Diarrhea Once Killed More Soldiers Than Combat — and Is Still a Threat, with Mary Roach

I started out with this amazing quotation from William Osler, the father of modern medicine, which is I think he said this in the 1890s: "Dysentery has been more fatal to soldiers than powder or shot." Powder and shot being what they killed people with in combat. The statistics were amazing. You look at the Mexican-American War, which was linked forever to diarrhea, and sadly, the ratio of seven to one: soldiers killed from malaria and other diseases versus combat wounds.

A lot of it was dysentery; more than it was malaria. Dysentery is an extreme form of diarrhea where the pathogens are invading the lining of the intestine to the point where you have blood. It's a serious situation; you're dehydrating and you're bleeding. Nowadays, you don't see soldiers dying of diarrhea, but what you do have are situations where, especially in Special Operations and Special Forces, these folks are operating, say, out in Somalia or Yemen and instantly dealing with villages. Insurgents are coming in, trying to win people over.

They're sitting down to meals with a lot of, you know, elders in the village, eating food that's not been refrigerated necessarily, and drinking water that's not filtered or treated. They're getting sick at a rate twice that of the average enlisted service members. They are also doing the really easy, the high-risk, classified missions, you know, like going in and taking out Osama bin Laden, whatever they're doing. Some of them are snipers.

It's a situation that may be a life-or-death one. You can't sort of stop in the middle of a mission and go, "Excuse me, I'm dealing with some extreme urgency; I’ve got to duck behind a rock." They're just in a situation where they're going to soil themselves. It was an interesting reporting challenge I found myself in at Camp Lemonnier in Djibouti, where a lot of this counterinsurgency work goes on.

The Special Operations folks are off in their own restricted zone, but they come into the cafeteria with everyone else. I had to approach strangers over dinner and have conversations about diarrhea, which is an interesting reporting challenge. But to them, it wasn’t a silly topic; you know, it was serious, and they had a lot to say about it. So that was really interesting.