Trench Fever

Some reviewers of the film Goodbye Christopher Robin are saying that A.A. Milne had post-traumatic stress disorder. Yes, he was at the front during the Battle of the Somme; in August 1916 he was a signals officer there, and worked in no man’s land. But PTSD didn’t send him home. He was brought down by trench fever (bartonellosis). A bacterial infection spread by body lice (not those of the head or pubes), it causes a high fever, which repeats itself a few times every five days. It doesn’t kill, but sometimes leaves its victims feeling weak for many months. This happened to Milne. After being invalided home, he lost weight and developed fatigue, said to be caused by ‘overwork’, but much more likely due to the persistent effects of Bartonella quintana. In the early autumn of 1917 he spent three weeks at Osborne House on the Isle of Wight, then a convalescent hospital for officers.

The overwhelming majority of British soldiers on the Western Front were lousy, and lice caused nearly a third of admissions to casualty clearing stations, two out of three being due to bartonellosis, with the rest caused by dermatitis.

Trench fever disappeared after the First World War. It came back during the Second. It persists today, along with body lice, as a condition of the homeless. From the entomological point of view nothing much has changed since I was a casualty officer at St Thomas’s Hospital in London more than half a century ago. When we undressed a down-and-out with dermatitis, a vast number of lice left his cooling clothes in a shimmering wave seeking new warm hosts. Sister Casualty rubbed her hands, rolled up her sleeves, and said: ‘This reminds me of Dunkirk!’

When I was a house officer on Charity Ward, four nurses gave me a copy of Winnie Ille Pu for my birthday. They'd written on the flyleaf: 'Hic liber est donum nostro amico, homini domus in Caritate, discipulo Hippocratis, magni cerebri, die suo natale.'

Nursing has changed enormously since then. Not only through the invention of the intensive care unit, such technical developments as routine hip replacement surgery, and the transfer of children with leukaemia and adults with Hodgkin’s disease from terminal palliation to cure, but with the onward march of such clinically important rational recording, done by nurses, as the Bristol stool scale.

Last month, the Royal College of Nursing published Safe and Effective Staffing: Nursing against the Odds, which reported ‘clear evidence of a shortage of registered nurses in the UK’:

For the first time in years there are now more nurses and midwives leaving the NMC [Nursing and Midwifery Council] register than joining. The impact of the EU referendum appears to be driving EEA nationals away. UK-trained nurses and midwives are also leaving the register, before retirement.

One in three nurses are due to retire within the next ten years … The implications for patient safety and patients’ experiences are extremely worrying …

Nursing staff describe harrowing experiences at work. They say that safe and effective staffing is the exception, not the rule. They describe a lack of staffing actively preventing them from doing work they love, to the standard patients, families and carers deserve. They report that they are regularly working additional unplanned time, usually unpaid. It is clear that our health and care workforce are personally and professionally plugging the gap between missing staff and the demand for care, because of factors beyond their control.