Although no one knows the exact numbers, it’s estimated that between half a million and a million Allied soldiers in World War I suffered from Trench Fever. Today, Trench Fever cases are rare, but they’re making a bit of a comeback among the growing populations of homeless.

In 1915, medical officer Maj. J.H.P. Graham wrote that “the patient’s condition on admission was marked by frontal headache, dizziness, severe lumbago, a feeling of stiffness down the front of the thighs and severe pains in the legs referred chiefly to the shins.”

The most remarkable feature of this infection was the relapsing fever. It was a combination of symptoms he hadn’t seen before. Trench Fever was recognized as a unique disease in 1916. Then came the search for a cause.

Trench Fever’s relapsing fever reminded Capt. T. Strethill Wright of malaria, and he thought it could be spread by one of the flies or parasites infesting the trenches. He suspected it was the common body louse because the fever was common in the winter months when there were few flies or mosquitoes. By the end of 1916, most were convinced that the louse transmitted Trench Fever, but nobody had definitive proof.

In the middle of 1917, the British set up a committee to study Trench Fever in France, coordinating with Americans to find the cause. They determined that the fever spread via louse feces, and American investigators working in France discovered a novel type of organism in the blood. In 1918, scientists isolated the bacterium that caused Trench Fever, now called Bartonella quintana.

In 2019, the number of homeless around the country increased by 3 percent, the third yearly increase in a row. The impact of COVID-19 on these trends remains to be determined.

It’s not surprising that a number of diseases arise in this population that are rare in those that are adequately housed. Because of poor living conditions and limited access to health care, homeless persons are exposed to many infectious diseases. Data suggests that many diseases are prevalent among the homeless, like HIV, hepatitis B virus, hepatitis C virus, active tuberculosis, scabies and body louse infestation. B. quintana infection is the most common louse-borne disease in urban homeless populations.

B. quintana is carried by the human body louse, P. humanus corporis, which lives in clothes and bedding. The bacterium lives in the intestine of the louse and spreads through the louse feces to infect people with wounds or open sores on their skin. The fever begins two to three weeks after infection and lasts up to three days. The fever recurs every four to six days with each succeeding attack less severe. Some infections can last up to eight years, and some can also develop a potentially fatal inflammation of the heart lining called endocarditis or affect heart valves and require surgery to fix.

Today, Trench Fever is a disease associated with homelessness, war and refugee camps — another reason to eliminate these things from our world.

Medical Discovery News is hosted by professor emeritus Norbert Herzog, and professor David Niesel of the University of Texas Medical Branch. Learn more at


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