Well – I have to resort to this after all, dear – but let’s blame it on the military situation. I’ve really been and still am – quite busy, darling – and glad to have the chance to dash even this off.
No mail yesterday – but quite a number of packages – none for me, this time. Despite everything – we’re planning a regular big Christmas celebration here – and already have a big tree set up here. We found some decorations and lights and the tree is beginning to look real nice.
I wonder how things are at home and what kind of Christmas you’ll have. It’s so long since I’ve had a sort of recent letter from you, dear – I seem to be out of contact with things at home. But I hope you have a pleasant day – and by the way – how about New Year’s Eve, sweetheart? I hope you have something planned. Whatever you do, I’ll be with you in everything but person – dear. All for now, darling. My love to the folks – and
The winter of 1944-45 was the coldest and wettest in years, and the wet cold, combined with the tactical situation, created conditions most favorable for the development of trench foot and frostbite. Moreover, two points of view prevailed about the possibility of a winter campaign in Europe, neither of them conducive to preparations for the prevention of cold injury. Historically, decisive military campaigns had not been fought in western Europe during the cold winter months. On the other hand, it was the opinion, at least in certain circles, during the summer and early fall of 1944, that the war would end before winter. Thus, staffs were not psychologically attuned to the need for large supplies of special combat clothing, footgear, and other winterizing equipment, or to the necessity for an extensive program for the prevention and control of cold injury when there was time. A calculated risk also was taken by command decision to bring forward ammunition, gasoline, and other combat requirements to the exclusion of winter clothing and footgear.
What follows has been extracted from The Annals of Surgery, August 1946; Vol. 124, Issue(2), pages: 301–313. To read the entire article, click here.
"Trench foot" is a diagnostic term used by the U. S. Army Medical Corps to describe the cold injury resulting from prolonged exposure to just above freezing temperature (340 to 400 F.). It has occurred almost exclusively in combat infantry riflemen who were forced into immobility by enemy action. "Frost-bite" is the term used to describe the cold injury resulting from exposure to below-freezing-temperatures-either "ground type" occurring in the ground forces, or "high altitude type" occurring in combat air crews. "Immersion foot" designates the cold injury resulting from prolonged exposure of the feet to cold water. For administrative reasons, these injuries are described as different clinical entities, but it now appears that they all produce similar pathologic changes and can be treated identically.Here is an article about trench foot published by TIME magazine, 01 January 1945 titled "Medicine: Again, Trench Foot"
Following the early November offensive, and again after the German counter-offensive in December, I944, the U. S. Army casualties increased at an alarming rate, several weeks reaching 50 per cent of battle casualties. During the Lorraine campaign, 20 in November 1944, the 328th Infantry Regiment had to evacuate more than 500 men as casualties from trench foot and exposure during the first 4 days of one engagement; this number exceeded the number of battle casualties.
TOTAL MONTHLY ADMISSIONS TO HOSPITALS ON CONTINENT
Battle Trench Foot and Frost-bite
Nov. 1944 ......... 41,793 6,869
Dec. 1944 ......... 37,336 11,469
In trench foot, the sequence of events leading to the injury followed a fairly constant pattern. The combat infantry soldier is forced into immobility in a wet foxhole for a prolonged period of time. During this period, he first notices tingling or complains of a stinging sensation in his feet, which may become quite intense. After a period of exposure, the feet become numb and finally anesthetic, "like blocks of ice." When the attack is ordered, or he is relieved, walking causes severe burning pain; and on the removal of his shoes, the feet become swollen and warm. Three factors were always present in the carefully examined cases. First, wet cold; second, a prolonged exposure in a relatively immobile position; and third, physical activity following the exposure. Of these factors, wet cold is undoubtedly the most important. Peak casualties always followed periods of wet cold weather.
The secondary etiologic factors which combine with wet cold to produce the final injury are important since they are often correctable. Combat activity was always followed by an increase in trench foot casualties. Fifty per cent of the soldiers were injured in their first combat experience. Proper and adequate foot gear was unavailable in 8o per cent of the casualties during the November, I944, offensive. After the U. S. Army overshoe was issued, this foot gear proved inadequate in many instances. The important fact that a boot should be designed for rapid removal is not considered in the standard American and British foot gear. Soldiers repeatedly use this excuse for their failure to replace wet socks under combat conditions.
First and Second Degree Trench Foot
Third Degree Trench Foot
2 days, 2 weeks, 4 weeks and 6 weeks after exposure
Constriction of the foot and ankle by improperly fitted shoes was difficult to evaluate. Many soldiers complained that their "shoes felt too small after several days of exposure" but the first sign of cold injury is edema and probably caused this complaint. Prolonged dependency and immobility of the feet appeared important in a few cases occurring in tank crews and artillery squads. These soldiers alone had either dry feet (tank crews) or were in a position to maintain an adequate rotation policy. This suggests that dependency and immobility increase the susceptibility of the feet to cold injury. The soldiers with a history of previous foot trouble, either cold injury or other conditions, sustained milder injuries than the entire group examined. Only 20 per cent suffered second- or third-degree injuries as compared to 63 per cent with similar injuries for the entire group. In other words, previous foot trouble made the soldier "foot conscious" and medical aid was requested early.
The most important correctable secondary factor is an improved rotation policy for troops during combat activity. If a few men are relieved for only an hour daily from each group, adequate foot care could be required under supervision, if necessary. This was almost impossible when the tactical situation required troops to wade streams and "dig in" until relief arrived. Company commanders most successful in avoiding casualties under these circumstances, required each soldier to exchange old wet socks for clean dry ones when daily food rations were issued. This often required the mess sergeant to deliver food and clean socks from foxhole to foxhole during the hours of darkness.
Soldiers reporting into Battalion Aid Stations with "cold feet" should be immediately sent to a nearby "Restoration Area" for at least 24 hours' observation. Experienced clinicians have difficulty in estimating the degree of injury until the reactive hyperemia or inflammatory reaction develops. In the Restoration Area, the most important point in the evacuation chain, all "cold feet" should be given a cold foot bath and placed in a cool dry bed. Warm food and drink should he given to restore normal body temperature and gradual, slow restoration of normal blood flow of the feet. External heat, walking or vigorous massage is avoided at this period. Slow restoration of blood flow will avoid stasis in the capillary bed which subsequently leads to skin necrosis.
Europe's mud and slush of October and November caught the U.S. Army with its feet unprepared. Result: up to Dec. 12, 17,500 G.I.s had developed trench foot, something no one expected in World War II (partly because no one expected the war to settle down into mud and trenches).
Trench foot is a sort of mild frostbite that results from letting feet stay cold and damp for a long time. Shelter foot and immersion foot (TIME, May 10, 1943) are essentially the same thing. Circulation slows or stops, feet turn white and numb, sudden warming causes painful burning. The devitalized tissues may recover if kept cool and dry for a few days or weeks. But in some cases blisters develop and become infected, even cause gangrene, amputation or death. Many victims who emerge with feet intact can never fight again because their feet ache on long hikes and are very sensitive to cold.
Boots and Massage. In contrast to U.S forces, the British have no trench-foot problem, even though they have been actually wading through Holland. Their stout workmen-type boots and gum boots have turned out to be drier than anything the U.S. has produced. But the most important factor is that British soldiers are required to keep their boots waxed, to massage their feet with oil and change frequently to dry socks.
Most U.S. soldiers have tramped the mud in rubber-soled, rough-side-out leather combat boots (fairly water-repellent if coated in a waxy substance called dubbing); some had only ordinary G.I. boots with legging extensions (an extremely soggy combination); a few had galoshes. Most trench-foot casualties occurred because officers and men were still careless about dubbing and foot massage, and did not bother with dry socks or galoshes.
Already the trench-foot rate has been cut 75% simply by making the G.I.s take care of their feet, even in battle. Men are learning to dry their socks on bushes or in their jackets or helmets. In some forward areas, dry socks are issued along with rations. Now improved boots are on the way. They are the Quartermaster Corps' new calf-high shoe-pacs, synthetic rubber up to normal shoe height and leather the rest of the way, designed to be worn with two pairs of heavy socks. Production began in August and a few shoe-pacs have already been issued to the troops fighting under the worst conditions.
Discipline and Massage. The Germans have not licked the problem (in one group of 46 captured German casualties, 14 had trench foot) but the Russians have—thanks to long experience and rigid discipline. All Russian soldiers are paired off, required to massage each other's feet regularly; and the man whose massage buddy gets trench foot catches hell.