APPENDIX J
HEADQUARTERS
NORTH AFRICAN THEATER OF OPERATIONS
Office of the Surgeon
APO 534
6 JUNE 1944 710.
SUBJECT: Trench Foot
TO: Commanding General, NATOUSA
1. The total cases of trench foot as shown on hospital bed status reports from 12 Nov. 43 to 30 Apr. 44 was 5,670. The total battle casualties for Fifth Army for the same period was 21,674, giving a ratio of trench foot to battle casualties of 1 to 3.8. Trench foot accounted for 9% of all disease admissions from Fifth Army for the period 1 Nov. to 30 April.
2. Information available indicates that 20% of trench foot cases return to duty in 3 to 6 weeks, the remaining 80% have a prolonged hospitalization period with a probable return to full duty of not over 60%. The remainder must be used in limited assignment or evacuated to the ZI. Those cases returned to duty are much more susceptible to further injury due to cold. One battalion surgeon reports that out of 281 cases of trench foot evacuated from his battalion (Hawaiian) 29% were recurrences.
3. The prevention of trench foot is primarily a training problem which must depend entirely upon the education and discipline of the individual soldier. The problem is complicated during combat by the fact that the most susceptible group, the infantry, has a rapid turnover in personnel. We must teach the recruit how to keep from becoming a trench foot casualty at the most tense moment in his life, namely, when he is about to engage the enemy in close combat for the first time. To date there is repeated evidence that replacements in this theater have not received instruction in the prevention of trench foot prior to joining the combat division.
4. British troops in the beachhead had less trench foot than US troops. This was probably due to:
a. Better foot discipline and training in care of the feet.
b. Heavy wool socks.
c. Shoes large enough so that no constriction of the feet was caused by wearing heavy wool socks. (US troops tend to fit shoes too small for cold weather when heavy socks or two pair of light socks must be worn).
d. A pair of clean dry socks for each man daily. issued with the ration.
e. More frequent shifting of personnel in the line.
5. It is apparent from the above that trench foot is a serious problem. Foot disabilities experienced in warm weather are not as serious as trench foot but because of their prevalence they greatly affect troop efficiency. The solution of these problems can be obtained by proper training and equipment.
6. Studies in equipment requirements have been made and appropriate recommendations made to the War Dept, radio to AG WAR, ref. No. F53022, 31 May 44:
"Training in care of the feet and foot discipline has not reached the required standard. It is therefore recommended:
1. All units be issued the NATOUSA pamphlet on care of the feet and that it be used as a basis for unit training.
2. All unit training programs include at least 4 hours instruction in care of the feet.
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3. That special training in care of the feet be given to unit commanders and NCO's and that they be taught the fundamentals of foot inspection by medical officers of the unit.
4. That unit commanders and NCO's be held responsible for foot casualties. A high incidence of these conditions to be indicative of lack of leadership.
5. That frequent inspections of feet and foot gear be made by the officers of combat units. That following such inspections immediate action be taken to correct deficiencies found in training, equipment or physical condition of individual's feet.
6. That all Replacement Depots conduct a school in care of the feet and certify that all individuals furnished to combat units have completed such a course."
7. Laundry facilities for socks should be provided for combat divisions during cold wet weather. Under such conditions one pair of dry socks should be furnished each individual daily with the ration.
8. In addition to the above measures commanders should arrange, during cold weather, for men in front lines to be released frequently. If this is not done they will lose one man with trench foot for each 3 to 4 battle casualties.
MORRISON C. STAYER,
Major General, USA.,
Surgeon.
