(1).
These are briefly as follows: -
That the aetiological factors of classical frost bite
are by no means identical with those of the allied condition,
which for want of a bettor term we have called "Trench Feet ".
(2). That two such divergent types of causal factors cannot,
and do not, produce the same pathological condition; and,
that this present condition is therefore not true classical
frost lotto, but a clinical entity allied closely to it,
which probably was first diagnosed as such in the Russo -
Japanese war, but which, until. the Flanders Campaign of this
winter, has never before ranged in line with those great
and grave diseases which are inevitable concomitant of
every great war.
(3). That whilst it is a condition allied to classical
frost bite, yet, in its severest type it only approximates to this
condition, not only in the destructiveness of its lesions,
but also in its depth of pain.
(4). That in more detail, the condition of "Trench Foot"
differs from that of Classical Frost Bite in being much less
destructive, but at the same time capable of producing
generally a more wide spread affection, especially of the
peripheral nerves of the extremities. The necrosis of
"Trench Feet" is more superficial - the lesions are more
symmetrical - the pain less excruciating - the prognosis
and progress more satisfactory than those of classical
"frost bite ".
(5). That the essence of the aetiology of the present
condition consists in:- A prolonged and intimate exposure
on the lower extremities to a medium of stagnant mud and
water, in an atmospheric temperature at or near the freezing
point. The feet and legs must be in close contact with
this chilled medium which by its physical nature continuously
induces a radiation of local heat into the surrounding
atmosphere.
(6)The predisposing factors are: -
(i) Absence or great abeyance of those muscular movements
which are a natural response of the organism to cold,
and which, by stimulating the circulation, tend to
remove products of fatigue from the tissues.
(ii)
Continuous assumption, for periods measured in days,
of faulty attitudes and postures of the body, especially
of the lower limbs - calculated to induce simultaneously
in the distal parts, fatigue in muscle and nerve, and
stasis of blood and lymph
(7)That certain accessory causal factors do not enter to that
extent which as been attributed to them, viz: -
(i) That continuous pressure of wet puttees upon the leg
has been proved not to exist, in so much that the trained
soldier will not wear a tight puttee.
(ii) That the theory of tight boots is equally and for
a similar reason fallacious; and further, that the
increased pressure against the boot is an after effect
due to the oedema, which,in its turn,is one of the
earlier expressions of an already well developed
pathological condition.
(iii) That the unavoidable scarcity of hot and stimulating
food and drink in the trenches, whilst adding to the
suffering, can have but little effect in
ameliorating the severity of the factors producing the
condition.
(iv) That the excessive use of tobacco,with its
possible affects upon the vaso-motor nerve
terminals, is contraindicated.
That from the point of view of service conditions
here, and from what we consider justifiable clinical and
pathological grounds, and from the stand point of common -
sense,and practicability,we have put forward a
classification of "Trench feet" into three degrees: -
(i). Degree 1. Mild,with defective sensibility.
(ii). Degree 2. More severe,with oedema and neuritis.
(iii). Degree 3. Dry gangrene superficial in type.
(9)That hitherto we have not observed one case of
genuine "Trench Feet" which exhibits that preponderance
of subjective symptoms of an emotional type over
objective symptoms, trivial in character,and associated
with slight local lesions,which a recent writer has
described as a "neurosis ".
(10)Whilst a functional derangement of the nervous
system is capable of simulating to a certain extent
the defects of sensibility which characterise "Trench
Feet", the type of an anaesthesia, however, produced by
the latter is similar to that of an organic lesion, - viz,a peripheral neuritis. Frost bite as a neurosis
therefore does not exist.
(11). While there is abundant evidence to show that the
condition is one essentially due to a prolonged local
interference with the circulation of the blood and
lymph in the distal parts of the limbs, yet,there is also
ample evidence for believing that the peripheral nerves
of the lower extremities are also the seat of definite
lesions.
(12). Intense degrees of frost such as have been
associated with the production of classical frost bite
have not been experienced in Flanders during the present
winter, and, therefore cannot enter into the aetiology
of the present condition; but, on the other hand, that
particular meteorological phase which is associated with
"Trench Feet ", consists in a heavy and continuous
rainfall, accompanied intermittently by sharp attacks of
frost - conditions which have actually occurred in
Flanders during the greater part of this winter.
