Trench Fever and Lice in World War I
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 with 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 despite naming it, the doctors had no definite idea of what caused it. Only after the war was the cause discovered: 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 in close proximity 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 though, 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.
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 certainly wanted to be rid of the lice that infested their clothing. They called their unwelcome visitors "chats." "Chatting" took place on a regular basis, 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
- 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.
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 was also tried, but the problem was that there were not the facilities to treat all the uniforms with any regularity.
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 (see right). Pill No. 9 was a laxative beloved of the British Army doctor; it's doubtful that it did much to help a man suffering with a fever.
Not all men suffering with 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. It's likely that many of them were 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.
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 with 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 had found that up to 20% of homeless patients examined had been infected by the Bartonella quintana bacterium.