Correspondence: H. Erdem, I ˙ nfeksiyon Hastalıklari Klinigi, Kasimpasa Askeri, Hastanesi, Kasimpasa-Istanbul, Turkey. Tel: +90 532 7842024. E-mail: hakanerdem1969@yahoo.com (Received 12 December 2010; accepted 24 March 2011) Introduction In the absence of antibiotics, infections were the nightmares of mankind for centuries. The modern era of antimicrobial chemotherapy began with the discovery of sulphonamides in 1936. This was fol- lowed by the discovery of penicillin in the 1940s, and by 1950 the golden age of antimicrobial chemother- apy was well underway [1]. The Ottomans suffered enormously from person- nel losses in the First World War. Apart from the wounded and wound-related deaths, mortality and morbidity due to infections were extremely high. The Third Ottoman Army was responsible for all of the operations in Eastern Anatolia, and the military doc- tors served not only the military, but civilians as well [2]. Just after the start of the First World War, the Third Ottoman Army was on the verge of perishing due to outbreaks of disease. Even the Army Commander, Hafız Hakkı Pasha, died of typhus in February 1915 [3], and until the implementation of effective measures after 1916, the situation could not be controlled [4]. Since 1915 was the year of epidemics in the Third Ottoman Army, our study was focused on that year. In this study, infectious diseases were evaluated on the basis of the Third Ottoman Army records of 1915. Our study had 2 goals. The first was to delin- eate the probable impacts of infectious diseases on human populations in the 21 st century in which either wars or natural disasters had the potential to destroy healthcare infrastructures. The second goal was to disclose the mortality rates of infectious diseases in the absence of antibiotics. ORIGINAL ARTICLE War and infection in the pre-antibiotic era: The Third Ottoman Army in 1915 HAKAN ERDEM 1 , AHMET TETIK 2 , OZGUR ARUN 3 , BULENT AHMET BESIRBELLIOGLU 4 , OMER COSKUN 4 & CAN POLAT EYIGUN 4 From the 1 Department of Infectious Diseases and Clinical Microbiology, Kasimpasa Hospital, Istanbul, 2 Archives Department of ATASE, Ankara, 3 Department of Gerontology, Akdeniz University, Antalya, and 4 Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey Abstract Background: The aim of this study, which evaluated historical data, was to delineate the probable impacts of infectious diseases on human populations under extraordinary circumstances. The second goal was to disclose the mortality rates for infectious diseases in the absence of antibiotics. Methods: The Third Ottoman Army records at the Turkish General Staff Military History and Strategic Study Directorate were studied retrospectively for the period between March 1915 and February 1916. Results: For the Third Ottoman Army, the number of infection-related deaths over the single-year period was 23,601. Malaria, relapsing fever and dysentery were the most common infections. In that pre-antibiotic era, the high- est mortality rates were seen for cholera (80%), pulmonary tuberculosis (58%) and typhoid fever (51%). However, typhus had the maximum share in soldier deaths (6053 soldiers). The rate of vector-borne infections peaked in the summer of 1915, while the frequency of respiratory tract infections was highest in the colder months. In contrast, gastrointestinal tract infections appeared to maintain a steady state throughout the year. Conclusions: If the wartime data for 1915 are accepted to provide a model for extraordinary circumstances in the 21 st century, vector-borne, respiratory tract and gastrointestinal infections can be accepted as the challenging issues with significant mortality. Keywords: Pre-antibiotic, infection, mortality Scandinavian Journal of Infectious Diseases, 2011; 43: 690–695 ISSN 0036-5548 print/ISSN 1651-1980 online © 2011 Informa Healthcare DOI: 10.3109/00365548.2011.577801 Scand J Infect Dis Downloaded from informahealthcare.com by Tubitak on 09/26/11 For personal use only.