The Mutual Enemy of WWI

The first world war bought great suffering to many and not just as a result of military engagement at the war torn fronts of the conflict. Disease was rife across Europe and even those who remained on home soil didn’t escape the sickly grasp of illness.

Famously, in 1918, one of the most devastating outbreaks arose in the United States of America; odd perhaps then that it became known as Spanish Flu. In a time when secrecy meant everything many hierarchies of affected personnel refused to report the magnitude of the problem for fear of the enemy using the intel to their advantage. However, Spain was a neutral force and as such was able to be scrutinised by the media who could account the full scale of the problem, leading to a widespread belief that the outbreak originated in Spain. At its height, in July,  the Spanish flu  infected 46, 275 British soldiers serving in France, in the space of a single week, completely devastating the capabilities of an already stretched medical service. Things went from bad to worse when a second variant of flu met the first and mutated into a far more virulent strain. Many healthy individuals were struck down as their body overcompensated for the sudden appearance of the virus, resulting in a fatal haemorrhagic autoimmune response. It is estimated that 50 to 100 million people were effected world wide; 20% of Samoa’s population died and 17 million deaths occurred in India alone, the same figure as the total number of casualties during WWI. London witnessed unprecedented fatalities from an outbreak of influenza, totalling 13,000.

The culprit for this death toll was Influenza A subtype H1N1, experienced more recently with Swine Flu, a mutation of the human and  porcine variants. This pandemic remains in the minds of many and to those of us who experienced its impact it appeared incredibly severe. Yet only 14, 286 deaths resulted from this contagion, only slightly above those experienced solely in London 110 year earlier, which highlights the stark impact the 1918/19 pandemic had.

Recorded incidents of respiratory are vast and were also resultant of the damp conditions many soldier were forced to face. The prologue stalemate during the wetter months meant pneumonia, bronchitis and even TB weren’t uncommon. These were also often instigated in soldiers who had experience the terror of gas attacks. Airborne chemical weapons had long lasting effects on top of recurrences of those listed above, such as asthma, COPD, bronchiectasis, not to mention the devastating effects on the skin and eyes. Anything from everyday complaints like epiphora and conjunctivitis to debilitating carcinomas were stacked on top of already suffering soldiers.

For the men in the trenches, horrors were to be found around every corner and even the ‘comfort’ of your own trench didn’t keep you free from infection and infestation. Of all the medical conditions the soldiers on the western front suffered ‘Trench Foot’ is by far the most notorious. Caused by long exposure to cold and wet conditions the foot undergoes a series of changes before suffering from necrosis, where the tissue hardens, blackens and begins to decay. Although short periods of exposure to the optimum conditions can cause trench foot, such as waterlogged festival sites, the western front’s stagnated style of warfare was perfect for the onset of numbness, erythema, cyanosis and eventually gangrene. Another necrotising infection frontline soldiers sometimes experienced was  ‘Trench Mouth’, or acute necrotising ulcerative gingivitis to give it its full medical name. A build up of bacteria on the gums leads to ulceration and severe decay of tissue. Although nothing about the physical and environmental conditions of the trenches would have facilitated the development of the condition it is believed the psychological effects payed a considerable part, which also explains the high number of trench mouth cases noted in populations that suffered continual air raids during the second world war.

Personal hygiene in the trench wasn’t top of the agenda so it isn’t surprising to know that infestations of human body lice was common place, bringing with it ‘Trench Fever’, or pyrrexhia, a rarely fatal infection causing severe fatigue and anaemia.  Despite its name the infection wasn’t confined to the western front and was found in practically every theatre of war. It is likely responsible for many of the recorded occurrences of neurasthenia in soldiers’ service records. Despite significant anti-lice treatment programs and development of delousing stations the problem of pediculosis was so severe that media speculation was often brushed under the carpet and the details were kept out of public view in fear it would deplete moral and affect  the willingness of people to get involved in the war effort. The human body louse, known colloquially amongst soldiers as a chat, was also responsible for spreading Typhus amongst the ranks. Typhus causes severe fevers and headaches, culminating in meningoencephalitis, and is accompanied by a rash. Although Typhus was prevalent on the Western Front it was on the Eastern front where the disease took its toll. In Serbia alone there were 150,00 deaths from Typhus, a death rate of approximately 40% of those infected. The delousing stations seen on the western front did not materialise in the East and many of those caring for the sick became ill as the lice or fleas spread amongst the overcrowded treatment facilities.

Across all theatres and styles of warfare, dysenteric infections were an everyday occurrence. Human waste mingled with living areas and contaminated drinking water; fresh water was hard to come by and sanitation was often an afterthought. Fatal bouts of diarrhoea, sometimes haemorrhagic in nature, are record in the service records of every nation that took part in the war. Outbreaks of cholera and typhoid hit hard and fast and infection spread like wildfire as these unsanitary conditions continued unchecked. The medical services were fraught enough treating wounded soldiers and ever increasing rates of highly contagious infections pushed them to breaking point. There simply wasn’t the staff to treat everyone and certainly not enough time to take preventative action.

For those soldiers serving in the Middle East, Asia and North Africa, along with Italy, Greece and the Macedonian front, Malaria was a very real threat. Similar to trench fever in its cyclical nature, malaria is spread by mosquitos who would have been attracted to many activities carried out by the military. ‘Digging in’, and digging for water, would have been the biggest action that assisted in the potential for an epidemic, such as the one that occurred in Macedonia in 1916/17, which hospitalised over 1800 British soldiers and caused the deaths of 587. Malaria also posed a risk to the general populace in Britain as infected soldiers returned home, possibly accompanied by hitchhiking mosquitos. Soldiers returning form areas where malaria was endemic were banned by the Ministry of Health from being stationed in Kent and parts of Sussex as the wetland environments here would have made managing the spread of the disease impossible. By the end of 1918, 34,000 infected soldiers returned to the wider London area causing 500 fresh ‘imported’ cases of malaria. A further  3, 216 cases of malaria were identified at the London General Hospital by the end of 1919; the last malaria epidemic to occur in the British Isles.

Some people have commented that disease was the only real winner of the first world war. This isn’t hard to understand when you consider how previously unexperienced disease traverse across Europe and decimated populations of soldiers and civilians alike. It unnerving  to realise that although this is a brief account of some of the most common medical conditions experienced by those who served during and lived through the first world war it is in no way an exhaustive list. Diphtheria, measles, mumps and even small pox played their part alongside countless other autoimmune, immunodeficient, inflammatory, hypersensitive, sexually transmitted, airborne, foodborne, waterborne, viral, bacterial and parasitic infectious and physiological diseases.