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Chapter III

Contents

CHAPTER III

Clothing

Colonel Tom F. Whayne, MC, USA

PHYSIOLOGIC MECHANISMS FOR ADAPTATION TO HEAT AND COLD

The study of clothing to meet military needs and protect the health of the American soldier in World War II became a science. The application of this science materially influenced the comfort, efficiency, well-being, and health of the soldier. This was of basic interest to preventive medicine in its mission of the conservation and maintenance of mental and physical health.

Man is a tropical animal. Without the aid of clothing he is physiologically best adapted for the warm climates. Since man must wear clothing, the best types of garments can be developed only by full consideration of his physiologic makeup and his mechanisms for adaptation to heat and cold. For optimum well-being, the human body must maintain a relatively constant internal body heat by a balance between the rate of heat dissipation and heat gain. Fundamentally, the problem is conservation of heat in the cold and the efficient dissipation of heat in the hot climates. In heat regulation and heat exchange, the human body has a remarkable adaptation through a wide range of temperatures. Several mechanisms are involved.

At least two centers, located in the hypothalamus, appear to act as "thermostats," one basically concerned with heat dissipation, the other with the conservation of heat. These centers are closely connected by nerve pathways and, by a mechanism that is not well understood, react reflexly to sensory stimuli from peripheral thermoreceptors and probably to internal body temperature, including that of the brain stem itself. Newburgh1 and his associates favored the hypothesis that the thermoreceptor mechanism lies in a gradient across the skin between the surface and the blood and that the steepness of the gradient in one direction gives rise to the sensation of cold, while that in the other stimulates the feeling of warmth. It is well understood that heat regulation is intimately related to blood and the flow of the blood stream. Central nervous system control of vasodilatation and vasoconstriction and certain local reflex mechanisms comprise a large part of heat regulation. Thermal adaptation through the nervous system is rapid.

1Newburgh, L. H., ed.: Physiology of Heat Regulation and the Science of Clothing. Philadelphia, W.B. Saunders Company, 1949.


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Prolonged adjustment to temperature appears to be a function of the endocrine system and is under the master control of the pituitary gland. The mechanism of control through the endocrine system probably is chemical by means of hormones, the products of metabolism, or the metabolic reaction of special chemicoreceptor cells. Metabolism, as the principal process through which body heat is produced, comes under endocrine control through the internal secretions of the thyroid, the medulla of the suprarenal gland, and possibly other internal glands. Adrenalin produced in response to stress undoubtedly increases heat production. The role of the secretion from the cortex of the suprarenal gland and the reaction of the human body to stress has received considerable attention at the hands of Selye2 and others, but is not completely understood. Lange and co-workers3 have demonstrated the protective influence of thyroid gland administered to rabbits exposed to extremes of cold, and Leblond and his co-workers,4 through the use of radioactive iodine, have shown an increased thyroid response in rats exposed to cold after a latent period of approximately 3 days. Return to normal activity occurred after a period of exposure of 40 days and probably indicated that other mechanisms of adaptation had come into play. Schachner and co-workers,5 working in the Armored Medical Research Laboratory at Fort Knox, Kentucky, after the war, extended the range of observations to shorter and longer intervals, 2 hours to 60 days, and in general confirmed the work of Leblond. The endocrines also exert a definite influence in the control of water balance and the blood level of chlorides. Bazett6 and others have described blood volume changes characterized by an increase in heat and a reduction in cold.

Bazett stressed the point that body temperature is not constant for all parts of the body, and that variations in surface temperature and even deep muscle temperatures in the extremities occur in the process of heat regulation and the maintenance of thermobalance according to external temperatures. The most constant body temperature is probably represented by that of the liver, the brain, and of the blood as it leaves the heart. Even deep rectal temperatures vary according to heat stress or heat loss.

In response to cold, there is an initial general vasoconstriction involving all types of superficial blood vessels, possibly accompanied by deep splanchnic dilatation. Gooseflesh roughens the skin and the hair rises in an effort to

2Selye, H.: The general adaptation syndrome and the diseases of adaptation. Practitioner 163: 393-405,  Nov 1949.
3Lange, K.; Gold, M. A. A.; Weiner, D., and Kramer, M.: Factors influencing resistance to cold environments.   Bull. U. S. Army M. Dept. 8: 849-859, Nov 1948.
4 Leblond, C. P.; Gross, J.; Peacock, W., and Evans, R. D.: Metabolism of radio-iodine in the thyroids of rats exposed to high or low temperatures. Am. J. Physiol. 140: 671-676, Feb 1944.
5Schachner, H. E.; Gierlach, C. S., and Krebs, A. T.: The response of the thyroid gland to low environmental temperature as studied with radioiodine. Med Dept Fld Research Lab Project Rpt 6-64-12-02, 1 Jun 49. AFML.
6Bazett, H. C.: The regulation of body temperature. In Newburgh, L. H., ed., op. cit., pp. 109-192.


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decrease airflow over the skin surface and to maintain a layer of air insulation over the body. Bazett points out that the level of deep body temperature, as exemplified in rectal recordings, is influenced by so many factors of adaptation that it is not readily depressed in cold nor increased by moderate warmth. Data collected carefully by Bazett and his group, however, do demonstrate that such an effect is discernible. He states that, "Thus the data . . . indicate differences in average rectal temperature of 0.7 C. (1.3 F.) for the whole range from just endurable cold to sweat-causing heat."

Reflex shivering increases the metabolic rate as part of the physiologic protective response to cold. If exposure to cold is prolonged, the continued vasoconstriction sets up a need for a reduction in blood volume to compensate for splanchnic dilatation. As a result, there is some concentration of plasma protein, which eventually disappears. An increase in cell concentration may occur, but over a long period this also is reduced and the cell composition of the blood is comparable to that seen in subjects in equable temperatures. In vasoconstriction, which affects arteries and veins alike, the blood returns through the venae comites in close apposition to the arteries. Under these circumstances, arterial blood on the way to the surface is cooled and venous blood, coursing centrally, is warmed by an exchange of heat. This results in a gradual cooling of the extremities and eventually allows surface temperatures to fall. This may cause a decrease in evaporation, radiation, and convection from the skin and act as a mechanism for the conservation of heat.

Acclimatization to cold appears to be less specific than adaptation to heat. Increase in thyroid activity in man exposed to cold has not been substantiated. There is some evidence that plasma protein is reduced to accommodate sustained vasoconstriction of the superficial vessels. Roughening and drying of the skin may occur and probably afford better insulation. Individuals exposed to cold develop tolerance and greater comfort within about 1 week. Optimum acclimatization to cold requires long periods of experience in cold climates and appears to involve more of "learning to live with cold" than physiologic adjustment, about which very little fundamental knowledge exists.

Physiologic adjustment of the body to heat is largely a function of the circulatory system insofar as is now known. The basic reactions are the opposite of those described above for cold. A continuous vasodilatation is an early response to heat and apparently depends upon reflex responses to peripheral thermoreceptors acting through thermocenters in the hypothalamus. There is an increased flow of blood, especially at the periphery, and the route of flow of returning blood is in the superficial veins. This allows blood flowing toward the periphery to carry heat outwardly, to lose it near the skin surface through the cooling effects of evaporation and convection, and to return centrally at lowered temperatures to accomplish internal cooling. In the initial adaptation, vasodilatation is accompanied by splanchnic constriction. With further adjust-


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ment, however, there is an increase in blood volume. Blood protein increase subsequently parallels the fluid increase, but elevation of hemoglobin levels has not been conclusively substantiated.

The physical mechanisms through which body heat is lost are primarily evaporation of sweat and convection and, to some degree, by conduction of heat through the tissues. The sweating mechanism is largely controlled by the sympathetic nervous system and to a less extent by peripheral heat stimuli acting through a thermocontrol mechanism located in the hypothalamus. Robinson7 has summarized evidence to the effect that local heat stimuli may also initiate sweating. He further states that the center in the hypothalamus is influenced by afferent impulses from temperature receptors in the skin, direct temperature changes in the center which are determined by the temperature of the arterial blood supply, and possibly by stimuli arising from neuromuscular activity. The initiation of sweating depends largely upon the skin temperature and increases rapidly above a threshold of 34.5 Centigrade.8   Water output through sweating is therefore in proportion to the heat stress to which the body is exposed. Under heavy stress, dehydration ensues if water is not replaced in adequate quantities. Total water balance in the heat is largely related to sweating, kidney function, and thirst.  Robinson9 has studied the rate of sweating and points out that in addition to the factors noted above, sweating may vary by individual, degree of acclimatization, fatigue, and excessive salt intake. Under stress up to 4 liters of sweat per hour may be lost through the sweating mechanism, although averages are considerably less. High rates of sweating cannot be maintained indefinitely because of fatigue of the sweating apparatus. The ability to sweat and resistance to fatigue of the sweating mechanism vary by individual. Indeed, a few individuals appear to be incapable of sweating to any great degree and therefore are unfit for living in the hot climates.

Acclimatization of men to heat stress is a complex process. Ability to sweat increases, the chloride content of the sweat decreases, and there appears to be some general lowering of the metabolic rate. Robinson points out that in the acclimatized individual, sweating begins earlier upon exposure to heat than in the unacclimatized individual. The heat regulation mechanisms of the body adapt themselves rapidly to increased heat loads and most individuals accomplish a large part of the acclimatization process within a week of having been placed in a hot environment. Robinson notes the great capacity of the circulation to make adjustments to heat stress, and gives as an example observations on well-acclimatized men studied in his laboratory who could maintain thermal equilibrium and water balance while working for 6 hours with a

7Robinson, S.: Physiological adjustments to heat. In Newburgh, L. H., ed., op. cit., pp. 193-231.
8Winslow, C.-E. A.; Herrington, L. P., and Gagge, A. P.: Physiology reactions of the human body to varying environmental temperatures. Am. J. Physiol. 120: 1-22, Sep 1937.
9See footnote 7.


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metabolic rate of 190 calories per square meter per hour in an air temperature of 50 C. and a relative humidity of 18 percent, or in an air temperature of 33 C. and a relative humidity of 95 percent. Under such circumstances, these men were meeting a threefold demand over and above metabolic requirements as far as the circulatory system was concerned.

The period required for complete acclimatization in hot climates is not known. For practical purposes, however, the war experience demonstrated that the vast majority of men who were transferred from temperate to hot climates had become acclimatized within a period of 1 month to 6 weeks.

This brief summary of the physiologic aspects of the body s adaptation to the extremes of temperature was taken largely from Newburgh10  and his collaborators and from the reports of the Subcommittee on Clothing of the Aviation Medicine Committee, National Research Council. The purpose has been to emphasize the concept that the development and use of clothing must be predicated upon man's physiologic responses to his environment and not alone to fit, wearability, and adaptation to combat efficiency. This point of view was slow in its evolution. As late as 1940 the development of clothing was largely the responsibility of the Quartermaster Corps School and Depot in Philadelphia, Pennsylvania, aided by field testing for field use and combat adaptation by the Boards of the appropriate Army branches.

In 1940 and early 1941, the Quartermaster Corps Technical Committee was developing the clothing program with the aid of civilian experts in clothing production.11 Their major interests were fabrics, fit, durability, adaptation to combat and other military requirements, appearance, and supply. It was not until The Surgeon General expressed interest in the development of clothing in relation to the physiologic requirements of the soldier that intensive studies on this subject were begun. Thus, the concepts briefly summarized above were largely an outgrowth of the combined efforts of The Surgeon General and The Quartermaster General during the war, with the assistance of the National Research Council and a number of experimental laboratories.

PROPERTIES OF PROTECTIVE CLOTHING

Forbes12 has described the properties of clothing as porosity, permeability, flexibility, elasticity, design and fit, thickness, number of layers, color, texture, and weight. Utilization and proper weighting of these properties of clothing promote human comfort and efficiency, and are potent factors in the prevention of injury and disease. They govern the passage or retention of heat and water vapor, and decrease the effect of solar radiation, convection, and wind. Those

10See footnote 1, p. 31.
11
Risch, E., and Pitkin, T. M.:  Clothing the Soldier of World War II.  QMC Historical Studies No. 16, Washington, Government Printing Office, Sep 1946.
12Newburgh, L. H., ed., op. cit., pp. 320-329.


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who develop clothing for military purposes cannot ignore the effects of design and appearance upon the morale of the soldier, for what makes up fashion in a uniform is oftentimes neither physiologically sound, nor operationally practical. Fourt and Harris13 have remarked that "clothing is often chosen on the basis of fashion rather than physiology and physics."

The development of special types of clothing for the protection of the soldier against diverse environmental hazards was a necessity during World War II. The American soldier experienced combat in the dry heat of the desert, the wet moist heat of the tropics, the cold of winter in Italy and Western Europe, and the damp cold at Attu and the Aleutians. (See Fig. 6.) Thus, even with the knowledge of body regulation to heat and the development of fabrics and design of uniforms that existed at the end of the war, uniforms for special requirements could not be avoided.

The characteristics of the uniform for hot climates were lightness, permeability to water vapor, lack of absorbability for water, insectproofness, and firmness of weave sufficient to protect the skin from injury and abrasion. White or other light colors were desirable because of their ability to reflect radiated heat, but were unsuitable for camouflage. Fabrics should be able to conduct heat, dry quickly, reflect radiated heat, interfere as little as possible with the cooling process of evaporation of sweat, and give maximum ventilation during periods of activity while at the same time affording some protection against the wind and lower night temperatures when the soldier is at rest. In hot humid climates, any type of clothing may impede evaporation of sweat to such an extent as to interfere with heat balance. In hot dry areas, a covering of clothing over the body protects from radiation from the sun and prevents heat coming in contact with the body in much the same way that arctic clothing in the cold protects from excessive heat loss.

The effectiveness of clothing for cold climates depends upon thermal insulation properties. Thermal insulation requirements of the human body, however, vary so greatly between hard physical activity and rest in cold climates that great flexibility in design is required. In activity, layers must be shed and neck and cuff openings undone to facilitate ventilation and evaporation of sweat for the maintenance of thermal equilibrium. When sweating is intense, clothing picks up much moisture which later turns to frost or ice and greatly reduces thermal insulation during periods of rest.

Still air is a good insulator. Consequently, the design and construction of clothing for cold climates came to embody those principles which trap air in the interstices of the fabric and between layers of clothing. Moving air on the other hand rapidly dissipates heat so that wind in contact with porous clothing covering the body rapidly causes loss of body heat. It was learned during the

13Fourt, L., and Harris, M.: Physical properties of clothing fabrics. In Newburgh, L. H., ed., op. cit., pp. 291-319.


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Figure 6.  A. Men of 160th Infantry stalking through Waikia Forest Reserve jungle site, Hawaii, June 1943.  B. Armored troops in a frontline position in Holland receive an issue of clothing. October 1944.  C. Alcan Highway, 1942.  D. Below the snowline, the patrol stops to change back to OD's. Fifth United States Army, Italy, December 1944.

war that a tightly woven, lightweight, windproof outer garment, worn over more porous fabrics as inner layers to give the effect of layers of still air for insulation, gave the best protection. Another characteristic was looseness of fit to encourage the trapping of air and to avoid fatigue by friction or restriction of movements.


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Other problems in the development of military clothing have largely to do with special problems, such as protection against fire and chemical warfare agents, and clothing in relation to industrial hazards. At least three hazards required the impregnation of clothing with separate chemical substances. These were fire, vesicant gases, and insects. In all three, toxic effects from the chemicals used provided a difficult problem during the war and necessitated many laboratory man-hours of testing. These chemical substances must be nontoxic, effective for the purpose for which they were designed, and change the characteristics of the fabrics used in the uniform as little as possible. The processes for impregnating them into the fibers of the fabric or in the fabric itself must be simple and preferably susceptible to use in the field or in improvised field installations. These problems became more complex when the type of operation was such that protection against both fire and chemical warfare agents might be anticipated and impregnation with insect repellents or insecticides was a requirement.

Protection of the extremities in both heat and cold gave rise to special problems during the war. In tropical climates fungus infections were prevalent and constant wetness from perspiration or water conditioned the skin to trauma. In the areas of dry cold, frostbite commonly affected hands and feet. Where cold was experienced in association with wetness, the problem of protecting the feet was especially difficult. Footgear alone could not be expected to solve the problem. Conservation of total body heat by efficient protective clothing for other parts of the body had to complement the provision of properly designed, constructed, and fitted socks, and appropriate shoes such as the shoepac and the arctic overshoe in the prevention of trenchfoot. Looseness of fit to avoid constriction of the extremities, layering of socks, wetproofness of the shoe, and ventilation through the uppers of the shoe came to be important considerations in the development of the best type of footgear for protection against cold injury.

CLOTHING IN WORLD WAR I14

The development of clothing for the American Expeditionary Forces in Europe in World War I was largely on the basis of expediency. The American Army had had no experience with operations on such a large scale and no basic research had been initiated to develop the best items of clothing and equipment for operations in a temperate climate where winters are relatively severe. Supplies were short, and it was necessary to purchase many items of clothing abroad to meet requirements for United States Forces. Inadequacies in transportation made unit supply difficult.

14The Medical Department of the United States Army in the World War. Washington, Government Printing Office, 1926, vol.  VI, pp. 608-661.


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Until late in the war, the preventive medicine aspects of clothing appear to have received little attention, but great emphasis was placed upon the weight of equipment and clothing. It had been determined that the burden of the individual soldier should not exceed one-third of his own weight if he was to have maximum freedom of action on the march and in battle. The mean weight of American soldiers varied between 141 and 144 pounds. The average equipment for the rifleman weighed 61 to 73 pounds. When clothing was added, the weight was 80 to 91 pounds. There are no reports which point out the effect of these loads on the health in the American Expeditionary Forces. It was a common practice, however, for the World War I soldier to discard clothing and equipment. It is recorded that 50 percent of the men discarded extra shoes, 30 percent the extra blanket, and 25 percent the extra suit of underwear.

Operations late in 1917 demonstrated that the 16-ounce Melton cloth for service coats was too light. The Chief Quartermaster, American Expeditionary Forces, recommended an increase to 20-ounce Melton, and a change in construction and lining materials. With the increase of wool consumption and the resulting shortages, the cloths produced were coarse and patchy in appearance. The American soldier appeared poorly dressed in comparison to those of other armies in Europe. Gen. John J. Pershing recommended a new design which, however, was not produced in time for use in Europe.

Great difficulty was experienced in the proper fitting of clothing. Sizes recorded on paper labels were lost and resizing of salvaged clothing was frequently careless in practice.

Special types of clothing were developed for the American Expeditionary Forces in Siberia and northern Russia in late 1918 and 1919. These consisted largely of overcoats with sheepskin lining under an outer shell of moleskin cloth or cotton duck. Parkas came into use, along with heavy fur headgear and fur-lined hoods. Some use of the layering principle was made in winter clothing for Europe as demonstrated by the development of a leather jerkin which was designed to be worn over the uniform coat and under the overcoat. The jerkin was a popular garment and often was worn to the exclusion of the overcoat.

Footgear

The shoe developed by the United States Army before World War I did not stand up in combat use. Changes in design and construction were made in May 1917, but because of the Goodyear-welt construction these shoes were not waterproof and were unsatisfactory. It was not until January 1918 that the Chief Quartermaster, American Expeditionary Forces, investigated the failures of this shoe and recommended improvements, a circumstance reduplicated by the January 1945 conferences on clothing in the European Theater of Operations.


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The "Pershing shoe" developed in World War I had such sound military characteristics that its principal features were recommended for inclusion in the military shoe for spring, summer, and fall operations toward the end of World War II.15

Shoe Tariffs.  Even in World War I, shoe tariffs for United States Forces included 90 sizes: 5 to 12 in half sizes and A through EE in widths. Companies recorded the sizes of the soldiers'  shoes. Supply based on these records resulted in a preponderance of the smaller sizes. The problem was further complicated by the recruitment of division personnel by region. Tariffs for the New York City units, made up largely of men of average or small stature, could not be the same as those for units comprised of the men of average to large stature from the Midwest.

Fitting of Shoes.  It is recorded that "In the American Expeditionary Forces the fitting of soldiers' shoes was far from being satisfactory practically throughout the existence of these forces."16  There were no fitting machines, and the selection of shoe sizes was largely a responsibility of the commanding officer of the unit. This personal element and added command responsibility gave rise to much variance in the efficiency with which shoes were fitted. Even when fitted well, due regard was not given to the fact that the foot of the soldier increases in size under the exigencies of marching and combat, and that it was necessary to wear two pairs of socks for comfort during the winter months. Misfitting prior to the winter of 1917-18 was so much in evidence that some divisions reported as much as 90 percent of their men as suffering from foot trouble. Nearly all of the misfits were too small. In the fall of 1917, General Pershing cabled the War Department to stop the shipment of small sizes and established a new tariff in January 1918. In addition, The Quartermaster General caused a study of the problem to be made at Camp Upton, New York, in the spring of 1918. Some divisions called upon division orthopedic surgeons to supervise shoe fittings with improved results.

Reasonably satisfactory dubbins for waterproofing shoes were developed during World War I. Success in their use, however, appears to have depended upon the method of use, which was time consuming and tedious.

The design and construction of rubber boots and arctic-type overshoes were found to be defective. Cloth (cashmerette) uppers for overshoes were failures. They did not wear well and leaked after short periods of wear as was found to be the case with the cloth-type arctic used in World War II.17

Socks.  Wool socks were worn exclusively. A heavy wool sock worn over a lighter wool sock was the standard procedure. As in the case of shoes, sizing

15Memo, L. B. Sheppard, Off Chief QM, for Maj Gen R. M. Littlejohn, Chief QM ETOUSA, 18 Mar 45, sub: Footwear and socks for use in the ETO. HD: 332.31 ETO.
16The Medical Department of the United States Army in the World War. Washington, Government Printing Office, 1926, vol. VI, p. 630.
17ETMD, ETO, Dec 1944. HD: 350.05.


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seems to have been the greatest deterrent in the use of these otherwise satisfactory items. Because of the difficulties in the supply and exchange of socks, it was necessary for a general order to be published early in 1918 which directed that all soldiers in forward areas would be provided with three pairs of wool socks so that at least one change per day could be made.18  The order further established a sock exchange system roughly similar to that found to be so essential in the prevention of trenchfoot in World War II.

Clothing for Hospital Patients

Clothing for hospital patients was not considered satisfactory in the American Expeditionary Forces. A uniform convalescent suit patterned after a similar British item was recommended, but was not adopted. The nightshirt which was recommended as part of this suit was adopted, and the number of blankets issued to each patient was increased from 3 to 4 in the spring of 1918.

Nurses' Uniforms

At the beginning of the war, there was no prescribed outdoor uniform for nurses in the American Expeditionary Forces. The American Red Cross furnished many items for American nurses. It was not until late in the war that the War Department finally approved initial issue of clothing for nurses at Government expense and provided facilities whereby they could keep themselves comfortable and well clad. The nurse's uniform was standardized towards the end of the war and a basis of issue was established. In the period between the two World Wars, little effort was made to develop a satisfactory field uniform for members of the Army Nurse Corps so that at the beginning of World War II the nurses were little better off than they had been when World War I started.

Laundering

Mobile field laundries were not originally part of the American Expeditionary Forces. Late in June 1917, the Chief Quartermaster and the Chief Surgeon, Headquarters American Expeditionary Forces, jointly recommended the establishment of laundries and the Chief Surgeon again on 19 August 1917 reemphasized the need and recommended that laundries be established alongside or in conjunction with delousing stations and the facilities for the sterilization of clothing. Until January 1918, however, the laundering of clothing was left to the individual soldier. Local village women were the laundresses or the soldier did his own, usually using cold water from muddy streams. This did not accomplish efficient cleansing and certainly did not disinfest the clothing. A general order late in January 1918 directed the establishment of free laundries and the first mobile laundry was shipped to Europe on 5 June 1918.

18GHQ AEF GO 11, 17 Jan 18.


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Three more were in the theater by 18 August and it was only on Armistice Day that 24 additional mobile laundries were shipped from the United States.

The impregnation of clothing for the control of lice was not practiced in World War I. It is interesting, however, that a member of the Medical Research Committee of the American Red Cross in Paris urged a practical trial for the impregnation of underclothing with an emulsion of cresol and soft soap as a louse control measure. While members of the Medical Research Committee wore underclothing thus impregnated for many days without reported cutaneous irritation or allergic manifestations, there is no record of field trial or use by American military personnel.

Control of the ubiquitous "cootie" was largely confined to disinfestation of clothing and the provision of bathing facilities. Methods of disinfestation were by steam sterilization, hot air, and a variety of improvised methods, such as the Serbian barrel or steam boxes which were dependent upon heat or steam. Large delousing plants were established under the control of a bathing and delousing division. The technical director in the division was a medical officer who, in most instances, had had experience as a division medical gas officer. Subsupervisors operated by echelon downward to include regiments and battalions. Successful disinfestation was accomplished at great expense in time and large static facilities. Disinfestation for the individual and for small groups was unsatisfactory. Reinfestation occurred easily because simple heat sterilization of clothing provided no residual insecticidal effect. The bath and delousing units of World War I were the antecedents of the bath and sterilization and the bath and fumigation units of World War II. In contrast to the methods used in World War I, MYL and DDT dusting, together with bathing and laundering and methyl bromide treatment of clothing, kept the American soldier essentially louse-free during World War II. The residual effect of DDT was the factor of greatest importance.

Trenchfoot was not a significant cause of disability in American Forces in Europe in World War I. The role of clothing in the prevention of cold injuries, however, came to be well understood.19

In World War I the development of clothing in relation to the function of the soldier and to meet his physiologic requirements received little study and no emphasis. Medically, major interests were directed toward the sanitary aspects of clothing, especially those having to do with laundering and disinfestation. The relation of footgear to trenchfoot was appreciated.

CLOTHING IN WORLD WAR II

Clothing as a preventive medicine interest received little attention in the period between the two World Wars. At the beginning of World War II, the

19See footnote 18, p. 41.


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American soldier was clothed in a uniform which, with the exception of a moderate trend towards making it suitable for dress and garrison use, was the same as that in use at the end of World War  I.20  The last development in arctic clothing before the war was in 1928. Little attention was given to special types of clothing for unusual military uses. Some observations were made upon the relative desirability of cotton versus wool uniforms for wear in the field in the tropics. The physiologic implications of these observations, however, were on an unsound footing because of the conviction on the part of commanders in general that soldiers fared better on restricted water intake during periods of heavy physical activity. In September of 1936 at Fort Riley, Kansas, field tests were made of clothing impregnated against vesicant gases.21  The tests, however, were limited to observations on four men and were made by a contract surgeon, rather than under the auspices of trained research personnel.

The need for a field jacket to replace the service coat was established in the middle 1930's. Development began in 1935, ended early in 1937, and after much delay resulted in the adoption of the olive-drab field jacket in November 1939. Lightness of weight, water-repellency, and tightness of weave for wind resistance characterized this garment which might be considered the initial step toward the development of the specialized uniforms required for World War II. 22

The Chemical Warfare Service laboratories at Edgewood Arsenal, Maryland, maintained a Medical Research Division which stimulated interest in the protection to be derived from clothing or specially treated clothing. A manual, "Prevention and Treatment of Casualties from Chemical Agents," was prepared in 1940 with assistance from the Medical Department and included references to the uses of impregnated clothing.23  In December 1940, the Training Division of the Surgeon General s Office recommended that the 5th Medical Battalion, assigned to the 5th Division at Camp Custer, Michigan, be used as a unit for winter training and testing. Study was limited to medical care in the cold, and protective clothing suitable for the wounded to wear during evacuation was included.24

Isolated medical problems did receive some attention, as is illustrated by the concern over the possibility of pathogenic anaerobic bacteria said to have been found in samples of woolen clothing.25  Samples of woolen clothing from various sources, including quartermaster stocks, were tested for pathogenic Clostridia. The Army Medical School laboratories came to the conclusion

20See footnote 11, p. 35.
21
Ltr, J. R. Fuchlow, Contract Surg USA, to SG thru Surg, Ft. Riley, Kans., 10 Sep 36, sub:  Medical officer's report on soldiers during a test wearing of impregnated uniforms. SG: 421-1.
22See footnote 11, p. 35.
23WD TM 8-285, 10 Jul 41.
24Memo, Capt T. J. Hartford, SGO, for Gen Love, SGO, 11 Dec 40. HD: 353 (Chron).
25Ltr. Dir Army Med School to SG, 13 Sep 41, sub: Anaerobic bacteria in woolen fabrics. SG:  700.2-1(AMS).


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that woolen clothing uncontaminated by soil was not a significant source of gas gangrene or tetanus. Clothing contaminated by the soil of European battlefields or in some training areas in the Midwestern States, might contain enough viable Clostridia to cause gas gangrene or tetanus.

In such important items as work clothing, medical opinion was not obtained prior to the adoption of herringbone twill, and there is no record that consideration was given to the use of this cloth in the tropics, either as to its qualities of protection against insect bites or its undesirable characteristics in the dissipation of heat. One- and two-piece herringbone twill fatigue suits were authorized for Army use to the exclusion of denim in February 1941.26

A member of the Quartermaster Corps Technical Subcommittee on Combat Winter Clothing tested Army items of winter clothing on an annual hunting trip of a party in the Maine woods in the fall of 1941, and submitted practical recommendations on the defects and good points of the articles tested.27

These examples serve to illustrate the uncoordinated approach to the study of combat clothing. As late as the latter part of 1941, an adequate research program had not come into being. Prior to this time, the development of clothing had been largely the responsibility of the Quartermaster Corps Technical Committee on Clothing and of the Quartermaster Corps School in Philadelphia, located in the Quartermaster Depot. Newly developed items of clothing, however, were submitted to the Infantry Board, and to other Service Boards, including the Medical Board, for field trials. The failure to develop better Army clothing in the period between the wars cannot be attributed entirely to lack of foresight or appreciation of the need for versatile combat uniforms. Great emphasis had been placed upon economy by Congress, and funds were not available to establish the research facilities or to train specialized personnel necessary for the required researches.

Medical interest in clothing was largely centered in the Training Division of the Office of The Surgeon General and at the Medical Field Service School at Carlisle Barracks, Pennsylvania. The trend of this interest, however, was focused upon the care of the wounded, and protective clothing for patients during evacuation from combat areas, rather than the prevention of disease and injury through the development of appropriate, flexible, well-designed uniforms based upon the physiologic characteristics of man operating in extremes of climate, and exposed to the hazards of insect vectors of disease. The greatest emphasis had been placed upon the development and testing of field equipment for the Medical Department in the Equipment Laboratory at the Medical Field Service School and in field maneuvers and unit exercises.

26Memo, TAG to QMG, 5 Apr 41, sub: Adoption of herringbone twill clothing. SG: 421.-1.
27Ltr, M. E. Barker, CWS Member QM Subcommittee, 8 Dec 41, sub: A study of the requirements of winter clothing. SG: 421.-1.


45

Development of Medical Research on Clothing

No agency within the Office of The Surgeon General was by directive assigned the responsibility for the study and development of clothing. Because of the role of clothing in the protection of the health of the soldier, this responsibility quite logically came to rest with the Preventive Medicine Service, and more specifically, the Sanitation Division. Under the direction of its chief, Col. William S. Stone, MC, clothing came to be considered a part of man's environment which might aid materially in the protection of his health or jeopardize his chances of survival.

Sanitary reports from the Panama Canal Department and other tropical areas motivated the chief of the Sanitation Division to call upon The Quartermaster General's Office to review the entire problem of adaptation of clothing to the physiologic requirements of the soldier.28  Conferences resulting from this action brought the program under review. It was recommended that The Quartermaster General establish a research program fashioned after that of the Harvard Fatigue Laboratory, which had been studying physiology in relation to fatigue and the stresses of heat, cold, and altitude, under the direction of Dr. David Bruce Dill. The Harvard Fatigue Laboratory was requested to begin a series of tests of clothing as it influenced man's ability to function in extremes of climate. Pilot investigations already had been stimulated by The Surgeon General at this laboratory. Early in February 1941, the National Research Council approved support of investigations by this laboratory on "clothing, fatigue, and supplementary substances."29  The director of the Harvard Fatigue Laboratory addressed a letter to the Chief, Supply Division, Office of The Quartermaster General, outlining the researches approved for the laboratory under Army auspices, and requested certain equipment and soldier personnel as subjects for the experiments. The request was supported by The Quartermaster General and in turn by The Surgeon General, in consequence of which The Adjutant General directed the action and authorized the Commanding General, First Corps Area, to give full cooperation in supplying equipment and subject personnel. This marked the beginning of physiologic researches on clothing, and a coordination of effort on this problem between The Quartermaster General and The Surgeon General.30

Simulated cold, hot dry, and hot moist climates were established in the laboratory in which treadmill and other tests were used to study the effects of clothing already adopted, and to determine the physiologic principles on which

28Gen Sanitary Rpt, Trinidad Base Comd, 31 May 41, with 2d ind, SG to TAG, 30 Jun 41, and 3d ind, TAG to CofEngrs and QMG, 23 Jul 41. SG: 721.1 (Trinidad) F.
29Ltrs, Chairman, Div Med Sciences NRC, to Dr. D. B. Dill, Harvard Fatigue Lab, 6 Feb 41 and 11 Feb 41. SG: 421.-1.  (Uniforms).
30Ltr, Actg Dir, Harvard Fatigue Lab, to Chief Supply Div OQMG, 13 Mar 41, with 1st ind, QMG to TAG thru SG, 28 Mar 41, and 2d ind, SG to TAG, 28 Mar 41. SG: 421.-1. (Uniforms).


46

to base further development of fabrics and design. The first report upon the relation of clothing to fatigue from the Harvard Fatigue Laboratory was transmitted to The Surgeon General by the Chairman, Division of Medical Sciences, National Research Council, on 8 July 1941.31   Eventually other laboratories, notably the John B. Pierce Laboratory of Hygiene at New Haven, Connecticut, and the physiology departments of various universities were brought into an extensive program of research and testing.

As an outgrowth of the conferences and researches already noted, it became obvious that sound studies on clothing could not be made without a comprehensive knowledge of climatic conditions in all parts of the world where military operations of American forces might be expected to take place. Knowledge of the climates of cold regions and dry and moist hot regions was limited. The chief of the Sanitation Division, Office of The Surgeon General, suggested these studies and vigorously supported their development. The Quartermaster General obtained the services of Dr. Paul A. Siple, meteorologist and geographer, who had accompanied the Byrd expedition to the Antarctic. Dr. Siple was commissioned in the Quartermaster Corps and made the director of a climatic research unit in the Special Forces Section and took an active part in the program for the study of clothing in relation to climates.32

Acting upon the recommendation of the chief of the Sanitation Division, plans were made for establishing a climatic research laboratory in which could be brought together the skills and knowledge of the physician, the physiologist, the textile expert, specialists in the design of clothing, and the meteorologist for the comprehensive and thorough scientific study of clothing. This culminated in the Climatic Research Laboratory at Lawrence, Massachusetts, which was housed in the plant of the Pacific Mills.33  Three highly qualified medical officers were assigned for duty in this laboratory, one of whom had had experience in testing clothing in the Panama Canal Department, and the other two qualified in physiology or other research skills related to clothing and climatic studies. One of these officers, Lt. Col. (later Col.) John H. Talbott, MC, directed the medical phases of the research work at this laboratory and eventually was designated official representative of The Surgeon General as well as The Quartermaster General in tests conducted on clothing and equipment.34

While the National Research Council had been active in establishing research projects on clothing, this organization came to take a very much more active part in the scientific study of this difficult technical problem.

31Ltr, Dr. L. H. Weed, Div Med Sciences NRC, to SG, 8 Jul 41, with incl, sub: Preliminary report on experiments on soldiers and their clothing under different climatic conditions. SG: 421.-1 (Uniforms).
32See footnote 11, p. 35.
33Physiological testing. Textile Research 14: 222-227, July 1944.
34(1) Ltr, QMG to SG, 28 Aug 42, sub: Physiological and climatological research program of the QMC. SG: 421.-1 (Uniforms).  (2)  Semimonthly Rpt, Sanitation and Hygiene Div SGO, 16-31 Dec 44. HD.


47

The Surgeon General of the Navy early in June 1942 called to the attention of Dr. E. F. DuBois, Chairman of the Committee on Aviation Medicine, the unsatisfactory state of aviation clothing. This served as the basis for the creation of a subcommittee under the Committee on Aviation Medicine which had as its terms of reference the study of clothing for the aviator. The Subcommittee on Clothing was organized on 12 June 1942. Members of the subcommittee were Dr. L. H. Newburgh, Chairman, Dr. E. R. Schwartz, Dr. L. P. Herrington, and Dr. W. H. Forbes. The initial interest of the subcommittee was the development of lightweight functional flying uniforms for aviators, so constructed as to protect against cold, flexible enough for wear in the heat, and embodying protective features against fire and drowning. Development of satisfactory headgear, gloves, and shoes was also considered. An electrically heated aviator's suit had been developed by the Canadians, who also had produced a satisfactory helmet. The electrically heated suit, however, was heavy, and required too great a load on the electrical output of the plane to make it practical. A comprehensive research program on physiologic regulation of heat, characteristics of fabrics, design of the uniform, thermal insulation, flash protection from fire, and flotation garments was instituted. The initial meeting of the subcommittee brought together representatives of the Committee on Medical Research of the Office of Scientific Research and Development, the Committee on Aviation Medicine of the National Research Council, the Canadian Research Committee, the British Medical Research Council, the National Bureau of Standards, the National Institutes of Health, and the Textile Research Institute. Armed Forces'  members included representatives from the Office of The Quartermaster General; the Materiel Laboratory, the Equipment Laboratory, and the Aero-Medical Center of Wright Field; and the Bureaus of Supplies and Accounts, Aeronautics, and Medicine and Surgery of the United States Navy.35  Subsequently, there were representatives from the Office of The Surgeon General, the Air Surgeon's Office, and the Armored Force Medical Research Laboratory (later redesignated Armored Medical Research Laboratory) at Fort Knox, Kentucky, as well as liaison personnel from the Royal Air Force, the Rochester Desert Laboratory, the Harvard Fatigue Laboratory, the Textile Foundation, and others. Included in the makeup of the subcommittee and its liaison group were the many skills and sciences having a bearing upon the development of clothing. The subcommittee had been reorganized by the fourth meeting on 17 June 1943, and had brought into its membership Dr. Milton Harris, Dr. Sid Robinson, and Professor C. P. Yaglou. At the same time, its terms of reference were expanded to include consideration of the clothing problems of ship and ground forces, as well as air forces, and researches were initiated on hot weather

35Minutes of Meeting, NRC Subcommittee on Clothing, Committee on Aviation Medicine, 17 Jun 42.  HD: 040.


48

clothing, comfort at low temperatures, especially as related to electrically heated clothing, cooling characteristics of air, decontamination clothing and footwear, textile materials, and clothing as related to exposure to water.36

Because of the urgency of developing satisfactory clothing for operations in the jungle, a series of special meetings was held by the subcommittee to coordinate knowledge and findings on this problem and to push forward the research phases which were not then well developed. The studies initiated and coordinated by the subcommittee, together with the field and combat testing resulting from their findings, were responsible for major advances in adaptation of clothing to the physiologic needs of the soldier and for development of fabrics and design of uniforms which were durable and efficient for combat and, at the same time, contributed to the comfort, efficiency, and well-being of the soldier. Through its efforts, the science of clothing had been launched and was thoroughly established by the end of the war.

The results of the intensive studies guided by the subcommittee have been brought together in one volume by Dr. L. H. Newburgh and his associates under the title of "Physiology of Heat Regulation and the Science of Clothing."37 Despite the depth and range of these far-reaching investigations, Newburgh and his collaborators repeatedly stressed the point that many phases of clothing in relation to man are not understood, and that there is a need for continued basic and applied research.

The Armored Force Medical Research Laboratory, initiated by the Preventive Medicine Service, the Surgeon General's Office, was established at Fort Knox, Kentucky, in September 1942 with the specific mission of conducting research on physiologic problems of practical significance to the Armored Force. Special attention was directed to the study of the soldier in relation to his duties. The aim of the laboratory was:38

To obtain the basic data on selection and training of personnel and performance of equipment, from which conclusions may be drawn which will enable the individual soldier to perform his duties with maximum obtainable efficiency for the longest possible time, and to determine these limits imposed upon personnel so that they may be used to the best advantage by commanders and tacticians.

With this objective, the study of clothing in relation to the functioning soldier became of necessity an important part of the program.

While the Armored Medical Research Laboratory was not a testing organization, its researches nevertheless were largely applied, rather than basic. Its work, therefore, complemented rather than duplicated the studies of the Subcommittee on Clothing. After June 1942, close liaison was maintained with the laboratory staff of the British Fighting Vehicle Physiological Laboratory. In

36Minutes of Meeting, NRC Subcommittee on Clothing, Committee on Aviation Medicine, 17 Jun 43.  HD: 040.
37See footnote 1, p. 31.
38Historical Rpt, Armored Med Research Lab, 3 Oct 45.  HD: 319.1-2.


49

the summer of 1942 temporary laboratory facilities were established at the Desert Training Center, Camp Young, California, for the study of the effects of dry heat on personnel operating in tanks.39

As the program of the Armored Medical Research Laboratory progressed, climatic studies were made which included the protective efficiency of cold weather clothing, the physiologic effects of cold, observations of men in controlled chambers simulating humid jungle heat, ranges of use of clothing for jungle operations, the effects of impregnated and impervious clothing upon the efficiency of personnel, environmental heat and humidity in relation to acclimatization, anthropometric measurements of groups of men in an effort to fit tanks to men and to develop their clothing and equipment for efficient use in tanks, tests of flame-proofed clothing, and the design and fit of army shoes. The findings in this laboratory greatly influenced the fabrics and designs for clothing ultimately developed, especially for hot weather operations.

The impregnation of clothing for protection against vesicant gases, fire, and insects necessitated the use of chemicals which to accomplish their primary purpose also had to be nonirritating and nontoxic to the wearer. Testing for toxicity and allergic manifestations therefore became an important part of the development of special types of protective clothing. In the early phases of the program, much of the testing was done by the Medical Division of the Chemical Warfare Service Laboratory, Edgewood Arsenal, Maryland. Subsequently, the Army Industrial Hygiene Laboratory assumed the responsibility for this phase of the work on clothing.40  While this laboratory came into operation late in the war, it carried out many thousands of tests on the skin toxicity of various materials treated with waterproofing, fireproofing, and fungicidal agents.  Additionally, a safety shoe program and various types of protective clothing used in Army-owned or Army-operated industrial plants were subjects of study at this laboratory.

Both the Armored Medical Research Laboratory and the Army Industrial Hygiene Laboratory were initiated by and came directly under the control and guidance of the Preventive Medicine Service, Office of The Surgeon General. Specifically, their functions were the responsibility of the Division of Occupational Health and Industrial Medicine.

The primary responsibility for the development and production of clothing of all types rested with the Office of The Quartermaster General. Failure to appreciate fully the medical aspects of clothing and the necessity for the adaptation of clothing to the physiologic needs of man under a variety of stress circumstances, before and during the early phases of the war, was responsible for the loose organization and integration of the research and testing agencies previously discussed. Because of the sequence of their establishment, there

39Ibid.
40Rpt, Army Industrial Hygiene Lab SGO, 17 May 45, sub: Toxicity of tropic-proofed equipment.  HD: 422.3 Protective Clothing.


50

was considerable overlap of function and lack of coordination of purpose. Some duplication of effort was inevitable throughout the program, but by the end of 1942 there was a general understanding of the role each had to play and a mutually accepted division of responsibility. The roster of attendance at meetings of the Subcommittee on Clothing was proof of the interest in integration of effort in the development of military clothing. Further, these combined efforts extended to the research facilities of American Allies, the Canadians and the British.

Field Testing.  As the program developed, field testing became an increasingly important practical necessity before adoption of clothing items. Extensive tests were carried on by the Quartermaster Board at Camp Lee, Virginia; representatives of the Medical Department frequently served as observers and participants. Testing of jungle clothing was done in the Panama Canal Department, in Florida, and in the Pacific theaters. Similarly, winter and arctic-type clothing were tested in the Rocky Mountain area by organizations operating in the northern part of the United States, in Alaska, and in Canada. Durability as a military characteristic of clothing was tested on the Quartermaster Board combat course and shoe test track, but combat testing required the concurrence of the Army Ground Forces.

In the early phases of the war, the Office of The Quartermaster General worked on the theory that combat clothing needs could best be met by development of a series of special types of clothing to meet a variety of combat requirements. As the war progressed this point of view changed. The principal objective became the development of the fewest possible items with the greatest possible flexibility to reduce the number of special clothing units to the minimum.41  Field testing in theaters involved sending teams of qualified Quartermaster Corps clothing experts to observe the use of clothing items by soldiers under as many conditions as possible. These teams went to great lengths to sample soldier opinion as to desirability and utility of individual clothing items and equipment. Further development often was decidedly influenced by the results of these surveys. While this fair and impartial practice produced a wealth of practical information, the results often appeared to have more influence on change of policy and clothing development than they merited. This defect emphasizes the need for greater training of the soldier in what he may expect from clothing and especially the efficient use of clothing assemblies for protection of his health in extremes of climate.

Medical Problems Associated with Clothing in World War II

On that part of the chronicle of clothing which follows, no effort will be made to detail one by one the failures and successes incurred in providing satisfactory military clothing. Neither will detailed theater experiences be

41See footnote 11, p. 35.


51

recorded, but rather examples will be given to illustrate pertinent problems involving principles, major developments, and significant trends. Review of the source material has dictated the advisability of considering the subject on the basis of climatic extreme and special problems. If the reader fails to detect sufficient reference to the tedious negotiations, the slow progress, and the frustrations that often accompany the development of new programs in the military forces, it is not because they may not have existed, but rather that the author feels that they are not apropos to the purpose of this history and would add unnecessary detail to an already over-long story.

CLOTHING FOR HOT CLIMATES

Relation of Clothing to Heat Regulation, Comfort, and Efficiency

Clothing is a thermal barrier. In hot climates, it interferes with efficient dissipation of body heat under most circumstances. The initial impetus in embracing this concept provided by the Office of The Surgeon General was soon reinforced from other sources. A study on protective clothing was begun in the fall of 1941 at the United States Department of Agriculture Laboratory at Orlando, Florida, at the request of The Surgeon General.42  Tests of several fabrics for bite resistance to mosquitoes were carried out in 1943 as a part of the jungle clothing program of the Subcommittee on Clothing. Aedes taeniorhynchus, A. aegypti, and Anopheles quadrimaculatus mosquitoes were used. It was found that Byrd-cloth offered the best protection, followed by poplin and Army twill. Nylon, British cellular-weave, and herringbone twill were unsatisfactory. These findings had a great bearing upon the work which had already been initiated to improve adaptation of the uniform for hot climates.43  Eventually, field tests of developmental uniforms were established. Field tests in the jungle in Panama under simulated day and night combat conditions demonstrated the protection to be had from the tightly woven fabrics, such as Byrd-cloth.44  Even more important were the observations in the Everglades of Florida45 and a provisional test in the Southwest Pacific area which corroborated the effectiveness and utility of the lightweight, tightly woven fabrics and established the criteria for adoption of the World War II jungle uniform.46

42Man and Animal Document No. 5174, Mar 1942. USDA Bureau of Entomology and Plant Quarantine.
43Minutes of 7th Meeting, NRC Subcommittee on Clothing, Committee on Aviation Medicine, 15 Dec 43. HD: 040.
44Rpts, Maj C. H. Kearny, Inf, Mobile Force, Panama Dept, 1944. SG: 426.-1.
45Minutes of 4th Meeting on Jungle Clothing, NRC Subcommittee on Clothing, Committee on Aviation Medicine, 6 Oct 43. HD: 040.
46(1) ETMD, Caribbean Def Comd, Mar 1944. HD: 350.5.  (2) QMG Rpt, Mosquito proofing the jungle soldier. SG: 725.11 (1945).


52

Great interest in improving the jungle uniform is evidenced by the following radio from General MacArthur:47

For jungle warfare, British grenfell, or material equivalent weight, found best on provisional test because they are lighter, wet or dry, easier to launder in the field, and absorb less water or sweat. Herringbone twill absorbs large quantity of moisture which fatigues wearer, and is very uncomfortable. Advise durability test light material for possible ultimate adoption in the field.

It was determined that the desirable properties of jungle clothing should be:48

(a)  Minimum resistance to heat loss,
(b)  Maximum resistance to mosquitoes,
(c)  Maximum resistance to other insects,
(d)  Camouflage,
(e)  Abrasion protection,
(f)  Durability,
(g)  Flexibility (that is, it should be possible to open or remove parts during the day when the mosquitoes are not present), and possibly,
(h) Minimum weight when wet.

Tightly woven fabrics were found to give the best protection against mosquitoes and on the basis of subjective comment, it was observed that the lightweight fabrics, although tightly woven, were preferred for comfort as well as their light weight when wet.

The Armored Medical Research Laboratory set up projects, in conjunction with programs as directed by Office of Scientific Research and Development, to determine the relative physiologic load imposed by various types of clothing upon acclimatized men working in simulated jungle environment and concluded that:49

a.  Acclimatized men work with greatest effectiveness and comfort and least burden upon their heat regulating, cardiovascular and sweat mechanisms and have the lowest water requirements when unclothed (wearing only shorts, socks and shoes).

b.  Any garment covering a major portion of the body adds a definite and measurable burden which is manifested by marked increases in heart rate; rectal temperature and sweat loss, and by subjective sensations ranging from moderate to extreme discomfort.

c.  In order of magnitude of the added load and the undesirable effects produced, the tested garments or ensembles are as follows:  (1) British fireproof overalls, tank crews, one-piece manufactured by T. Ravden and Sons, Ltd., 1942.  (2) U. S. Army Suit, one-piece, herringbone twill, protective modified with overlapping flaps; union suit, cotton, protective two-piece; socks, wool, light, protective; hood, wool, O. D., protective and gloves, cotton, protective, (Leggings canvas, M1938, O. D., dismounted, protective, and gas mask not worn).  (3) U. S. Army fatigue coveralls, Suit, one-piece, herringbone twill, made fire-resistant at M. I. T. by C. W. S. process of impregnation with 22% antimony oxide and 12% Vinylite VYHH resin. (4) U. S. Army Suit, one-piece, herringbone twill,

47Quoted in report cited as footnote 46 (2), p. 51.
48See footnote 45, p. 51.
49Rpt, Armored Med Research Lab, 1942-46, Project 2, sub: Operation at high temperatures, p.1.  AFML.


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unlaundered. (5) U. S. Army Suit, one-piece, herringbone twill, worn 2-6 months and laundered repeatedly. (6) U. S. Army Shorts, Cotton.

d.  When items (3), (4), and (5) above, are wetted with unevaporated sweat the differences between them become insignificant.

Accordingly, the laboratory recommended:50

(a)  That all clothing to be issued for jungle operations be tested on standardized test subjects before acceptance, to determine the physiological burden which is imposed upon the wearer.

(b)  That all jungle clothing (wool excluded) be thoroughly laundered before use in hot humid environments.

(c)  When the military situation permits, and when there are no hazards from fauna, flora or solar radiation, men in hot humid climates be permitted to work in minimum amount of clothing.

Further studies in the Physiology Department at Indiana University quantitatively demonstrated that,51

Coolness of clothing is directly related to the thinness of the fabric (not to fabric weight); inversely related to weight of suit; inversely to the amount of water required to saturate the suit or to the time required to dry the saturated suit, and directly to the amount of ventilation by openings. The coolness of any design is directly related to the percent of skin surface exposed. The coolness is not related to the permeability of the fabric to air under pressure, for low rates of air movement ( mph); for 1 to 2 mph a small effect was seen.

Thus porosity of clothing came to be regarded as of little importance so long as the fabric was permeable to water vapor. It was also determined that impregnation of lightweight, tightly woven fabrics with insect repellents, insecticides, and protective agents against vesicant gases or fire had little or no effect on the comfort and effectiveness of uniforms made from these materials.

The results of these researches and field tests justified the conclusion that thin, tightly woven fabrics were best for the jungle uniform. Nylon and Byrd-cloth appeared to give the best physiologic results which, however, were almost equaled by poplin and Army twill. The insect type of bite resistance of the nylon fabric tested was unsatisfactory. Production of poplin and twill in quantities was practical, whereas Byrd-cloth and nylon would have required additional industrial facilities. For this reason, poplin and twill were adopted for further severe testing under jungle combat conditions.

This recommendation, based almost entirely upon the physiologic and health protective characteristics of clothing, was accepted by The Quartermaster General. The Quartermaster Board conducted severe tests on its combat course and indorsed the feasibility of a jungle combat uniform made as a two-piece suit: jacket of 5-ounce poplin, and trousers of 8.2-ounce cotton uniform twill.

50Ibid.
51Minutes of Meeting, NRC Subcommittee on Clothing, Committee on Aviation Medicine, 6 May 44. NRC Med Records Sec.


54

Combat testing was initiated by The Quartermaster General in the spring of 1944. Extensive tests were carried out in the Southwest Pacific area, the China-Burma-India theater, and the Central Pacific area. The Surgeon General opposed this action on the basis that the uniform was urgently needed for the prevention of malaria and was suitable for this purpose. It was a command decision that combat testing should be carried out, following which The Surgeon General contributed full support.52   The Commanding General, Army Service Forces, authorized the tests and subsequent reports from the theaters concerned indorsed with few modifications the tropical combat uniform thus developed.53

Dr. Sid Robinson, a member of the Subcommittee on Clothing, after an extensive field study in the China-Burma-India theater made the following report on 24 October 1945:54

The design of the U. S. tropical combat uniform in its latest model is probably not perfect, but there are no major modifications necessary. Particularly advantageous design features are the shirt which can be worn with the tail in or outside the pants. . .Other properties of clothing which are important to the combat soldier are the ease with which it can be kept clean, rapid drying, smoothness on the skin, and warmth at night when he has to sleep without shelter. Experiments and field tests have shown that the lightweight, smooth fabrics (Byrd-cloth, poplin, and Oxford cloth) are all definitely superior in the first three of these properties.

Difficulties in the adaptation of the uniform for use in a combat theater are illustrated by a report of the observations in the South Pacific by Lt. Col. (later Col.) David Bruce Dill, MC:55

In rear areas the 6-oz. khaki shirt and 8.2-oz. trousers are usually worn, with no undershirt by about half of the men. The rest wear the dark herringbone twill, with no jacket, and no undershirt, acquiring a beautiful tan. The trousers are often cut off to make shorts. The fighting Infantry wear HBT-all of it, day and night. It is impregnated with dimethyl phthalate against the mite. The suggested new tropical uniform was tested on Bougainville, Biak, and Leyte, and was approved by the men wearing it. The reasons for approval were not altogether expected. Mosquitoes were not a consideration, for insect bites were not numerous, and the men have insect repellent. The tight woven uniforms were distinctly cooler. The weight was favorable, that of HBT. Ease of washing and the fact that dirt does not penetrate so readily, were important in the soldiers'  minds.

52Memo, SG for CG ASF, 5 Jun 44, sub: New tropical combat uniform, with 1st ind, CG ASF to SG, 10 Jun 44.  HD: 422.3 Protective Clothing.
53(1) Ltrs, QMG to CGs SWPA and CBI, 1 Jul 44, and to CG CPA, 17 Jul 44, sub: Tests of jungle combat clothing. SG: 421 Boots.  (2) In the Pacific Ocean areas, the uniforms were issued to soldiers functioning in combat and later, by questionnaires and interviews, the combat adaptability and efficiency of the uniform was determined as well as the likes and dislikes of the soldiers and their criticisms concerning this uniform. It was recommended that a uniform of 5-ounce poplin made from the design of the experimental jacket and trousers, combat, tropical, with certain modifications resulting from the tests be standardized immediately and put into quantity production as expeditiously as possible. In Ltr, Surg POA to SG, 4 Mar 45, sub: Tests of jungle combat clothing. SG: 421.
54Minutes of Meeting, NRC Subcommittee on Clothing, Committee on Aviation Medicine, 24 Oct 45.  HD: 040.
55Minutes of Meeting, NRC Subcommittee on Clothing, Committee on Aviation Medicine, 26 Jan 45.  HD: 040.


55

Studies on clothing for hot dry climates did not produce such concrete results. Adolph56 reported no differences in rates of evaporation of sweat from men in hot dry environment wearing various types of light clothing. Solar radiation was the important factor. Protective clothing, even though it be only a thin white garment, was found to reduce materially the effects of solar radiation, and clothing was advantageous in hot sunshine only when the degree of work was moderate. The principle was established that lightweight uniforms so constructed as to facilitate free ventilation were best adapted for desert use. Color was an important factor and, ideally, white would be desirable. The deeper shades, best for camouflage purposes, absorbed heat, added to the heat load of the soldier, and thus more readily exposed him to the danger of heat exhaustion. Differences of opinion existed as to the advisability of special headgear for desert wear. The consensus was that a loosely fitted helmet which allowed free circulation of air provided the best protection.57  Likewise, footgear with porous uppers facilitated heat loss. Traumatism from thorns of cacti and other desert plants was an important factor. It was necessary that clothing be sturdy enough to reduce injury from these sources to a minimum. Adolph,58 towards the end of the war, summarized the status of clothing and the understanding of acclimatization of men to hot dry climates by noting that knowledge of these subjects was limited and that further long-continued studies of climate, physiologic reactions of men to heat, and fabrics and design of clothing would be necessary.

In summary, men are more comfortable when wearing uniforms made of thin, tightly woven fabrics, so designed as to facilitate ventilation in the moist tropics. During activity, work, or combat, the greatest working efficiency goes with the fewest clothes. In hot dry climates, working efficiency at moderate degrees of activity is highest when lightweight clothing, preferably light in color, is worn. Clothing appears to have little relation to acclimatization. Heat exhaustion is the end point of stress to heat. Susceptibility to heat exhaustion in general is greater when clothing is worn; design, color, and weight of fabrics are important factors in its prevention.

Clothing and Vectors of Disease

Clothing remained the first line of defense against the biting of adult mosquitoes during World War II despite the development of efficient repellents and powerful insecticides. The Office of The Surgeon General and malariologists in the field consistently stressed the importance of developing mosquito-proof uniform fabrics. Following studies in the China-Burma-India theater,

56Adolph, E. F.: Desert. In Newburgh, L. H., ed., op. cit., pp. 330-338.
57Ltr, SG to QMG, 6 Mar 43, sub: Sun helmets. HD: 422.3 Protective Clothing.
58
See footnote 56.


56

a representative of the Subcommittee on Clothing of the National Research Council reported:59

Protection against mosquitoes is a property of clothing which all malariologists with whom I talked in military establishments and civilian laboratories and other medical authorities in Delhi, Calcutta, Rangoon, Colombo, Kandy and Bombay, agreed should be provided for military personnel in malaria zones.

Before the war, considerable study had been given to the development of efficient head nets, mosquito gloves, and bed nets. Because the bed nets and head nets were of small mesh, interfered with air movement, and therefore were uncomfortable, it was difficult to obtain the cooperation of the soldier in using them.60  The development of repellents greatly reduced the need for head nets and even for bed nets and netted hammocks for field use, also mosquito gloves. Repellents functioned satisfactorily in tests on head nets up to -inch mesh construction, which would have resulted in greater visibility, improved ventilation, and marked savings in materials and production costs. The -inch mesh head net was never issued, however, since its effectiveness depended upon re-treatment every few days. With the development of satisfactory repellents, an effort was made to improve the insectproofness of the uniform by impregnation. Experimentally, it was possible to provide effective repellency for periods up to 1 week.61  Impregnation produced no significant difference in heat exchange through the fabric.62  The method, however, was never used on a large scale against mosquitoes in the field. Reliance was placed upon use of repellents on the skin of exposed parts of the body and at clothing openings. In practice the duration of effectiveness of repellents was found to be short, 4 to 6 hours, and was materially reduced by exposure to wet during rains and stream crossings.

Research on insect repellents and insecticides carried out during the first months of the war came to have a significant bearing on the role of clothing in the protection of the health of the American soldier. In training areas in the United States, mites, or common "chiggers," caused much discomfort and disability secondary to infections at the site of bites. In the summer of 1941 The Surgeon General requested the Orlando laboratory of the United States Department of Agriculture to study means and methods for controlling mites by repellents or insecticides, or a combination of both. This work led to the consideration of other insects and resulted in the development of dimethylphthalate, Indalone, Rutgers 612, and later dibutylphthalate. Madden, Lindquist, and Knipling of the Orlando laboratory successfully demonstrated the protective value of dimethylphthalate and Indalone for troops in the Louisiana

59See footnote 54, p. 54.
60Annual Rpt, Surg Panama Canal Dept, 1942.  HD.
61See footnote 43, p. 51.
62(1) Minutes of Meeting, NRC Subcommittee on Clothing, Committee on Aviation Medicine, 10 Mar 44.  HD: 040.  (2) See footnote 51, p. 53.


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maneuvers in 1942. In 1943 these results were corroborated by an Australian medical officer, Capt. R. N. McCulloch, MC, who used dimethylphthalate and Indalone against New Guinea species of mites. McCulloch demonstrated that dimethylphthalate and dibutylphthalate also were actually effective miticides.63

Extensive tests in New Guinea and in the Far East showed that clothing impregnated with dimethylphthalate or dibutylphthalate was a potent weapon in the control of scrub typhus.64  The urgent need for the protection of troops against this disease hastened the development of practical improvised field methods of impregnation, but not without opposition.65  It was claimed that the GI soap used as an emulsifying agent in the process was conducive to fungus infections.66  One precaution was noted; nonimpregnated shorts were to be worn to prevent irritation of the scrotum.67  No primary irritation of the skin was found to result from wearing impregnated clothing and the impregnates did not aggravate fungus infections of the skin.68  Later, a concentrate embodying an emulsifying agent (Triton-X-100, Tween 20, Span 20) simplified the field impregnation of clothing with miticides. Subsequently, benzyl benzoate was used as a miticide because of its easy availability and the short supply of some of the chemicals required to produce dimethylphthalate.69

The impregnates were lost from the clothing through successive launderings. Dibutylphthalate and benzyl benzoate appeared to withstand the greatest number of launderings and were favored for that reason. Field tests on benzyl benzoate showed that it could be carried through five launderings, but dibutylphthalate gave longer sustained protection. For practical purposes, however, it was recommended that reimpregnation be carried out after each laundering.70

In the early phases of the war, there was neither vaccine nor an effective lousicide for the prevention of epidemic typhus fever. In view of the historic wartime havoc from this disease, The Surgeon General instituted a search for improved methods of destroying lice. Tests of fumigation gases, such as chloropicrin, eventually resulted in the adoption of methyl bromide for both individual and mass delousing of clothing. Considerable question arose as to the

63(1) Bushland, R. C: Tests against chiggers in New Guinea to develop a practical field method for impregnating uniforms with dimethylphthalate for scrub typhus prevention. Am. J. Hyg. 43: 219-229, May 1946.  (2) Rpt, Capt R. N. McCulloch, 3d Australian Mob Ent Sec, 10 Oct 43, sub: Trombiculid mite control.  HD: 710 Typhus (Rpts).
64Ltr, Dr. F. G. Blake, Dir USA Typhus Commission, to CG USASOS, 11 Dec 43, sub: Scrub typhus in New Guinea-preliminary report and recommendations.  HD: 710 Typhus (Rpts).
65Rpt, Brig Gen G. B. Denit, Chief Surg USASOS, sub: Mite protection of military personnel by simple clothing treatment.  HD: 710 Typhus (Rpts).
66Ltr, Lt Col C. B. Philip, SnC, to Surg USAFFE, 5 Aug 44, sub: Scrub typhus on Owi and Biak Islands.  HD: 710 Typhus (Rpts).
67Ltr, Maj R. R. Kierland, MC, to Surg Base F SWPA, 31 Jul 44, sub: Investigation of clothing impregnated with dimethylphthalate in an emulsion of G. I. soap.  HD: 710 Typhus (Rpts).
68Ltr, SG to Chief Surg USASOS, 6 Sep 44, sub: The effect on the skin of clothing impregnated with soap-dimethylphthalate.  HD: 710 Typhus (Rpts).
69Semimonthly Rpt, Prev Med Serv SGO, 16-31 Mar 45.  HD.
70
Ltr, Capt R. C. Bushland, SnC, USA Typhus Commission, to Brig Gen S. Bayne-Jones, USA Typhus Commission, 22 Mar 45, sub: Field tests on clothing treatment.  HD: 710 Typhus Reports.


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possibility of toxic effects from clothing treated by methyl bromide, but were not substantiated.

Concurrently, the search for a more practical individual method produced MYL powder. The Orlando laboratory conducted tests with MYL powder on Negro volunteers. Underwear impregnated with this powder remained lousicidal for periods up to 150 days.71  Prior to the development of DDT, MYL dusted into the clothing and on the underwear was widely used by United States Forces in North Africa.

The researches on DDT began in the fall of 1942. It was soon apparent that an insecticide of wide range and multiple usages had been discovered. Tests at the Orlando laboratory demonstrated its effectiveness against lice when dusted into clothing. Its role in mass delousing was conclusively proved in the Naples typhus epidemic. Clothing thus dusted was shown to be lousicidal for periods of a month or longer provided it was not laundered. So effective was the method for mass delousing that Quartermaster Corps fumigation and bath companies were reequipped with hand and power dusters for use with American troops if necessary, but pointed primarily at the prevention of typhus fever by delousing prisoners of war, refugees, displaced persons, and populations of liberated or occupied territories.72

Efforts were made to impregnate clothing with DDT. It was found that the impregnation of underwear was sufficient. A practical field test was attempted in December 1943 when DDT-impregnated underwear was forwarded to the North African theater where it was issued to selected companies of French Goums. The test could not be followed to its ultimate conclusion because of movement of personnel and loss in supply channels of some of the underwear, but it was noted that the troops observed were still free from lice at the onset of warm weather. It was concluded that the DDT-impregnated underwear had been responsible for drastically reducing the louse infestation of persons who normally are constantly infested with lice.73

Experimental work continued under the auspices of the Preventive Medicine Service, Office of The Surgeon General. It was announced on 31 May 1944 that impregnation of underwear was a practical procedure and that an emulsion had been found which retained its effectiveness against lice after the clothing had been laundered 8 times over a period of 2 months.74  The DDT emulsion concentrate for impregnation consisted of DDT, 25 percent; Triton X-100, 10 percent; and Xylene, 65 percent.75  By dilution with water, any strength of

71Knipling, E. F.: Insect control investigation of the Orlando, Fla., laboratory during World War II.  In Annual Report of the Smithsonian Institute, Washington, Government Printing Office, 1948, pp. 331-348.
72ETMD, ETO, Jun 1944.  HD: 350.05.
73Ltr, Surg NATO to SG, 1 Jul 44, sub: Testing of DDT impregnated underwear. SG: 421 Boots.
74Speech by Lt Col A. L. Ahnfeldt, SGO, at press luncheon, Hotel Pennsylvania, New York, under auspices of Geigy Company, Inc., 31 May 44.  HD: 700.7.
75Semimonthly Rpt, Sanitation and Hygiene Div SGO, 16-30 Sep 44.  HD.


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DDT desired could be prepared. In practice, 1 part of concentrate to 11 parts of water was found desirable and gave a DDT-dosage of slightly over 2 percent of the dry weight of the garment. Underwear impregnated with this material was worn in field tests and found to retain its lousicidal effect for periods of 1 to 4 months without toxic effects or skin irritation. There was some danger to personnel handling fuel or lubricating oils while wearing clothing impregnated with DDT. The practical hazard was incurred when oil which was spilled on the clothing would dissolve the DDT and might be absorbed through the skin.76   The critical supply situation for Triton X-100 necessitated the use of other emulsifiers. Span 20 and Tween 20 proved to be the equal of Triton in fresh water, and better as an emulsifying agent in salt water.

Appropriate clothing acted as a barrier against the cercariae causing schistosomiasis. The summary of a report of the 5th Malaria Survey Detachment and Medical Research Unit is representative of the experimental work done.77

(a)  Cercariae of Schistosoma japonicum did not penetrate O. D. woolen trouser material within 2 hours in any of a large series of experiments both when the cloth was tested untreated and impregnated with either emulsified dimethyl phthalate, dibutyl phthalate, or benzyl benzoate. No cercariae passed through untreated Byrd-cloth. Uniformly, untreated old suntan and fatigue trouser material allowed more cercariae to penetrate.

(b)  In rigorous washing tests clothing impregnated with dibutyl phthalate was most resistant to penetration by cercariae.

(c)  In continuous water immersion tests, benzyl benzoate impregnation prevented penetration one day longer than dimethyl or dibutyl phthalate.

(d)  Woolen sock material did not prevent the passage of cercariae even when impregnated.

Practical considerations dictated that schistosomiasis control was best obtained by remaining away from infested water. For engineers, signalmen, and others required to work in water at times, waterproofed clothing and boots were desirable but not always practical. By the end of the war no effective impregnating agent for clothing had been discovered and attention had been turned to research on cercariacidal agents and snail control.78

Leeches were prevalent in the jungles of the Pacific and Far Eastern areas. It was necessary to wear trousers inside combat boots to prevent ingress of leeches through upper shoelace eyelets or around tops of the boots.

76TB MED 194, 17 Aug 45.
77Ltr, 5th Malaria Surv Det and Med Research Unit AFWESPAC to SG, 16 Jul 45, sub: In vitro experiments on the penetration of cercariae through untreated and impregnated cloths.  SG: 421.
78(1) McMullen, D. B., and Graham, O. H.: The control of schistosomiasis japonica II. Studies on the control of Oncomelania quadrasi, the molluscan intermediate host of Schistosoma japonicum in the Philippine Islands. Am.  J. Hyg. 45: 274-293, May 1947.  (2) McMullen, D. B., and Ingalls, J.W.: The control of schistosomiasis japonica IV.  The effect of various chemicals on cercariae of Schistosoma japonicum. Am. J. Hyg. 45: 294-298.  (3) Army Epidemiological Board: Collected Reprints. Washington, Government Printing Office, vol. IV, 1946; vol. V, 1947.


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The Quartermaster General was placed under considerable pressure to develop a tropical uniform consisting of shorts and shirts with short sleeves. A precedent had been set by the British who had used uniforms of this type in their tropical stations for a number of years. The Army Air Forces were foremost in pressing for the adoption of such a uniform as "special items over and above minimum issue of long sleeved and long trousered cotton uniforms."79  In response to a request for the procurement of 800,000 of these uniforms, the Air Corps was required to substantiate the need. The Surgeon General considered that such a uniform was not necessary; it exposed the soldier to the hazard of mosquito bites and, for the infantrymen, materially increased the incidence of skin trauma and infections. An indorsement to this correspondence quite clearly states his position:80

1.  The policy of this office on the issue of short sleeved shirts and short pants as items of equipment for troops has been there is no objection to the issue of this type of equipment provided it is in addition to the standard clothing issued to troops in the field. However, it must be pointed out that the short pants and short sleeved shirts if issued should be authorized only for wear in daylight hours because of the danger of contracting malaria in most tropical stations when protective clothing is not worn after dark. In addition, there will be a great increase in the number of skin infections, and traumatic skin lesions, as well as lesions due to leeches and other noxious parasites.

2.  The British Army is abandoning the use of short pants and short sleeved shirts for most theaters of operation. In those theaters where this clothing is authorized there are strict orders that it must not be worn after sunset or before sunrise in the morning. . . . 

3.  In the Malayan and Burma campaigns from 50%-90% of the English troops engaged contracted malaria. The type of clothing and equipment possessed by a large proportion of these troops consisted of short pants and short sleeved shirts. Due to the high incidence of malaria, orders were issued during the campaign to discontinue the wearing of this type of equipment, but due to the shortage of supplies it was impossible to comply. Medical authorities assigned to these forces considered the high incidence of malaria to be blameable to a large extent upon the nonprotective type of clothing possessed by the troops.

4.  The only advantage that can be claimed for the short sleeved shirts and short pants is the coolness of this type of equipment and the ability of the wearer to withstand high temperatures as compared with wearing the conventional long sleeved shirts and long-legged trousers. That there is considerable erroneous information in this respect is evidenced by investigations recently completed under the auspices of the Committee on Medical Research of the Office of Scientific Research and Development by the Harvard Fatigue Laboratory. . . "Results of these experiments indicate that the standard summer outfit of 8.2-ounce cotton shirt and ankle length trousers does not limit to any important degree the capacity for elimination of body heat. Such an outfit is well adapted for use of troops since it is durable and affords necessary protection from sun, wind, insects and possible chilly nights. Small but measurable increases in coolness may be obtained by omitting the undershirt, opening the neck of the shirt, and rolling sleeves and pants legs."

79Memo, CG AAF for CG SOS, 6 Oct 42, sub: Uniform for wear in tropic and semi-tropic climate. HD: 421.-1 (Uniforms).
80Ltr, CG AAF to QMG, 17 Oct 42, sub: Procurement of tropical clothing. SG: 421.-1 (Uniforms)


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5.  It is therefore recommended that the short pants and short sleeved shirts not be issued to troops unless they are issued as additional items of equipment, and restrictions are placed on their use so that these items of clothing are not worn after sunset or before sunrise in any malarious area.

Shorts were never an item of issue by the quartermaster. Several theaters permitted local purchase of shorts and shirts with short sleeves. In these theaters, the wearing of shorts was permitted between sunrise and sunset. An additional problem of discipline, training, and inspection was thus created and undoubtedly was a factor in the prevalence of malaria.

A consensus of theater reaction to the question of shorts is expressed in the report of the Air Surgeon after an extended tour of forces located in malarious areas:81

Standing orders in malarious areas prescribe long-sleeved shirts and long trousers for all American military personnel.  The same is true in the Australian Army. The reasons are summarized in the following statement of the Combined Advisory Committee on Tropical Medicine, Hygiene and Sanitation: "In the opinion of the Committee, it is essential, not only for malaria protection, but also for protection against other diseases, such as dengue fever and scrub typhus, and against skin injuries, insect bites, septic sores, tropical ulcers and blast burns that long-sleeved shirts and slacks be worn on all occasions." There have been complaints of heat rash ascribed to the wearing of such garments.

As a result of their experiences in New Guinea, the Australian Army authorities prohibited the wearing of shorts, day or night.82

Clothing and Skin Diseases

Clothing in relation to skin diseases was an unsolved problem. It was the experience in all theaters located in hot climates that skin diseases were an important cause of disability and loss of time. Dr. Sid Robinson, after spending 5 weeks in India, Burma, and Ceylon, reported that:83

The most difficult and most prevalent problem confronting the ground forces in Burma and India is skin trouble. Beginning with prickly heat as the most universal disturbance, a long list of troubles could be listed including tropical sores, ringworm, blisters, toe rot, athlete's foot, scabies, dhobie itch, etc. Infections of the feet and legs, jungle or tropical sores being quite common, were the most disabling skin infections of the front line troops in Burma. . . . All medical and operational personnel in the theater recognize skin trouble to be a major problem.

This was borne out by the experience in other theaters in the tropics, notably the Southwest Pacific area.84  Skin diseases as influenced by clothing appeared

81Rpt, Inspection Trip SWPA, [Mar 1943] Brig Gen D. Grant, Air Surg. HD: 333.
82Tidy, Henry L., and Kutschbach, J. M. Browne: Inter-Allied Conferences on War Medicine. London, Staples Press Limited, 1945, p. 88-100.
83See footnote 54, p. 54.
84(1) Skin diseases in the tropics. Bull.  U. S. Army M. Dept., No.  80: Sep 1944.  (2) Clark, T. W.:  Treatment of skin diseases in the tropics. Bull. U. S. Army M. Dept., No. 87: 70-76, Apr 1945.  (3)  Dermatological problems in tropical theaters. Bull. U. S. Army M. Dept. 4: 299-300, Sep 1945.  (4)  Epstein, E.: The lichen planus-eczematoid dermatitis complex of the Southwest Pacific, a study of 65 cases. Bull. U. S. Army M. Dept. 4: 687-694, Dec. 1945.


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under three main considerations: footgear and trichophytosis; the wearing of the uniform to prevent insect bites, scratches, abrasions, and cuts which, when they occurred, often became secondarily infected; and miliaria, or prickly heat, which may have been made worse by clothing covering the major portions of the body. So many variables influenced the prevalence of dermatophytosis that it was impossible to define the precise role of clothing. The experience of the war established that type of footgear was an important consideration, and especially incriminated the combat boot.85  The protection afforded by clothing against skin trauma is a part of many records. In the Middle East, annual admission rates per 1,000 for miliaria for the months July, August, and September 1944, were 4.88, 5.39, and 9.05 respectively, and in the China-Burma-India theater, 2.47, 3.16, and 2.09 during the same months. Rates for cases severe enough to affect efficiency but not made of record will never be known, but undoubtedly were high. Dr. Robinson noted the prevalence of prickly heat in the Pacific theater and pointed out that the University of Queensland, Australia, had sponsored the organization of a research team for work on the fundamental aspects of skin physiology. He recommended the initiation of research on the same problem by American scientists.

Footgear

The leather combat boot of World War II was not satisfactory for jungle operations. In addition to its probable role in trichophytosis, it did not stand up well under use in the wet jungles. The Surgeon General encouraged development of special footwear for the tropics which would combine protection against biting insects, ventilation of the feet, and comfort. The Quartermaster General developed a rubber-soled boot with permeable duck-fabric upper and stitched tongue that was impermeable to mud, insect bites, and leeches, but at the same time provided ventilation. A removable fabric insole was a feature of the boot, and when worn with a cushion-soled sock, sweat from the feet was dissipated by evaporation.86  The feet dried more rapidly whether wet by perspiration or water. The leather service shoe, on the other hand, was found by the Armored Medical Research Laboratory to permit dissipation of only a relatively small amount of foot moisture to the exterior.87

The advisability of developing a mosquito boot for the protection of the American soldier against malaria was considered by The Surgeon General and discarded as impractical and unnecessary, a decision that proved to be sound as the tropical uniform and insect repellents came into use. The need for this

85(1) Quarterly Rpt, 144th Sta Hosp SWPA, 1945-3. HD.  (2) Quarterly Rpt, Med Det 839th Engr Avn Bn SWPA, 1945-3.  HD.
86Pitkin, T.: Quartermaster equipment for special forces. QMC Historical Studies No. 5, OQMG, Feb 1944.
87Rpt, Armored Med Research Lab, 4 Dec 45, sub: Study of sweating of the feet of marching troops.  HD: 421 Shoes.


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item for use by officers, nurses, and troops, however, was insisted upon by Air Force personnel stationed in Africa. British practice had set the precedent, and Pan-American Airways had used a similar item with satisfactory results. Extra length boots were recommended for members of the Army Nurse Corps. The Surgeon General's policy and opinion on the development of this boot is expressed as follows:88

1.  This office does not consider the issue of mosquito boots to troops and/or nurses as satisfactory or desirable for the protection of the health of the individuals concerned, provided all troops are furnished standard long trousers and canvas leggings, and nurses are provided with uniform, one-piece, coverall type with canvas leggings. The canvas leggings and long trousers afford adequate protection against mosquito bites and greater protection than mosquito boots against the bites of crawling insects such as chiggers, fleas, and ticks. They also prevent the ingress of leeches which abound in most tropical jungle areas in Africa and Asia. For the same reasons, the one-piece uniform, coverall type, with canvas leggings, affords much greater protection for nurses than mosquito boots. The mosquito boot affords no protection for nurses against crawling insects and leeches. It is extremely uncomfortable to wear, fatiguing, and practically impossible to keep in place during operations in jungle territory.

2.  The use of mosquito boots at fixed camps and stations may have some value, but for all-around military purposes, it is felt that this type of equipment is undesirable as an item of issue to troops in tropical regions.

3.  It is strongly recommended that mosquito boots not be standardized for issue to troops and nurses.

Development of the item was subsequently discontinued by The Quartermaster General.89

CLOTHING FOR COLD CLIMATES AND FOR WINTER OPERATIONS 
IN TEMPERATE CLIMATES

Development of Research and Field Tests

Provisional data recorded approximately 90,535 cases of cold injury for United States Forces operating in all theaters during World War II.90  This experience has been summarized in a study at the Harvard University School of Public Health in which the role of clothing as one of a number of environmental factors was demonstrated.91 The history of the development of cold weather clothing has been carefully prepared by the Office of The Quartermaster General,92 the physiologic adaptation of man to cold has been briefly

884th  ind, SG to Dir Regmts Div SOS, 15 Aug 42, on Ltr, CO SOS USAF Central Africa to CG SOS, 22 Jul 42, sub: Mosquito boots. SG: 421.-11 Shoes.
89
13th ind, CG SOS to QMG, 2 Jan 43, on Ltr, QMG to CO SOS USAF Central Africa, 11 Aug 42, sub: Mosquito boots. SG: 421 Boots.
90Information supplied by Medical Statistics Division, Office of The Surgeon General, 22 Mar 55.
91Whayne, Tom F.: Cold Injury in World War II, A Study in the Epidemiology of Trauma. Thesis, Harvard School of Public Health, 1950.
92See footnote 86, p. 62.


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summarized above, and Newburgh and his associates93  have made a thorough review of the literature and of the results of research during World War II.

Cold injury in World War I was minimal, and affected American troops only in the last weeks of the war. Training maneuvers in the cold climates between the wars and early in World War II did not provide sufficient exposure to alert those responsible for preventive medicine to the casualty-producing potentiality of cold and wet. The history of wars fought in winter cold, however, were a continuing story of crippling losses from cold injury.

The Surgeon General was not active in the development of cold weather clothing during the early phases of the war. The chief of the Sanitation Division, Preventive Medicine Service, in his recommendations that led to the study of the physiology of man in relation to clothing, had included adaptation to cold. In 1941 The Surgeon General advised The Quartermaster General that semi-impervious ski clothing was satisfactory for arctic wear provided provision for adequate ventilation was made during periods of physical exertion. Isolated activities were initiated, but were not included in the preventive medicine program. An opportunity to take part in special projects in a cold climate that involved the use of clothing was declined in the fall of
1942.94

Consideration of plans for cold weather operations emphasized the lack of knowledge of arctic clothing, medical equipment, and supplies. The Surgeon, Headquarters Alaskan Department was ordered to the Office of The Surgeon General for consultations on clothing, hospitalization and evacuation, medical equipment and supplies, housing, and arctic sanitation in 1942. Upon his return to Alaska, field studies were begun which included observations upon clothing.95  The Surgeon General initiated action for the procurement of arctic clothing for nurses early in September 1942.96  Changes in the basic list of items and standardization with men's arctic clothing where possible delayed procurement beyond the period of the Attu operation.

Investigations on protection for the extremities by footgear and gloves of improved design were carried out by the Armored Medical Research Laboratory, in the summer of 1943, and were expanded to include tests of the adequacy and ranges of use of winter combat clothing in subsequent research.97  The Surgeon, Headquarters, United States Air Forces, Central Canada, reported upon the inadequacies of winter clothing in August 1943 and continued cloth-

93See footnote 1, p. 31.
941st ind, SG to CG SOS, 30 Oct 42, on Memo, CG SOS to SG, 19 Oct 42, sub: Arctic clothing. SG: 422.-1.
95Memo for record, Col T. F. Whayne, MC, 17 Oct 50, sub: Conference with Col W. S. Stone on the development of cold weather clothing.  HD: 422.3 Protective and Special Clothing.
96Ltr, SG to CG SOS, 5 Sep 42, sub: Arctic clothing and equipment for nurses.  HD: 421 Uniforms (Nurses).
97Annual Rpt, Armored Med Research Lab, 1945. HD.


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ing observations into 1945.98  A study of the effect of climate on protective clothing for personnel was made a joint project between the United States Army, the Canadian Army, and British Army in 1944.99  Two expeditions to Alaska, one in 1943, and one in 1944, tested mosquito repellents, mosquito head nets, mosquito gloves, mosquito socks, and certain fabrics to determine clothing and procedures best adapted for protection against pest insects in the North.100

Surgical consultants of the Professional Service, Surgeon General's Office, shared the interest in prevention of cold injury with the Preventive Medicine Service, while at the same time placing much emphasis upon treatment, rehabilitation, and reconditioning. It was not until after the losses of the first winter in Italy that an energetic effort was brought to bear upon the prevention of trenchfoot and other cold injuries.101

Representatives of the Office of The Surgeon General participated actively in the proceedings of the Subcommittee on Clothing, National Research Council, the studies of which embraced cold weather clothing. Research by Newburgh and his associates was far reaching in its approach to the problem of man and his clothing in relation to cold. Physical responses, physiologic adjustment, and emotional reactions of man to the stress of cold were studied. Regional heat loss, the range of physiologic response to climatic cold, indices of comfort and the physical properties of clothing fabrics, clothing in relation to climate, and protection from clothing against the extremes of climate in the field were investigated.

Textile research and development produced no synthetic fibers and fabrics which were superior thermal insulators to wool and alpaca pile materials or to the fur of northern animals such as the caribou. The development of pile fabrics as clothing insulation for arctic climates made possible for the first time in history the fabrication of washable combat garments which approached, in the protection they afforded, the fur parkas used by the Alaskan scouts before World War II. A tightly woven, wind-resistant 9-ounce Oxford cloth was developed as the best of the wind-protective fabrics which were practical from the standpoint of mass production and combat-wear life. The combination of pile insulators and wind-resistant outer covers was one of the major advances in cold weather clothing development. Several types of arctic footgear were developed. Fur, wool, and other fibers were used in various ways, including felts, without producing an entirely satisfactory item. For winter operations in temperate climates, the shoepac, as finally designed was considered satis-

98ETMDs, USAF Central Canada, 2 Aug 43, 19 Mar 45.  HD: 350.05.
99See Minutes of Meetings, NRC Subcommittee on Clothing, 1944, 1945.  HD: 040.
100Rpt, 2d Arctic mosquito test expedition, 1944.  SG: 725.11.
101Rpt, Lt Col M. Ladd, JAGD, to SG, 9 Jun 45, sub: Study of records and of investigation relative to trench foot. . . . HD: 710 Trench Foot.


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factory when fitted loosely over two pairs of wool ski socks in graduated sizes and worn with a felt insole in the bottom of the boot.

Experiments with impervious latex rubber socks gave promise of much improvement in protection of the feet. A wool sock next to the foot, covered in turn by a rubber sock, a second wool sock, and finally a second rubber sock, experimentally gave greatly improved protection, but in field tests was not readily accepted by the soldier.

The end of the war brought promise of the development of better protective fabrics with the studies on silica aerogel. First studied as a water-repellent agent of great buoyancy for use in flotation suits, it was also discovered that aerogel had great thermal resistance. In the form of a powder, it was first used as insulation in sleeping bags, certain types of experimental jackets, and blankets. Later, through a bonding process with latex, it was incorporated into certain types of fabrics by laminating techniques and designated under the name "Aerobond." Experimental use in antiexposure suits, ponchos, parkas, and trousers for wet weather wear, waders for the prevention of schistosomiasis, arctic clothing, gloves, and liners for combat boots, gave considerable promise.102  However, while silica aerogel in its pure unbonded form has a superior thermal insulation value to that of still air, serious problems arose due to the difficulties of anchoring the powder in place without destroying its desirable properties. In addition, no successful, practical methods were found for containing the aerogel in vapor permeable materials, so this project was abandoned.

These researches and developments in clothing were carried out during the war period. Consequently, preparations for combat in the cold lagged despite the great efforts that were made to translate the results of these studies into practical protection for the soldier in the field.

Clothing and Cold Injury

Many American soldiers suffered unnecessary cold injury on Attu, in the Mediterranean theater, and in Western Europe for lack of adequate types and supplies of clothing or because their training in the use of clothing had been incomplete.

On Attu, troops were largely equipped with high-topped, laced leather boots. Among those so equipped, trenchfoot developed in large numbers, whereas those with the shoepac were much better protected.103  When the Attu task force was getting ready to depart, in May 1943, Quartermaster Corps cold-climate specialists had recommended shoepacs to the commanding general.

l02(1) Minutes of Conference on Hydrophobic Silica Aerogel, NRC Subcommittee on Clothing, Committee on Aviation Medicine, 30 Sep 44.  HD: 040.  (2) See footnotes 54 and 55, p. 54.
103Annual Rpt, 183d Sta Hosp Alaska, 1943.  HD.


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Instead of the shoepac, he had chosen a 12-inch leather Blucher boot, which was perhaps a more comfortable item but not so well insulated nor so efficient as the rubber-footed shoepac would have been in the slush of Attu.104  In an after-action report dated 10 June 1943, the surgeon of the forces on Attu stated:105

The large number of casualties due to foot trouble were the result of damp feet, added to cold and the inability of men pinned down in foxholes or other cover to keep up proper circulation by exercise. A waterproof type of footgear would probably have prevented the occurrence of disability in many of these cases.

For the Attu action, the annual rate for total cold injury for the 22-day period was 1,301.2 per thousand per year. This figure reflects the task force's unpreparedness for winter combat and their deficiencies in training and clothing. The principal problems of protective clothing in relation to cold injury in the Mediterranean Theater of Operations were summed up by the Fifth United States Army Surgeon in his annual report for 1944:106

The Winter Campaign of 1943-44 found Fifth Army troops poorly equipped to meet the dangers of trench foot. Troops were provided only with the Standard Army shoe or combat boot and a light wool sock. These shoes and boots became water-soaked and the light wool sock offered no protection against either wet or cold. The shoe or combat boot fit so snugly that a heavy wool sock could be worn only by issuing a larger size shoe. Supplies were not adequate for such a readjustment, nor were heavy wool socks available for issue early in the winter. Apart from these deficiencies, neither officers nor enlisted men were alert to the dangers of trench foot, or adequately indoctrinated in preventive measures. Trench foot was a new experience to Fifth Army troops and the preventive measures urged by the Surgeon were difficult to put into effect.

Recommendations were made for a daily change in socks, but at first there were not sufficient socks on hand to enable their being "issued with the rations". . . .

In the winter of 1944-45, Fifth Army troops were better equipped and trained to prevent the occurrence of trench foot. All combat troops were issued shoe pacs to be worn with two pairs of heavy wool ski-socks and a pair of felt innersoles. All divisions made provisions to supply front-line troops with an exchange of socks and to provide warming and drying stations near the front lines. . . .

When, despite the issuance of shoe pacs, a flood of trench foot cases occurred in Fifth Army troops in the month of October 1944, the Office of the Surgeon prepared a questionnaire for every trench foot admission to a Fifth Army Hospital to determine the cause for this influx of cases. It was discovered that a number of the troops had not been properly instructed in the use of the shoe pac, nor had they been issued proper sizes.

The shoepacs as originally issued in the Mediterranean theater in the fall of 1943 were unsatisfactory. They had neither heel nor arch support, traction was poor, and the combat soldier felt they were a hindrance in combat.107  Studies

104U. S. Army in World War II. The Quartermaster Corps: Organization, Supply, and Services, vol. I, p. 106.  Washington, Government Printing Office, 1953.
105
After-Action Rpt, Surg Attu Force, 10 Jun 43.  HD: 319.1-2.
106Annual Rpt, 5th Army Med Serv MTO, 1944.  HD.
107Memo, Dir Sanitation and Hygiene Div SGO to Chief Prev Med Serv SGO, 20 Jun 44, sub: Immersion (trench) foot problem.  HD: 350.05  (NATOUSA, Mar 1944).


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of footgear conjointly made by the Surgeon, Mediterranean Theater of Operations, United States Army, and Chief Quartermaster prior to and during the Anzio beachhead operation were forwarded to the War Department through Quartermaster Corps channels and recommended heels, arch supports, and sole traction for the shoepac, and an adequate supply of the heavy wool ski sock. The necessity for a heavier sock was further supported by a comparison of the American and British experiences. By 20 December 1943, the Fifth United States Army had had over 900 cases of trenchfoot, whereas a like number of British troops experienced only 50 cases. The principal difference was that American troops were issued 20-percent wool smooth-ribbed, lightweight socks, whereas the British wore a heavy-ribbed, pure wool sock. French troops wearing the American issue likewise had high rates for trenchfoot.108  Adequate supplies of heavy wool socks did not begin to reach the theater until late in the winter. The essential technical medical data report for March 1944 reported tests of heavy socks in the 3d Infantry Division and supported their use as a "definite step in the right direction in the prevention of trench foot."109  The supply of socks was greatly improved before winter operations late in 1944. The entire Fifth Army had shoepacs by the middle of October, but it was not until December that the desirable ski sock was available for general issue.110  The essential technical medical data report for the month of January 1945 stated that:111

Shoepacs when properly worn, appear to be a real protection against trench foot since only 11 percent of cases in December were wearing shoepacs with the two pair of ski socks as recommended. A total of 38 percent were wearing shoepacs but 27 percent were wearing the wrong socks. Fitting of shoepacs is now better, but there is still a shortage of smaller sizes. The most frequent complaint against shoepacs as noted on trench foot questionnaires is that feet perspire in them and then get cold. The solution is to change socks frequently allowing the damp socks to dry against the body. There is also some difficulty in maintaining stocks of ski socks so that men can always wear two pair and carry two pair.

The German troops were reported not to have suffered severely from cold injury in the Mediterranean theater. They attributed this to excellent foot hygiene and discipline, easily removable high leather German field boots, and the four pairs of thick, but loosely woven, all-wool high stockings provided to German troops in forward areas in the winter.112

Some shortages of other items of the uniform existed in the Mediterranean theater in the winter of 1943-44, but footgear was cause for the greatest concern. At the end of December 1943 only 50 percent of nurses in the North African

108ETMD, NATOUSA, Dec 1943.  HD: 350.05.
109ETMD, NATOUSA, Mar 1944.  HD: 350.05.
110ETMD, MTO, Dec 1944.  HD: 350.05.
111ETMD, MTO, Jan 1945.  HD: 350.05.
112ETMD, MTO, May 1945.  HD: 350.05.


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theater were equipped with woolen uniforms.113  In the fall of 1944 many troops were issued standard War Department uniforms including the jacket,  field, M-1943; trousers, field, cotton; shoepacs; ski socks; and the high-necked sweater.  Initially, this uniform was not well accepted by troops. Investigations revealed that these uniform items had not been well fitted and were not being worn in the manner for which they were designed. Training classes and a refitting program indoctrinated troops with the proper use of the uniform and resulted in a general acceptance. Training programs stressed that any constriction of clothing should be avoided, that perspiration was dangerous in the cold, that tight closures at neck, wrist, waist, and ankles were essential for maximum warmth, and that damp socks should be changed regularly.

In the European theater, planning, training, and stockpiling of clothing and footgear failed to take full cognizance of the clothing lessons learned in Italy. Confidence born of the rapid sweep across Europe in the summer of 1944 and the conviction on the part of many that the successes of Allied arms would be rewarded by victory before the onset of winter contributed to the unpreparedness for winter combat. Under these circumstances, command, training, and technical directives initiated by the Preventive Medicine Division of the Office of the Chief Surgeon, European Theater of Operations, produced few results. The onset of trenchfoot early in November 1944 could be likened to the situation in the Mediterranean theater in the fall of 1943. The greatest defects as to clothing were insufficient supplies, inadequate footgear, improper sizing and fitting, and failure to train the soldier in the proper use of clothing.114

Only the Seventh United States Army, which had previously served in Italy, was supplied with shoepacs by the middle of November 1944.115  The Annual Report, Division of Preventive Medicine, Office of the Chief Surgeon, for 1944 reported:116

Clothing and Equipment: The most outstanding deficiency in respect to clothing has been that related to overshoes and shoepacs. Shortage of these items has contributed to the incidence of trench foot. The following were apparent reasons for insufficient supplies:  (a) Troops embarking to this theater equipped with overshoes were required to turn them in prior to departure, the understanding being that they would be similarly equipped upon arrival overseas.  (b) There was a critical shortage of these items which was alleviated in part by air shipment from the United Kingdom.  (c) There was an overage of smaller sizes of overshoes which further complicated the overall basis of allowance and issue.  (d) Priority in issue was justly given to combat troops at the expense of service units. The latter troops were many times working continuously in the rain and mud without suitable foot cover.

113See footnote 108, p. 68.
114(1) Rpt, 3d Army Trench Foot Control Team, 10 Apr 45.  HD: 710 Cold Injuries (ETO).  (2) Rpt, 1st Army Trench Foot Control Team, 7 Apr 45.  HD: 710 Cold Injuries (ETO).
115Ltr, Lt Col R. P. Mason, MC, to Chief Surg ETOUSA, 11 Jan 45, sub: Report on study of trench foot in Seventh Army.  HD: 710 Cold Injuries (ETO).
116 Annual Rpt, Chief Surg ETO, 1944.  HD.


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Many reports of medical officers stated that the soldiers were inadequately clothed to withstand the severity of the European winter. It is felt that the M-39 field jacket normally issued is not practicable and cannot be compared with the British woolen battle jacket as regards warmth. The garrison cap, OD, worn by many troops in the rear, is worthless as headwear in that it neither keeps the rain from the face, the sun from the eyes, nor affords protection to the ears. Many units such an anti-aircraft gun crews who have to stand watch in fixed positions should be issued subarctic clothing for comfort since they have little opportunity for movement and the wearing of such apparel will not interfere with their work.

Blankets were in short supply during the early autumn, many units having but two per individual. The authorized issue of 4 per man still cannot be provided in many instances. Sleeping bags are heartily received by the troops, and no adverse comments relative to their use have been heard.

The shoepac was not considered entirely satisfactory for western European winter operations.117  A variety of expedients in footgear were tried, some of which were deemed satisfactory. Blanket-strip wrapping and socks, made from blankets and worn inside the arctic overshoe, were among the most effective of these.118

Unit shortages in the supply of footgear, especially the arctic-type overshoe, form a part of too many of the official records of units to be detailed. A study made by the Preventive Medicine Division, Office of the Chief Surgeon, showed that in November 1944, only 3 divisions were completely equipped with overshoes; in December, 9 divisions were still incompletely equipped; and in January 1945, 7 still lacked overshoes for their entire commands. When rates for cold injury were related to supply of overshoes, it was found that divisions fully equipped in November had an average rate of 4.3 per thousand per annum; those not fully equipped until December, a rate of 10.5; and those not fully equipped until January 1945, a rate of  11.7.119  Soldiers often declined to wear overshoes into combat because of weight and poor traction and some divisions ordered overshoes left behind when combat activities took place.120  By January 1945 both shoepacs and overshoes were in much more generous supply. Woolen socks were never in critical shortage, but difficulty was experienced by many units in getting them forward for daily exchange.121

Tariffs for shoes and overshoes were predominantly in the small sizes because they had not been established with the view to the extra sizes required to fit footwear over two pairs of wool socks. Correspondingly, overshoes were not available in the required large sizes. Many men had not been resized since passing through reception centers.122

117See footnotes 17, p. 40 and 114, p. 69.
118(1) Semiannual Rpt, Surg 3d Armored Div ETO, 1945-1.  HD. (2) Semiannual Rpt, Surg 44th Cav Recon Sq (Mecz) ETO, 1945-1.  HD.
119See footnote 91, p. 63.
120Rpt, Maj. P. A. Siple, QMG Tech Observer, 12 Apr 45, sub: Report on adequacy of winter clothing in ETO, winter 1944-45.  HD: 710 Cold Injuries (ETO).
121See footnote 114, p. 69.
122See footnote 114(2), p. 69.


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In addition to the difficulties with fitting, the M-3 and the field combat boot were poorly constructed for the prevention of trenchfoot. The welt-type sole leaked, there was too little room in the vamp, and the uppers were so scantily cut around the ankles and above, that properly fitted shoes could rarely be laced together without causing some constriction. With the bulk of extra socks, these defects were particularly objectionable and some constriction from lacing the shoe was the rule. These basic defects were recognized by The Quartermaster General. Based on a special report by Mr. Lawrence B. Sheppard,123  Assistant Director of the Leather and Shoe Division, War Production Board, after a survey of footgear requirements in the theater, the Chief Quartermaster, European Theater of Operations, United States Army, made several recommendations. He suggested that a combat boot similar to the one used throughout the war be maintained but that a change be made from a welt construction to a more waterproof type; that the last fits too closely and therefore requires further development; that better fitting devices and procedures be executed, especially at reception centers.124

In February 1945, a representative of the Quartermaster General's Office was sent to the European theater to observe the adequacy and use of winter clothing. He reported that the complete clothing assembly as developed by The Quartermaster General was adequate for frontline troops, but was provided in insufficient quantities and in many cases so late in the season that it was not available for winter combat. The winter campaign in Europe was fought by most combat personnel in a uniform that did not give proper protection. The principal weaknesses described were insufficient insulation, poor balance of insulation, lack of windproofness, lack of water repellency, and faulty closures. The report further pointed out that the clothing initially provided for the European theater could not afford sufficient insulation because of poor balance, insufficient overall thickness, and the inefficiency with which it was worn.125

Clothing conferences were held by the Chief Quartermaster, European Theater of Operations, and attended by Quartermaster Corps representatives from major forces and units on the Continent in January and March 1945. The purpose was to determine which articles of clothing were best adapted for preservation of the health of the combat soldier, for combat adaptability, and for durability. They also considered the service uniform for service troops and for all troops after the cessation of hostilities. The keynote of the conference was the provision of a simple and practical uniform and the reduction of the number of different uniform items. The winter combat jacket was unanimously favored and the wool and combat trousers met acceptance. Little

123See footnote 15, p. 40.
124Memo, Chief QM ETO to QMG, 23 Mar 45, sub: Footwear and socks for use in the European Theater of Operations, HD: 332.31 (ETO) (Winter Clothing).
125See footnote 120, p. 70.


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change in underwear, shirts, hand gear, and headgear was thought necessary, but modifications of the combat boot, service shoe, overshoe, and shoepac were recommended. It was thought that socks should undergo some modification; sweaters should be unchanged; and the overcoat be limited to the poncho, lightweight, nylon type and the overcoat, field, trenchcoat type. The Chief Surgeon, European Theater of Operations, favorably indorsed these recommendations to the War Department.126

The role of protective clothing was emphasized in a period report for 1 January to 30 June 1945 by the Surgeon, Third United States Army:127

It was self-evident that cold type injuries were preventable in seventy-five to ninety percent of the cases. Prevention depends upon a combination of factors:

1.  Adequate, properly fitting winter clothing.

2.  Adequate, properly fitting footgear or combination footgear (shoepacs, regulation shoes, combat boots, and overshoes).

3.  Adequate, properly sized socks.

4.  Continuous, daily sock exchange to combat troops during the winter months.

5.  Rotation of small and large units of combat troops out of the line at frequent regular intervals to enable warming, drying and changing of individual soldier's wet shoes and socks. Providing tents, huts, etc., wherein these things may be done.

6.  Instruction and training of troops in the early recognition of signs and symptoms preceding injury of tissue due to cold and dampness and the individual precautions necessary to prevent frostbite.

7.  Continued emphasis of the command responsibility for the above items.

8.  Frequent inspections (at least once weekly) of feet and footgear of the command. Necessary corrective action, insofar as possible, must be taken on the spot.

So many factors combined to produce the approximately 64,008 American casualties128 from cold injury in Western Europe that it is impossible to estimate accurately what proportions could have been prevented, or the relative weight of one factor such as clothing.

Several important principles, however, did evolve from the wartime research and theater experiences on clothing for the cold regions.

1. Clothing is one factor among several which influenced noneffectiveness from cold injury. In a conference of trenchfoot control officers, held in Paris, 21 April 1945, these experienced officers placed the following factors in the prevention of trenchfoot in the order of their importance as follows:129

126Memo, Chief QM ETO to QMG, 9 May 45, sub: Winter uniform, with 1st ind, Chief Surg ETO to CG ComZ ETO, 12 May 45.  HD: 332.31. The chief surgeon's indorsement contained the following statement: "Subsequent to the above meeting, a general conference of all trench foot control teams of armies was held in Paris. The line was principally represented, together with medical officers responsible for preventive medicine.  It is significant that this group came to essentially the same conclusion in respect to clothing as did the Quartermaster conference."
127Semiannual Rpt, Med Sec 3d Army, 1945-1.  HD.
128This constitutes more than four 15,000-men divisions. Approximately 90 percent of cold casualties involved riflemen and there were about 4,000 riflemen per infantry division. Thus closer to 13 divisions were critically disabled for combat. For further details see volume on Cold Injury, History of Medical Department, United States Army, World War II, to be published.
129See footnote 100, p. 65.


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    a.  Individual foot care.
    b.  Clothing and equipment.
    c.  Rotation.
    d.  Weather.

2.  No clothing developed during the period could be considered as complete protection against cold.

3.  Properly designed and effective clothing covering the torso is just as important as protective clothing items for the feet in the prevention of trenchfoot. Loss of heat from any part of the body predisposes the cold injury of another part. This concept was dramatized by the Chief of the Preventive Medicine Service, Office of the Chief Surgeon, European Theater of Operations, when he said: "'When a soldier takes off his hat, his feet begin to get cold."130

4.  The most effective clothing for cold climates embodied layering of wool clothing underneath an outer garment of tightly woven windproof, water-repellent, durable fabric. This principle made the maximum use of the insulating properties of still air.131

5.  For maximum protection against the cold, the various items of clothing must be worn for the purposes for which they were designed. The Quartermaster General developed groups of clothing items appropriately called "clothing assemblies." Unless utilized as a total assembly, the degree of protection was materially reduced. This could be accomplished only by adequate supplies to forward elements of all components of the assembly, and by careful training of all personnel in the utilization of the winter clothing assembly to provide maximum protection.

6.  Prevention of trenchfoot required waterproofed footgear worn over sufficient insulation by air and wool as provided by at least two pair of heavy woolen socks. Since wetness destroyed the insulation thus provided, opportunities for a change to dry socks must be provided daily and certainly within the average incubation period (3 days) of trenchfoot.132

7.  Loose fit of clothing and footgear to avoid constriction of the parts and unnecessary friction, and to provide freedom of action is essential for full clothing protection against cold.

SPECIAL CLOTHING PROBLEMS

A number of special problems arose in connection with clothing, some principally medical in character, others obliquely so because specialized protective techniques introduced health hazards in themselves.

130See footnote 100, p. 65.
131See footnote 120, p. 70.
132See footnote 91, p. 63.


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Impregnation of Clothing

Impregnation of clothing is patently a responsibility of the Chemical Corps. Toxicity, skin irritation, and added physiologic heat loads produced by the impregnates in clothing were of pertinent medical interest. Clothing impregnation with insecticides has been discussed in the section on clothing in the hot climates. Although plans for testing wool impregnated with these agents were made in the summer of 1945,133  no evidence that they were carried out has been found.

The medical aspects of fireproofing and water repellency techniques came under the surveillance of the Subcommittee on Clothing, National Research Council, as early as 1 September 1942.134  Pursuing the concept of developing clothing in accord with physiologic demands, The Surgeon General in the fall of 1942, called to the attention of the Chief of Staff the probable hazards from clothing impregnated against vesicant gases to soldiers operating in the tropics. In January 1943 a directive from the Chief of Staff to the Chief, Chemical Warfare Service, set up the requirement that all overseas troops were to be equipped for chemical warfare by that spring, and pointed to the doubts that had arisen over the suitability of impregnated clothing for the tropics. By direction, a committee to study this problem was established, participation by The Surgeon General directed, and arrangements made for studies in the John B. Pierce Laboratory of Hygiene, New Haven, Connecticut, and for tests to be conducted in a tropical region (Panama and, if practical, in Liberia or the Southwest Pacific as well).135  The National Institutes of Health investigated the effects of chemical warfare protective clothing upon the efficiency of soldiers in tropical climates. Early tests at the Pierce Laboratory concluded that the impregnating agent CC-2 imposed no unusual physiologic load nor impairment of efficiency, and recommended additional field testing.136  Interim reports from the Panama tests confirmed these observations, and the final report on 15 June 1943 recommended that clothing impregnated with CC-2 was satisfactory for use by troop personnel under combat conditions in tropical climates. The water-suspension process of impregnation was favored. It was found that clothing should be reimpregnated or replaced after 14 days'  wear and that laundering of impregnated clothing in the tropics should be kept to the minimum compatible with reasonable standards of cleanliness. Skin-patch testing had not been completed and further studies were required as to abrasiveness, porosity, flexi-

133Semimonthly Rpt, Prev Med Serv SGO, 16-30 Jun 45. HD: 024.
134Minutes of Meeting, NRC Subcommittee on Clothing, Committee on Aviation Medicine, 1 Sep 42. HD: 040.
135(1) Memo for Record, 25 Jan 43, sub: Expedited tests of permeable protective clothing. SG: 421.-1.  (2) Ltr, CG SOS to SG, QMG, and Chief CWS, 13 Feb 43, sub: Committee for controlling tests for permeable protective clothing. SG: 334.8-1.
136Ltr, SG to Dir Reqmts Div SOS, 27 Feb 43, sub: Expedited tests on permeable protective clothing. SG: 421.1.


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bility, weight, comfort, fatigue, wear, and functional restrictions.137  Further testing showed that impregnation of the underwear worn under the herringbone twill one-piece suit was almost as effective as when both outer and under garments were impregnated.138

The impregnation of women's clothing was made the subject of a separate study. It was concluded that protective clothing impregnated with CC-2, either by the solution or the water-suspension method, is physiologically satisfactory for constant wear over a period of at least 4 weeks by women engaged in moderately strenuous activity in temperate climates. Occasional dermatitis resulted, but it was concluded that the skin of women is no more sensitive to clothing than the skin of men.139

In December 1943 the Armored Medical Research Laboratory was requested by The Quartermaster General to test a group of flameproof treatments for clothing, notably fire-retardant, CM, manufactured by the DuPont Company, an ammonium sulfomate type, and "Flame-Out," manufactured by Treesdale Laboratories, a borax-boric acid type.140  The DuPont product was recommended and approved for limited use. Coveralls treated with the CM fire retardant were to be issued to tank and other vehicle crews, gasoline and ammunition handlers (first echelon), personnel handling or using incendiary agents, including flamethrowers, and other personnel designated by unit commanders because of exposure to fire hazards. Some skin irritation was seen, but the protection afforded the personnel noted was considered to outweigh disability likely to arise from skin irritation.141

Studies on protective clothing against chemical agents and fire continued into 1945. In November 1944, the Chemical Warfare Service requested the services of the director of the Armored Medical Research Laboratory for cooperative special studies on protective clothing.142  These studies resulted in tests on "Banflame" and the initiation of field tests of garments impregnated with this agent by the Army Ground Force Boards.

The Subcommittee on Clothing in March of 1944 recorded that, "Mosquito-repellant impregnation of clothing seems to produce no difference in heat exchange. This is also true of water-repellency treatments, and Chemical Warfare Service impregnations, which are themselves water-repellent."143

137Rpts, Lt Col T. H. Marshall, CWS, Lt Col W. S. Stone, SGO, Mr. H. A. Secrist, QMGO, to CG ASF, 29 Apr 43, and 15 Jun 43, sub: Protective value, life span and physiological effects of impregnated cotton clothing in tropic zone. SG: 421.1.
138CWS  Rpt, M. Sullivan and C. M. Hunt, 28 Mar 44, sub: A comparison of the penetration of measured droplets of H through CC-2 impregnated and unimpregnated clothing worn by men. Filed at Army Chem Ctr, Md.
139Memo, 1st Lt M. Hayes, MC, for SG, 10 Nov 43, sub: Test of clothing, women's, protective, QMBT-1305. SG: 421.1.
140Ltr, QMG to SG, 28 Dec 43, sub: Test of flameproofing for clothing. SG: 421.1.
141(1) Rpt, Project 27, 13 Mar 44, sub: Fire resisting compounds for clothing, in Annual Rpt, Armored Med Research Lab, 1945.  HD.  (2) See footnote 120, p. 70.
142Ltr, Chief CWS to SG, 21 Nov 44, sub: Investigation on protective clothing. SG: 421 Boots.
143See footnote 62(1), p. 56.


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The development of the foam-impregnation technique for clothing improved the heat dissipation characteristics of impregnated clothing, simplified the problem of laundry,144 and made possible the impregnation and reimpregnation of clothing during the laundry process in both fixed and mobile laundries. The multiple impregnation of clothing with insecticides and flame and chemical protective agents, while comprising technical difficulties, did not materially affect clothing in relation to the physiology of man.

Dubbin

The use of dubbin for shoes is a form of impregnation. The procedure was important medically only in that the dubbin allegedly waterproofed shoes and improved their wearing qualities and comfort, and aided in protection against cold injury. Dubbins containing antivesicant impregnates were used for protection against chemical warfare agents. Based on complaints from the field that dubbin makes shoes colder in the cold and hotter in the heat, a series of laboratory tests were made in which it was shown that dubbin did not significantly affect the thermal insulation of leather, but did reduce porosity. Dubbin was ineffective in improving the performance of shoes in protection against cold injury.145  Dubbins containing impregnates were overrated and a series of tests by the National Bureau of Standards revealed that there was little difference between the impregnated and unimpregnated dubbins in their ability to protect against vesicant agents.146

Since there was considerable demand for dubbin, a decision was made late in 1943 to issue both types indiscriminately for normal use. Development of a new and improved dubbin impregnate against chemical warfare agents was initiated.147

Special Gas Masks

The development of the gas mask for World War II has been recorded in reports of activities of the Chemical Warfare Service. In the European theater, certain hospitals were considered to be vulnerable to gas attack from the air. A head wound gas mask appeared desirable. Upon receipt of the recommendation from the European Theater of Operations, the War Department canvassed other theaters to determine the desirability of the item. All advised development. The Surgeon General had such an item under study, but even-

144(1) Ltr, Chief CWS to CO Armored Med Research Lab thru SG, 14 Apr 45, sub: Heat load studies on clothing flameproofed by foam impregnation method. SG: 421.  (2) Ltr, Chief CWS to CO Armored Med Research Lab thru SG, 20 Jul 45, sub: Laboratory tests on worn flameproof protective clothing. SG: 421.  (3) Filler, L.: Laundry and Related Activities of The Quartermaster General. QMC Historical Studies No. 13, Washington, Government Printing Office, 1946.
145See footnote 114(2), p. 69.
146Rpt, QM Climatic Research Lab, 17 Apr 46, sub: Dubbin on footgear, heat and cold effect of. SG: 400.112.
147Ltr, QMG to CG ASF thru Chief CWS, 2 Mar 44, sub: Study of dubbing and shoe impregnate.  SG: 400.112.


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tually the Chemical Warfare Service took over this responsibility, together with that for requirements, storage, and issue.148

Allergy to Clothing

Allergic manifestations and skin irritation resulting from fabrics, dyes, and impregnating agents were not a significant medical problem. Tests of the standard uniform in producing allergic dermatitis were negative. Some reaction to the cushion-soled sock was reported by the Armored Medical Research Laboratory.149  In March 1943, the senior consultant in dermatology in the European theater noted an increasing number of men with sensitivity of the skin to dye, wool, and other materials in uniforms, severe enough at times to be disabling. Issue of long cotton underwear upon the recommendation of the Office of the Chief Surgeon was authorized for these patients. Likewise, he reported that patients with skin disease apparently had been made worse by contact with the general issue, blue-gray woolen pajamas used in Army hospitals.150  In the China-Burma-India theater, a dermatitis venanata, or "Dhobie-mark dermatitis," resulted from the use of "bichi" nut ink used for laundry marking.151

Tropic-Proofed Clothing and Equipment

Mildew formed by fungi affected many types of fabrics, leather, and equipment. Tentage, bed clothing, canvas linings of the combat shoe and shoe leathers were the items of clothing, or related to clothing, that were affected. In the early phases of the war, toxicity of the mildew-proofing agents under study was tested by the Chemical Warfare Service Laboratory and by the Armored Medical Research Laboratory. With the establishment of the Army Industrial Hygiene Laboratory in Baltimore, Maryland, this function became a part of its responsibilities. Many fungicides and mildew-proofing agents were patch-tested on human volunteers without reference to ultimate adoption by the developing agency. These chemicals were classified according to the degree of exposure or contact of the soldier with the agent.152

Footwear

Dyes and Finishing Material.  With the cessation of European hostilities, improvement in the appearance of the flesh-side out shoe became a matter of some importance. Toxicity from unauthorized shoe dyes was cause for the

148(1) Ltr, Chief Surg ETO to SG, 16 Feb 44, sub: Development projects. SG: 470.7.  (2) Ltr, SG to CG ASF, 7 Aug 44, sub: Standardization of mask, gas, head wound, M7-11-9. SG: 470.7.
149Appendix B to Annual Report cited as footnote 96, p. 64.
150Ltr, Lt Col D. M. Pillsbury, Senior Consultant in Dermatology ETO, to Chief QM ETO, 4 Mar 43, sub: Long cotton underwear for use on patients with sensitivity to wool uniform. HD: 422 (ETO).
151CBI Field Med Bulls, vol. 2, No. 6, Jun 1943; vol. 3, No. 6, Jun 1944.
152See footnote 40, p. 49.


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testing of a number of products by the Army Industrial Hygiene Laboratory. A War Department circular in May 1945 directed use of dubbin or shoe impregnate, and prohibited the application of dyes, coloring, or finishing material on combat boots and service shoes without specific authorization or approval by the War Department.153

Plastic Insoles (Saran).  A variety of materials were used as insoles for shoes. Felt eventually was adopted and was further improved after the war for use with shoepacs. Plastic-mesh net soles were given trials both by the Quartermaster Board and in the Mediterranean Theater of Operations. Being impervious to water and because the mesh construction provided airspace and a bellows action, it was hoped that these insoles would prove of benefit for both cold weather and tropical wear.154  Troop trial in the Mediterranean theater both supported and criticized the device. Medical officers indicated that they added to marching comfort when fitted with the proper size shoes, kept the foot warmer in moderately cold weather, and aided in drying of socks. The consensus of opinion was that Saran insoles were a comfort in cold wet weather, but would not greatly influence the incidence of trenchfoot.155  A supply of shoes big enough to fit over the necessary socks and the insole was a practical consideration. Tests at Camp Lee, Virginia, early in 1944 caused the Quartermaster Board to recommend "that the Saran insoles be considered as not possessing sufficiently outstanding or clearly evidenced value to warrant their issue for general use of troops in temperate climates with the service shoe or combat boot"156

Sizing and Fitting of Footgear.  In March 1945, the Chief Surgeon, European Theater of Operations, in commenting upon improvements in the uniform recommended by the Chief Quartermaster, European Theater of Operations, stated, "In almost thirty years of service, I have rarely seen shoes fitted with the care and expertness that this function deserves."157  "Improper Fitting of Shoes" was the subject of a War Department memorandum published on 17 September 1942, which called attention to the fact that enlisted men were being issued shoes at reception centers and elsewhere in the sizes they requested, a practice which resulted in many improper fits. Commanding generals of all service commands were directed to see to the fitting of shoes in compliance with the provisions of Army Regulations (AR) 850-125.158  Fitting of shoes for Wacs was unsatisfactory for the same reason. Women preferred fits over thin hose and resisted sizing by fitting machines. Eventually correct sizes were prescribed and issued without consideration of the Wac's choice. Inspection

153WD Cir 137, 8 May 45.
154Ltr, SG to QMG, 5 May 43, sub: Insole, ventilating, experimental. SG: 421.11 (Shoes).
155Ltr, SG for QMG, 15 May 44, sub: Insoles, ventilating, lab test No. AMRL3. SG: 421.-1.
156Rpt, The QM Board, 30 Jul 44, sub: Report of test of insole, ventilating, Saran: fused edge type and fused and bound edge type. SG: 400.112.
1571st ind, Chief Surg ETO to CG ComZ ETO, 26 Mar 45, on basic ltr cited in footnote 124, p. 71.
158AG Memo S850-2-42, 17 Sep 42, sub: Improper fitting of shoes. AG: 333.1.


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to insure the fitting of clothing and directing that woolen and other winter clothing issued during warm weather was to be tried on and inspected for proper fit in compliance with AR 850-126 was the subject of another War Department memorandum in December 1942.159

The medical implications of the misfitting of shoes were recognized in the research project carried out at the Armored Medical Research Laboratory in the spring of 1943. The report of the findings recommended:

a.  That a thorough study of foot disabilities resulting from misfitted shoes be undertaken.

b.  That anthropometric measurements of soldiers' feet be secured to provide a basis for the design and fitting of Army shoes.

c.  That certain recommended changes in the structural characteristics of Army shoes be given consideration.

Further action on these recommendations approved anthropometric studies of measurements by this laboratory. Results of these preliminary studies showed that the design of the army shoe was not altogether in accord with shape and size of feet, and that procedures for fitting soldiers' feet were not satisfactory. The laboratory believed that this situation contributed in no small measure to foot disabilities and that further study of the problem could result in marked improvement.160

Improper fitting and the sizing of combat boots and shoepacs in Italy in the winter of 1943-44 contributed to trenchfoot prevalence and complicated the problem of control. There was much improvement by the winter of 1944-45.161

In the European theater, the long wait in England before the assault on the Continent saw little emphasis upon the fitting of clothing and footgear, especially as it related to combat activities in the cold. The importance of fit, however, was stressed in a headquarters circular prepared in the Office of the Chief Surgeon in October of 1944.162

Numerous essential technical medical data reports and sanitary reports from the European theater pointed out deficiences in the fit of shoes, shoepacs, and overshoes, and their relation to cold injury.163  The importance of proper fitting of shoes was stressed in War Department Circular 312, 22 July 1944. The headquarters of the Ground Forces Replacement System in the European theater drew attention to the urgency of the proper fitting of shoes in their Circular 55, dated 13 December 1944.164

Investigation of clothing problems in the spring of 1945 led the Chief Quartermaster, European Theater of Operations, to the conclusion that shoe lasts fit too closely, that better fitting devices and procedures must be found,

159AG Memo W30-15-42, 26 Dec 42, sub: Improper fitting of clothing. SG: 421.-1 (Uniforms).
160Appendix B to Annual Report cited as footnote 96, p.
161Simeone, F. A.: Trench foot in the Italian campaign. HD: 314.7-2.
162Hq ETOUSA Cir 108, 26 Oct 44, sub: Care of the feet. HD.
163(1) For example see footnote 17, p. 40.  (2) ETMD, MTO, Oct 1944. HD: 350.05.
164See footnote 90, p. 63.


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that shoe tariffs included far too many sizes, and that the tariff must be expanded upward to include larger sizes.165  The medical implications of improper sizing and fitting were summarized by the Chief Surgeon, European Theater of Operations, in an indorsement to the report of the above investigations:166

*                 *                 *                 *                *                *

2.  Insofar as cold injury (trench foot, frostbite, immersion foot) is concerned, the generalization may be made that it is the direct result of lack of adequate circulation of the blood. With sufficient blood circulating at a temperature of 98 degrees Fahrenheit, little or no damage can be done to tissue by cold.

3.  It follows, then, that prevention of cold injury lies entirely in the maintenance of adequate circulation. The factors of decreased circulation, particularly in the extremities, are:

a.  Loss of surface heat.  As a defense mechanism against lowering the body temperature as a whole, surface blood vessels are constricted reflexly when surface temperatures are lowered by exposure to cold. Surface temperature is lowered faster through a wet medium than through a dry medium. For this reason, extremities are injured at higher temperatures when wet than when dry; and trench foot occurs in higher temperatures than frostbite.

Consequently, warmth and waterproofness in a shoe or garment is to be sought. If it be impossible to waterproof an item, the skin should be further protected by a heavy layer of material which retains a large part of its insulating quality when wet-such as wool.

b. Constriction of circulation.  It is of the greatest importance that circulation be not constricted by tight shoes or clothing. A large proportion of patients with trench foot showed the marks of shoe laces over their insteps. Shoes that fitted too tightly were solely responsible for many cases of trench foot.

It is impossible to fit shoes properly unless socks be of uniform thickness.

Furthermore, the construction of both the Type III shoe and the combat boot-with quarters that are wide apart over the instep, invites tight lacing.

c.  Stagnation of circulation.  Hours of inactivity promote stagnation of circulation, particularly in the extremities. One way to combat stagnation is to have the footwear fit loosely enough to permit of active movement of the foot within the shoes.

Sizing of socks offered some difficulty, and some units requisitioned socks only in size 12 in order to have enough large sizes. Shrinkage of socks occurred as a result of the quartermaster laundry procedures, which complicated the satisfactory reissue of properly sized socks. This failing was critical enough to justify The Quartermaster General in instituting research to determine laundry procedures and treatments of wool to reduce shrinkage to a minimum.167

Tariffs

Complaints about the uniform, field investigations, and practical experience in the Zone of Interior and in the several theaters of operations, thoroughly

165See footnote 124, p. 71.
166See footnote 157, p. 78.
167See footnote 124, p. 71.


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demonstrated that a scientific basis for design, sizing, and establishment of clothing tariffs had not been available to guide the provision of clothing stocks during the war. With a realization of this defect, The Quartermaster General in October 1945, authorized the Climatic Research Laboratory to conduct a series of anthropometric studies on a sufficiently large number of male and female Army personnel to establish authentic guides for design, sizing, and tariff determinations. Between May and November 1946, 105,062 men selected in accord with the population distributions prepared by the Bureau of the Census were subjected to detailed anthropometric measurements.168 Additionally, over 8,000 women were measured. The data on males and females were subjected to statistical analysis. The distribution of body types was found to fall into distinct groupings that arranged themselves roughly into the form of a normal curve. These data, establishing type groups and distribution of body types within the military population, should materially improve fit, appearance, tariffs, and stockpiling of the uniform. These studies have been continued into the postwar period.169

Reconditioning and Reissue

The reissue of salvaged clothing and textile items was not a matter of great medical concern. The Office of The Surgeon General adhered to the policy that ordinary laundering or dry cleaning offered sufficient sterilization and disinfestation. Exceptions were noted for the clothing of soldiers known to have been ill of communicable diseases or where the degree of louse infestation might require the use of methyl bromide disinfestation.170  Spread of fungus infections through reissued shoes came under consideration in 1941. Until the middle of 1943, the methods recommended or concurred in by The Surgeon General involved the use of chlorine as a fungicidal agent.171  Some question arose as to the necessity for sterilizing shoes under any circumstances. The Division of Medical Sciences, National Research Council, on 27 June 1944 made the following recommendations to The Surgeon General:

1.  Foot baths for the prevention of "athlete's foot" are not prophylactic, not necessary, and their use should be discontinued by the Army.

2.  Shoe sterilization:

a.  For factory rebuilt shoes: Sterilization is desirable, at least until further information is available.

168QMC Climatic Research Lab, Rpt No. 122, 2 Jul 47, sub: Survey of body size of Army personnel, male and female. QM: 420 Anthropometric Survey.
169QMC Research Lab, Proposed Studies, 5 Oct 48, sub: Body size measurements of inductees and body size measurement and clothing fitting tests on inductees. QM: 420 Anthropometric Survey.
170(1) Ltr, QMG to SG, 6 Oct 44, sub: Sterilization of clothing for reissue, with 1st ind, SG to QMG, 26 Oct 44.  SG: 720.5.  (2) Ltr, Dir Sanitation and Hygiene Div SGO to Mr. M. E. Kent, UNRRA, 4 Feb 44.  SG: 720.5.
171Ltr, QMG to SG, 18 Apr 42, sub: Sterilization of class B shoes.  SG: 421.-11.


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b.  For shoes turned in for exchange, but not requiring repair: There is not sufficient evidence that such shoes transmit fungus infection of the feet to warrant sterilization.172

Subsequently, a method of sterilization, using formaldehyde in 1-percent solution, followed by a soap solution, and finally immersion of the shoes in an oil emulsion with 5-percent pentachlorphenol173 came into limited use.

Some soldier resistance to wearing rebuilt and reissued shoes because of foot complaints was observed. The large-scale program for the rebuilding of service shoes was so important that the adverse comments of the 326th Glider Infantry, Army Air Base, Alliance, Nebraska, was cause for thorough investigation by Quartermaster Corps and Medical Department consultants.174  The investigation substantiated the wisdom of the rebuilt shoe program and further emphasized the need for fungicidal treatment. Formaldehyde fumigation according to the method developed by Dr. Fred O'Flaherty, at the University of Cincinnati, was the basic sterilizing procedure used in the army shoe reconstruction factories.

Transmission of trichophytosis through gymnasium shoes used in reconditioning facilities was cause for concern. The Preventive Medicine Service, Office of The Surgeon General, recommended a pair of shoes for each individual during hospitalization with fumigation before reissue by the O'Flaherty procedure.175

Industrial Medical Aspects of Clothing

Protective clothing in industrial operations in Army-owned or Army-operated industrial plants conformed largely to commercial practice. Among the most significant health problems was trinitrotoluene poisoning. Personnel handling toxic explosives were provided with powder uniforms, socks, suitable underwear, head coverings, powder shoes, and sweat shirts or sweaters as necessary. These articles of clothing remained in the plant. Freshly laundered uniforms were furnished each day. Each worker was required to have a bath and a complete change of clothing after the work shift. These were requirements that could be met only by careful supervision and maintenance in the bath and change rooms. Special types of protective clothing were developed for workers involved in the application of radioactive luminous paint to instrument dials.176

Appropriate protective clothing for service personnel engaged in handling heavy shipping on docks, in railway yards, and in similar operations received

172Ltr, NRC Div of Med Science to SG, 27 Jun 44. SG: 421.-11. (Boots).
173Ltr, QMG to SG, 2 Sep 43, sub: Disinfecting worn shoes for athletes foot. SG: 421.-11 (Boots).
174Memo, CG ASF for SG, 9 Jul 43, sub: Rebuilt shoes. SG: 421.-11 (Boots).
175Semimonthly Rpt, Prev Med Serv SGO, 1-15 Jul 45. HD.
176Rpt, Army Industrial Hygiene Lab SGO, 9 Oct 50, sub: Relationship of clothing to industrial hazards including the use of protective clothing during World War II. HD: 422.3 Protective Clothing.


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little medical attention, but was largely within the province of safety officers and safety engineers. The Surgeon General's concern for the problem was expressed in an indorsement reporting standardization of safety working shoes, in which he noted that, while civilian employees were used whenever possible in storage, transportation, and repair of materials for war in the Zone of Interior, military personnel accomplished such work in the theaters. This personnel should be protected by safety shoes wherever needed.177

Miscellaneous

Anti-Louse Suit.  In 1942 an anti-louse suit was designed in the European Theater of Operations and submitted to the War Department for development.178  DDT modified the requirement. In October 1943, 2,000 suits were requested. Their use was to be limited to heavily exposed personnel and to sterilization and bath units.179  Subsequently, protection from DDT and vaccination were considered adequate and the anti-louse suit was discarded.

1771st ind, SG to QMG, 8 Jan 44, on Ltr, QMG to SG, 27 Dec 43, sub: Shoes, safety, working, composition sole. SG: 421.-11. (Boots)
178Ltr, Chief Surg ETO to Chief QM ETO, 8 Dec 42, sub: Anti-louse protective clothing. HD: 422  ETO.
179Memo, Chief Surg ETO to Chief QM ETO, 17 Nov 43, sub: Anti-louse suits. HD: 422  ETO.

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