TRENCH FOOT 



2149 



known, described by Pinoy and Ravaut, and due to C. thibiergei Pinoy and 

 Ravaut, 1909 (see p. 1066). 



Symptomatology. — In the only case on record there were numerous sub- 

 cutaneous and intramuscular gummatous nodules, which had developed very 

 slowly; they slowly softened, some ulcerating. In the pus the fungus was 

 found. 



Treatment. — Potassium iodide is to be recommended. 



Other nodular actinomycoses of nocardial origin, and character- 

 ized by the presence of abscesses, or gummata in which fungi of 

 the genus Nocardia are found, have been described by Riviere and 

 others, and very ably in England by Foulerton. 



Nocardial Abscesses. 



Species of the genera Nocardia and Cohnistreptothrix may, at 

 times, give rise to abscesses in various parts of the body. One such 

 case was described by Broughton Alcock as being due to Nocardia 

 asteroides Eppinger. 



TRENCH FOOT. 



Remarks. — Trench foot is not a tropical disease, but as it has been con- 

 sidered to be of hyphomycetic origin and aetiologically related to Madura foot 

 by Raymond and other recent observers, we propose giving a short account 

 of the condition. 



etiology. — -There can be little doubt that damp cold plays a very important 

 role in the aetiology of the disease, but there is much difierence of opinion on 

 the point whether a low temperature is the real aetiological factor or merely a 

 predisposing cause. Many authorities hold that trench foot is a separate 

 entity from ordinary congelation conditions. Raymond and Parisot believe 

 that the true aetiological agents of the malady are fungi, principally Scopu- 

 lariopsis koningii Oudemans and Sterigmatocystis versicolor. 



According to Castellani's researches, cocci, bacilli, and various fungi of the 

 genera Scopulariopsis Baisnier, Aspergillus Micheli, Sterigmatocystis Cramer, 

 Penicillium Link, Monilia Gmelin, are often found, but they are probably 

 secondary invaders. Castellani has noted in several cases a spirochaete. 

 Certain authorities consider the affection to be a form of avitaminosis. 



Among the predisposing causes one may mention the race — black troops 

 in the trenches being much more prone to develop the condition than white 

 troops — fatigue and mental depression, and the wearing of putties. 



Symptomatology. — In a well-marked case the whole foot is oedematous, 

 swollen, often of a dark red colour, and painful on pressure. Bullae may 

 develop, and after a variable period of time a gangrenous process may set in; 

 but this is far from being a constant feature, and can be frequently avoided 

 if a proper treatment is carried out. There are, however, fulminating gan- 

 grenous cases. A feature of the condition which has apparently escaped the 

 attention of most observers is the presence in many cases of a low inter- 

 mittent fever, even when there is no sign whatever of gangrene. 



Prognosis. — This should be always guarded, as even if symptoms of 

 gangrene do not occur the affection may run a very long course. 



Treatment. — Raymond and Parisot recommend a boracic camphorated 

 lotion, and in mild cases camphorated oil. Castellani has used as routine 

 treatment, with good results, the following: — Calcium lactate in 5 or 10 gr. 

 doses is given three times a day, and the affected parts are painted once or 

 twice daily with an ichthyol lotion (ichthyol i dr., aq. ad i oz.), and very lightly 

 wrapped in cotton-wool. It is advisable t0 4keep the affected foot slightly 

 raised by means of cushions. In severe gangrenous cases a surgical treatment 

 is necessary. 



