Here were the beginnings of "Trench Feet." To have the feet wet, to have the feet cold for long spells, will cause chilblains, i.e., local inflammations showing first as red itching lumps, afterwards if neglected, developing into open sores. Long periods of standing, and any constriction of the circulation from tight boots or tight puttees, help cold and damp to cause chilblains; and chilblains used to be almost invariably neglected by the soldier. Then came the final aggravating cause—the filth of the Flanders mud getting into the sores of the broken chilblains, and, behold, a typical case of Trench Feet.
In the early days cases were often of dreadful severity, sometimes leading to amputation. In one of my billets at Montreuil was a French soldier who had lost both his feet from this cause. Later, both treatment of the disease and, more important, the prevention of it, were so perfected that really bad cases were rare.
The story of the fight against "Trench Feet" is one of the many fine stories of the war. In the main it was, of course, a story of medical skill and devotion, but also it was a story of unstinted generosity on the part of the War Office, and of admirable and intelligent service on the part of regimental officers. The medical staff told me that it would have been impossible to carry on to success the campaign against "Trench Feet" if they had not been intelligently and perseveringly backed up by regimental officers, and if the War Office had not poured out very many thousands of pounds sterling for the furtherance of every approved preventive measure.
Preventive measures covered a wide field; precautions against tight boots and tight puttees; increased provisions of socks; increased bathing facilities; provision of waterproof rubber boots for men while in the trenches (these boots were of the high wader type); paving of the trenches with "duck-boards" which gave a dry standing; more frequent reliefs in wet trenches. These were material provisions. To second them there was an active propaganda in personal hygiene, and here the regimental officer and non-commissioned officer were enlisted to help the medical staff to make the men understand that the smallest sign of a chilblain was to be met with prompt treatment. A whale oil ointment was provided both as a prophylactic and as a curative for mild chilblains. When necessary this was reinforced by spirituous lotions. On officers was put the responsibility of seeing that their men's feet were kept clean and well anointed with oil, and that any breach of the skin tissue was promptly treated. So officers became chiropodists, and you might see enthusiastic company commanders assisting their men to wash and anoint their feet, to show them how it should be done.
The winter of 1917-1918 put to a severe test the precautions against "Trench Feet," for in almost every part of the Western Front the British had pushed the Germans back, and there was no longer the old organised trench system. Nevertheless the British hospital records show that the disease was held. It was still a trouble; but, thanks to the plentiful supply of comforts and preventatives, and to the scrupulous care demanded by regimental and medical officers, it was no longer a grave menace.
The fight against mustard gas in 1918 was another fine achievement of the Medical Services. But this subject of the medicine of the war calls for a volume to itself. Let me only add here that the successful medical results won in this war were largely due to the fact that—contrary to the system of other wars—the doctor had a real influence and power at G.H.Q. In his own department he was supreme. So were solved successfully the vast medical problems which the Great War presented. The greatest armies known to history grappled in a continuous and furious struggle, not for a day or a night or a week, but for months. The wounds caused by hand grenades and high explosive shells were often of terrible extent. The battlefield to a depth of five miles was under constant shell fire, and transport of the wounded for that distance was therefore always under fire, and roads were torn up almost as soon as made. Conditions of infection were extraordinarily favourable. Traffic regulation had to overcome the most serious obstacles, since railways, roads and tracks had to provide for the constant reinforcements, for the frequent passage to and fro of relieving Divisions, for food and water for men and horses, and also for ammunition unprecedented in quantity.