rtherly winds, and
on the afternoon of November 19th there was a heavy fall of snow. That
evening a hard frost set in which lasted for several days. The men in
the trenches began to suffer severely.

It was at this time, the third week of November, 1914, that
the serious evil known as "Trench Feet" first made its appearance in
the Army in France. The cases were at first labelled "Frost Bite," but
as they were subsequently found to occur without any fall of the
temperature to freezing point, this term was evidently a misnomer.
Indeed, cases have occurred during the month of August.

The condition is caused by prolonged immersion in water, and certainly
can occur when the temperature of the water is as high as 50 deg.F. It is
seldom caused unless the immersion is as long as 24 hours, but the
cooler the water the less is the time required to produce it. In most
cases the temperature of the water has been below 40 deg..

In addition to cold water, the onset is favoured by--

(_a_) Prolonged standing in one position, as is often the case
with men deep in mud.

(_b_) Tight puttees and tight boots.

(_c_) Exhaustion and want of food.

(_d_) A natural tendency to feeble circulation, _e.g._, men who
suffer from chilblains.

(_e_) Lying out, after being wounded, in wet and cold weather.

The condition observed varies very much according to the severity of
the case:--

(_a_) The feet may be merely very painful and tender.

(_b_) Much more often they are very swollen and cold, with but
little feeling in them.

(_c_) Frequently the whole foot is like a big "chilblain" and is
very hot, red and swollen. _Blisters_ are common in all such
feet.

(_d_) The toes may be black and the foot blue.

(_e_) The toes especially, and the foot much more
rarely, may die and become gangrenous.

Except in slight cases, the men affected are quite unfit for duty for
two or three months at least, especially for duty in trenches in cold
weather. If men are sent back to duty too soon, a short exposure at
once brings back all the trouble in an aggravated form. Of course, if
gangrene occurs, the man is permanently invalided.

The only _real_ preventative is to arrange that the men do not remain
deep in mud or cold water for prolonged periods. If this is not
possible, cases of "trench feet" are inevitable. Apart from avoiding
this, the primary cause, various s