Recommended: The Gallipoli Gallop: Dealing with Dysentery on the "Fringes of Hell"

Dysentery Patients Being Evacuated at Gallipoli

By Steve Flint, Glyn Harper, and Nick Wilson

The Gallipoli campaign is a well recorded piece of New Zealand history,  particularly remembered every year on ANZAC Day. Dealing with the seemingly hopeless task of facing an enemy in well entrenched positions on higher ground was made even more challenging by the appalling conditions the soldiers had to face in terms of addressing basic survival needs and dealing with infections. A particularly burdensome part of the latter was dysentery.

Dysentery is an enteric infection frequently caused by Shigella bacteria, typically associated with unhygienic water supplies or contaminated food in developing countries. It is also caused by Entamoeba histolitica, an amoeba, but this is more common in the tropics. The type of dysentery facing the New Zealand troops in Gallipoli was most probably bacillary dysentery (or shigellosis) caused by the Shigella bacterium, most likely spread by contaminated water and/or food (with flies also playing a key role in this contamination).

There are four different species of Shigella: Shigella sonnei; Shigella flexneri; Shigella boydii; and Shigella dysenteriae. The first is the most common and the last produces the most severe symptoms. Shigellosis is typically associated with watery stools (diarrhoea), which may include blood and mucus. This is associated with abdominal pain, tenesmus, fever, and dehydration. Constipation and fatigue may also develop. The symptoms normally appear one to three days following infection and can persist for up to one week. According to the WHO, there are approximately 120 million cases of severe dysentery annually around the world, mainly in developing nations and generally affecting children.

Treatment is based on coping with the dehydration by drinking water; however, getting clean water would have been a challenge for the soldiers at Gallipoli. Getting enough water to combat dehydration is critical. In severe cases, where re-hydration is not possible, dysentery can be fatal. At least 200 of the deaths among the New Zealand soldiers at Gallipoli were from infectious diseases such as dysentery and typhoid. "Lack of clean water and sanitation in the trenches meant that diarrhoea and dysentery were common place, for the better-fed officers as well as the troops."

While there is evidence to show that the New Zealand soldiers at Gallipoli generally had sufficient food in terms of energy, the military rations were deficient in some micro-nutrients.. In particular the low intake of vitamin A may have contributed to the risk of becoming infected with dysentery and dying from it (given the role of vitamin A in immune function and protecting against infectious disease mortality). Furthermore, there were difficulties in getting sufficient water for the troops, largely due to the need to bring in the water across difficult terrain. "There was always a shortage of water and the possibility of no water at all. One pint of water a day was the usual issue." The official ration for New Zealand soldiers was somewhat larger at two quarts (2.3 liters) a day, but it still had to be used for all purposes: drinking, cooking and washing. Most went to make tea. As one New Zealand soldier wrote: "Water is worth its weight in gold here."

As the campaign progressed, the summer heat with the hordes of flies that came with it, when combined with the open latrines, inadequate diet and limited water supplies contributed to extremely high rates of dysentery on Gallipoli. By the end of May 1915, as the weather warmed and the flies appeared, the first isolated cases of dysentery occurred. By July a particularly virulent form of dysenteric diarrhoea had spread through the whole Allied army but was most serious at ANZAC Cove because of closely packed conditions there. The affliction was colloquially known as "the Gallipoli trots" or "the Gallipoli gallop." By August 1915, just prior to the great Allied offensive, 80 percent of the troops at ANZAC and Cape Helles had it.

This high prevalence of dysentery continued well into October 1915, until the cooler weather arrived. That month alone, 5000 men were being evacuated from Gallipoli each week through illness, with the most prevalent cause being the "Gallipoli trots." The whole situation was exacerbated by the preparation of food by individual soldiers in the trenches. Clearly, there were issues in dealing with basic hygiene. The following quote, paints a clear picture of what the conditions for food preparation were like. "The baneful system of individual cooking, then prevalent, would have ruined any ration however good; every man cooked for himself, every dug-out became a midden of fly contaminated food and food refuse." Flies were referred to in frequent reports, and they would have almost certainly helped in the spread of the disease.

The following excerpts from the diary of Major William McAra  help paint the picture of the scene at Gallipoli. McAra was a doctor from Gore, Otago, who arrived on Gallipoli with the Fifth Reinforcements in August 1915. By November he was feeling the effects of the restricted diet.

Been sick for three days–never ate a bit, felt savage & wanted to be left alone, just too much meat & tea & no potatoes or green vegetables.

6 November 1915

Two days later McAra was incapacitated with dysentery. He wrote in his diary:

Was very ill – had abdominal pain all afternoon which became so acute that hadn’t time to dodge for latrine with disastrous results. Sent for Sergeant & got him to carry me up on stretcher to 16th Casualty Clearing Station. There headache seemed worse & while they gave me bromides without avail while dysentery went on increasing. Had no sleep all night.

8 November 1915

Next day, with a temperature of 38.98 C [102.1 F] and constant bowel pain, McAra was evacuated from Gallipoli.

Fortunately, in subsequent campaigns in the First World War, the enteric disease burden for New Zealand soldiers was much less. Innovations such as typhoid vaccine probably helped, but there was also more scope for providing water and better sanitation systems on the Western Front. Even so, for many in the frontline trenches during the rest of this war, there were persisting threats to hygiene in terms of mud and rats.

Source: Microbiology Australia, September 2014