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Trench Foot

Trench Foot

Many soldiers fighting in the First World War suffered from trench foot. This was an infection of the feet caused by cold, wet and insanitary conditions. In the trenches men stood for hours on end in waterlogged trenches without being able to remove wet socks or boots. If untreated, trench foot could turn gangrenous and result in amputation. Trench foot was a particular problem in the early stages of the war. For example, during the winter of 1914-15 over 20,000 men in the British Army were treated for trench foot. Brigadier-General Frank Percy Crozier argued that: " The fight against the condition known as trench-feet had been incessant and an uphill game."

Arthur Savage pointed out that trench foot had serious consequences: "My memories are of sheer terror and the horror of seeing men sobbing because they had trench foot that had turned gangrenous. They knew they were going to lose a leg." Brigadier-General Frank Percy Crozier explained how the officers tried to solve the problem: "Socks are changed and dried in the line, thigh boots are worn and are dried every four days when we come out."

The only remedy for trench foot was for the soldiers to dry their feet and change their socks several times a day. By the end of 1915 British soldiers in the trenches had to have three pairs of socks with them and were under orders to change their socks at least twice a day. As well as drying their feet, soldiers were told to cover their feet with a grease made from whale-oil. It has been estimated that a battalion at the front would use ten gallons of whale-oil every day.

The trenches were wet and cold and at this time some of them did not have duckboards and dug-outs. The battalion lived in mud and water. Altogether about 200 men were evacuated for trench feet and rheumatism. Gum boots were provided for the troops in the most exposed positions. Trench feet was still a new ailment and the provision of dry socks was vitally important. Part of the trench was reserved for men to go two at a time, at least once a day, and rub each other's feet with grease.

If you have never had trench feet described to you. I will tell you. Your feet swell to two or three times their normal size and go completely dead. You could stick a bayonet into them and not feel a thing. If you are fortunate enough not to lose your feet and the swelling begins to go down. It is then that the intolerable, indescribable agony begins. I have heard men cry and even scream with the pain and many had to have their feet and legs amputated.

My memories are of sheer terror and the horror of seeing men sobbing because they had trench foot that had turned gangrenous. They knew they were going to lose a leg. Memories of lice in your clothing driving you crazy. Filth and lack of privacy. Of huge rats that showed no fear of you as they stole your food rations. And cold deep wet mud everywhere. And of course, corpses. I'd never seen a dead body before I went to war. But in the trenches the dead are lying all around you. You could be talking to the fellow next to you when suddenly he'd be hit by a sniper and fall dead beside you. And there he's stay for days.

Some of their feet were horrible to look at: raw skin and bleeding blisters and big, angry sores. Their army boots rarely fitted comfortably. They were made in a few standard sizes, and a man was lucky if he got a pair that was neither too big nor too small. To march all day in them with blistered feet must have been a torment... The men marched like beasts of burden with heavy packs on their backs, rifles and bandoliers of ammunition slung across their shoulders. Sometimes they would break into a marching song to ease the misery, but now and then, as I marched at the head of my platoon, I would hear a clatter behind me and turn to see a man lying prostrate in the road.

The sergeants were instructed to prod them and order them to get up. There was always the possibility that the man had decided that he had taken as much as he could bear and had staged his collapse to get out of it. But most of them were genuine - down and out.

The fight against the condition known as "trench-feet" had been incessant and an uphill game. However, science and discipline had conquered, and now we seldom have a case, and if we do there is trouble. Socks are changed and dried in the line, thigh boots are worn and are dried every four days when we come out. Things are better, but the weather gets worse.


Tag Archives: trench foot

[The fourth of a series of essays about the gallant nurses of World War I commemorating the centennial of America’s entry into the war on April 6, 1917. The nursing care of soldiers exposed to poison gas on the Western Front is explored at greater length in chapter 4 of Easing Pain on the Western Front: American Nurses of the Great War and the Birth of Modern Nursing Practice (McFarland, 2020)].

Now, sadly, chemical weapons are back in the news. But large-scale chemical warfare reaches back over a century. In WWI, Germany released 5,730 cylinders of chlorine gas across a four-mile stretch of no-man’s-land into the Allied lines during the Second Battle of Ypres in April, 1915. Thus the birth of chemical warfare. Britain replied in kind, releasing cylinders of chlorine gas during the Battle of Loos the following summer, and Germany upped the horror in July, 1917, delivering artillery shells filled with dichlor-ethyl-sulphide or “mustard gas” just prior to the Third Battle of Ypres.

Chlorine gas attacked the airways. Severe respiratory swelling and inflammation killed many instantly and the rest struggled to nearby casualty clearing stations with acute congestion of the lungs, pneumonia, and blindness. Soldiers who had inhaled the most gas arrived with heavy discharge of a frothy yellow fluid from their noses and mouths as they drowned in their own secretions. For the rest, partial suffocation persisted for days, and long-term survivors had permanent lung damage, chronic bronchitis, and occasionally heart failure. Mustard gas burned the skin and respiratory tract, stripping the mucous membrane off the bronchial tubes and causing violent inflammation of the eyes. Victims were left in excruciating pain and utterly helpless.[1]

Nurses, no less than physicians, were initially confused about the nature of the gas and the severity of its effects.[2] But they quickly came up to speed and realized that soldiers suffering from poison gas posed a nursing challenge no less formidable than those dying from gangrenous wounds. Nurses were accustomed to losing patients, but not to being powerless to provide comfort care, to ease patients’ agony during their final days. How to nurse on when nursing was unavailing, when the burns were so terrible that “nothing seems to give relief”?[3]

WWI nurses in gas masks treat soldiers after a gas attack

Of course, nurses did what little they could. Inflamed eyes were repeatedly irrigated with alkaline solution. Respirators soaked in hyposulphate could be provided to patients able to use them. At American Base Hospital 32, soldiers who had breathed in mustard gas were given a mixture of guiacol, camphor, menthol, oil of thyme, and eucalyptus that caused them to expectorate inflammatory material. According to Maude Essig, an American Red Cross Nurse who worked at the hospital, the nurses helped devise it.[4]

According to Essig, the mixture provided some temporary relief to soldiers with burning throats and mouths. But nurses otherwise echoed a shared sense of impotence when it came to making gassed patients comfortable. During the Second Battle of Ypres, when chlorine gas was first used by the Germans, Canadian nurse Agnes Warner recalled the initial wave of gassed troops: “There they lay, fully sensible, choking, suffocating, dying in horrible agonies. We did what we could, but the best treatment for such cases had yet to be discovered, and we felt almost powerless.”[5] Shirley Millard was graphic in describing the severe burn patients who rendered nursing futile. “Gas cases are terrible,” she wrote at war’s end in November, 1918.

They cannot breathe lying down or sitting up. They just struggle for breath, but nothing can be done . . . their lungs are gone . . . literally burnt out. Some with their eyes and faces entirely eaten away by the gas, and bodies covered with first degree burns. We try to relieve them by pouring oil on them. They cannot be bandaged or even touched.[6]

Whereas soldiers with even the worst of battlefield wounds usually did not complain, the gas cases “invariably are beyond endurance and they cannot help crying out.” Millard’s judgment was affirmed by many others. Maude Essig wrote of a “star patient,” one Leo Moquinn, who “was terribly burned with mustard gas while carrying a pal of his three-quarters of a mile to safety after the gas attack. Except for his back, she added, his “entire body is one third-degree burn. He cannot see and has developed pneumonia and he is delirious.”[7] Such were the burn patients.

Essig’s reference to pneumonia alludes to the multitude of infectious diseases that accompanied battlefield wounds and complicated (or prevented) recovery. Pneumonia could be rampant during winter months gangrene and tetanus were prevalent year round. Typhoid was partially controlled by the antityphoid serum injections troops received, usually prior to disembarkation but otherwise in the reception huts of clearing stations and field hospitals. But bronchitis, trench fever, diphtheria, cholera, dysentery, meningitis, measles, mumps, erysipelas,[8] and, finally, influenza, were not. Nurses recorded deaths resulting from various combinations of the foregoing, such as Edith Appleton’s “poor little boy, Kerr,” who died of gas, pneumonia, and bronchitis.[9]

Infected shrapnel and gunshot wounds could be irrigated or bathed continuously in antiseptics, first developed in the 1870s and packed in sterile dressings available in sealed paper packages since 1893.[10] But in the preantibiotic era, nursing care of systemic infections was limited to the same palliatives we employ today: rest, warmth, hydration, nutrition, aspirin (and, back then, quinine), all amplified by the nurse’s caring, maternal presence.

Trench foot, a combination of fungal infection, frostbite, and poor circulation, was endemic during the winter months, when soldiers lived in trenches flooded with icy water, often waist-high, for days on end. They struggled into clearing stations with feet that were “hideously swollen and purple,” feet “that were “raw with broken blisters and were wrapped in muddy, dripping bandages.”[11] But trench feet, however disabling, at least permitted more active measures. In addition to giving morphine, there was a treatment protocol to follow, such as this one at a British Military Hospital in the winter of 1917:

We had to rub their feet every morning and every evening with warm olive oil for about a quarter of an hour or so, massage it well in and wrap their feet in cotton wool and oiled silk – all sorts of things just to keep them warm – and then we put big fisherman’s socks on them. Their feet were absolutely white, swollen up and dead. Some of their toes dropped off with it, and their feet looked dreadful. We would say, ‘I’ll stick a pin in you. Can you feel it?” Whenever they did feel the pin-prick we knew that life was coming back, and then we’d see a little bit of pink come up and everybody in the ward would cheer.”[12]

It is the dizzying confluence of multiple battlefield injuries, many gangrenous, with the effects of poison gas and intercurrent infectious diseases that threatened to, and occasionally did, overwhelm the WWI nurses. Reading their diaries and memoirs, one sees time and again how the nurses’ calling, amplified by the camaraderie of other nurses, surgeons, and orderlies who felt similarly called, overpowered resignation and despair. In a diary entry of September 14, 1916, Kate Luard referred to the “very special nursing” required by soldiers with multiple severe injuries. She had in mind

The man with two broken arms has also a wound in the knee – joint in a splint – and has had his left eye removed today. He is nearly crazy. Another man has compound fractures of both legs, one arm, and head, and is quite sensible. Another has both legs amputated, and a compound fracture of [the] arm. These people – as you may imagine – need very special nursing.[13]

If one adds to such clusters the serious general infections that often accompanied battlefield injuries, one has some sense of what nurses were up against, and just how special their nursing had to be. When influenza, the deadly Spanish flu, began to swamp clearing stations and hospitals in the spring of 1918, nurses simply added it to the list of challenges to be met with the resources at hand. And they did so in the knowledge that as many as half of the infected would die.[14] Beatrice Hopkinson, a British auxiliary nurse, recorded the new protocol developed at her General Hospital in St. Omer to meet the rush of influenza patients:

During those early days of the flu the treatment was to strip the patients in one tent, their clothing going immediately to the fumigator. Then, the patient was bathed in disinfectant and taken to the different wards. Some of the patients were very ill and died with pneumonia after a few days.[15]

The early days of the pandemic gave way to the later days, and after the Armistice was signed on November 11, 1918, nurses occasionally felt boredom, even mild malaise, when the demands of “special nursing” relented and they increasingly found themselves nursing “mostly mild influenza cases.”[16]

I admire the nurses of WWI because they did what was required of them absent any preexisting sense of what they could be required to do, absent, that is, anything approaching a “job description.” Without medical residents, internists, and infectious disease specialists to fall back on, they collapsed specialism into global care-giving identities. This meant they managed multiple war wounds and intercurrent infections, prioritizing among them and continuously adjusting treatment goals in the manner of highly skilled primary care physicians. By the same token, they realized the importance of compassion in the face of ameliorative impotence. Somehow they found time to be present, to slip into a ward with a soldier dying of gas gangrene every few minutes “to do something perfectly useless that might perhaps give a ray of comfort.”[17]

Ironically, given the environment in which they labored and their “patient population” of soldiers in extremis, the nurses embodied the values of primary care medicine, since they took upon themselves the role of primary caregivers obligated to stay with their patients through thick and thin, to summon senior colleagues and surgeons as needed, and to ease life transitions, whether to recovery, convalescence, lifelong disability, or death.[18] And they did so whatever the weight of multiple assaults on their own bodily and mental integrity.

Nurses, technically noncombatants, suffered alongside the troops. During rushes, their clearing stations, hospitals, and living quarters were under land and air assault and occasionally took direct hits. They contracted infectious diseases, especially flu,[19] during which they usually carried on with the aid of simple analgesics until they felt better or worse. When Helen Boylston became feverish in November, 1918, a symptom she attributed to diphtheria, she braced herself for a long-awaited evening dance with “quantities of quinine and finally a stiff dose of whiskey, and I felt ready for anything.” But not ready enough, it turned out. She collapsed at the dance with a bad chill and had to be carried to her bed. When she went on duty the following day, she became delirious in the ward and was lugged off by an orderly and subsequently seen by a doctor. “So here I am,” she wrote in her diary. “I’ve developed a heart and a liver, and am as yellow as a cow-lily. I have to lie flat on my back and be fed. For three days I lay motionless all day long, not caring to move or to speak, I was so tired.” Boylston was soon joined by a second nurse with diphtheria, placing the camp “in a panic,” with every staff member now given daily throat cultures.[20]

Despite training in the use of gas masks in the event of direct shelling, mask-less nurses suffered the effects of poison gas from daily proximity to patients on whom the shells had landed. Their own vulnerability to gas attack and attenuated exposure to the poison lent special intensity to their care of burn victims. They understood, with Maude Essig, that mustard gas burns indeed meant “terrific suffering.”[21] Whether infected or poisoned, they usually labored on until they collapsed or were so near collapse that medical colleagues ordered them out of the wards, whether to bed, to a general hospital for treatment, or to a nearby convalescent homes for recuperation and a desperately needed “time out.”[22]

Civil War nurses too eased transitions to death, but their nursing goal during a soldier’s final days was to reconfigure mortal battlefield injury into the promise of a beneficent afterlife. So they stayed with the dying, soliciting final confessions of sinful living, allowing soldiers to reminisce and reflect, and soliciting (and writing down) words of comfort to sustain family members in believing that their soldier had died a “good death.”[23] World War II, on the other hand, witnessed the development of new vaccines, a national blood bank program, the widespread availability of sulfa drugs in 1941 and penicillin in 1944, major advances in the control of shock and bleeding and in battlefield surgery, and much greater speed of evacuation of the seriously wounded to European and stateside base hospitals. Taken together these advances created a buffer between nurses and the prolonged witnessing of soldiers dying in unrelievable pain.

It was the nurses of WWI who took it on the chin. They could not sustain themselves and their patients with the naturalistic view of the afterlife popular during the Civil War.[24] Nor did they have the benefit of more “modern” technology and organization to shield them, if only somewhat, from the experiential onslaught of dying soldiers. It was not death per se but the agony of dying – from infected battle wounds and/or systemic infections, gas gangrene, chlorine and mustard gas, rushed amputations followed by reinfection and blood loss – that took them to their own existential no-man’s-land, the kind we encounter in the writings of Mary Borden and Ellen LaMotte.

In the summer of 1917, the nurses at No. 12 General Hospital on the outskirts of Rouen struggled with a gas victim whose paroxysms of coughing came every minute and a half “by the clock,” and who had not slept in four days. To quiet him, they rigged up a croup tent under which they took turns holding a small stove that heated a croup kettle from which the soldier could breathe the steam. When sleep finally came, they were “ready to get down on their knees in gratitude, his anguish had been so terrible to watch.” To their head nurse, Julia Stimson, they remarked that “they could not wish the Germans any greater unhappiness than to have them have to witness the sufferings of a man like that and know that they had been the cause of it.”[25]

It was bearing witness to unrelievable suffering that was the worst assault borne by the nurses. “It is dreadful to be impotent, to stand by grievously stricken men it is impossible to help, to see the death-sweat gathering on young faces, to have no means of easing their last moments. This is the nearest to Hell I have yet been.” This is the voice of an anonymous British Red Cross nurse, unsettled by the dying Belgium soldiers she encountered on ambulance runs in the fields of West Flanders in the winter of 1915. The American nurses at No. 12 General Hospital brushed up against this same hell, and they could think of no greater punishment for enemy combatants than to witness what they witnessed, often for weeks on end. And yet the nurses of WWI were not stymied by seeming impotence in the face of pain. They labored on to the breaking point in the service of soldiers who, all too often, were already broken. This makes them warriors of care and, in a devotion to patients that was literally and not metaphorically self-less, heroes of the first rank.

[1] Christine E. Hallett, Veiled Warriors: Allied Nurses of the First World War (Oxford: OUP, 2014), 79-80, 203.

[2] E.g., Julia C. Stimson, Finding Themselves: The Letters of an American Army Chief Nurse in a British Hospital in France (NY: Macmillan, 1918), 80 John & Caroline Stevens, eds., Unknown Warriors: The Letters of Kate Luard, RRC and Bar, Nursing Sister in France 1914-1918 (Stroud: History Press, 2014), loc 1945.

[3] Maude Frances Essig, My Trip with Uncle Sam, 1917-1919: How We Won World War I, unpublished journal written during the summer, 1919, entry of March 24, 1918.

[4] Agnes Warner, My Beloved Poilus’ (St. John: Barnes, 1917), loc 861.

[5] Warner, My Beloved Poilus’ , loc 814.

[6] Shirley Millard, I Saw Them Die: Diary and Recollections (New Orleans, LA: Quid Pro, 2011), loc 514.

[7] Essig, My Trip with Uncle Sam, entry of March 24, 1918.

[8] Erysipelas is an acute bacterial infection of the upper dermis, usually of the arms, legs, and/or face, that is accompanied by red swollen rashes. Without antibiotic treatment, It can spread through the blood stream and cause sepsis.

[9] Edith Appleton, A Nurse at the Front: The First World War Diaries, ed. R. Cowen (London: Simon & Schuster UK, 2012), 111.

[10] Rodney D. Sinclair & Terence J. Ryan, “A Great War for Antiseptics,” Australas. J. Dermatol, 34:115-118, 1993. These nineteenth-century antiseptics included salicylic, thymol, Eucalyptus oil, aluminum acetate, and boric acid.

[11] Helen Dore Boylston, Sister: The War Diary of a Nurse (NY: Ives Washburn, 1927), loc 154.

[12] Kathleen Yarwood (VAD, Dearnley Military Hospital), in Lyn MacDonald, The Roses of No Man’s Land (London: Penguin, 1993 [1980]), 197-198.

[14] Millard, I Saw Them Die, loc 472.

[15] Beatrice Hopkinson, Nursing through Shot & Shell: A Great War Nurse’s Story, ed. Vivien Newman (South Yorkshire: Pen & Sword, 2014), loc 1999.

[16] Hopkinson, Nursing Through Shot & Shell, loc 2609.

[17] [Kate Norman Derr] “Mademoiselle Miss”: Letters from an American Girl Serving with the Rank of Lieutenant in a French Army Hospital at the Front, preface by Richard C. Cabot (Boston: Butterfield, 1916), 76-77.

[18] For an exposition of these values and how they gained expression in American medicine in the nineteenth and twentieth centuries, extending through “general practice” of the 1950s and ’60s, see Paul E. Stepansky, In the Hands of Doctors: Touch and Trust in Medical Care (Santa Barbara: Praeger, 2016).

[19] “The flu is back again and everybody has it, including me. I’ve run a temperature of one hundred and two for three days, can hardly breathe, and have to sleep on four pillows at night.” Boylston, Sister, loc 630.

[20] Boylston, Sister, loc 1350, 1357.

[21] Essig, My Trip with Uncle Sam, entry of March 23, 1918.

[22] E.g., Luard, Letters, loc 1247: “Sister D, the Mother of all the Abdominals, has her marching orders and goes down to Rouen to a General Hospital tomorrow. Her loss is irreparable.” Edith Appleton recounts taking care of three sick nurses and a sick VAD at one time: “I have begun to feel like a perpetual night nurse to the sick sisters as I have another one to look after tonight with an abscess in her ear”(A Nurse at the Front, p. 123). Maude Essig contracted erysipelas in the spring of 1918 and reported feeling “awfully sick” the following fall, when she relied on “quinine and aspirin in large doses” to keep going (My Trip with Uncle Sam, entries of April 9, 1918, April 14, 1918, and October 27, 1918).

[23] Drew Gilpin Faust, This Republic of Suffering: Death and The American Civil War (New York: Vintage, 2008), chapter 1.


WAR CULTURE – TRENCH FOOD

At the start of the war, British soldiers at the front were allowed 10oz of meat and 8oz of vegetables per day, a luxury compared to what would be provided in the years to come. Parcels from home loaded with chocolate, tins of sardines, and sweet biscuits would be a welcome but irregular source of extra nourishment. For day-to-day meals, soldiers’ options were limited.

The size of the British Army and the efficiency of the German submarine blockade grew in tandem, with doubly bad results for the state of British Army rations. By 1916, the meat ration was down to 6oz a day, and later, meat was only provided once every nine days. Things were getting worse, and Tommies were beginning to fend for themselves. There are reports of vegetable patches being established in reserve trenches, and of men going hunting and fishing while not in the front-line, both to pass the time and to supplement their meagre rations.

The winter of 1916 saw a major shortage of flour. It was replaced by dried, ground-up turnips which produced unappetising, diarrhoea-inducing bread. At this time, the staple food of the British soldier was pea-soup with horse-meat chunks. The hard-working kitchen teams were having to source local vegetables as best they could, and when that was not an option, weeds, nettles, and leaves would be used to whip up soups and stews.

Each battalion was assigned two industrial-sized vats for food preparation. The problem was that every type of meal was readied within these containers, and so, over time, everything started to taste the same. As a result, pea-and-horse flavoured tea was something the soldiers had to get used to.

Food transportation was also an issue. By the time it reached the front, bread and biscuits had turned stale and other produce had gone off. In order to combat this, soldiers crumbled the hard food that arrived and added potatoes, sultanas, and onions to soften the mixture up. This concoction would then be boiled in a sandbag and eaten as a sandy, stale soup.

Soldiers and kitchen staff were forced to carry soups and stews through the communication trenches in cooking pans, petrol cans, and jars. Upon arrival at the front-line, the food would be cold or spilled. In an effort to rectify this, field kitchens were relocated further forward, but they were never able to get close enough to provide hot food for the men. Some were lucky enough to obtain small camping stoves from town shops, but with fuel in such high demand, this was never much of an advantage, and the stoves also had to be carried.

One widely-used and equally widely-disliked ration was the canned soup, Maconochie. A thin, watery broth containing sliced turnips and carrots, Maconochie was tolerated by famished soldiers, and detested by all. One soldier summed up the army’s attitude towards the stuff by saying, ‘Warmed in the tin, Machonochie was edible cold it was a man-killer.’

Of course, to allow the Germans to get wind of this desperate food situation would never do. The British Army had to be portrayed as a content, well-fed, determined body whose morale was unwavering. An army announcement that British soldiers were being given two hot meals a day, however, caused widespread outrage among soldiers. The army subsequently received over 200,000 angry letters demanding that the dire truth be made known.

Making ­­Maconochie
Normally prepared in a dug-out or reserve trench, in a modern kitchen Maconochie stew should not be difficult to make. Here’s how:

Ingredients
340g beef (or one can of corned beef)
140g waxy potatoes
30g onions
30g carrots
30g beans, cooked (white beans such as navy or great northern)
60ml beef stock or water
15ml flour
15ml fat (lard or rendered beef fat)
Salt to taste

Procedure
1. If using fresh beef, cut into ½ inch to 1 inch pieces.
2. Thinly slice potatoes, onions, and carrots.
3. Steam or boil the beef, potatoes, carrots, and onions until tender.
4. Heat the fat in a pan.
5. Add cooked potatoes, carrots, onions, beans, and beef over medium heat.
6. Make a batter of the beef stock or water with flour.
7. Add batter to the stew.
8. Cook until thickened.
9. Salt to taste.


How Do You Treat Trench Feet?

Treatment for Trench Foot should be started as soon as possible to reduce the risk of permanent damage:

  • Good Foot Hygiene: Thoroughly clean and dry the feet. Use an anti-bacterial, anti-fungal dressing and air the feet regularly


A review of trench foot: a disease of the past in the present

From the French Invasion of Russia in 1812, to Glastonbury festival in 2007, trench foot has been reported, yet the exact nature of the condition remains unclear. This review explores the pathogenesis and treatment of trench foot. Trench foot is considered to be a nonfreezing cold injury often complicated by infection, in which exposure to cold temperatures just above freezing, combined with moisture, results in a peripheral vasoneuropathy. The presence of physical trauma, bacterial or fungal infections, malnutrition, venous hypertension and lymphoedema mean that some individuals are at greater risk of trench foot. Trench foot may be prevented by warming the feet, changing socks, staying active, rubbing the skin with oil and regularly inspecting the feet. Avoiding risk factors may help prevent the condition. The management of trench foot is less clear. Vasodilators such as iloprost and nicotinyl tartrate or sympathectomy may help. Trench foot may lead to necrosis, cellulitis, sepsis and amputation. It remains a poorly understood condition.


Trench warfare

Trench warfare and its horrors – artillery, mud, water, disease, rats and death – have become the most iconic feature of World War I.

Origins

Trench warfare is a form of static, defensive warfare.

Trench warfare was not itself an invention of World War I. It had been used in the American Civil War (1861-65), the Boer War (1899-1902) and in other conflicts. It was the industrialised weaponry of World War I that made trench warfare the norm rather than an occasional strategy.

Trench warfare took shape on the Western Front in late 1914. It emerged as both armies dug in to prevent flanking attacks from the other. By late 1916, the Western Front contained more than 1,000 kilometres of frontline and reserve trenches.

Dangers

The dangers of trench warfare were plentiful. Enemy attacks on trenches or advancing soldiers could come from artillery shells, mortars, grenades, underground mines, poison gas, machine guns and sniper fire.

Soldiers in the trenches endured conditions ranging from barely tolerable to utterly horrific. Exposed to the elements, trenches filled with water and became muddy quagmires. One of the worst fears of the common Western Front soldier was ‘trench foot’: gangrene of the feet and toes, caused by constant immersion in water.

Trench soldiers also contended with ticks, lice, rats, flies and mosquitos. Diseases like cholera, typhus and dysentery thrived because of vermin, poor sewage and waste disposal, stagnant water, spoiled food and unburied bodies.

‘No man’s land’

If the Western Front was a breeding ground for disease, then the territory between its opposing front lines – widely referred to as ‘no man’s land’ – was a veritable nightmare.

Chewed into mud and craters by shell fire, strewn with barbed wire, discarded rubbish, bodies and body parts in all stages of decomposition, the soldiers dreaded it. One English officer toured ‘no man’s land’ and reported:

“I climbed into the field, which of course consists of shell holes, and had a look ’round. Along by the high banks of the trenches thousands of tins are lying: bully beef, jam, soup, cigarette, sausage, etc. Bits of iron and bits of shell are everywhere, and here and there are fuses, our own and the enemy’s (since this ground was once in German hands). I found a dugout that had got lost and took some crockery out of it. Corpses had been uncovered so I had some men out to rebury them. Every shell that falls here disturbs some wretched, half-decayed soldier. Farther back on the other side of the German wire, all smashed to bits, there were a dozen dead men, two of them lieutenants. I got a party of men and buried the poor fellows. They were all blackened, and the hands were almost fleshless. Over each man’s mount, we stuck a rifle and bayonet, with his cap on the rifle butt.”

History of trench warfare

Soldiers previously equipped with bayonets and inaccurate rifles now found themselves with heavy artillery, machine-guns capable of 400 rounds per minute and precision-firing small arms.

Yet for all these advances, the armies of World War I were constituted as they were a century before: mostly infantry (foot-soldiers) with some cavalry (soldiers on horseback). Regardless of size or strategy, they were largely defenceless against this new firepower, particularly when advancing.

Generals who had no effective tactical solutions soon resorted to trench warfare, where they could at least hold their position.

Contrary to popular opinion, there were very few generals who deliberately butchered soldiers by ordering futile charges against machine-guns and heavily defended positions. Manpower was not so plentiful that any general would consider wasting soldiers in pointless attacks.

The blunders of the Western Front were more commonly caused by an age-old military error: underestimating the strength of the enemy’s men or overestimating your own.

Zig-zags and networks

The Western Front itself was not one long trench but a complicated trench system. Both the Allies and the Central Powers relied on a three-trench network, each running parallel to the enemy and connected by communications trenches.

This pattern is visible in an aerial photograph of a trench network (see picture above) which shows German trenches on the right, Allied trenches on the left and ‘no man’s land’ between them.

Having multiple lines of trench allowed soldiers to retreat if the frontline trench was overrun or destroyed by the enemy. Reserve trenches also provided relative safety for resting soldiers, supplies and munitions.

Trenches were usually dug in a zig-zag pattern rather than a straight line this prevented gunfire or shrapnel from being projected along the length of a trench, if a shell or enemy soldier ever landed inside.

Other common features of Western Front trenches were dugouts (underground shelters or offices) and ‘bolt holes’ or ‘funk holes’ (sleeping cavities, hacked into trench walls). Most digging and maintenance work in the trenches took place at night, under cover of darkness, so soldiers often spent daylight hours huddled and sleeping in these small spaces.

Trench routines

Contrary to popular assumptions, soldiers on the Western Front did not spend all or even most of their time in frontline trenches.

Unless a major offensive was imminent, the roster had most men spending six days in the trench system and six days well back from the front line. Only two or three days of this six-day rotation was spent in the frontline trench itself the rest was spent in reserve or support trenches.

The duties of a trench soldier varied widely. Maintenance – digging new trenches, repairing old ones, draining water, filling sandbags, building parapets and unfurling barbed wire – was never-ending (some soldiers’ accounts tell of more back-breaking labour than actual fighting).

Catering

Food supplies in the trenches were adequate until late 1915, after which shortages and interruptions to shipments created problems. Fresh meat was in short supply so most soldiers relied on ‘bully beef’ (canned corned beef).

Bread took 6-8 days to reach the trenches so was invariably stale a common substitute was ‘hardtack’, a flavourless biscuit that stayed fresh for years but was so brick-hard it had to be soaked in water or soup.

By 1917 food was so scarce that some units were fed with whatever could be scrounged locally. One Allied regiment was given a watery soup brewed from grass, weeds and thin strips of horsemeat.

A historian’s view:
“At many places along the opposing line of trenches, a ‘live and let live’ system evolved, based on the realisation that neither side was going to drive out the other anyway. It resulted in arrangements such as not shelling the latrines or attacking during breakfast. Some parties even worked out arrangements to make noise before lesser raids so that the opposing soldiers could retreat to their bunkers.”
Jackson J. Spielvogel

1. Trench warfare was used extensively on the Western Front by both sides, after the Battle of the Marne in 1914.

2. At its core, trench warfare was a form of defensive warfare intended to halt enemy assaults and advances.

3. Trench systems were extensive and complex, intended to hinder an enemy assault while allowing for fallback positions.

4. This type of warfare was difficult and dangerous, both because of the fighting and the adverse conditions in trenches.

5. The area between the trenches was dubbed ‘no man’s land’ and was strewn with mines, craters, mud, unexploded ordinance, barbed wire and countless bodies.


Military Boots: Hob nails, Shoody goods and Trench Foot

Barefoot warriors were commonplace in antiquity but sometimes the upper foot was covered for protection. The Romans militarised their sandals and made them robust with copper tacks to secure the union between the sole and upper. The origins of hob nailed boots can be traced back to Roman times. Protruding nails on the sole of the sandal extended the lifespan of footwear as well as give added traction. In the 20th century the British Army were supplied with hob nailed boots as an ecomomy. This Blutcher or Derby style footgear flowed through to the industrial working boot.

In the Great War it was estimated some 2,500,000 pairs of sgreat War hoes were made for the Allied troops. Laid end to end this would cover the complete coastline of Western Australia. 380,000 cattle required to be slaughtered to provide the equivalent of 17.5 million square feet of leather or 400 acres. The soul leather alone would weigh 4,000 tons metal for nails would be 1,150 tons with 55 tons of thread and 78,000,000 eyelets. War has always meant big business to the shoe and textile industries. Sadly, this has not always brought the best from friendly suppliers and it is estimated human greed can account for almost as many casualties as enemy fire in modern warfare. Soldier’s boots need to be suoerior quality for the conditions of combat otherwise then their fighting ability is undermined.

During the American Civil War, the US cavalry were demoralised because of shoddy workmanship. Supplied with sub-standard cardboard, cowboy boots, their feet and legs were cut to ribbons. The term shoddy was added to the English lexicon meaning ‘inferior quality, second rate’.

During the Second World War footwear supplies to the front were fatally delayed because vital supplies were misappropriated by Black Marketeers. It was quite common to find non-combat units wearing superior footwear intended for their colleagues at the front. Trench fighting during the Great War meant the men were stood in very cold mud for long periods of time. Their footwear was no match for the atrocious conditions of the trenches and many suffered Trench Foot.

In the Second World War, trench foot was responsible for putting more Allied Forces out of action than the German 88 (artillery). In December 1944, northern Europe's witnessed its coldest winter during which 45,000 men - the equivalent of three full infantry divisions, were pulled out of the front line because of trench foot. Three days before the Battle of the Bulge began so great were the casualties to trench foot, men unable to walk were carried from sheltered pillbox positions at night to firing positions in the day time. Behind the US Lines it was decreed any soldier suffering trench foot would be tried for court martial. Senior officers were suspicious some soldiers were hoping to avoid combat by actively encouraging symptoms of trench foot.

One reason why trench foot was so common was soldiers slept with their boots on. During engagement they were recommended to dry and warm their feet as best they could, and sleep with their boots off. This was often impractical and most ignored the directive.

Conditions in the Falklands War were also extreme. The British soldiers were severely challenged by their inferior boots. The direct moulded sole failed to keep their feet dry and water poured through the lace holes. The impermeable sole provided a perfect reservoir and feet was immersed in cold water for long periods. Trench foot was commonplace and a major concern to the assault forces. The Argentine boot, on the other hand, was superior in every way and provided ideal protection to the elements hence it became a valued prize of war.


Trench Foot or Immersion Foot

Trench foot, also known as immersion foot, occurs when the feet are wet for long periods of time. It can be quite painful, but it can be prevented and treated.

What are the symptoms of trench foot?

Symptoms of trench foot include a tingling and/or itching sensation, pain, swelling, cold and blotchy skin, numbness, and a prickly or heavy feeling in the foot. The foot may be red, dry, and painful after it becomes warm. Blisters may form, followed by skin and tissue dying and falling off. In severe cases, untreated trench foot can involve the toes, heel, or entire foot.

How is trench foot prevented and treated?

When possible, air-dry and elevate your feet, and exchange wet shoes and socks for dry ones to help prevent the development of trench foot.

Treatment for trench foot is similar to the treatment for frostbite. Take the following steps:

  • Thoroughly clean and dry your feet.
  • Put on clean, dry socks daily.
  • Treat the affected part by applying warm packs or soaking in warm water (102° to 110° F) for approximately 5 minutes.
  • When sleeping or resting, do not wear socks.
  • Obtain medical assistance as soon as possible.

If you have a foot wound, your foot may be more prone to infection. Check your feet at least once a day for infections or worsening of symptoms.


What you should know about trench foot

Trench foot, also known as immersion foot syndrome, is a type of non-freezing cold injury. It is a condition that develops when feet are cold and wet for a long time and affects the skin.

Trench foot got its name during the First World War (1914-1918) when around 75,000 British and 2,000 American soldiers developed the condition after spending long periods of time in the cold, wet trenches on the front line.

Later, sailors serving during World War II (1939-1945) also developed the condition, and there are reports of it being experienced by homeless people today.

Share on Pinterest Prolonged exposure to cold and wet conditions may cause trench foot.
Image credit: Mehmet Karatay, 2007

Trench foot or immersion foot is a type of tissue damage caused by prolonged exposure to cold and wet conditions. It leads to swelling, pain, and sensory disturbances in the feet. It can lead to damage to the blood vessels, nerves, skin, and muscle.

Trench foot is distinct from frostbite, another form of tissue damage to the feet, in that the skin does not freeze. It is known as a non-freezing cold injury (NFCI).

People who have the condition today do not experience the same level of tissue loss as the soldiers that developed it during the wars.

It is a preventable condition that causes long-term damage and it is not contagious.

Symptoms of trench foot can include:

  • tingling or itching
  • pain
  • swelling
  • cold and blotchy skin
  • numbness
  • a prickly or heavy feeling

Once the foot warms up, people may notice their foot changes from white to red, eventually becoming dry and painful. Blisters can form, leading to skin and tissue falling off the injured foot.

If trench foot is left untreated, it can lead to gangrene and even the need for amputation.

Cases of trench foot are categorized into one of the four following stages:

  • Stage 1 – injury stage: The blood flow is restricted, and the tissue is cold and numb. The limb may be red or white, and there is no pain.
  • Stage 2 – immediate post-injury: Once the limb has warmed, it can turn from white to blue and stay cold and numb. There may be mild swelling.
  • Stage 3 – hyperaemic phase: This can last from 2 weeks to 3 months. During this time, the limb becomes hot and red, and the skin becomes dry. There is often pain and pins and needles. In severe cases, blisters may develop.
  • Stage 4 – post-hyperaemic stage: This may last for the rest of the person’s life. They may experience increased sensitivity to the cold, pins and needles, and some pain. There may also be some ongoing ulceration.

Trench foot results from exposure to temperatures of between 0°C to 15°C and the risk increases if the feet are also wet. It occurs when low temperatures restrict blood flow to the affected area.

Some people can develop symptoms after just an hour of exposure in others, symptoms may not appear for up to a week.

The severity of the injury will depend on the degree of cold, the wetness of the tissue, and how long a person was exposed to the conditions.

Military personnel are the most likely to be affected, and there is a suggestion that military stress contributes to the development of trench foot.

Trench foot has also been known to occur among people that fish for a living and homeless people. Studies have also shown that people of African ethnicity are more likely to develop the condition than Caucasians.

Anyone who suspects they have trench foot should seek medical attention. A healthcare professional will examine the foot to decide what stage the trench foot has reached.

While the immediate effects of trench foot can be alleviated, the condition can lead to long-term tissue damage and chronic pain. A person with trench foot may require long-term follow-up care.

The first thing to do is to remove the person from the cold, wet environment and warm the affected limb up slowly. Quickly warming the foot can make the damage worse.

People can take painkillers to ease the pain and should protect any pressure sores.

  • cleaning and drying the feet thoroughly
  • wearing clean, dry socks every day
  • not wearing socks when sleeping or resting

In serious cases, people will find it difficult to walk because of the swelling, pain, and blisters. They should avoid walking and elevate their feet as this will help to reduce the swelling. Ibuprofen will also help to reduce inflammation.