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THE SOLDIERS' MANUAL 
 
 OF 
 
 FOOT CARE 
 
 and 
 
 FOOT WEAR 
 
 and 
 
 CECIL WEB3-JOHNSON, M.B., Ch.B. 
 
 Captain, R.A.M.C.(T.) attached to 10th Middlesex Battn. (D.C.O.) 
 
 Hon. Sec. of Naval and Military Medicine and Surgery Section 
 
 OF THE British Medical Association. 
 
 Compiled from articles published in the ^-^ British Medical 
 
 JournaV and from lectures delivereddn 
 
 Engla7i,d and e Ise where. 
 
 London : DRYDEN PUBLISHL\G COMPANY, LTD. 
 10, Essex Street, Strand, London, \V.C. 
 
 1916 
 

INTRODUCTION 
 
 THIS small book is composed of the 
 articles I wrote for the British Medical 
 Journal on the outbreak of war ; a 
 paper I read at the Annual Meeting of the 
 British Medical Association in July, 1914, 
 and of lectures given by me on various 
 occasions to the Surrey, Middlesex, and 
 other Regiments, at home and in India. 
 Written originally for doctors dealing with 
 troops, there are many medical words and 
 expressions which may be incomprehensible 
 to the lay reader, but I have not considered 
 it necessary to alter them, as the purely 
 scientific parts may well be omitted by the 
 non-medical public. The subject of the 
 soldiers' feet has never been taken really 
 seriously by any Government prior to this 
 war, and even in 191 4 it was common know- 
 ledge that a certain nation could not enter 
 the European arena for lack of footgear, and 
 
 3G0627 
 
IV INTRODLXTION. 
 
 we ourselves have had to provide millions 
 of boots for the armies of our Allies. 
 Although Governments have been backward 
 in recognizing- the importance of the soldiers' 
 feet and footgear, the same cannot be said 
 of the military leaders of the past. Napoleon 
 said he made war with legs as well as arms. 
 Marshal Niel thought good shoes as 
 important for his infantry as good mounts 
 for his cavalry. Saxe said that military 
 tactics depended upon the feet of his soldiers. 
 Wellington, when asked the most important 
 part of a soldier's equipment, replied, 
 ** firstly, a pair of good shoes; secondly, a 
 second pair of good shoes ; and thirdly, a 
 pair of half soles.'' In the war of 1870-71 
 frost-bite was common amongst the French 
 troops, who had no socks and only bad 
 leather shoes of very inferior quality. It is 
 recorded that they used straw in their boots 
 in place of socks. 
 
 A critic of this book wrote : — ** The 
 general effect of cold may have lost Napoleon 
 his Moscow Army, but one of the immediate 
 
INTRODUCTION. V 
 
 causes which rendered the units helpless 
 against the Russian guerillas must have 
 been frost-bite of the feet. Whenever there 
 is a rapid advance across hostile territory 
 continued for several days, an advancing 
 army gains impetus by the elation which 
 comes of following a retreating enemy. But 
 if the greatest care is not taken, it will lose 
 its speed and elan at an increasing rate by 
 reason of foot trouble. It may even be pos- 
 sible that this factor has effected to some 
 minor extent the failure which followed the 
 three great advances which the Germans 
 have made during the present war." In the 
 present campaign there has been so much 
 trench warfare that, in proportion to other 
 wars, the wear and tear of the soldiers* feet 
 have been less than usual. Still, the fact 
 remains that, according to Botha, our 
 soldiers' feet gained us German South-West 
 Africa, and we could not have accomplished 
 the great retreat at the commencement of the 
 war had our soldiers not been able to stand 
 long and forced marches. Trams, motors 
 
VI INTRODUCTION. 
 
 and aircraft will do much to reduce the 
 amount of marching, but in any great war 
 there will always come a time when the feet 
 of the army must be depended upon. 
 
 It has often been stated that the German 
 Army is the most powerful and best 
 organised in the world, and the following 
 extract from the German Field Service 
 Regulations is of interest : '' By far the most 
 important factor affecting the efficiency of 
 troops for war is their power of marching. 
 In many cases the arrival of troops at the 
 right place, at the right time, and in good 
 fighting trim, may be the decisive factor in 
 the situation.'* 
 
 The Germans insist upon the washing of 
 the feet every day, and hold any man respon- 
 sible who falls out on the march through any 
 neglect on his part. Recognising that every 
 ounce added to the weight of a man's boot is 
 equal to loo ounces on his back, they see that 
 the boots are light, and even use aluminium 
 nails. Foot deformities are responsible for 
 a great wastage of fighting material, and in 
 
INTRODUCTION. VII 
 
 1882 L6ques found that foot troubles 
 accounted for one-third of all cases of 
 exemption from active service amongst 
 young French soldiers. For this reason it is 
 the duty of every country to do its utmost 
 to train boys and young men to v^^ear properly 
 fitting boots, and take care of their feet, and 
 such teaching should naturally come in the 
 course of the series of ** Health Lectures '' 
 which most schools provide. It is said that 
 *' cleanliness is next to godliness/' but one 
 finds in practice that with some people it is 
 *' next to impossible." Once insist upon the 
 feet being washed and thoroughly dried 
 every day, and the majority of cases of foot 
 soreness will disappear. The other great 
 point I would insist upon is : if the foot does 
 not fit the boot, make the boot fit the foot. 
 Eliminate foot and hoot disease from the 
 Army, and the efficiency of the forces will 
 be enormously increased. 
 
 For trench w-arfare on the Continent for 
 the winter months, I should like to see the 
 adoption of long boots, and the use of putties. 
 
VIU INTRODUCTION. 
 
 which are not suitable for wet weather, done 
 away with. When wet, putties are liable to 
 contract, and in addition to being- very un- 
 ' comfortable, are apt to cause or ag^gravate 
 such disabilities as gangrene, frost-bite, and 
 inflammation of the veins of the feet and 
 legs. 
 
 Fort William, 
 
 Calcutta, July, 191 5. 
 
THE SOLDIERS' MANUAL 
 
 OF 
 
 FOOT CARE 
 
 and 
 
 FOOT WEAR 
 
 THE question of feet comprises in itself a 
 subject of no inconsiderable magni- 
 ^ tude. The importance of soldiers 
 having well-formed and normal feet cannot 
 be exaggerated, for an army lasts only as 
 long as the feet of its infantryman. Feet to 
 the soldier are what tyres are to the motor, 
 wings to the bird. In fairy lore, classical 
 literature, and mythology, the means of 
 locomotion given to man and beast have 
 engaged the attention of the greatest writers 
 of the centuries. Children love to hear of the 
 magic boots of the giant whose every stride 
 covered a mile, while the tales of Cinderella 
 and her slipper, and of the children y^\\o lived 
 in a shoe, have become immortal. The 
 
people of Abarimr.n, a district of Scythia, we 
 are told, could only live in their native air,, 
 and their feet had toes behind their heels. 
 Mythology tells us that Mercury, the son of 
 Jupiter, had wings to his feet which enabled 
 him to transport himself from place to place 
 with lightning velocity. Amongst his many 
 exploits he is said to have robbed Venus of 
 her girdle, and Mars of his sword ; nor must 
 we forget Achilles, who was plunged by his 
 mother in the Styx, and rendered invulner- 
 able except in his heel. His life .was one 
 long day of deeds of valour until he met his 
 death at the hands of Paris, who wounded 
 him with an arrow in his vulnerable heel. 
 Like Achilles, armies have proved themselves 
 invulnerable except in their feet, and have 
 suffered the humiliation of seeing victory 
 snatched from their grasp on account of in- 
 ability to march any further. When once the 
 ambulatory power of a force breaks down, its 
 moral and spirit suffer, and its attributes of 
 pertinacity of purpose and celerity of move- 
 ment are lost. This has been recognised by 
 
all the armies in the field to-day, and every 
 endeavour is being made to cope with the 
 question from a military and a medical stand- 
 point. No one has shown more solicitude for 
 the soldiers' feet than our King, who, when 
 visiting the wounded, made anxious inquiries 
 about their feet and footgear. The letters 
 from soldiers at the front, published in the 
 daily papers, constantly contain complaints 
 about their feet, and may be well summed up 
 in the sentence of Private F. Burton, of the 
 Bedfords, who writes : ** Sore feet are the 
 great trouble, most of us being a bit lame.** 
 Brave as a man may be, it is a physical im- 
 possibility for him to march far with blistered 
 and sore feet, and he becomes a drag on his 
 comrades. In this respect one cannot help 
 calling to mind how Captain Oates walked 
 out of the tent into the Antarctic blizzard, 
 with his poor maimed feet tortured with 
 frostbite, his one thought being to save his 
 comrades, who refused to proceed to ** One- 
 ton Camp ** until he could accompany them. 
 No army in the world is better provided 
 
with good serviceable footgear than our 
 own, and the Government, recognising this 
 to be of the utmost importance, are making 
 strenuous efforts to keep this efficiency con- 
 stant and lasting. The British ** Tommy " 
 has a special aifection for his boots, for he 
 knows that, in war time, they are his best 
 friends, and a striking example of this is 
 related by Sir Frederick Treves in his book, 
 The Tale of a Field Hospital, in which he 
 says : ** Amongst other traits, one notices 
 that the soldier clings with great pertinacity 
 to his few pwDSsessions, and especially to his 
 boots. There was one pKX)r man at Spear- 
 man's who was in great distress because, 
 just as he was being sent down to the base, 
 he had lost his solitary boot. He said it con- 
 tained a puttie, a tin of jam, two shillings in 
 money, and a bullet that had been taken but 
 of him.'' 
 
 The evolution of the human foot is of great 
 interest. Man is the only animal whose 
 thighs and trunk are in a straight line when 
 standing, for even anthropoid apes have their 
 
I 
 
 lower limbs bent towards the belly at the 
 hips, and flexed at the knees, when walking. 
 To have gained our present erect posture has 
 taken millions of years, for there is no bone, 
 muscle, or organ in the body, which has not 
 changed. Although the ordinary monkey 
 runs on all fours, the gibbon, or small 
 anthropoid ape, runs along the branches of 
 a tree on its legs in an erect posture, only 
 using its long arms to seize overhanging 
 twigs to help it on its way, or to swing from 
 bough to bough, or tree to tree, when pur- 
 sued or in a hurry. In the gorilla the legs are 
 comparatively stronger, and fashioned to 
 bear the weight of the whole body, and in 
 consequence have lost some of the features 
 which make the monkey's foot chiefly a 
 grasping organ. Pithecanthropus, the 
 
 earliest human-like fossil discovered, had in 
 all probability a foot like our own, for no 
 human foot has ever been seen with the great 
 toe separated like a thumb, as is the case in 
 all anthropoids. To the scientific mind, ho>y- 
 ever, there is little doubt that the great toe 
 
was once set like a thumb, and that the foot 
 was used as a grasping organ. Wire- 
 walkers and the native artisans of the East 
 use the great toe to steady and balance them- 
 selves and their work, causing the muscles 
 of this organ to be well developed. The 
 human foot was evolved, as far as one can 
 say, in the Miocene i>eriod, and the upright 
 posture of man appeared with the evolution 
 of the gibbons. The chief changes which 
 have taken place in the lower limb are : 
 
 (a) The straightening of the limb into a 
 
 line with the trunk when standing. 
 
 (b) The stiffening of the mid-tarsal joint. 
 
 (c) The lowering of the heel until it 
 
 reached the ground when standing 
 or walking. 
 
 (d) The disappearance of the thumb and 
 
 the substitution of the great toe. 
 
 The two diagrams show roughly the posi- 
 tion of the lower limb in the pronograde dog- 
 like monkey and in the anthropoid ape. 
 
 In the former the limb is bent towards the 
 belly, and flexed at the knee, while the mid- 
 
tarsal joint is very flexible, and the heel is a 
 long- way from the ground ; while, in the 
 
 ■Snaoch c/ a itw 
 
 Fig. I. — Diagram of the foot of pronograde dog- 
 like monkey grasping a branch of a tree. The heel 
 is bent up and does not touch the branch ; mid-tarsal 
 ^oint is flexible. 
 
 latter, the limb is getting nearer the straight 
 line, the mid-tarsal joint is becoming less 
 flexible, and the heel is approaching the 
 ground. The human foot, having to bear the 
 whole weight of the body, is provided by 
 nature with natural arches, which are recog- 
 nized by engineers to be the strongest in 
 existence. The hollow bony arches of the 
 foot give the necessary strength and elasti- 
 city, and, in addition, protect delicate struc- 
 tures (blood vessels and nerves) from 
 pressure and injury. 
 
8 
 
 . In man, the arch of the foot was evolved 
 by: 
 
 (a) Development of a tonic and tetanic 
 condition of the muscles of the toe 
 and the flexors. 
 
 (h) The stiffening of the mid-tarsal joint. 
 
 (c) The approximation of the meta- 
 tarsals 2, 3, 4, 5, to metatarsal r, 
 and not the opposite, as is usually 
 supposed. 
 
 
 ^.^j^S 
 
 t>rar2ch a/ o ♦'vee 
 
 Fig. 2. — Diagram of the foot of an anthropoid ape. 
 The heel is not bent so much, and nearly touches 
 the branch ; mid-tarsal joint is less flexible. 
 
9 
 
 From within outwards, the longitudinal 
 areh is dependent upon : 
 
 (a) The way in which the bones are 
 fitted together to form an arch. 
 
 (h) The way in which the bones are held 
 together by ligaments, especially 
 the inferior calcaneo-scaphoid 
 ligament, supporting the head of 
 the astragalus. 
 
 (c) The tendons running round the inner 
 ankle inverting the foot and flex- 
 ing the toe, all tending to 
 strengthen and maintain the arch, 
 especially the tibialis posticus. 
 
 {d) The small muscles of the foot. 
 
 (e) The plantar fascia and the skin. 
 In walking or standing the maintenance of 
 the arch depends on muscular action. If, 
 from strain or overwork, the muscles or 
 tendons lose their power of bracing up the 
 arches of the foot, and this task is left to the 
 ligaments, which may themselves give way, 
 either rapidly by rupturing or gradually by 
 
stretching, the result is what is known as 
 ** flat-foot/' It follows from this that the 
 weight of the body should be distributed so 
 as to cause least burden on the muscles of 
 the arch, and should fall just in front of the 
 transverse arch. 
 
 The skin of the sole of the foot is com- 
 posed of three layers, the most superficial 
 
 Fig. 3. — Diagram ot section of a foot lengthways, 
 showing bones of longitudinal arch. 
 
 of which varies in thickness and hardness 
 according to the amount of friction and 
 pressure it is subjected to. The middle or 
 mucous layer is intimately connected with the 
 other two layers, and, although it contains 
 no blood vessels, it may allow fluid from 
 those in the deeper layer to pass through it. 
 
This exuded fluid, not being able to pass 
 the hard horny layer, separates the first and 
 second layers, and forms a blister. The 
 third layer, or true skin, is composed of dense 
 elastic tissue containing blood vessels, nerve 
 endings, sweat glands, &c., and this is the 
 layer which is affected when men complain 
 of sore feet. 
 
 Having briefly touched on the morphology, 
 
 Fig-. 4. — Section of a foot crossways, showing- bones 
 of transverse arch. 
 
 anatomy, and physiology of the human foot, 
 we must next consider how it is protected 
 from injury by artificial means. The custom 
 of wearing something to cover and protect 
 the foot is of great antiquity, and in the 
 British Museum there are specimens of 
 Egyptian shoes and sandals dating back 
 
12 
 
 some three thousand years. Sandals of 
 plaited papyrus and other materials were 
 used by the ancient Egyptians, Greeks, and 
 Romans, and are worn to this day in the 
 East. They persisted, in Europe, until the 
 fourteenth and fifteenth centuries, when the 
 poulames became the fashion. On account 
 of their length, which sometimes reached 
 several feet, the poulaines were found in- 
 convenient, and gave way about the end of 
 the fifteenth century to the souliers camus. 
 In turn the narrow and broad shoes came, 
 and were followed by various forms of boots, 
 the chief fault of which was that there was 
 little or no difference in the two feet. Gradu- 
 ally the patten, which was used for outdoor 
 wear, was superseded by the heel, and each 
 foot was properly fitted with its own boot. 
 The sandal, being correctly shaped to the 
 normal foot, with a straight inner edge, 
 caused little deformity, and the two straps, 
 the latchet and the forestrap, which kept it 
 in position, helped to maintain the proper 
 adducted position of the great toe in walking 
 
and standing. Ancient writers, about the 
 time of Christ, in spite of this, have left on 
 record descriptions of deformities caused by 
 ill-fitting sandals and shoes. In Europe, 
 when the sandal was discarded in favour of 
 the shoe, the tendency amongst the fashion- 
 able set was to have it smart and pointed, 
 though in the reign of Henry VIII it was 
 considered more fashionable to have shoes 
 wide and broad. 
 
 We must next review the steps taken by 
 the Government to provide soldiers with suit- 
 able footgear. On joining the Regular Army 
 each soldier is given two pairs of Army boots 
 and three pairs of socks, free. They are 
 kept in stock sizes, and it is the duty of the 
 officer to make quite sure that the correct 
 sizes are issued, for if the soldiers are allowed 
 to choose their own boots without official 
 supervision, they are apt to let ** vanity over- 
 ride wisdom," and choose too narrow or too 
 small a boot. This is known in the Army as 
 *' fitting the eye instead of the foot," and 
 even after the proper size boots have been 
 
14 
 
 issued, the soldier will often have them 
 altered in shape at his own expense tO' make 
 them look smarter. This should never be 
 allowed, and, if discovered, should be 
 severely dealt with. It may happen that no 
 stock size will fit, in which case a man is 
 permitted to have his boots specially made 
 for him. The fact must not, however, be 
 overlooked that such a man may prove a 
 menace to his unit in a long campaign, for 
 when his boots are worn out he will find it 
 extremely difficult, or impossible, to get 
 another pair to fit him. In every battalion 
 there is a shoemaker's shop, where the boots 
 are repaired at a fixed rate. The Army socks 
 are made of grey worsted, and are of regula- 
 tion sizes. It is the duty of the soldier to 
 see that they are kept clean and in proper 
 repair. Periodically a kit inspection is held, 
 when it is decided whether the boots and 
 socks are in satisfactory condition. If the 
 company officer is not satisfied that such be 
 the case, he either orders them to be repaired 
 or new ones purchased. Every soldier has 
 
15 
 
 a clothing allowance, out of which new kit is 
 purchased. If, at the end of a certain period 
 there is a surplus, the money is added to his 
 regular pay, but if there is a deficit it is sub- 
 tracted. By this means every soldier is 
 
 Tonqtjc 
 
 Vdra^ 
 
 Billea 
 Sole 
 
 encouraged to be careful and economical. If 
 he is careless and extravagant, he has to pay 
 for such weaknesses out of his own pocket. 
 When the British Army is mobilized, every 
 soldier should possess two pairs of boots and 
 
i6 
 
 two pairs of socks. If these are not in good 
 condition, the Government supply new boots 
 in place of those not considered fit for active 
 service. On reaching a foreign country, in 
 order not to hamper the soldier when march- 
 ing, his kit-bag containing his spare kit is 
 left in charge of the company storeman at the 
 Infantry Base Depot. Amongst the other 
 articles in this spare kit are one pair of boots 
 and one pair of worsted socks, which can be 
 forwarded from the base when it is con- 
 sidered convenient or necessary. On active 
 service the British soldier does not carry a 
 spare pair of boots with him, but fifty pairs 
 of shoes and thirty pairs of ankle boots or 
 Highland shoes for each infantry battalion 
 are carried in the regimental transport. 
 There should always be supplies at the base 
 for replacements. The Territorial in peace 
 is not supplied with either boots or socks by 
 the Government, so that the oddest assort- 
 ments of both are often seen. The County 
 Associations, however, usually make a grant 
 to men who are in possession of suitable boots 
 
17 
 
 for the annual camp, and on embodiment 
 every Territorial is given los. by the Govern- 
 ment if his kit is considered satisfactory by 
 his company officer. It would make for more 
 uniformity and efficiency if the Government 
 could see its way tO' provide both boots and 
 socks free of cost to every Territorial on 
 embodiment. Every reserve man has his 
 mobilization equipment, including* his boots 
 and socks, kept ready for him at the 
 mobilization stores. 
 
 The German recruit is given one pair of 
 Wellingtons (lange stiefel) and one pair of 
 canvas shoes {Schnilrschuhe). 
 
 The Wellingtons are of black calf skin, 
 into which the trousers can be tucked, and 
 are hobnailed. There is no issue of socks, 
 and each man must provide his own, so that 
 many, to save expense, use square foot 
 cloths {Fiisslappen) to wrap their feet in, and 
 they are often greased or oiled. In the 
 German Army, although the footgear is so 
 inferior, the question of sore feet is not as 
 large as might be expected, because of the 
 
i8 
 
 constant supervision of the feet. Dusting 
 powders and formalin are constantly used on 
 the march, while the daily washing of the 
 feet is compulsory, and there is severe 
 punishment for the soldier falling out on the 
 march on account of sore feet, if his company 
 officer consider it in any way due to neglect. 
 Every company has a boot-maker, whose 
 duty it is to repair the boots and keep them 
 in order. In the American Army each recruit 
 is supplied with five pairs of boots and one 
 pair of barrack shoes in his first year. Un- 
 like the British Army boots, the American 
 ones are supplied with ** box toe caps," and 
 the men say that they are not only very com- 
 fortable, but that they do not cause blisters, 
 as the cap is lifted from the toes, while the 
 British ** toe " is apt to cling to them. The 
 boot is made to fit well up round the ankle 
 and so prevent ** rubbed heel." Every 
 American recruit is given fourteen pairs of 
 stockings, eight pairs cotton, and six pairs 
 woollen. The woollen socks are kept solely 
 for marching, and the cotton ones for 
 
19 
 
 garrison duties. To ensure having always a 
 clean pair of socks on the march, four pairs 
 of woollen socks are taken, one pair being 
 worn, another pair being carried on the man 
 in his personal kit, while the other two pairs 
 are in the surplus kit. 
 
 The Army Boot. 
 
 Photographs of the Army boot are given 
 in three positions. Made of stout leather, it 
 consists of the following parts : — 
 
 The Sole is composed of two stout layers 
 of leather sewn together, with or without a 
 central filling. To add to its durability, and 
 to prevent slipping on wet ground, nails are 
 inserted into it, and the sole is said to be 
 ** billed." The danger of hob-nails is that 
 they may fall out and leave holes, through 
 which water may gain entry into the inside of 
 the boot. 
 
 The Waist being the narrowest part of 
 the sole, is apt to ** give " too much, and for 
 this reason a piece of stout leather is usually 
 inserted between the two layers, from the 
 heel to the tread. 
 
20 
 
 The Heel consists of stout leather, and is 
 ** whole-tipped '* in order to prevent it wear- 
 ing out too quickly, and to act as a protection 
 from stones and other objects when march- 
 ing. Generally speaking, the lower the heel 
 
 The boot bostcriox- to this The boot anterior to 
 Wne sbould fit closc\y. Ihis line should fit 
 
 Bisection in which 
 /bot should griJD 
 
 V/aist 
 
 TredcL 
 
 S\DVl»?q 
 
 the better, for if too high, it tends to throw 
 the weight of the body on to the toes and 
 strain the arch of the foot and the ligaments 
 of the ankle, especially when marching down- 
 hill. 
 
The Vamp, or front portion of the boot, is 
 made of a softer leather, and is rounded over 
 the toes. It covers the toes and instep, and 
 
 CouuTcr 
 
 Heel 
 
 Wbol<2 
 heel titD 
 
 is continued up in front of the ankle into the 
 tongue, which reaches well to the top of the 
 boot. 
 
The Quarter, or back part of the boot, 
 covers the ankle-joint and the heel, and is 
 pliant over the former and stiff over the 
 latter. It is composed of two halves seamed 
 together, with the edges of the seams turned 
 outwards. It is stitched to the vamp in front 
 and the '' counter '' behind, and is pierced 
 with eyelet-holes for lacing. The laces are 
 made of strong leather. On no account 
 should hooks for facilitating lacing be 
 allowed. 
 
 Fitting the Boot. 
 
 It may seem a matter of small importance 
 to insist that the boots fit the feet properly, 
 but it must not be forgotten that ill-fitting 
 boots are the cause of bunions, corns, hallux 
 valgus, metatarsalgia, ingrowing toenails, 
 hammer toes, bromidrosis, and hyperidrosis. 
 
 The fitting of ready-made boots is no easy 
 matter, and many things have to be con- 
 sidered before the right pair is finally 
 selected. Not only the length and breadth 
 of the foot, but also the height of the instep, 
 
23 
 
 must be taken into account, and for this 
 reason magnitude as well as size must be 
 allowed for. The size and magnitude are 
 stamped on the inside of the boot for future 
 reference, the former being placed below the 
 latter — for example 1. 
 
 When standing or walking, the whole 
 weight of the body is thrown on the feet, and 
 two changes then take place, namely : (a) The 
 whole foot spreads out and increases in 
 length and breadth, (b) The great toe is 
 drawn to the middle line of the body, 
 although its alignment is seldom that of the 
 first metatarsal bone, as it should be. For 
 these reasons it is necessary to make the 
 soldier stand and walk in the boots to see if 
 they are comfortable and roomy enough in 
 front. It is important to remember that the 
 foot swells when heated and fatigued, and 
 that a boot which fits perfectly over a thin 
 sock, may be very uncomfortable over a thick 
 one. 
 
 An ideal boot should protect the foot from 
 cold, wet, and external injury, and support 
 
24 
 
 it without hindering any of its normal move- 
 ments or causing any undue pressure upon 
 any part. It should fit tightly round the heel 
 and as far forward as the middle of the meta- 
 tarsus, but should be roomy in front of this 
 to allow for the spread xDf the foot, the adduc- 
 tion of the great toe, and the free use of the 
 metatarso-phalangeal joints. The sole of the 
 boot should have a good projecting welt, be 
 straight on the inner edge, and be pliant, so 
 as to ease the toes and the tread when march- 
 ing. If the front part of the sole is not 
 pliant, it bends up and forms a curve called 
 the '' spring '' of the boot, and gets fixed in 
 this position. Although some soldiers say 
 that such a boot facilitates marching by 
 enabling them to use their feet simply as 
 rockers, with minimum muscular effort, 
 sooner or later troubles will arise, such as 
 corns in the sole of the feet, with pain and 
 inflammation around the metatarso- 
 phalangeal joints. The vamp of the boot 
 should be pliable, especially near the roots 
 of the toes, so as to allow free movement to 
 
the ** natural hinge " of the foot, and should 
 be boxed up and rounded over the toes to 
 prevent pressure or friction. The quarters 
 should not interfere with the bending of the 
 ankle, nor should they quite meet in front, 
 otherwise it will be impossible to lace them 
 so as to apply firm pressure. If the quarters 
 are too high, the soldier will be tempted to 
 leave one or two of the upper holes of the 
 lacing undone to give more movement to the 
 ankle. 
 
 I would insist upon the following details 
 being carried out in fitting a soldier with 
 boots : — 
 
 1. Fit the boot after a march, when the 
 
 foot is fatigued and swollen. 
 
 2. Fit the boot over the thickest sock. 
 
 3. Have both boots properly laced, to 
 
 see that the quarters are not too 
 high and that the ankle-joint is 
 free. 
 
 4. Fit both feet. 
 
 5. Make the soldier stand and walk in 
 
 his boots before deciding which 
 pair to give him. 
 
26 
 
 6. If no ready-made pair fit, insist upon 
 
 a special pair being made. 
 
 7. Give full instructions about the pre- 
 
 paration and subsequent care of 
 the boots. 
 
 8. Give a boot that is too large rather 
 
 than one that is too small, for 
 leather, when wet, shrinks. 
 
 On handing a recruit a new pair of boots, 
 he should be told to soften them before wear- 
 ing them, and this is best done by well soak- 
 ing them, inside and outside, with crude 
 castor oil. It is important to keep the uppers 
 supple by the constant use of oil or dubbin, 
 and especially is this necessary when the 
 boot is thoroughly wet. If this is not done 
 regularly, the leather becomes hard and 
 brittle, and one of the commonest mistakes 
 a soldier makes is to place his wet boots near 
 a fire. It is on record that during the first 
 winter in the Crimean War our soldiers 
 suffered from their boots getting soaked 
 through, and many were in the trenches with- 
 out either boots or socks, as the leather of 
 
the boots shrank so much from the constant 
 wetting that, once they were taken off, it was 
 impossible to get them on again. 
 
 In the Balkan War, the result of the men 
 being in wet trenches for twelve to twenty- 
 four hours on end was seen in various forms. 
 Many suffered from cholera and dysentery, 
 but it is also stated that gangrene of the foot 
 was not an uncommon occurrence, beginning 
 in a painless way with mere discoloured 
 blistering over one or two toes to death en 
 masse of the leg as high as the knee (Max 
 Page). Depage considers that many of 
 these cases were caused by the pressure of 
 damp boots and putties shrinking as they 
 dried. It is probable that a vasomotor dis- 
 turbance very similar to this occurred in the 
 Crimean War, and was classified in the 
 statistics as frost-bite. 
 
 It is true that, Cucullus non facit mon- 
 achum, but the boot may make the soldier, 
 and no trouble can be considered too great 
 which not only provides him with a sound 
 and perfectly fitting boot, but also with the 
 
28 
 
 knowledge of how to keep it supple and in 
 an efficient state for the hardships of war. 
 
 The Army Socks. 
 
 The question of the soldier's socks, 
 although not so important as his boots, is 
 one which requires most careful attention. 
 Some years ago the Germans did away with 
 socks, and kept the soldiers' feet well 
 greased. It was reported to have been suc- 
 cessful, not only from the point of view of 
 economy, but it was maintained that the men 
 marched more easily, and that the feet 
 showed fewer blisters than when socks were 
 worn. That this plan had its disadvantages 
 is proved by the fact that the Germans are 
 provided with socks at the present time. The 
 socks should be prpperly shrunk before being 
 worn, and should be a little on the large 
 size. If too small, they will cramp the foot 
 and compress the toes, and be liable to wear 
 into holes very quickly. If too large, they 
 are liable to cause blisters and sore feet from 
 wrinkling. Unshrunken socks should be at 
 
29 
 
 least two or three sizes larger than the foot, 
 otherwise, after several washings, the heels 
 will be pulled down under the soles, and 
 cause trouble. The Army socks are made 
 of grey absorbent worsted, and must be kept 
 clean, or they become hard and non- 
 absorbent, and cause sore and offensive feet. 
 Each soldier should be taught to darn his 
 socks evenly, so as to leave neither ridges nor 
 imperfections, and on no account should he 
 be permitted to wear socks with undarned 
 holes. As thousands of socks are being 
 made by patriotic ladies all over the country 
 at the present time, the following particulars 
 may be useful : — 
 
 The socks are made with heels and toes of the 
 usual kind, and should be woven or hand-knitted 
 with No. 13 needles, and 4-ply super-fingering or 
 wheeling in grey, Lovat's mixture, or natural colour. 
 The lengths of foot asked for are 10 in., 105 in., 
 II in., and 115 in. ; the largest number required are 
 those measuring 105 in. and 11 in. in length. For 
 sizes I and 2, 64 stitches should be cast on in the first 
 instance, and for sizes 2 and 3, 68 stitches. 
 
 A substitute has been tried for socks in the 
 
 shape of foot -cloths (Fiisslappen), which can 
 
be more easily washed and dried, as they are 
 simply wrapped round the feet. It is a 
 matter of small consequence if they shrink, 
 but, even w^ith these advantag-es, good, well- 
 fitting woollen socks have proved to be more 
 efficacious. Socks should not be washed too 
 often, but should be carefully dried and 
 cleaned by shaking and rubbing. 
 
 The Soldiers' Feet. 
 
 The soldier's foot has not only to support 
 the whole weight of the body, but also to 
 act as a buffer, and prevent shocks being 
 transmitted to the knee and hip joints when 
 jumping or doubling over rough ground. 
 The Germans found that lifting the foot high 
 when marching made the troops more sure- 
 footed, and that while, before its adoption, 
 25 per cent, of the men stumbled, and 10 per 
 cent, fell in a charge over rough ground, the 
 new method practically eliminated such mis- 
 fortunes. Any horseman will recognize this, 
 for not only is it safer to canter than to trot 
 on rough ground, but a horse that does not 
 
31 
 
 lift its feet is a danger anywhere, not only 
 to himself, but to the rider. 
 
 The soldier's foot must be capable of 
 standing the strain of long marches without 
 becoming incapacitated by pain and loss of 
 power. The medical officer should reject as 
 unfit any recruit who suffers from the follow- 
 ing conditions in a bad form : 
 
 1. Flat-foot. 
 
 2. Hallux valgus. 
 
 - 3. Hammer toe. 
 
 4. Ingrowing toenail. 
 
 - 5. Corns. 
 
 - 6. Bunions. 
 
 Some of these conditions can be cured so 
 as to give a man a serviceable foot, but with 
 others it is quite impossible. In the former 
 case a recruit should not be accepted until 
 he has undergone treatment, and been cured, 
 while, in the latter, he should be uncondi- 
 tionally rejected. 
 
 I. Flat-foot, if of a slight degree, may be 
 disregarded, as in many cases it does not 
 get worse with long marching. Some 
 
32 
 
 medical officers refuse all cases of flat-foot, 
 but in my opinion this is too drastic. I 
 know a well-known Quartermaster, rejected 
 twenty-nine years ago by the 17th Lancers 
 on account of a slight degree of flat-foot, 
 who was accepted next day by the Grenadier 
 Guards, and who assures me that he has 
 
 Fig-. 5. — Hallux valgus showing bunion and defor- 
 mity ; A, bunion. 
 
 never had any trouble with his feet from 
 that day to this. In a great number of cases 
 the healthy outdoor life of a soldier, coupled 
 with the physical exercises and marches, 
 tones up the muscles which support the arch. 
 Flat-foot causes the rejection of 11.6 per 
 
thousand men examined, and shows the 
 following signs : — 
 
 (i) A person with flat-foot usually walks 
 with his knees bent, and assumes 
 the attitude of a man pushing a 
 wheel-barrow. He rests on the 
 inside of the sole, thus preventing 
 the proper action of the ankle 
 joint. 
 
 (2) When the foot is placed on the 
 ground, the sole projects so much 
 on the inside that the linger cannot 
 be introduced beneath it. 
 
 ^3) The inner side of the foot is flat, or 
 even convex, instead of being 
 concave. 
 
 (4) The foot is narrower near the toes 
 
 than in the neighbourhood of the 
 ankle. 
 
 (5) The back of the foot is not suffi- 
 
 ciently arched, and a hollow exists 
 below the outer ankle. 
 
 (6) The inner ankle is very prominent, 
 
 and is placed lower than the 
 normal. 
 
34 
 
 In the French Army, flat-foot {pied plai) 
 must be very severe to cause the rejection 
 of a recruit, and the simple effacement of the 
 arch (voute) is not considered sufficient to 
 cause incapacity. The formation and main- 
 tenance of the arches were fully discussed 
 earlier in this paper ; when the muscles and 
 ligaments have yielded, the head of the 
 astragalus and scaphoid may even rest upon 
 the ground, on standing. The flat-footed 
 person walks with the toes turned out, and 
 the heels do not leave the ground, so that all 
 •elasticity in walking disappears. In a bad 
 case a man complains of pain along the inner 
 side of the foot and in the calf on marching, 
 and gets tired very quickly. I make it a rule 
 to reject a man with flat-foot if he is quite 
 unable to raise himself on his toes and 
 restore the arch by the action of the muscles 
 of the calf. If the flat-foot is only slight, 
 tip-toe exercises, combined with massage of 
 the deep muscles of the calf and sole of the 
 foot, improve the condition. Mechanical 
 supports are not to be encouraged in the 
 
35 
 
 soldier, though they may be of use in civil 
 life.^ I am of opinion that careful lacing of 
 the boots, so as not to retard too much the 
 increasing convexity of the tarsus in the act 
 of rising w^hen walking, considerably helps 
 matters, and a good plan is to tell the men 
 to knot their laces low down (as for a shoe), 
 and then to continue to lace less tightly in 
 the upper holes. The heel and sole of the 
 boot may be made continuous on the inner 
 side, or the inner border may be raised so 
 as to throw the foot on to its outer border. 
 
 2. Hallux valgus^ if in an advanced state, 
 incapacitates a man for marching, for the 
 great toe is pushed either above or belo^\ 
 the second toe, thus crowding the other toes 
 together and making them liable to cross. 
 
 * This statement must be qualified considerably 
 now the war has been in progress so long. There 
 is little doubt that such companies as the SchoU 
 Manufacturing Company have done a great deal, by 
 supplying suitable supports, to increase the number 
 of serviceable recruits. The dangers of these supports 
 in the Army are, naturally, their loss or breakage by 
 accident, and the subsequent difficulty of replacement. 
 
3^ 
 
 The head of the first metatarsal bone is 
 pressed upon by the boot, and gives rise to 
 a bunion. 
 
 It is not within the province of this paper 
 to discuss the operative treatment of this 
 deformity, but one may unhesitatingly say 
 that a man with such a foot should be 
 
 >/CorKi 
 
 ^orTi 
 
 Fig-. 6. — Hammer toe, showing deformity and 
 favourite situation of corns. 
 
 rejected. Slight cases may be treated by 
 giving a boot with wide toes and a straight 
 inner border, and by keeping the great toe 
 in a straight line by mechanical means. 
 
 3. Hammer Toe. — In this condition the 
 toe is flexed at the proximal phalangeal 
 joint, on the top of which there is generally 
 a corn. At the end of the toe, where it 
 
presses on the boot, another corn is often 
 found, and these corns become exquisitely 
 painful, and prevent a man from marching. 
 
 Formerly the toe was amputated, but 
 to-day the proximal phalangeal joint is 
 excised or the toe straightened by section of 
 the flexed tendon and the lateral ligaments 
 at the first interphalangeal joint. If either 
 of these treatments be adopted successfully 
 there is no need to reject a man, but if opera- 
 tive treatment be refused, he should be found 
 unfit for service. 
 
 4. Ingrowing Toenail. — This is an ex- 
 tremely painful condition, caused by wearing 
 boots with narrow toes. In a slight case, the 
 boots having been corrected, the nail should 
 be cut square and a w^edge-shaped piece 
 taken from the centre, or the centre of the 
 nail should be scraped and filed down, and 
 the pressure relieved by packing plugs of 
 cotton-wool under the free ends and sides 
 of the nail. If this does not relieve the 
 symptoms, the nail should be removed by 
 one of the recognized methods. 
 
5- Corns. — Hard corns, caused by the 
 pressure of tight boots, are most commonly 
 found on the sides of the toes, under the 
 tread, and on the heel. Soft corns, caused 
 by dirt and sweat, are usually found between 
 the toes. Corns are more painful in wet than 
 in dry weather, and are said to '* shoot," a 
 condition due to a sudden increase of activity 
 in the vascular and sensitive papillae on the 
 approach of damp w^eather. The treatment 
 of corns may be divided into palliative and 
 radical, but it should be remembered that if 
 the boots fit properly without undue pres- 
 sure, the soldier should be free from them. 
 If no chiropodist is at hand, the corns may 
 be rubbed down daily with pumice stone, and 
 if tender, protected with a piece of stock- 
 ingette plaster, stretched over the corn with 
 a good margin. For the radical cure, the 
 area of corn is painted with tincture of 
 iodine, and all the thickened epidermis is 
 cleared away with a scalpel, this being facili- 
 tated by making the skin tense with the left 
 fingers. Then the concentrated apex or 
 
39 
 
 ridges, which are the actual caus^ of the 
 pain, are Hfted out with a sharp-pointed 
 straight scalpel. Often there is a small 
 adventitious bursa, which should also be 
 removed, and an antiseptic dressing placed 
 in the cavity. Circular plasters are seldom 
 effective, as the portion on the distal side of 
 the corn may press back in walking, and 
 irritate, but it is advisable to pad with a 
 crescent-shaped piece on the posterior aspect 
 of the wound, and cover with a stockingette 
 plaster. 
 
 6. Bunions are generally associated with 
 hallux valgus, and, if accompanied by syno- 
 vitis, prevent marching. To alleviate the 
 pain a wedge-shaped felt pad should be worn 
 between the great and second toes at the 
 base, and, in addition, a crescent-shaped 
 adhesive felt pad on the metatarsal aspect, 
 posterior to the joint. This condition is 
 greatly helped by a i-in. zinc oxide strapping 
 round the shafts of the metatarsal bones, 
 sufficiently tight to hold them a little closer 
 together, as with a bunion there is always 
 
40 
 
 a lateral expansion of these bones. This 
 strapping should be put round slightly 
 diagonally, encircling the foot twice and 
 overlapping, so that the total width is i J in. 
 Leslie's zincoplast is the best for this pur- 
 pose, as it causes no irritation and can be 
 worn for a fortnight without discomfort. 
 
 Fig. 7. — B. Wedge-shaped piece of felt ; c, bunion. 
 
 Incipient bunions may be painted with iodine 
 or rubbed with iodex ; if there is much 
 inflammation, the joint can be quickly 
 reduced by an application of antiphlogistine. 
 7. Foot sw^elling {Fiissgeschwulst) is a 
 condition almost always found in soldiers, 
 
41 
 
 and is caused by an abnormal weight being 
 suddenly placed on the middle metatarsal 
 bones. It occurs more frequently in soldiers 
 than civilians because the former are com- 
 pelled to continue marching when tired, and 
 are not allowed to rest when in this condi- 
 tion. It occurs as the result of either sudden 
 pressure from marching over rough and 
 stony ground when fatigued, or from wear- 
 ing ill-fitting boots. To prevent its occur- 
 rence it should be recognized that the soldier 
 is not a machine, and, whenever it is pos- 
 sible, periodical stops should be ordered on 
 the march. 
 
 Sore Feet. 
 The disabilities of the foot already men- 
 tioned, although coming under the general 
 heading of sore feet, as used in military 
 parlance, do not constitute the ordinary 
 variety met with after a march. Sore feet 
 are of several varieties and degrees of 
 severity, and, if promptly and properly 
 treated, may be quickly cured. When the 
 skin of the foot is irritated by the boot or 
 
 E 
 
42 
 
 sock either pressing or rubbing on it, or 
 when, through lack of cleanliness, sweat and 
 various germs collect on it, the foot becomes 
 hot, swollen, and tender. If the condition is 
 not suitably and quickly treated, blisters 
 form, especially under the heel and above it, 
 at the sides of the feet, between the toes. 
 
 root o/ thx2 toe 
 
 I 
 
 y . ^g o--'-^ — ^^^-^ ^ 
 
 Qrcat to€ \ * ^ 
 
 Oall or woij^ heel 
 
 Figf. 8. — Common situation of blisters. 
 
 and at the anterior roots of the toes. If this 
 in turn is neglected, there is a danger of the 
 hard, horny skin being rubbed off, and the 
 tender deep layer of the true skin being 
 exposed, and if this is not treated there is 
 every possibility of the deeper tissues being 
 involved, and of an ulcer forming. The 
 
43 
 
 causes of sore and blistered feet after a 
 march are : — 
 
 1. Boots — 
 
 (a) Too tight, causing pressure. 
 (h) Too loose, causing friction. 
 
 (c) Too hard, through lack of oil or 
 
 dubbin. 
 
 (d) Shrunk, through getting wet. 
 
 (e) Nail or seam inside boot. 
 (/) Improperly laced boot. 
 
 2. Socks — 
 
 (a) Too tight, causing compression of 
 toes, or heel of sock getting 
 under sole of foot. 
 
 (h) Too loose, causing wrinkles. 
 
 (c) Dirty socks. 
 
 (d) Socks with holes. 
 
 (e) Too thin and non-absorbent socks. 
 (/) Badly darned socks. 
 
 3. Feet — 
 
 (a) Dirty feet. 
 (h) Sweaty feet, 
 (c) Deformed feet. 
 
 4. Accidental — 
 
 (a) Grit or foreign matter in boot. 
 
44 
 
 (b) Burn or scald when cooking. 
 
 (c) Punctured wound from external 
 
 object. 
 {d) Weight, such as rifle, falling on 
 
 foot. 
 (e) Kick or stumble. 
 5. Vasomotor — 
 
 (a) Frost-bite. 
 
 (b) Chilblain. 
 
 Practically all these causes can be avoided 
 if a little care be exercised and it is seen 
 that : — 
 
 (a) the boots and socks fit properly ; 
 
 (h) they are periodically inspected ; 
 
 (c) the boot is kept soft and supple ; 
 
 (d) the sock is kept clean and well 
 
 darned ; 
 
 (e) the feet are washed and thoroughly 
 
 dried daily ; 
 
 (/) there is a regular foot inspection ; 
 
 (g) the chiropodist is consulted early. 
 
 In the paper on '' Common Ailments in 
 
 Camp " which 1 read in 1914 at the annual 
 
 meeting of the British Medical Association,^ 
 
 ♦ British Medical Journal, August 29th, 191 4, P- 385- 
 
45 
 
 I said : — ** One of the greatest troubles in 
 camp is blistered feet, and a large percentage 
 of men are rendered unfit for duty for one or 
 more days on this account. The men should 
 be taught to see that their feet are washed 
 and thoroughly dried every day after work 
 is over, and if this is found to be impractic- 
 able, the feet should be thoroughly wiped 
 with a wet towel, especially between the 
 toes, and then dried. The socks should be 
 greased on the outside with soap, and when 
 they show a tendency to shrink they should 
 be stretched and worn on the opposite feet. 
 I would suggest that a regular foot inspec- 
 tion be conducted by the medical officer in 
 conjunction with the company officers, so 
 that all feet requiring attention can be 
 treated, and at the same time the boots and 
 socks inspected." I have little to add to 
 this, except to put forward a few sugges- 
 tions as to the best means to adopt to 
 prevent the tender foot from blistering. 
 
 Instead of one chiropodist for an infantry 
 battalion or depot, I would suggest that one 
 
40 
 
 be appointed for every company, and that he 
 be carefully trained in his duties. He should 
 regularly inspect the feet of all the men in 
 his Company, and attend to any minor 
 troubles he may discover. He should be 
 directly responsible to the Medical Officer 
 for the feet of his own company, and should 
 be able to instruct men with ** fired or blis- 
 tered ' ' feet how to deal with them. He 
 should be in charge of a few necessary, 
 instruments, and also of the various 
 powders, ointments, and lotions used for the 
 various foot troubles he will have to deal 
 with. To encourage good men to take an 
 interest in their work they should receive a 
 little extra pay. 
 
 It cannot be denied that some men*s feet 
 blister more readily than others, and it is 
 wise in such ca^es to try to harden the skin 
 and make it less susceptible. When a man's 
 feet are sore and inflamed, but not blistered, 
 it is advisable for him not only to carry out 
 ^11 the rules laid down in this paper, but also 
 regularly to do one of the following : — 
 
47 
 
 (a) Rub the feet night and morning with 
 spirit, to which may be added i to 
 2 per cent, of salicylic acid. 
 
 (h) Paint the tender parts once or twice 
 a day with either a saturated solu- 
 tion of picric acid, or a solution of 
 chromic acid (2 to 3 grains to the 
 ounce). 
 
 (c) After drying the feet, sprinkle with 
 
 a powder composed of talc and 
 salicylic acid (salicylic acid 2 grs., 
 talc I oz.). 
 
 (d) Soak the feet in a bucket of cold 
 
 water to which potassium perman- 
 ganate, salt, alum, tannic acid, or 
 saltpetre has been added. 
 In the German Army the following dusting 
 powder is used : — 
 
 Salicylic acid ... ... 3 parts. 
 
 Starch ... ... ... 10 ,, 
 
 Talc 87 ,, 
 
 In both t^e French and German Armies 
 the feet are swabbed with a 10 per cent, 
 solution of chromic acid, and this may be 
 repeated in 2 — 6 weeks' time. 
 
48 
 
 Men who complain of excessive sweating 
 of the feet should soak them daily in a solu- 
 tion of formalin and water (i to 800), dry 
 them, and dust them with zinc oxide or some 
 other powder. In most battalions about 
 twenty men will suffer severely from this 
 complaint, and they should be frequently 
 inspected by the chiropodist. In bad cases 
 the Germans use a strong solution of for- 
 malin, even up to 30 per cent., but I consider 
 this solution too strong. Tender feet may be 
 well greased with zinc or boracic ointment, 
 or the soles of the feet may be soaped. When 
 a man's feet are normally fatigued at the end 
 of a long march, after he has washed and 
 dried them he will find great relief if he lies 
 down and raises the feet by resting them 
 against some firm object. 
 
 If, in spite of all these precautions, a 
 blister forms, the fluid should be evacuated 
 aseptically, and the surplus skin, liable to 
 cause pressure, cleared away. An antiseptic 
 ointment should then be applied, and the 
 blister covered with stockingette plaster. 
 
49 
 
 As, after the heel, the most common situa- 
 tion for a blister is the plantar aspects of 
 the fourth and fifth toes, it is in this case 
 advisable to use animal wool round and 
 under the toes to counteract the flexion which 
 causes the pressure on these parts. 
 
 In France a strap consisting of good 
 leather was devised to pass round the foot 
 and ankle in a figure of eight over the boot. 
 At one end was a strong buckle, which was 
 adjusted so as to be on the outside of the 
 foot just above the external malleolus, while 
 the other end was pierced with a dozen holes. 
 It was applied sufficiently tight to give sup- 
 port without causing constriction, and acted 
 by more or less fixing the foot in the boot 
 and preventing slipping and rubbing move- 
 ments, which commonly cause blisters and 
 abrasions. It also acted by minimising the 
 disadvantages of too large or badly fitting 
 boots. It was found as the result of many 
 trials with this strap that it not only pre- 
 vented blistered and sore feet, but that if 
 such conditions were present it helped men 
 
50 
 
 to march without discomfort who would 
 otherwise have been incapacitated. Further, 
 it was found that the blisters and abrasions 
 healed and dried up, and this was no doubt 
 due to the congestion of the foot caused by 
 the strap (modified Bier). According to all 
 accounts, even men with sprained ankles 
 were able to march with the support of these 
 straps, and although we do not know if the 
 French are using them in this war, it is a 
 simple and cheap contrivance which should 
 at least be given a trial in the British Army. 
 
 The commonest cause of chilblains is 
 sitting over the fire with wet, cold boots, and 
 these are best treated by restoring the cir- 
 culation by gentle massage and by wearing 
 warm footgear. Lead and opium plaster 
 may be applied, or the internal administra- 
 tion of tincture of opium may act as a charm 
 in some cases. 
 
 Frost'hiteSy caused by exposure to cold, 
 have given the soldier trouble in the past, 
 and will do so in the future if the circulation 
 is not kept In a vigorous condition and the 
 
51 
 
 foot warmly clad. In treating any case of 
 frost-bite a great amount of patience is 
 necessary to restore the circulation gradu- 
 ally. If the toes are frost-bitten, it is advis- 
 able to do this before taking the soldier into 
 a warm place, and on no account should he 
 be brought near a fire until the circulation 
 has been restored. Begin by rubbing the 
 affected part gently with snow, and bathe 
 the feet with water, increasing the tempera- 
 ture gradually until the circulation is fully 
 restored, when the affected parts may be 
 wrapped in cotton-wool or flannel. 
 
 Dumarest found that hypodermic injec- 
 tions of oxygen were useful in treating gan- 
 grene of the foot, and also in so-called frost- 
 bite in the war, but prevention is better than 
 cure. An excellent way of keeping an active 
 circulation in the feet is to wear a pair of 
 woollen socks, and then, over these, a pair 
 of stockings. This can usually be done if the 
 boots are slightly larger than necessary. 
 
 One cannot leave the question of the 
 soldiers' feet without mentioning the fact 
 
52 
 
 that the gonococcus is responsible for many 
 foot disabilities in the army. The fons et 
 origo of the trouble should be drastically 
 treated and the serum injections resorted to^ 
 but a man with gonococcic arthritis or flat- 
 foot should be rejected, as he will always be 
 a danger to his unit. In no small measure 
 the question of the marching power of a 
 soldier depends upon the medical officer, for 
 not only has he the power of rejecting an 
 unsuitable man, but also he has the respon- 
 sibility of seeing that the soldier keeps his 
 feet in good order, and ready for efficient 
 service. To do this means constant super- 
 vision and advice, and he should remember 
 that there is no deus ex machina to remedy 
 the disability immediately it occurs. 
 
 Summary. 
 
 To make the soldier as perfect a marcher 
 as is consistent with the human foot, I 
 would, in addition to what is being done at 
 present, suggest the following : — 
 
Feet. 
 
 (a) No recruit with any bad degree of foot 
 deformity should be accepted as medically fit 
 until the condition is cured. 
 
 (b) Every soldier, on enlistment, should 
 be given a printed pamphlet explaining the 
 importance of foot cleanliness, and he should 
 be periodically lectured on it by an officer. 
 
 (c) Foot parades should be more thorough 
 and more frequent. 
 
 (d) The battalion or company chiropodist 
 should be more often and sooner consulted. 
 
 (e) It should be made compulsory for the 
 feet to be washed after every long march. 
 
 (/) No medical officer should find any diffi- 
 culty in obtaining adequate supplies of 
 chromic and picric acids, formalin, and dust- 
 ing powders, or any other drugs he Considers 
 necessary. 
 
 Boots. 
 
 (a) The army boot might be improved by 
 allowing more depth over the toes. This 
 could be accomplished by boxing up the 
 anterior part of the vamp and having the end 
 more rounded. 
 
.S4 
 
 (b) Printed instructions and lectures should 
 be given on the best means of keeping the 
 boots in good condition. 
 
 (c) No man should be allowed to wear new 
 boots until they have been well softened. 
 
 (d) The proper fitting of a boot should be 
 considered an art, and not a nuisance. Fully 
 one-half of the foot troubles are caused by 
 careless or too rapid fitting. 
 
 (e) The boot should allow more ventilation 
 of the foot. It is a debatable pK)int which is 
 the worse of the two evils, namely, the pos- 
 sibility of a little water percolating into the 
 boot or the continuous saturation of the foot 
 and sock with stale sweat. In my opinion, 
 a wet foot in free communication with the 
 air is less likely to cause trouble than one 
 which is rendered sodden, soft, and offensive 
 by being bathed in its own sweat, without 
 aeration. To give more ventilation, the 
 tongue of the boot should not be attached to 
 the uppers to the exclusion of all air, and the 
 quarters should be perforated by ventilating 
 holes so as to admit fresh air and allow the 
 
55 
 
 escape of foul emanations and gases arising 
 from the heated and fatigued state of the 
 foot. 
 
 Socks. 
 
 (a) These should be fitted as carefully as 
 the boots. 
 
 (h) They should be issued after having 
 been shrunk. 
 
 (c) They should be washed after a long 
 march, and different pairs should be worn on 
 alternate days. This should be compulsory. 
 
 It may be argued that many of these 
 points are already known to the men, who 
 have been lectured on them by their officers. 
 Even so, it does not follow that they carry 
 out what they are taught and know to be 
 correct, any more than when a man is taught 
 to be good he becomes a saint, or a gouty 
 subject abstains from port because his 
 medical adviser tells him to do so. Further, 
 we must remember that we are discussing 
 the feet not only of the Regular Army, 
 but those of the T^^rpto^ial' For?:^ ':an(j 
 
56 
 
 Kitchener's Army. If every soldier were 
 taught to take as much care of his feet, 
 boots, and socks as his rifle, and, in addition, 
 were compelled to do so, sore feet would 
 cease to give trouble. The civil surgeon 
 may inquire, **Why all this toil for the 
 triumph of an hour? " and my answer is, 
 '^ Finis coronal opus/' The crowning hour 
 of success may be gained by men whose feet 
 can carry them to victory, but can never be 
 won by those who cry in despair, Volo, non 
 valeo. 
 
 THli A'r'ess Pri^^jtCef^Js, IIvd. 6^^-76, Long- Acre, London. 
 
Trade 
 
 Mark. 
 
 P^ORDINe 
 
 m 
 
 LTD. 
 
 WATERPROOFERS. 
 
 By Special Ai>i)oint7iteyit. 
 GUARANTEED 
 
 WATERPROOF BOOTS 
 
 for all purposes. 
 
 ' GNIDROC" KNEE BOOTS 
 
 Drab Waterproof Canvas Uppers, Leather 
 Foot, Stout Leather Sole, Studs at Toes 
 and Heels, if desired. Require no grease 
 nor dressing. 
 
 Send size of easy-fitting, hoot, or old hoot as jyattern- 
 
 WATERPROOF WADERS. 
 
 GEO. CORDING, Ltd., 
 
 125, REGENT STREET 
 
 & 16, NEW BOND STREET, 
 
 LONDON, W 
 
THI? BO^ 
 
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