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Key Facts & Summary
- Trench foot is not a war injury. Rather, it is an injury that developed due to the precarious living conditions soldier were forced to endure throughout the First World War.
- How does Trench foot manifest itself? According to My Health Alberta (2017), the following are the most common symptoms:
- Red skin that eventually becomes pale and swollen (this is because the blood vessels constrict)
- Burning and Itchiness
- Cramps in one’s leg
- ‘A slow or absent pulse in the foot’
- Blisters and ulcers
- Necrosis (or gangrene) would be the consequence
- How did soldiers get Trench foot? By staying in cold water or areas with much moisture.
During the cold 1914-1915 winter, trench foot was reported under several names, such as ‘frostbite, chilled feet, effects of exposure, N.Y.D. feet, or feet cases’ (The Medical Front, no date).
The main difference between the Austrian and German trenches, compared to the French, American, and British trenches, was that the latter occurred at lower elevations. Such characteristics of the land would mean two things: firstly, water would accumulate quickly when it rained; and secondly, one did not have to excavate very deeply before naturally reaching groundwater. It was easier to be affected by trench foot on land that was close to sea level. In fact, it was enough to dig half a metre before the trenches would fill up with water.
Water in the trenches was a problem that the Allied troops (Serbia, Russia, France, United Kingdom, Italy, Belgium, USA) had to face.
Being immersed in water for long hours caused soldiers to develop a fungus which was named ‘trench foot’ and would destroy soldiers’ feet. Trench foot often resulted in the amputation of toes and/or feet in order to avoid the gangrenous infection from spreading to the rest of the body and causing sepsis.
Far from being the exciting and noble war that Europe had envisaged during the years preceding the combat, throughout the First World War, over twenty million people died, while a further twenty-one million people were injured (Biomedical Scientist 2018). Although many of them died during combat, others died due to the harsh, abominable, unsanitary conditions they were obliged to live in. The trenches had poor sanitation, dead bodies lay about, and rats carried germs.
Moreover the lack of food, and the spreading of diseases such as ‘fevers, parasites, and infections’ made life in the trenches a living nightmare (Biomedical Scientist 2018). Soldiers had to endure various types of illnesses, including ‘influenza, typhoid, trench foot, and trench fever’ (Biomedical Scientist 2018). Their sanitary conditions brought them to death just as much as weapons did. In fact, it was easy to get infected, as the Curator of the Army Medical Services Museum (Aldershot, Hampshire) states, ‘a simple cut to a finger from cleaning your gun or digging a trench could quite quickly become infected and develop sepsis’ (Biomedical Scientist 2018’ citing Gage).
The scene soldiers lived in is similar to a horror movie: Gage continues… ‘the men were knee-deep in mud nine out of twelve months of the year, surrounded by bacteria from the bodies of men and animals in no man’s land’ (Biomedical Scientist 2018; citing Gage). In fact, as Walters claims, in trenches one could find not only the corpses of fellow soldiers but also ‘dead horses and human excrement’ (1916).
Furthermore, illnesses could attack them since their immune systems were debilitated due to ‘lack of sleep, wet and dirty clothes and a restricted diet in which a piece of fruit or vegetable was a treat’ (Biomedical Scientist 2018’ citing Gage). Many of the soldiers came from poor backgrounds, too. In essence, it can be stated that the fighter’s immune system was not strong both for the physical and psychological conditions that induced stress.
Historical sources provide evidence that officers did not have to deal as much with trench foot, since it was the infantry - the most exposed part of the army - that suffered the most from this disease and higher classes occupied higher military positions (The Medical Front, no date).
However, the Allies lost many of their men due to the battles especially on the Western Front in France and Flanders, as well as in Gallipoli and Macedonia (The Medical Front, no date).
Although this article discussed the general degrading conditions endured by soldiers, our main discussion will focus on trench foot, i.e. a disease that - according to the 51st Field Ambulance - manifested itself in over 6.8% of WWI’s soldiers (Biomedical Scientist, 2018). Trench Foot was a ‘grave problem’ that the Allies had to endure especially during the winter months (Microbiology Society, 2014). In fact, soldiers had to march for miles on muddy, wet paths, and the weather was very often below zero (Microbiology Society, 2014).
Such disease was common for the men battling in the trenches. In fact, between 1914-15, over 20,000 Allied soldiers suffered from this condition and, by 1918, over 74,000 people had been affected (Biomedical Scientist, 2018).
Having dug the trenches, water would immediately fill the space up, and soldiers were obliged to remain there ‘in soaking wet socks and boots’ for hours (if not days) (Biomedical Scientist, 2018). Therefore, such a condition would cause a soldier’s feet to ‘swell and go numb, and then the skin would start to turn red or blue’ (Biomedical Scientist, 2018). As a consequence of constantly having damp feet, soldiers that were not able to appropriately cure their condition were faced with gangrene which ‘could lead to nerve damage, tissue loss and ultimately the need for amputation’ (Biomedical Scientist, 2018).
According to the Microbiology Society, in grave cases, the blisters that developed on the foot contained ‘clear “gangrene smelling” fluid’ (2014).
In other cases, the disease would become manifest only after several weeks: in fact, in those instances, the foot would not have an ‘abnormal appearance’ and would present ‘severe pain and acute cutaneous hyperaesthesia’ until it would become ‘very red and hot’ (The Medical Front, no date).
To summarise, it can be stated that ‘the disease may be due on the one hand to the direct effects of cold or, on the other, to the starvation of the parts resulting from the vascular constriction and the sluggishness of the circulation generally’ (The Medical Front, no date).
Trench Foot Prevention
How was trench foot prevented?
The Medical Front (no date) provides its readers with detailed instructions on how to prevent the disease. It claims that the person affected by it should ‘lie down’ in order to ‘keep the feet elevated’ and that the feet should be ‘washed with soap and water, followed by an antiseptic lotion, an injection of anti-tetanus serum must always be given... [subsequently] the feet should be painted with a 1% solution of picric acid in spirit… when the feet remain cold and numb they should be frequently rubbed, and in the interval wrapped in cotton wool… [however], if they are red and hot they are often best left exposed, for wrapping in wool only aggravates’ (The Medical Front, no date).
However, such advice was fairly impractical for soldiers fighting on the frontline and were trying to stay alive. Therefore, one of the suggestions given to the men in the trenches was that of changing socks as frequently as possible, and John Logie Baird made a business out of such a problem by making socks impregnated with sodium borate which would ‘help alleviate wet feet’ (Biomedical Scientist 2018).
Moreover, the lack of exercise and movement influenced the development of the disease in soldiers: in fact, during WWI, the soldiers’ necessity was that of remaining in trenches in order to avoid being killed, and since they were forced to hide in the most uncomfortable positions - with water and mud up to their knees - it is no surprise that ‘their blood circulation was much restricted’ (The Medical Front, no date).
However, the resulting loss of soldiers able to fight introduced the need for another solution which consisted of an elevated wooden floor on the floor of the trenches and the inclusion of drainage systems (Walters 2016). If the measures stated above were not observed, the army’s officials were considered ‘responsible for the development of trench foot’ (Walters 2016).
Although some were able to fight trench foot and recover, they nonetheless remained ‘more susceptible to a second attack’ (The Medical Front, no date).
Summary of soldiers' prevention of trench foot:
- avoid keeping feet and legs in water or mud for extensive periods of time
- keep feet in warm, dry, and clean conditions
- feeding soldiers hot, nutritious food
- applying ‘foot powder and grease’ (The Medical Front, no date)
- using rubber boots that extended above the thighs
Other Instances of Trench Foot
Although it was more prevalent during the First World War, trench foot disease was also reported during the Napoleonic Wars and, throughout the cold Russian marches, trench foot was already ‘a familiar condition’ (The Medical Front, no date). Such a condition was also reported in the Crimean War (1854-1856): during this time, one could get trench foot not only because of the same environmental reason stated in the previous paragraphs, but also because of ‘the lack of opportunities for changing clothes, tight boots, fatigue, and defective nutrition’ (The Medical Front, no date).
[1.] Biomedical Scientists (2018). Disease in the Trenches. Institute of Biomedical Science. [online] Available from: https://thebiomedicalscientist.net/science/disease-trenches
[2.] Healthwise Staff (2017). Trench Foot. [online]. MyHealthAlberta.ca Available from: https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=s
[3.] Microbiology Society (2014). A Microbiological Cause for Trench Foot? Issue: World War I. [online] Available from: https://microbiologysociety.org/publication/past-issues/world-war-i/article/a-microbiological-cause-for-trench-foot.html
[4.] The Medical Front (no date). The Chapter on Trench Foot in the Official “Medical History of the Great War; Medical Services; Surgery of the War; Vol. 1”. [online] Available from: http://www.vlib.us/medical/trenchfoot/trenchft.htm
[5.] Walters, P. (2016). WWI Diseases of the Trenches. Part I: Trench Foot. [online] Kansas WWI. Available from: https://www.kansasww1.org/ww1-diseases-of-the-trenches-trench-foot/