This short extract on the subject of
Trench Foot is from the 1916 book on Military Surgery by
Dr D. P. Penhallow.
Dr M. G. Miller, Editor
"MILITARY SURGERY" BY DUNLAP PEARGE PENHALLOW
S.B., M.D. (Harv.)
CHIEF SURGEON AMERICAN WOMEN'S WAR HOSPITAL, PAIGNTON, ENGLAND J
CAPTAIN MEDICAL COUPS, MASSACHUSETTS NATIONAL GUARD ; FIRST
LIEUTENANT MEDICAL RESERVE CORPS, U.S. ARMY (INACTIVE LIST) ;
DIRECTOR OF UNIT, AMERICAN RED CROSS EUROPEAN RELIEF EXPEDITION.
HENRY FROWDE, HODDER & STOUGHTON
PRESS, WARWICK SQUARE, E.C.
This term has been applied to those conditions in which the soldier develops painful and swollen feet due to long immersion in the cold water which is prevalent in the trenches during the winter. By many writers it has been
called "frost-bite," but strictly
speaking it is not a true frost-bite, but is rather a "water-bite."
Frost-bite is essentially a condition
of stasis of the circulation due to extreme cold
and occurs in the more exposed parts of the body, such as the face,
nose, or ear. It also affects the extremities hands and feet if these
are not properly protected, or
if they are in any way constricted so as to interfere with the free
circulation of the blood. This condition usually attacks the toes or
the heel and is rapidly
progressive, ending in gangrene.
Three classes of frost-bite are recognised, depending upon the severity and the extent of the freezing. The first stage is one of erythema, the second stage shows the formation of blebs and bullae, and the third and final stage results in the death of the part frozen. The convalescence of such cases is protracted, even in the erythematous form, and is associated with great pain and edema. The treatment of such cases will not be considered, as they are well known, especially among those who live in cold climates, but the essential facts are mentioned as a matter of comparison to the symptoms seen in trench foot.The condition known as trench foot is due more particularly to the inertia of the muscles and a resultant slowing of the circulation. Men who are exercising vigorously, and whose feet are in constant motion, are not so apt to suffer from the effects of the cold water as are men who are standing still. This condition too differs from true frost-bite in that the symptoms are usually more transitory than are the symptoms in frost-bite. The conditions seen in a typical trench foot consist of pain or hyperaesthesia over the dorsal and plantar aspects of the foot which comes on usually after the initial numbness, due to the immersion in the cold water, wears off. The foot may be slightly cyanosed or may show a faint erythema, and with this there may be a slight edema. Oftentimes, however, the foot is absolutely normal in appearance, and the only symptoms which are present are subjective.
In addition to the erythema and
oedema, we occasionally see cases in which there
is some vesiculation of the skin, and occasionally a small area of
necrosis. We may, therefore, say that the majority of the lesions
caused by "water-bite" are, on the whole, less severe than those caused
although occasionally we see instances where gangrene of the toes or of
areas of the skin surface occurs.
A condition similar to the trench foot is occasionally seen in the hands.
The treatment of this condition is largely symptomatic,
the early stages, and should consist of rest in bed and the application
evaporating lotion such as alcohol. Lead-and-opium wash often gives a
degree of relief if the hyperaesthesia is at all marked. Later,
exposure to the air and
gentle massage with olive oil or with camphorated oil tend towards an
of the symptoms. We have also been treating such cases with a weak
which apparently affords them a great deal of comfort.
Prophylaxis The prophylactic measures in such instances are perhaps best shown by the instructions which have been issued in the " Memorandum on the Treatment of Injuries in War " (3), by the War Office, which are as follows :
" 1. Boots should not fit tightly,
but should be at least a size too large. When boots
are large enough it is well to wear two pairs of socks ; but this is
dangerous if the
boots are small, as it leads to further pressure on the feet. Puttees
should never be
"2. The general circulation can be
kept up by keeping the body warm and dry. A
mackintosh sheet worn over the great-coat is of assistance where no
waterproof is available.
"3. A dry pair of socks should be
carried in the pockets when available.
"4. Boots and puttees should be taken off at least once in twenty-four hours, the feet rubbed and dried and a dry pair of socks put on.
"5. Boots should be well greased or dubbined. Officers should see that dry standing is provided in the trenches whenever possible, by means of drainage, raising of the foot level by fascines of brushwood or straw with boards on top, or by the use of pumps where these are available."