The unseen casualties of the First World War: insights from a randomly selected military sample

Aims Studies of the morbidity burden of military personnel participating in the First World War (WWI) have tended to focus on specific outcomes (e.g., injuries). Therefore, we aimed for a more complete assessment. Methods From a random sample of active war service-exposed New Zealand WWI veterans used in previously published work, we examined a random subsample of 200 personnel. Data on diagnoses, hospitalisations and outcomes were extracted from the online archival military files. Results These personnel experienced a very high morbidity burden with 94% having at least one new condition diagnosed during their military service (mean: 2.4 per individual; range: 0 to 8). The relative severity of these conditions was reflected by the high level of hospitalisation (89% at least once; mean: 1.8 hospitalisations for new conditions per individual) and 59% of personnel being deemed no longer fit for military service at some stage. More of the new diagnoses were for infectious diseases than for conflict-related injuries (117 vs 50 cases per 100 personnel). Respiratory conditions such as influenza, pneumonia and tuberculosis affected 33% of personnel, and 14% were diagnosed with sexually transmitted infections. Diseases reflecting hazardous environmental conditions were relatively common e.g., for dysentery/gastroenteritis in 12% and scabies in 5% of personnel. Diagnoses suggestive of post-traumatic stress disorder (PTSD) were present in 10% and chemical warfare injuries in 6%. Conclusions The overall morbidity burden of this military force in WWI was very high, and much higher than the previous official estimates.