Section I. CHARACTERISTICS/GENERAL FINDINGS OF COLD INJURIES
Cold injury occurs sporadically among the civilian population, but our primary
concern is cold injury and its affect on the military forces. Since the days of Xenophon
and Alexander of Macedonia, cold injury has been recorded as a problem of military
importance. Larrey classically described the role which cold injury played in the defeat
of Napoleon's Army in Poland in 1812. The United States had considerable experience
with cold injury during World War II. In the US Army, there was a total incidence of
90,535 time-lost injuries which included trench foot and frostbite in ground troops and
high altitude frostbite in air crews. In Korea, United States troops experienced more
than 9,000 cases of cold injury, chiefly frostbite in ground troops. Over 8,000 of these
cases occurred in the winter of 1950-1951.
a. Cold injury is defined as tissue trauma produced by exposure to cold. The
type of injury produced depends upon the degree of cold to which the body (or its parts)
is exposed, the duration of exposure, and certain concurrent environmental factors. For
practical purposes, cold injuries may be divided simply into "freezing" and "nonfreezing"
types. The former is the well-known frostbite (superficial or deep). The nonfreezing
types are chilblain, trench foot, and immersion foot.
b. There exists no real justification for distinguishing between trench foot and
immersion foot with respect either to pathology or management, nor even to
environmental conditions which are causative. Both result from prolonged exposure of
the feet to wet cold: trench foot to cold, wet socks and boots; immersion foot to cold
water--with or without socks and boots.
c. Chilblains is the only cold injury which is not of significant military importance.
d. Definitions of nonfreezing cold injuries:
(1) Chilblains. Chilblains result from intermittent exposure to temperatures
above freezing accompanied by high humidity.
(2) Trench foot/immersion foot. These result from prolonged exposure to
wet, cold foot gear or outright immersion of the feet at temperatures usually below 50F.
At the upper range of temperatures, exposure of 12 hours or more will cause injury.
Shorter durations at or near 32F will cause the same injury.