During the Great War, soldiers on both sides had common enemies at the frontlines. Those enemies included typhus and its relative, trench fever. In Serbia, a typhus epidemic decimated the civilian population and the country's army; on the Western Front trench fever incapacitated large numbers of soldiers on both sides.
In November 1914, about four months into the war, typhus struck with unprecedented deadliness in Serbia. This was not the first typhus outbreak in history, and not the first during a war. A typhus epidemic was first recorded in the Spanish siege of Granada in 1489.1 The Serbian outbreak was, however, the worst in history, producing a record mortality rate among those infected of 70% at its peak.2
The disease Rickettsia Prowazeki, or typhus, is a bacterium transmitted from human-to-human through the vector of the common body louse Pediculus humanus. Symptoms include high fever, headaches, chills, numbness, body pains, prostration, delirium, and in extreme cases, coma and cardiac arrest, likely leading to death.3 In fact, its name is derived from the Greek word for "stupor," due to the delirium infected individuals experience.
Although the disease would spread from Serbia to adjacent Balkan countries, it was first reported among Serbian civilian refugees displaced by the initial Austrian invasion in 1914, and the Serbs would suffer the most.
That lice, commonly called "cooties," were somehow to blame for typhus was known at the time. "If there is any typhus about, the 'cooties' spread it," one writer reported shortly after the war. "Under modern conditions, typhus is almost wholly a war disease. When large numbers of soldiers carrying typhus-bearing 'cooties' travel through a country and are quartered with the population, conditions are ideal for a typhus epidemic. This was just what happened in Serbia late in 1914."4 The lice were a nuisance even without the threat of typhus, as they cost soldiers considerable time removing them from their bodies.5 But the threat of typhus made their removal essential because adults suffered the effects of typhus more than did the young.6
The bacterium enters the human host when he scratches or rubs the lice on his skin. This opens the skin just enough for the bacteria, which is found in the excreta or crushed bodies of infected lice, to enter the host. During an eight- to twelve-day latent period—an asymptomatic period between exposure to disease and the first symptoms—the bacteria multiply in the host's stomach. Lice become infected when they bite an infected host. The lice, too, will die from typhus. Regular bathing and changes of clothing help prevent the spread of the disease, but on the frontlines, both of these otherwise common practices were seldom possible.
Ironically, the same outbreak of typhus that was decimating Serbian soldiers and the Serbian civilian population also served to help the Serbs. The Austrians, who had mounted three deadly, though repulsed, invasions of Serbia in 1914, chose to postpone a fourth invasion because they were fearful of contracting typhus during the Serbian typhus epidemic. Austria and Germany even took the precaution of initiating a program of heavy delousing among their troops.7
Ten months passed before Serbia was invaded again in October 1915—this time not only by Austrian, but also by German and Bulgarian forces. Serbia's ability to repel invasion was by then critically weakened by the loss of manpower in the previous year of fighting and the crippling typhus epidemic which, from January to June 1915, had claimed about 150,000 civilian and military lives.7
In some respects, the human cost of the war was greater for the Kingdom of Serbia than it was for any other nation that participated in WWI. Combat, famine, and disease, especially typhus, had taken a terrible toll. About 700,000 civilians and 300,000 military personnel were dead, twenty-five percent of Serbia's population—and nearly 60% of the male population. Only 100,000 Serbian soldiers remained of an army that was, at its peak, more than four times larger. More than 25% of Serbia's military personnel died in the war. To put the human loss in perspective, France, where almost all the Western Front fighting took place, was next in terms of percentage of loss, with about 17% of its military killed.
For unknown reasons typhus did not strike significantly on the Western Front, though trench fever, a relative of typhus, became a comparable threat. Never before medically recorded, this disease became obvious in 1914, the first year of the war, when it reached epidemic proportions on the Western Front, eventually affecting about one million soldiers.8 British Major J. H. P. Graham was the first to note the characteristics of the disease in 1915, but he could not identify the vector. It was not until August 1918 that an American research team in France identified the common body louse as the transmitting agent for trench fever, as it was already known to be the vector for typhus.9
Trench fever—Rickettsia Quintana, or Bartonella Quintana—received the name of Quintana due to the cyclical five day periods of sickness, remission, and recurrence. The disease is known for its short symptomatic periods but numerous relapses. Symptoms included a sudden onset of fever, headache, sore muscles and joints, characteristic shin pains, and outbreaks of skin lesions on one's chest and back. Unlike typhus, few actually died from trench fever. Nonetheless, 80% of soldiers fighting on the Western Front were unfit for duty for three-month periods, the typical length of the disease's cycle.10
Because the disease was believed to be new at the time, lice were not yet suspected as the vector, so no one knew how to stop the disease from spreading. Soldiers commonly removed lice as part of their hygiene, but any effective impact on the spread of trench fever would have required coordinated and comprehensive delousing programs. The doctors and medics on the Western Front did their best to treat the soldiers' symptoms, but they were unable to prevent or cure the disease.
New technologies indicate that the Western Front in WWI was not the world's first outbreak of trench fever. Modern DNA techniques indicate that in 1812 Napoleon's Grand Army suffered trench fever at Vilnius, Lithuania. Bartonella Quintana is evident in a human tooth which was found in Roaix, France, and is dated to c2000 B.C.E.11
By causing the Austrians to delay an invasion of Serbia, typhus impacted the course of the war in the Balkan Peninsula, just as on the Western Front trench fever affected the course of the war by incapacitating one million soldiers who otherwise would have been in the fight. To what extent did trench fever and typhus affect the course or the outcome of the war? Though that question may remain unmeasureable, perhaps an ultimately greater question may be whether bacteria are variables in man's effort to control the earth, or whether humans are variables in bacteria's effort to control the earth.
- 1R L Atenstaedt, "Trench Fever: The British Medical Response in the Great War," The Journal of the Royal Society of Medicine (20 March 2013): ncbi.nlm.nih.gov.
- 2David W. Tschanz, "Typhus Fever on the Eastern Front," MSU Entomology Group (27 November 2012): entomology.montana.edu.
- 3"Typhus," PubMed Health, National Center for Biotechnology Information (27 Nov. 2012): ncbi.nlm.nih.com.
- 4Homer Folks, "War, Best Friend of Disease," Harper's Monthly Magazine (New York: Harper & Brothers, 1920): 455-456: books.google.com.
- 5Winston Groom, A Storm in Flanders: the Ypres Salient, 1914-1918: Tragedy and Triumph on the Western Front (New York: Atlantic Monthly Press, 2002), p.175.
- 7Spencer Tucker, ed., The Encyclopedia of World War I (5 Vols; Santa Barbara, California: ABC-CLIO, Inc., 2005), Vol. IV, p. 1079.
- 8M. G. Miller, "Of Lice and Men: Trench Fever and Trench Life in the AIF," The World War I Document Archive (27 Nov. 2012): gwpda.org.
- 11Alfred Scott Lea, "Trench Fever," Medscape (March 20, 2013): emedicine.medscape.com.