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Trench Fever

1911 Encyclopedia Britannica

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Medical warning!
This article is from the 1911 Encyclopaedia Britannica. Medical science has made many leaps forward since it has been written. This is not a site for medical advice, when you need information on a medical condition, consult a professional instead.

"TRENCH FEVER. - Early during the World War, in 1915, it was noticed that a large number of soldiers in France and Flanders were falling victim to a disease the nature of which was not clearly understood. It was an infectious disease because men were affected who shared the same tents, huts or billets. It bore some resemblance to rheumatism in that pain in muscles and bones was a prominent symptom. It was also rather like influenza except for an absence of nasal catarrh.

The disease at first was given many names. Thus cases were called " P.U.O.," an army term meaning " pyrexia of uncertain origin." They were also called " rheumatism " and " influenza " and " myelitis " and " lumbago." If the cases were seen at a late date when palpitation and breathlessness had become prominent, they were often called " cardiac neurasthenia " or " disordered action of the heart" (" D.A.H.").

Soon, however, it was felt that these diagnoses were inaccurate and a serious attempt was made to study the disease. The earliest contributions to its literature were made by Dr. J. W. McNee, and others who worked with him. Afterwards several Trench Fever Committees were formed by the British medical authorities. One of these worked in connexion with the American Red Cross; another, known as the " War Office Trench Fever Committee," had a hospital in Hampstead. This Committee was presided over by Sir David Bruce; the director of its research work was Col. William Byam. Both Committees infected volunteers and the conclusions reached, though they differed on points of detail, were substantially the same.

Trench fever is a louse-borne disease. The lice do not become infectious at once after feeding on a trench-fever patient; there is a latent period of some 8-12 days before they are dangerous to other people. Thereafter the excreta of the lice, rather than their bites, are infective. If these infective excreta be rubbed into a scratch or scarification trench fever develops in about eight days. The importance of this discovery about the excreta lies in the fact that persons may contract the condition who have never had lice upon them. The excreta is a dry powder, easily blown about, and so apt to reach the clothes. It remains infective for long periods and even when exposed to sunlight. Water on the other hand seems to diminish its infectivity quickly.

The blood of trench-fever patients is infective to other patients when injected into their veins. Thus the parasite circulates in the blood. The parasite is also in the louse excreta. It has not, however, so far been positively identified, though there is a certain amount of evidence, that it is one of the so-called Rickettsia bodies. In this connexion the names of Dr. G. A. Arkwright and Prof. A. W. Bacot must be mentioned.

The disease is protean in its manifestations. A proportion of the cases begin suddenly with great muscular weakness and exhaustion, headache, furred tongue and blood-shot eyes. Other cases come on gradually, the above symptoms increasing daily in intensity. The patient feels very ill and usually develops a temperature-rise to 102°F. or 103°F. Various types of temperature have been described. In some instances there is but one wave lasting two or three days; in other instances a " saddle-back " curve is shown, the temperature falling slightly and then rising again. Some patients relapse definitely on the fifth day, others about the eleventh day. Others again relapse at irregular intervals for long periods, each relapse giving a " spike " of temperature of short duration.

In a few cases there is no rise of temperature. Thus three volunteers were infected with the same batch of louse excreta. All of the three developed symptoms of trench fever but in one instance the temperature remained normal. Yet lice, subsequently fed on this patient, were able to transmit the disease to other volunteers all of whom developed rises of temperature. (For similar disease-carrying by body-lice see Typhus Fever.) The skin pains of trench fever are characteristic. They do not as a rule appear until a few days after the onset. They are of a boring, gnawing character and may be so violent that the patient cannot even bear the weight of the bed clothes. Again they may be very slight or absent.

The diagnosis is easy in early cases but the disease tends to run a very chronic course. In one case a patient labelled as a " neurasthenic " was found to infect lice four years after his initial attack.

A percentage of patients become chronic invalids, others develop symptoms of functional heart trouble, others have nervous symptoms. It is probable that all these patients remain infected. The most reliable signs on which a diagnosis can be founded in the chronic stage are: (I) the patient's history, especially the state of his health before and after the initial attack; (2) the nature of his relapses; (3) the tenderness commonly met with on gently pinching the skin of the front of the leg (over the tibiae); (4) the presence of heart or nervous complications, e.g. breathlessness on exertion, pain, palpitation, gross tremor, etc.

The treatment is very unsatisfactory. At present no drug is known which will end the condition as quinine will end malaria. Thus it is necessary to attempt to build up the patient's strength against his infection. He should if possible lead an open-air life, he should have exercise, good plain food and cheerful surroundings. Some authorities lay stress on the value of thyroid, gr. 2 daily, in these cases. Others believe in iron tonics. Recent observations have suggested that the muscular weakness which follows the disease prevents the proper opening of the chest in respiration and so interferes with the suction action of the opening chest on the great veins. On this account the wearing of an abdominal belt has been recommended. It causes the patient to breathe with his chest and so tends to the restoration of thoracic movement. The disease is very disabling and its marked tendency to relapse makes it very distressing to the victim, who can never count on his health. Change of weather and wet weather seem specially to conduce to relapses. (R. M. WI.)