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recovery could be complete, or there could be lasting internal damage, particularly in the lung tissue. Disease, among the oldest threats in war, proved far more devastating, especially on the Eastern Front and in non-European theatres of war. In fact, the greatest achievement of Col. Paul von Lettow-Vorbeck's guerilla campaign in East Africa lay in the numbers of British troops who needed to be there in response to his efforts; among those British troops, disease caused more than 30 times the effective losses that battlefield wounds caused.

One should not leave the subject of disease without first considering the Influenza Pandemic, but at the same time, this was only tangential to the subject of World War One casualties. The movement of troops in the war did much to aid in the rapid transmission of disease, which was estimated to have killed about as many people as the war did. At the same time, it was not caused, or unleashed, by the war, and it was indiscriminate in its effect. Thus, its effects should remain separate from the toll of losses due directly to the war.

Medical science discovered a new category of casualty in this war and its aftermath, one that struck the mind instead of the body. It was known as "shell shock" in English; today we refer to it as Post-Traumatic Stress Disorder. The phenomenon is probably as old as war itself, but it was only in the 20th Century that it was recognized as a form of illness. The subjective component to psychological damage makes generalizations difficult, but it is safe to observe that the intensity and long-term duration of the stresses of trench warfare helped to create many cases that were so severe that the soldier never managed to integrate himself back into his community.

Civilians have always been casualties in wars, sometimes unintended, sometimes by design. This was true in World War One as well, from nearly 1400 Britons killed in German air raids to the Armenians who died in Turkey in enormous numbers. Some countries, such as Russia, Rumania and Serbia, are believed to have suffered significantly more civilian casualties than military ones. In these cases, disease seems to be a leading cause, but reliable figures are lacking.

Finally, one more category of casualty must be considered: a societal category. Throughout Europe, the First World War marked the death of the 19th Century order. In most cases, this change was a direct and proximate result of the Great War. Sometimes it marked the end of a government, as it did in Germany and Russia; in other cases, it marked the end of the country itself, as in the case of Austria-Hungary. Change was more subtle, but still palpable, among the winners as well as the losers. In Britain, for example, aristocratic families suffered a greater proportional loss in the beginning of the war than common families, mainly because the officer corps was overwhelmingly aristocratic in origin, until raw battle losses required a more "democratized" body of officers. In the long run, this did much to reduce the influence of the aristocracy in Britain simply by shrinking its numbers.

In short, World War One was destructive in ways that were unimaginable in the spring of 1914. The human toll was far beyond anything that had come before it, and in some respects, Europe has never fully healed.

Learn more about this author, Michael Fassbender.
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