Cause of Death - Trench Nephritis

[Neil Clark]

I have seen many references to TRENCH Nephritis in my new reference book. Can anyone please tell us all exactly what this was? Perhaps it was merely the phrase used to describe soldiers who contracted Nephritis whilst serving in the trenches?

Many Non-Coms have Nepthritis as the cause of death on their death certificates. It would seem that even these days the medical experts still don't know what exactly causes this life threatening condition. This bodes well for non-coms because if they can't state the causes, the non-com should ALWAYS be given the benefit of any doubt.

I know that ordinary Nephritis was Kidney problems -

Nephritis is inflammation of the kidney. The word comes from the Greek nephro- meaning "of the kidney" and -itis meaning "inflammation". Nephritis is often caused by infections, toxins, and auto-immune diseases.

Subtypes

* glomerulonephritis is inflammation of the glomeruli. (Often when the term "nephritis" is used without qualification, this is the condition meant.)

* interstitial nephritis or tubulo-interstitial nephritis is inflammation of the spaces between renal tubules.

* pyelonephritis is when a urinary tract infection has reached the pyelum (pelvis) of the kidney.

* Lupus nephritis is an inflammation of the kidney caused by systemic lupus erythematosus (SLE), a disease of the immune system.

Nephritis is the most common cause of glomerular injury. It is a disturbance of the glomerular structure with inflammatory cell proliferation. This can lead to: reduced glomerular blood flow leading to reduced urine output (oliguria) & retention of waste products (uremia). As a result, there can also be leakage of red blood cells from damaged glomerulus (hematuria). Low renal blood flow activates the renin-angiotensin-aldosterone system (RAAS), which therefore causes fluid retention and mild hypertension.

What is Nephritis?

Nephritis essentially involves the inflammation of the kidneys. It is the responsibility of the kidneys to filter out waste and excess fluid from the body, and when swelling occurs, their ability to filter properly is reduced. When this happens, the body accumulates both excess water and waste in the blood stream, while blood and protein are lost in the urine.

Because nephritis is a general term used to describe any kidney inflammation, the outcome and severity are entirely dependant on the underlying cause. In some cases, nephritis goes unnoticed and may not cause any serious problems. In other cases, nephritis is very serious and may lead to kidney disease such as glomerulonephritis, inflammation such as lupus nephritis, infections such as pyelonephritis, or even kidney failure in severe cases.

Diagnosing Nephritis

The first clues to nephritis may be your symptoms, but this is not always the case. For many people, nephritis is only discovered during a routine urine analysis test.

Doctors may be alerted to the fact that results come back with abnormal levels of blood or protein in the urine. In addition to a full urine analysis, your doctor may advise additional tests.

What Causes Nephritis?

Nephritis is essentially a general term with multiple causes, and in some cases the cause remains unknown.

* Post-infection with nephritogenic strains of group A beta-haemolytic streptococcus (typically occurs in children)

* Any of the other causes of glomerulonephritis

o Other bacterial infections - e.g. typhoid, secondary syphilis, MRSA infection, pneumococcal pneumonia, infective endocarditis

o Viral infections - e.g. hepatitis B, mumps, measles, infectious mononucleosis, varicella, coxsackievirus

o Parasitic infections - e.g. malaria, toxoplasmosis

o Multisystem systemic diseases - e.g. systemic lupus erythematosus, vasculitis, Henoch-Schönlein purpura, Goodpasture syndrome, Wegener granulomatosis

o Primary glomerular diseases - e.g. Berger disease (IgA nephropathy), membranoproliferative glomerulonephritis

o Guillain-Barré syndrome

o Diphtheria-pertussis-tetanus vaccine

Treatment

The treatment of nephritis is entirely dependent on the underlying cause of the condition, the severity of the condition, and whether it is acute or chronic. Acute nephritis, especially that following a strep throat infection, usually disappears in time with no specific treatment.

Apart from treating the underlying cause, the main aims of treatment are to reduce inflammation, limit the damage to the kidneys, and help support the body until the kidneys return to normal functioning.

Your doctor may suggest that you reduce salt and protein intake, and possibly lessen daily fluid intake. Bed rest may be necessary, and you may be prescribed a number of prescription medications.

CAUSES OF DISABILITY AMONG BRITISH FIRST WORLD WAR PENSIONERS

Wounds and Amputations 324,722 (38%)

Tubercolosis (TB) 65,370 (7.6%)

Respiritory Diseases 55,383 (6.5%)

Organic Diseases of the heart 31,502 (3.7%)

Functional Diseases of the heart 44,855 (5.2%)

Neurasthenia 58,402 (6.8%)

Malaria 44,749 (5.2%)

Rheumatism 33,908 (4%)

Ear Diseases 23,722 (2.7%)

Phychosis 13,030 (1.5%)

Dysentery 8,025 (0.9%)

Nephritis 15,837 (1.8%)

Other accepted causes 135,933 (15.9%)

TOTAL ALL DISABILITIES: 855,488

[HarryBettsMCDCM]

Link To Australian Govt Report on Trench Nephritis

Glomerulonephritis Link

This might help!!

[Neil Clark]

Fabulous link Thanks very much -

Trench Nephritis

An obsolete term for glomerulonephritis occurring in soldiers subjected to cold and damp conditions in trenches.

Diseases such as trench fever (an infection caused by louse faeces), trench nephritis (an inflammation of the kidneys), and trench foot (the infection and swelling of feet exposed to long periods of dampness and cold, sometimes leading to amputation) became common medical problems, and caused significant losses of manpower.

Around the 90-year anniversary of the Battle of the Somme, it is important to remember the international effort that went into responding to the new diseases, which appeared during the First World War, such as trench nephritis. This condition arose among soldiers in spring 1915, characterized by breathlessness, swelling of the face or legs, headache, sore throat, and the presence of albumin and renal casts in urine. It was speedily investigated by the military-medical authorities. There was debate over whether it was new condition or streptococcal nephritis, and the experts agreed that it was a new condition. The major etiologies proposed were infection, exposure, and diet (including poisons). Research pointed to the origin of the disease as being infective rather than toxic, but no definite cause was discovered. A number of labels were given to the disease, including war nephritis. However, trench nephritis was the one used most widely. Trench nephritis was a serious problem for the Allies, leading to 35 000 casualties in the British and 2000 in the American forces. There were also hundreds of deaths. The condition was treated in line with pre-war regimens designed for acute nephritis. No significant preventative methods were implemented for trench nephritis, as there was no consensus regarding causation. The medical response to trench nephritis was largely ineffective, with medical commentators recognizing that there had been a lack of medical progress.

trench fever

A louse-borne disease first recognised in the trenches of world war i, again a major problem in the military in world war II, seen endemically in mexico, n. Africa, e, europe, and elsewhere. The cause, rochalimaea quintana, is an unusual rickettsia that multiplies in the gut of the body louse. Transmission to people can occur by rubbing infected louse feces into abraded (scuffed) skin or conjunctiva (whites of the eyes). Onset of symptoms is sudden, with high fever, headache, back and leg pain and a fleeting rash. Recovery takes a month or more. Relapses are common. Also called wolhynia fever, shin bone fever, quintan fever, five-day fever, meuse fever, his' disease, his-werner disease, werner-his disease.

trench foot

immersion foot

A condition of the feet produced by prolonged exposure of the feet to water. Exposure for 48 hours or more to warm water causes tropical immersion foot or warm-water immersion foot common in vietnam where troops were exposed to prolonged or repeated wading in paddy fields or streams. Trench foot results from prolonged exposure to cold, without actual freezing. It was common in trench warfare during world war I, when soldiers stood, sometimes for hours, in trenches with a few inches of cold water in them. (andrews' diseases of the skin, 8th ed, p27)

[hillgorilla]

Thought that you may find this interesting.

1: Am J Kidney Dis. 1986 May;7(5):355-62.Links

Trench nephritis: a retrospective perception.Maher JF.

An epidemic of nephritis occurred among soldiers in World War I, predominantly those in the trenches. Characterized by the sudden onset of albuminuria, hypertension, edema, and dyspnea, atypical features such as bronchitis, an evanescent course, low early mortality, and frequent relapses distinguished it from poststreptococcal glomerulonephritis. Pathologic features included glomerular ischemia, capillary thrombi, endocapillary proliferation, and frequently epithelial crescents, suggesting an underlying vasculitis. The cause was not established, but a postinfectious, possibly postviral, etiology seems most plausible. Trench nephritis was the major nephrologic problem of World War I, accounting for 5% of medical admissions and more than 10% of military hospital bed occupancy at that time.

PMID: 3518420 [PubMed - indexed for MEDLINE]

The CMAJ also has some info, all be it from the time -

Can Med Assoc J. 1916 April; 6(4): 348–350.

[Neil Clark]

I think that we can safely say that if you find a potential non-com who died as a consequence of any kind of Nephritis (sometimes refered to by doctors as Bright's Disease), it's certainly worth moving forwards on the basis that the service authorities during the Great War fully accepted that this condition was caused/aggravated in some part by a mans war service - namely his exposure to wet and cold conditions in trenches and other external fortifications. Indeed from what I can see, modern medical opinion still supports this decison.

I shall concentrate next on Respiritory Conditions resulting from gassing and exposure to inclement weather (wet and cold).

I don't want the non-com sub forum to degenerate into a medical forum, but clearly the diseases I am concentrating on in these threads directly concern illnesses that many non-coms died from.

I have come accross many instances in the past where cases were ABORTED after it was established they died from one of these illnesses or diseases. If I can stop this happening in the future then it's worthwhile.

I hope these threads are useful to those out there interested in the non-com problem?

[Neil Clark]

Fred,

Here is that thread I was refering you to regarding Kidney Disease. I suggest you copy the content here and use it with your man. The more evidence you provide the better. If you have a problem lifting it, let me know and I will email the content to you in MS Word format.

[Doc2]

A good discussion of this is found in the medical journal

Kidney International (2006) 70, 635–640.

The medical response to trench nephritis in World War One By R L Atenstaedt

ABSTRACT

Around the 90-year anniversary of the Battle of the Somme, it is important to remember the international effort that went into responding to the new diseases, which appeared during the First World War, such as trench nephritis. This condition arose among soldiers in spring 1915, characterized by breathlessness, swelling of the face or legs, headache, sore throat, and the presence of albumin and renal casts in urine. It was speedily investigated by the military-medical authorities. There was debate over whether it was new condition or streptococcal nephritis, and the experts agreed that it was a new condition. The major etiologies proposed were infection, exposure, and diet (including poisons). Research pointed to the origin of the disease as being infective rather than toxic, but no definite cause was discovered. A number of labels were given to the disease, including war nephritis. However, trench nephritis was the one used most widely. Trench nephritis was a serious problem for the Allies, leading to 35 000 casualties in the British and 2000 in the American forces. There were also hundreds of deaths. The condition was treated in line with pre-war regimens designed for acute nephritis. No significant preventative methods were implemented for trench nephritis, as there was no consensus regarding causation. The medical response to trench nephritis was largely ineffective, with medical commentators recognizing that there had been a lack of medical progress.

----

Bottom Line: it was a version of glomerulonephritis, but of unknown origin, possibly a new etiologic agent. Interestingly, it does not seem to have recurred in subsequent wars. Doc

[Neil Clark]

Doc2,

Interesting info indeed. I wonder if the static nature of trench warfare had something to do with this disease? Conditions for most soldiers in the second scrap were vastly different in almost every respect. Or was it simply that by the Second World War the same symptoms were reported as something else?

Thanks for your continued guidance here Doc, it's greatly appreciated. It's nice to have a REAL medical professional (Consultant Doctor) on board. Your own particular discipline in medicine is closely linked to the illnesses and diseases being discussed here and I think others should consider this before arguing with your line of thought or advice.

[Doc2]

Doc2,

Interesting info indeed. I wonder if the static nature of trench warfare had something to do with this disease? Conditions for most soldiers in the second scrap were vastly different in almost every respect. Or was it simply that by the Second World War the same symptoms were reported as something else?

Thanks for your continued guidance here Doc, it's greatly appreciated. It's nice to have a REAL medical professional (Consultant Doctor) on board. Your own particular discipline in medicine is closely linked to the illnesses and diseases being discussed here and I think others should consider this before arguing with your line of thought or advice.

That is, of course, one possibility. Another is to remember that many diseases are quite localised. Anthrax or Tetanus, for example, may be found in one field and not in the neighboring field. I have always wondered if trench nephritis was due to an etiologic agent (bacteria, virus, or rickettsia) which was very localised in distribution. The disease could have broken out when the trenches were put into an infected area, and then died out when the troops moved somewhere else. That is a possible (note: possible, not proven) explanation. It was not seen in large numbers in "the second great unpleasantness".

Always glad to help, but you have to remember that in history I'm an amateur-- Some of the time there is more interest and enthusiasm on my part than actual knowledge-- In this business you hypothesize a lot. Certainly people can argue with me-- I'm not always right (heck, I spent 30 years in the military...) Doc

[Neil Clark]

Always glad to help, but you have to remember that in history I'm an amateur-- Some of the time there is more interest and enthusiasm on my part than actual knowledge

Doc,

As I have stated many times before on this forum - NEVER be intimidated by people who you percieve to be "expert" in any aspect of the Great War. In reality it's often that they merely have access to a large and comprehensive library of (expensive) books and databases. If I don't know an answer I will often find it in a book. I guess it's the same with medicine? As far as I'm concerned knowledge is helpful but NOT necessary, the most important thing is a willingless to learn and get involved

I honestly think that this forum contains some of the very best minds in the world when it comes to the Great War. I don't say that lightly either. Most of the so called experts who appear on TV are mostly just people in the right place at the right time (with the notable exceptions of (our) Paul Reed and Gordon Corrigan both of which I rate highly).

NONE of us know it all (although we do sometimes come across individuals who think they do). My advice here is to just "use them and laugh behind their back" like I do...

[mmm45]

Thanks Neil for posting this...Very useful for my case.

Ady

[Neil Clark]

Ady,

Glad it helped. Help yourself to anything on the thread for your covering letter which sets out the FACTS eg - Nephritis (Kidney Problems or Brights Disease) was caused by war service conditions (wet, cold, exposure etc...). The Ministry of Pension figures should be quoted here...

From what I've been able to find out this is STILL the case! No one can say for sure why serviceman are at increased risk like this but they are and thats a FACT.

Sock it too em....

[Neil Clark]

These points need to be stressed in any submission -

Some Established Causes of Nepthritis

o Other bacterial infections - e.g. typhoid, secondary syphilis, MRSA infection, pneumococcal pneumonia, infective endocarditis

o Viral infections - e.g. hepatitis B, mumps, measles, infectious mononucleosis, varicella, coxsackievirus

o Parasitic infections - e.g. malaria, toxoplasmosis

Therefore a man's wounds could result in infection and then NEPTHITIS. Interesting to see MRSA in this list too...