¹National Public Health Service for Wales and Institute of Medical and Social Care Research (IMSCaR), University of Wales, Bangor, UK

Correspondence: RL Atenstaedt, Institute of Medical and Social Care Research, University of Wales, Ardudwy, Normal Site, Bangor, Gwynedd LL57 2PX, UK. E-mail: Robert.Atenstaedt@nphs.wales.nhs.uk

Received 17 February 2006; Revised 9 April 2006; Accepted 18 April 2006; Published online 5 July 2006.

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.