The Rise and Temporary Conquest of Trench Fever

From:  "The First World War: Disease the Only Victor,"  Lecture by Professor Francis Cox at the Museum of London, 10 March 2014

Shortly after the beginning of the war, a new syndrome appeared, soldiers reported with intermittent fever, headache and pain in the leg and bones lasting about five days; it was rarely fatal but recovery took about a month. The problem with this new disease, soon called trench fever, was not that it was fatal but that it was incapacitating which meant that the fighting force was, at least temporarily, reduced. 

Symptoms of Trench Fever (Lancet)

It took some time, and a lot of disagreement between medical bacteriologists and parasitologists including Sir David Bruce and Sir William Leishman, both serving army officers with distinguished records in the field of tropical diseases, and the military authorities before it was established that the condition was caused by a bacterium, Rickettsia quintana (now Bartonella quintana), and it was not until towards end of the war was it was realised that this disease was transmitted by lice. This realisation was of tremendous significance because, even if it could not be cured, it could be prevented with the use of insecticides such as naphthalene and creosote, and heat fumigation. 

This came far too late, however, and it is estimated that some 800,000—97 percent—of Allied troops were at some time infested with lice. [?Total seems low.] Infection with trench fever represented a massive loss of active manpower. Sir David Bruce later suggested that had this disease and its mode of transmission been recognised earlier, the war might have been considerably shorter. After the war, disinfection centres were set up at all the Channel ports and there was not a single case of trench fever among the civilian population of the British Isles and the disease was soon eliminated from the whole of Europe. 

On the positive side, this is widely regarded as one of the most successful medical campaigns in military history. Microbes do not give up easily, however, and the descendants of the bacterium that were seen for the first time in the trenches have cropped up recently among the poor and homeless in France, Russia, Japan, and, in the United States, in Seattle and San Francisco. It is now clear that this disease has the capacity to establish itself in conditions of crowding and malnutrition in refugee camps and areas of deprivation anywhere in the world and has the potential to become a very serious emerging disease.