Trench Diseases of the First World War

Introduction to the Western Front

The establishment by the belligerent nations, in late 1914, of a complex line of trenches stretching almost 500 miles (800 km) from the North Sea to the Swiss Border, brought with it an extraordinary concentration of millions of men from many nations and cultures. These men were suddenly thrust together in an amazing troglodyte existence - trench warfare - with a climate that ranged over the year from the balmy to the ferociously cold. Additionally, everywhere was well doused by frequent rainfall and affected by seasonal snowfall and frost. Northern France and Flanders could be particularly wet and inhospitable. Throughout history, even relatively small concentrations of the military have suffered from outbreaks of disease, ranging from the discomforting to the catastrophic. These outbreaks were particularly associated with static warfare such as sieges, or over-wintering in encampments. Epidemics of typhus, malaria, typhoid (the infamous enteric fever), diarrhoea, yellow-fever, pneumonia and influenza, generously amplified by innumerable cases of venereal disease, scabies and the like, routinely wreaked vastly more casualties on these armies than those wrought by the engines of war; be it the bow and arrow or the H.E. shell. The Western Front proved to be no different. However, there were three diseases - the so-called 'Trench' diseases - that became of particular importance on the Western Front during the four years that the war lasted and which gained the permanent prefix 'Trench'. All three of these diseases had previously been recorded in many campaigns, but never on the scale of the Western Front where at times fears were expressed by the High Command that these diseases could have a serious effect on the prosecution of the war. Moreover, to a large extent, the general public then, as now, were largely in ignorance of the dreadful drain these diseases wrought on the morale and fighting efficiency of the troops at the front. Part of this was the general attitude of the time whereby the troops sought to spare their relatives, and the people back home, from such 'sordid' details, and the other part from the wish of the Allied High Command to play down the importance of these diseases from both a strategical and morale point of view. As the war progressed many civilians heard about these peculiar diseases which occurred in the trenches, but their knowledge about them went little beyond this.

Trench Foot during the first world war

Once the trench lines were established in late 1914, and the first winter of the war took hold, it quickly became apparent to the British High Command that the hastily dug trenches were subject to flooding and were breaking down into quagmires of mud and water. The virtual immobility of the soldiers in the trenches meant they were forced to spend long hours with their feet exposed to the wet and cold: the British Army ammunition boot was made of leather and not effectively waterproof. In the early days of trench warfare there was often little possibility of drying out, or even changing socks. After some hours, or days, of continuous exposure to the wet and cold, the skin of the soldier's feet became both waterlogged and chilled. The circulation of the blood became restricted and the affected feet became very painful. If these conditions of immersion and chilling continued, the skin began to break down. The feet became swollen, blisters formed and eventually they became numb from nerve damage. Over time, the skin could become infected by fungus. If this situation wasn't quickly resolved by drying out of the skin and the circulation re-established, gangrene could ensue. In the worst cases, amputation became necessary. The early rash of Trench Foot casualties - over 20,000 were recorded by the British on the Western Front in the winter of 1914/15 - stimulated preventive action. In many units frequent foot inspections of the troops were carried out by Regimental Medical Officers and additional pairs of dry socks made available to the infantry so they could be changed several times a day. Whale oil was rubbed into the feet as a team effort whereby soldiers would vigorously apply it to each other's feet. In this way the circulation was stimulated, whilst, hopefully, the whale oil would help to avert the waterlogging of the skin. By the nature of the war, the Germans were generally able to retreat to the higher land and thus their trenches were better drained than those of the British. Moreover, the German military philosophy was for at least semi-permanent fortifications, with the detailed planning and execution of their construction that this permitted. To the contrary, the British only had in mind temporary structures, as their over-riding principle was to forge forward into enemy territory at the first possible opportunity. According, the British were obliged to achieve more efficient drainage, issue waterproof gum-boots/waders to some of the more seriously affected areas and generally install elevated duck-boards to keep the men's feet dry. The so-called wooden inverted 'A Frame' proved particularly efficient at supporting the duck-boards above water level, and was widely used throughout the British trench system. All these measures were intended to offer a combined degree of protection to the soldiers in the trenches and, indeed, as the war progressed the incidence of Trench Foot in British troops progressively declined. The total recorded cases of Trench Foot for the British in the Great War were 74,000. However, it is thought many other cases either went unrecorded - in many units it was a chargeable offence to neglect the feet - or were misreported.

Trench Fever on the Western Front

As previously stated the disease epidemic typhus (causative organism Rickettsia prowazekii) has always been the bane of armies both in the field and in barracks. The human louse - Pediculus humanus (sub-spp. corporis, the body louse and capitis, the head-louse) - is the vector of the disease. Pediculus was rife in the trenches of the Western Front. It was the cause of much discomfort to the troops who found it almost impossible to get rid of them. Shaving the head and removing moustaches and beards would largely control the head louse, but the body louse, that hid away in the folds, creases and pleats of their uniforms - only emerging to feed - was a far more difficult problem; particularly in cold weather, when it was difficult to shed clothing. However, despite the prevalence of the body louse in the trenches of the Western Front there was no significant outbreak of epidemic typhus; although there was a serious epidemic in Serbian and Austrian troops on the Eastern Front in 1915. However, the body louse did cause another disease that became to be known as 'Trench Fever'. This organism (Rickettsia quintana), which is closely related to epidemic typhus, was transmitted by the scratching of the skin that forced the infected faeces of the louse into the lesions caused by the lice bites. The Rickettsia quintana infected faeces could remain infective for weeks. The body louse was infected by biting a soldier suffering from Trench Fever. The infected soldier did not show any signs, or symptoms, for anything from a week to a month, when a severe head-ache developed with debilitating muscle pains; characteristically of the shins - hence the commonly used alternative name 'Shin-bone Fever'. With a duration of around five days (hence the quintana in Rickettsia quintana = five days), the fever went into remission and often reoccurred (relapsed) one or more times. Twelve such debilitating remissions/reoccurrences have been recorded. There was no effective treatment for Trench Fever other than bed-rest (today, antibiotics would be used), and although the disease was generally much more benign than epidemic typhus, serious depression was a common complication. Accordingly, though fatalities were exceedingly rare, as many as 80% of men with the disease remained unfit for duty for up to 3 months. In the duration of the war, 800,000 cases of Trench Fever were recorded in the British Army, with comparable numbers for the other combattant nations. In manpower terms it was an exceedingly important disease for all the armies. Nevertheless, for many front-line soldiers it must have provided an uncomfortable, but welcome break, from the incomparable rigours and dangers of the Front. Since there were no effective measures for the treatment of Trench Fever, (the causative organism wasn't identified until 1918) the military authorities were restricted to trying to reduce the infestation of the men by the human louse. Obviously, fumigation, hot baths, laundries and frequent changes of heat-sterilised clothes and bedding were the essential requirements. But equally obviously, conditions in the front-lines made the achievement of these aims exceedingly difficult, and it was only in the 'Rest Areas' that these facilities could be established on any realistic scale; as they were as the war progressed. Later on in the war, primitive insecticides (napthalene, creosote and iodoform) were used with some effect, although the side effects of these insecticides on the troops themselves must have made their reception not unconditionally enthusiastic.

Trench Mouth on the Western Front

The third of the 'Trench' diseases - 'Trench Mouth' - was rather more benign than the other two but, no doubt, distressing enough. Particularly, when the majority of the front-line troops were in their teens, and twenties and, despite the dangers they faced, well aware of the importance of their attractiveness when they would eventually, at some point, again come into contact with the opposite sex. The name of the disease is rather a mouthful in itself, and rather threatening: Acute Necrotizing Ulcerative Gingivitis. It was brought about by a malign overgrowth of normal mouth-dwelling bacteria (Bacillis fusiformis) and spirochaetes (Borrelia vincentii), which attacked and eroded the gums, causing bleeding, ulceration, sloughing off of the gum membranes and particularly bad breath. The ensuing gum pain was such that eating, swallowing, and even talking, was frequently difficult. Often painful swellings in the glands in the throat and neck occurred. The cause of the complaint was a combination of: poor oral hygiene, physical/emotional stress, poor diet, lack of rest and heavy smoking. All essential elements of life in the trenches on the Western Front in the Great War . Treatment was palliative: removal of the source of stress, rest, good mouth hygiene, reduction in smoking and a balanced diet; all of which remained in short supply throughout the duration of the war.

Postscriptum

The plethora of tooth-less ex-soldiers in the decades after the Great War was, no doubt, much to do with the damage that this condition wreaked on the men in and around the trenches. 

Article by Dr David Payne

[This article first published in a previous version of the Western Front Association website: 22 May 2008]