"Immersion foot" is an ailment, normally rare, which results from having
the feet wet, as in a lifeboat, for days on end. It is aggravated by
cold, and since the freezing point of sea-water is lower than that of
human blood, the feet and lower legs of persons in lifeboats and on
life rafts are apt to exhibit symptoms of freezing if kept wet for
hours and days with ice cold sea water.
Torpedo victims are often huddled together with little chance for movement; immersion
foot is the result. Technical experiment has also demonstrated that vitamin deficiency
plays a great part in lowering the patients' resistance. It was discovered that immersion
foot could occur in warm southern waters as well as in the North Atlantic.
With no or improper first-aid or medical treatment, amputation is frequently
necessary, and intense suffering almost inevitable. However, with proper
precautions, first-aid and correct hospital treatment, much of this pain and
injury can be avoided. Three medical officers of the Canadian Royal Navy, Surgeon
Commander D. R. Webster, Surgeon Lt. F. M. Woolhouse and Surgeon Lt. J. L. Johnston have
developed such methods, described in the April 1943 issue of the Royal Canadian Navy
Monthly Review, from which this article is extracted.
Victims of immersion foot report that they felt no pain after the first cold in their
feet and legs. However, as their feet grew colder, and the circulation slowed down, the
tissues were damaged, and as time went on, the skin became waxy-white in color, and
insensitive to pain or temperature. Their extremities were practically dead with no
more than a spark of life to be nurtured back to health through a gradual rise in
temperature. Under such conditions, infection develops easily in the injured tissues
and gangrene would be an almost certain result.
Dangers of Improper First Aid
Sympathetic rescuers have massaged these pitifully swollen feet and covered them with
blankets and hot water bottles. Soon began, "intense, intermittent, stabbing, shooting
pains, which started in the ankle joint and radiated to the tips of the toes with a
generalized tingling sensation." Some victims of such misdirected treatment developed
gangrene, which sometimes resulted in amputation. This happened to the survivors of
one internationally known ship which was sunk in European waters. Of those picked up
by trawlers, almost all had to have their feet amputated.
It is most important to keep the feet dry and warm and to exercise the legs and feet--two
things next to impossible in a crowded life boat or a raft. The first thing to be done, if
possible, is to cover the legs and feet with a thick coating of grease as do long distance
swimmers. Constricting clothing and shoes must be removed--they are useless in keeping the
feet warm in the water anyway.
Correct First Aid
The first-aid rules are simple. The patient is to be kept dry and warm except for his
feet. Any wounds, cuts or sores are to be dusted lightly with sulphanilimide powder. The
legs are wrapped in some clean, soft material and laid on pillows,
Doctors Webster, Woolhouse and Johnston used as their basic theory, "treat cold with cold." The
affected areas were slowly brought back to normal temperature over a period of weeks. At first
when it became necessary to devise a treatment in line with this theory, the patient's legs were
placed, elevated, covered with a sterile towel, and packed with ice bags. Later, instead of ice, a
cold blast from a fan was used, and at another time, the patient's feet were left exposed in a
cold room while his body was warmly covered. Finally, a refrigerator was developed, with two
openings for the legs, like a prisoner's stocks.
So effective was this treatment in relieving pain in one case when the cooling system
failed, a patient fled to a window and promptly put his feet out to cool in the winter air.
There are some "must nots" which are most important:
No rubbing or massage;
No heat of any kind near the affected parts;
The patient must not stand or walk and his legs and feet must be gently handled;
The legs and feet must not be washed or soaked;
No lotions or antiseptics except sulphanilimide may be applied.
At an eastern Canadian port, of 150 cases so treated, only seven amputations were necessary.
Men who were cured had to learn to walk all over again, and had an unusual and awkward gait
until they regained the use of their limbs. Severe cold, too, would bring aches and pains
to their feet.