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Trench Fever and Lice in World War I

Judith has a long standing interest in World War 1 and has spent many hours researching the lives of the men of her town who fell in WW1.

Male body louse. The dark mass in the middle of the body is its last meal: blood.

Male body louse. The dark mass in the middle of the body is its last meal: blood.

What is Trench Fever?

From early on in World War I, men started falling ill to a mysterious illness. It wasn't terribly serious, but it was debilitating. Up to a third of British troops seen by doctors during the war were thought to have been suffering from the disease. The initial symptoms of the illness were generally short-lived, but recovery was often slow, and the patient could be left depressed.

The name given to the condition was trench fever, but the doctors had no definite idea of what caused it despite naming it. The cause was discovered after the war: bacteria carried by body lice.

Trench Fever and Body Lice

The human body louse (Pediculus humanus humanus), very similar in appearance to the head louse, infests people living nearby amidst unhygienic conditions. The louse doesn't actually live on the body but rather in the host's clothes, particularly around the seams. It does feed on the host's blood, moving to the skin to feed. The movement of the lice can cause severe itching, but itching would be the least of the host's worries because lice also carry disease.

Two diseases carried by lice are typhus and trench fever. Curiously, the more serious problem of typhus didn't arise too much in the trenches, but trench fever reached epidemic levels. Some estimates put the number of British troops affected at around one million. Other nationalities were also affected.

Other Names

Trench fever is characterised by a five day fever, so it is sometimes called:

  • Quintan fever
  • Five-day fever

It is also known as:

  • Wolhynia fever
  • Shinbone fever
  • His disease
  • His-Werner disease

(Wilhelm His Jr. and Heinrich Werner were amongst the first to describe trench fever).


Body lice spread trench fever, but the disease itself was caused by the bacterium Bartonella quintana. This bacterium was finally isolated in the 1960s by J.W. Vinson in Mexico City.

Infection occurred when a louse carrying the bacterium defecated whilst feeding. If the host scratched, the bacterium-infected feces would be spread across and into the small wound. Thus, the host became infected.

Chatting About Lice

Troops in World War I might not have been aware that lice caused trench fever, but they wanted to eliminate the lice that infested their clothing. They called their unwelcome visitors "chats." "Chatting" took place regularly, with men removing their clothes and doing their best to get the lice out of the seams. They either picked them out or ran a flame along the seams.

It is said that this is how we got the verb "to chat;" men sat around socialising and talking whilst they got rid of the chats.


Trench fever had a long incubation period, with men reporting illness between two weeks and a month after infection. The symptoms included:

  • Sudden fever
  • Loss of energy
  • Intense headache
  • Skin rash
  • Pain in the eyeballs
  • Dizziness
  • Muscle aches
  • Constant, severe pain and sensitivity in the shins—hence "Shin bone fever"

The fever had a peculiar characteristic in that it would break after five or six days, but then climb again several days later. This cycle might be repeated as many as eight times.

Recovery could be slow, taking several months. Complications included relapses of the illness (as much as 10 years after the initial bout), heart problems, fatigue, anxiety, and depression.

French troops in WWI.  Life was grim and in a confined space like this, lice were able to spread from man to man.

French troops in WWI. Life was grim and in a confined space like this, lice were able to spread from man to man.

Life and Lice in the Trenches

Lice thrive in squalid conditions in which humanity is packed together. The trenches of the Western front provided ideal breeding grounds. Men had limited access to bathing facilities or clean clothes, and when the temperatures dropped, they would huddle together for warmth, making it easy for lice to pass from one host to another.

A female louse can produce around 8-10 eggs ("nits") a day. Eggs generally take a week or two to hatch, and the immature lice take a further 9-12 days to mature and start breeding. Hence, infestations were quick to take hold.

Body lice are adapted to live in clothing. They burrow into seams and cling with their claw-like legs. Troops found that lice were particularly fond of the seams at the crotch of their trousers and in the back seams of their shirts.

In addition to "chatting" the Army also tried using NCI (Napthelene, Creosote and Iodoform) paste or powder. Heat and steam were also tried, but the problem was that there were no facilities to treat all the uniforms regularly.

Number 9, Doctor's Orders!

If you have ever played bingo, you will know the call "Number 9, Doctor's Orders!". Troops often played bingo in their free time and the call is one of theirs, referencing the ubiquitous Pill No. 9.


Medical Officers during World War I tended to put trench fever down as PUO—pyrexia (ie fever) of unknown origin. Often they would take a stern view and prescribe "M&D"—medicine and duty. The unfortunate soldier would be returned to duty with some medicine, often the notorious Pill No. 9. Pill No. 9 was a laxative beloved of the British Army doctor; it's doubtful that it did much to help a man suffering from a fever.

Not all men suffering from trench fever could return to duty; they were simply too ill. In those cases, they would be evacuated to a hospital for rest and recuperation. Many of them were likely in no rush to recover and rejoin their unit. Trench fever, though unpleasant, was undoubtedly a welcome relief from being shelled on the front line.

Nowadays, a course of antibiotics is prescribed for trench fever.

A young J.R.R. Tolkien during WW1, before he fell ill with trench fever.

A young J.R.R. Tolkien during WW1, before he fell ill with trench fever.

J.R.R. Tolkien and Trench Fever

John Reginald Reuel Tolkien served as a signals officer with the Lancashire Fusiliers during World War 1. He succumbed to trench fever on 27 October 1916 and was evacuated to the UK on 8 November 1916. Tolkien was never fit for active service again (he also suffered from trench foot) and spent the rest of the war either convalescing or on garrison duties.

A chaplain to the Lancashire Fusiliers, Reverend Mervyn S Myers, recalled an incident when he, Tolkien and another officer tried to get some sleep but were beset by lice.

We no sooner lay down than hordes of lice got up. So we went round to the Medical Officer, who was also in the dugout with his medical equipment, and he gave us some ointment which he assured us would keep the little brutes away. We anointed ourselves all over with the stuff . . . instead of discouraging them it seemed to act as a sort of hors d'oeuvre and the little beggars went at their feast with renewed vigour.

Tolkien's fellow writers, A. A.Milne and C. S. Lewis, also fell victim to trench fever during their time on the Western front.

Modern Trench Fever

People still suffer from trench fever. Modern outbreaks are usually amongst the disadvantaged. In 1998, The Lancet reported an outbreak in a refugee camp in Burundi. A couple of years earlier, separate studies in Seattle and Marseilles found that up to 20% of homeless patients had been infected by the Bartonella quintana bacterium.


Judi Brown (author) from UK on October 15, 2012:

Hi Mhatter99 - it's not that happy, but really I think I would prefer trench fever to time in the front line - it really would be a welcome relief!

Hi thikdifferent - my daughter is addicted to Horrible Histories! She loved the TV show and I am delighted that it has sparked a real interest to find out more.

Thanks very much to both of you for commenting, I appreciate it.

Mohammad Ali Colombowala from Mumbai, Maharashtra, India on October 14, 2012:

I read Horrible histories ww1 and it has many interesting stories about lice :-)

Martin Kloess from San Francisco on October 14, 2012:

Though not exactly a happy topic. this was an interesting report. Thank you.

Judi Brown (author) from UK on October 14, 2012:

Thanks David - I didn't know that, but yes, the desolation of Mordor and the marshes are like the desolation of Flanders. Another thing to follow up one of these days!

David Hunt from Cedar Rapids, Iowa on October 14, 2012:

Just one more comment. It's said that the mud of Paschendale, where so many soldiers slipped beneath the mud and mud-filled craters, "inspired" Tolkien to later include the marshes filled with the dead in Lord of the Rings. He was very reticent to attribute his experiences to his fantasies, but one could easily see how his living in Hall Green-- then still remote from Birmingham's gray sprawl-- could have inspired the Shire and the horror of the trenches and the urban despoilation (sp) of the countryside could have inspired Mordor or the "scouring of the Shire".

Judi Brown (author) from UK on October 14, 2012:

Hi GoodLady - it wasn't (and isn't) a pleasant illness, but I guess if you managed to find your way to hospital it was a blessing in disguise. Certainly was a horrible war and I do my best to ensure that it's not forgotten.

Hi Bill - I've read a very small amount about the trenches around Petersburg, I think I shall have to find out more - I'm dreadfully ignorant of your Civil War (and not much better informed about our own).

Hi Natasha - Tolkien had a miserable war, but he did manage to put off enlistment until after he got his degree. I think he and his wife managed to communicate in their own code in their letters so that she always knew where he was.

Thanks to all of you for your comments, as always it's a pleasure to hear from you.

Natasha from Hawaii on October 14, 2012:

Wow, I'd never heard about trench fever! And I certainly never knew Tolkien had it. I used to be obsessed with him - I'm surprised I never read about his trench fever.

Bill Holland from Olympia, WA on October 14, 2012:

Yes indeed! This was actually a big problem during our Civil War as well, especially during the trench warfare of Petersburg. Great job Judi; very well-researched and presented.

Penelope Hart from Rome, Italy on October 14, 2012:

Sounds ghastly. Glad I finally found out what "Number 9, Doctor's orders" comes from, thank you! As others have mentioned in the comments, the extra research and information on Tolkien and co makes your accounts always more interesting. Hateful, hateful war it was. Poor soldiers. I'm sure it's good you bring these dreadful facts up in detail - so we share the horror a moment or two, never forget; these men were our not so distant ancestors. Pinning in my library. Voting and sharing.

Judi Brown (author) from UK on October 14, 2012:

Hi Graham - I'm sure there's a story about Lord Kitchener and a No. 9 pill - I'll have to look into it!

Thanks for your kind comments, always appreciated.

Graham Lee from Lancashire. England. on October 14, 2012:

Hi Judi. Yet another first class hub and as UH said thanks for the info on 'No9' Great research.


Judi Brown (author) from UK on October 14, 2012:

Hi David - yes, definitely there was a view that men tended to be malingerers. My favourite bingo call is "88, two fat ladies" (never actually played bingo!) - glad to clear up the mystery of No. 9 for you!. As you say, feeling ill, standing in a foot of mud plus the army gives you the runs - brilliant.

Hi viveresperando - delighted that you enjoyed this hub. AA Milne wrote the Christopher Robin/Winnie the Pooh stories.

Thanks to both of you for your comments, I appreciate you taking the time to read and comment.

viveresperando from A Place Where Nothing Is Real on October 14, 2012:

Enjoyed reading this. Very well thought out and shows you did research and incorporating Tolkien, Lewis, brought me a smile. Love those authors. Never heard of Milne, at least I do not recall at the moment. Going to have to google.

David Hunt from Cedar Rapids, Iowa on October 14, 2012:

Hi JudiBee. Another very good WW1 article. I think a lot of times those poor sods were suspected as malingering-- you know, if his limbs weren't blown off and he still had his head, he was viewed with suspicion. Thank god for good old Number Nine pills. I only went to a bingo game once in England (favorite: Legs 11 [wolf whistle]). Didn't understand Number 9 Doctor's orders. Now I do. Bless you for filling that in. Oh, and so the pills not only did nothing to help but then the soldier would be suffering in the mud and muck AND have the s--ts? You know, its stuff like that that keeps me from deifying the medical profession.