached a threshold of success with the availability of abundant hydrogen bombs and the steady creation of more and more of them.
Further important background information is conveyed about the history of TB and war in general, including the difficulties of collecting exact epidemiological data (chapter 2), and the risk factors that hasten the spread of TB and its mortality during wartime (chapter 3). A special feature (chapter 4) on “Nazi medicine, TB and genocide” examines the horrendous, inhuman Nazi ideology, which during WWII used TB as a justification for murder, and targeted the disease by eradicating millions who had it.
The main risk factors for TB in wartime include malnutrition/starvation, which weaken host immune defenses. Overcrowding at the front, in concentration camps, prisoner of war quarters, and slave labor facilities worsens the transmission of tubercle bacilli. And disruption of medical and public health services limit treatment and control. All played a major role during WWII in most of the belligerent countries, both in the civilian population and in the military service.
The final chapter, number 20, summarizes the lessons learned from WWII and more recent wars and describes potential anti-TB measures for future conflicts. Today, HIV/ TB-coinfection has created a significant additional risk factor. A major step forward after WWII has been the foundation of several international governmental organizations (WHO, UNICEF, UNRRA) as well as non-governmental affiliations, which initiated or supported measures to improve post-war TB diagnosis and treatment.
Thanks to the pure coincidence of timing, in the midst of all the chaos and destruction during the last several months that terminated WWII in 1945, the first 2 effective drugs for the treatment of TB: para-aminosalicylic acid (PAS) and streptomycin were discovered almost simultaneously. When the war was over, the world’s reception to this monumental, long-awaited revelation – to some extent – quieted memories of and attention to the WWII-related outburst of TB. Heightened interest of patients, commitment by TB specialists, and researchers all sought to find the optimum way of using these promising new drugs. In 1952, the miraculous solution to the search for the missing element in the treatment of TB was discovered, isoniazid – highly effective, low toxicity, cheap, could not be patented – was soon combined with PAS and streptomycin to create “triple therapy,” the regimen that reliably cured TB for the first time ever and saved millions of lives. New antibiotics have subsequently been developed, but resistance against anti-TB drugs has become a serious problem.
The original observation established once and for all that the presence of World War I caused an explosion of TB during the 4-year period of warfare, plus another 2 or three years because of the overlapping end of the Spanish Flu epidemic. Roughly 20 years later, an identical recrudescence of TB occurred during WWII. And now of course, everyone recognizes that the ongoing war in Syria has kindled another obvious worsening of TB. These unmistakable messages keep reminding us: war exacerbates TB. Is not there something we could or should do about it?
We hope that our book provides useful and practical information, not only to TB specialists and pulmonologists but also to readers interested in public health, infectious diseases, and epidemiology. The partnership between war, military-related issues, and TB should be noted in the history of medicine. We believe it should also be of interest to non-medical readers like journalists, historians, and politicians.
Finally, we want to thank all our authors who represent so many countries and organizations for their dedicated participation. We are grateful for the contributions of Prof. Annette Finley-Croswhite for ensuring accuracy of historical facts and of Prof. Hans Rieder for his guidance about epidemiological issues. Special thanks go to Clare Pierard who read and revised numerous chapters and dealt with queries concerning much of the book. We thank Karger Publishers, notably Thomas Nold for his constant support and the Editorial staff, in particular Freddy Brian and Magdalena Mühlemann, for the superior production of this volume. Thanks also go to the two foundations that provided financial support for our work: