Trench Foot: The Medical Response in the First World War 1914–18

Atenstaedt, Robert

doi:10.1580/06-weme-lh-027r.1

Cited by 30 publications

(8 citation statements)

References 27 publications

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“…Trench foot or non-freezing cold injury (NFCI) has been documented historically in a number of military conflicts ( 1 ). Clinical observations and possible pathophysiological mechanisms were described in World Wars I and II, when Trench foot became a major problem ( 2 ). During this period, key studies were conducted by Hughes ( 3 ) in soldiers operating in trenches, and by Ungley et al ( 4 – 7 ), in soldiers who had prolonged limb immersion in cold sea water.…”

Section: Introductionmentioning

confidence: 99%

Trench Foot or Non-Freezing Cold Injury As a Painful Vaso-Neuropathy: Clinical and Skin Biopsy Assessments

et al. 2017

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BackgroundTrench foot, or non-freezing cold injury (NFCI), results from cold exposure of sufficient severity and duration above freezing point, with consequent sensory and vascular abnormalities which may persist for years. Based on observations of Trench foot in World War II, the condition was described as a vaso-neuropathy. While some reports have documented nerve damage after extreme cold exposure, sensory nerve fibres and vasculature have not been assessed with recent techniques in NFCI.ObjectiveTo assess patients with chronic sensory symptoms following cold exposure, in order to diagnose any underlying small fibre neuropathy, and provide insight into mechanisms of the persistent pain and cold hypersensitivity.MethodsThirty soldiers with cold exposure and persistent sensory symptoms (>4 months) were assessed with quantitative sensory testing, nerve conduction studies, and skin biopsies. Immunohistochemistry was used to assess intraepidermal (IENF) and subepidermal (SENF) nerve fibres with a range of markers, including the pan-neuronal marker protein gene product 9.5 (PGP 9.5), regenerating fibres with growth-associated protein 43 (GAP43), and nociceptor fibres with transient receptor potential cation channel subfamily V member 1 (TRPV1), sensory neuron-specific receptor (SNSR), and calcitonin gene-related peptide (CGRP). von Willebrand factor (vWF), endothelial nitric oxide synthase (eNOS), and vascular endothelial growth factor (VEGF) were used for assessing blood vessels, and transient receptor potential cation channel, subfamily A member 1 (TRPA1) and P2X purinoceptor 7 (P2X7) for keratinocytes, which regulate nociceptors via release of nerve growth factor.ResultsClinical examination showed pinprick sensation was abnormal in the feet of 20 patients (67%), and between 67 and 83% had abnormalities of thermal thresholds to the different modalities. 7 patients (23%) showed reduced sensory action potential amplitude of plantar nerves. 27 patients (90%) had decreased calf skin PGP 9.5 IENF (p < 0.0001), the remaining 3 patients had decreased nerve markers in subepidermis or foot skin. There were marked increases of all vascular markers (for vWF in calf skin, p < 0.0001), and increased sensory or regenerating SENF (for calf skin, GAP43, p = 0.002). TRPA1 (p = 0.0012) and P2X7 (p < 0.0001) were increased in basal keratinocytes.ConclusionA range of skin biopsy markers and plantar nerve conduction studies are useful objective assessments for the diagnosis of peripheral neuropathy in NFCI. Our results suggest that an increase in blood vessels following tissue ischaemia/hypoxia could be associated with disproportionate and abnormal nerve fibres (irritable nociceptors), and may lead to NFCI as a “painful vaso-neuropathy.”

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Section: Introductionmentioning

confidence: 99%

Trench Foot or Non-Freezing Cold Injury As a Painful Vaso-Neuropathy: Clinical and Skin Biopsy Assessments

et al. 2017

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“…Ongoing experimentation and clinical observation resulted in a consensus that circulatory compromise, as a consequence of cold and wet conditions, accompanied by immobility and constricting footwear were to blame. 16 This had been identified in the winter of 1914 where wet, cold, immobile feet in constricting footwear would potentially leave the ‘local circulation reduced to a very low ebb’ possibly leaving certain areas of circulation ‘arrested for a time altogether’. 17…”

Section: First World Warmentioning

confidence: 99%

Non-freezing cold injury, lessons from history for future prevention

Whitaker

2015

Trauma

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Living, operating and training in adverse and exposed environmental situations place humans at risk of climatic injury including non-freezing cold injury. Non-freezing cold injury has caused, and continues to cause, significant problems to both civilians and military personnel exposed to cold. This article reviews the impact of this condition through history and identifies lessons that can be drawn for prevention based on historical and contemporary evidence.

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“…A neglected area of research is the group of diseases that bear the name of the trenches, namely trench fever, trench nephritis and trench foot. [14][15][16] Trench fever was a short-duration relapsing fever spread by lice; trench foot involved pain and swelling of the feet due to exposure to cold and damp, which could lead to gangrene. Trench nephritis occurred secondary to an unknown cause but there are arguments to believe that at least many cases of trench nephritis were caused by Hanta virus disease (see below).…”

Section: Trench Nephritismentioning

confidence: 99%

Wars, disasters and kidneys

Lameire¹

2014

Acta Clinica Belgica

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This paper summarizes the impact that wars had on the history of nephrology, both worldwide and in the Ghent Medical Faculty notably on the definition, research and clinical aspects of acute kidney injury. The paper briefly describes the role of 'trench nephritis' as observed both during World War I and II, supporting the hypothesis that many of the clinical cases could have been due to Hantavirus nephropathy. The lessons learned from the experience with crush syndrome first observed in World War II and subsequently investigated over many decades form the basis for the creation of the Renal Disaster Relief Task Force of the International Society of Nephrology. Over the last 15 years, this Task Force has successfully intervened both in the prevention and management of crush syndrome in numerous disaster situations like major earthquakes.

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Trench Foot: The Medical Response in the First World War 1914–18

Cited by 30 publications

References 27 publications

Trench Foot or Non-Freezing Cold Injury As a Painful Vaso-Neuropathy: Clinical and Skin Biopsy Assessments

Trench Foot or Non-Freezing Cold Injury As a Painful Vaso-Neuropathy: Clinical and Skin Biopsy Assessments

Non-freezing cold injury, lessons from history for future prevention

Wars, disasters and kidneys

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