The Chapter on Trench Foot from "Military Surgery" by Dunlap Pearce Penhallow, MD. (Harv), London, Hodder & Stoughton, Oxford University Press, 1916
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 oedema. 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 oedema. 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 superficial necrosis.
We may, therefore, say that the majority of the lesions caused by "water-bite" are, on the whole, less severe than those caused by frost-bite, although occasionally we see instances where gangrene of the toes or of various areas of the skin surface occurs.
A condition similar to the trench foot is occasionally seen in the hands.
Treatment.-The treatment of this condition is largely symptomatic, especially in the early stages, and should consist of rest in bed and the application of some evaporating lotion such as alcohol. Lead-and-opium wash often gives a great 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 abatement of the symptoms. We have also been treating such cases with a weak faradic bath, 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 " 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 applied tightly.
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 if there is 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.
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