PHYSIOLOGY OF FREEZING.
DR. VON NUSSBAUM
SERIOUS ills often result from exposure to freezing, merely because many people do not know how to guard against troubles so induced. Delicate white faces are sometimes disfigured by the nose turning red; this is liable to happen to one who has suffered from freezing of the organ, usually at the first snow-fall, perhaps even in midsummer; the hands may display, at these times, bluish-red and swollen fingers, and all this only because at some time in early youth, when these members had become frozen, proper care was not taken of them, and because there was nobody at hand who could offer sound advice. Chilblains, when wrongly treated, become very troublesome, and may lead to the loss of fingers or toes by mortification ; and such an occurrence can even endanger life. If, during intense cold, we are subjected to influences that tend to lower our vitality, we may fall into a sleep, from which perhaps we may never awake.
No man knows in what circumstances he may at some time be placed. The courageous soldiers who, with Napoleon I, left the burning city of Moscow, probably never dreamed, while in sunny France, that they would sink down on snow-banks, and fall into a sleep that ends but in death ! Many of them could perhaps have saved their lives if they had ever heard of the proper precautions to be taken against this danger. Some persons think that the drinking of strong liquor will enable them to resist the cold more readily ; this, however, is very delusive. Even if we increase the activity of some organs by a stimulating drink, we must not forget that the taking of liquor causes the blood to rush to the brain, and that the cold, too, drives the blood from the skin to the inner organs, and particularly to the brain. Strong drink must, therefore, favor the congestion of the brain which is caused by cold.
Good nourishment, an energetic character, and a sound heart, are the best preventives against the danger of perishing by cold. Closefitting garments, which impede the circulation of the blood, and exposure in damp, windy weather should, if possible, be carefully avoided.
Many persons have the idea that life is endangered only, if the patient be brought too suddenly from the cold into a warm place. They believe that, if one proceed very carefully and slowly with the warming, the cold can never produce a lasting injury to the system. There is certainly no doubt that sudden warming is very dangerous, and that a great deal depends upon the right treatment of the frozen limb. Experience shows that, while some people have frozen joints treated in such a manner that they are completely restored, others are less fortunate, and suffer frequently in after-years. But one must admit that intense cold alone, without being followed by sudden warming, which proves so disastrous, suffices to cause severe suffering. In this respect, a great deal depends on the nature of the person. If very sudden transitions from heat to cold and from cold to heat be avoided, a healthy person can withstand intense cold without serious consequences, especially if he be mentally active, energetic, and muscular, and has a sound heart—that is, if his pulse be regular and strong. A robust person can withstand the temperature at which alcohol and mercury freeze. Members of north-pole expeditions have experienced temperatures of fifty or more degrees below zero without suffering harm.
However, it happens not unfrequently that even moderately cold weather, when the thermometer is but a few degrees below the freezing-point, causes serious ills, and sometimes even fatal results. This is apt to happen to persons who are anæmic, poorly fed, effeminate, or mentally depressed. Old men, children, anæmic girls, drunkards, and people with a weak heart, are all liable to be frost-bitten, and easily freeze to death if they succumb to sleep while exposed to intense cold. They fall into a sort of stupor, sit down to rest, soon fall asleep, and in most instances never awake. For a long time they remain in a condition bordering on death ; they breathe a little, and the heart makes feeble attempts to maintain the circulation of the blood.
This beating of the heart is the cause of the long duration of this death-like trance. The heart exerts a slight pressure on the lungs, and causes thereby a sort of artificial breathing, which, however, is so slight that laymen and even physicians often erroneously consider people who are merely frozen to be dead.
When Napoleon I had returned to France from Russia, he felt convinced that many of his soldiers had been buried alive, and he offered a large reward for the surest means of distinguishing between this trance-like condition and actual death. The prize was awarded to Professor Andral, who claimed that listening to the heart-sounds by means of the stethoscope was the surest way of ascertaining whether death had taken place or not, because with this instrument could still be heard the movement of the heart-valves, when by all other tests one could no longer detect any sign of life. Napoleon’s prize might, however, well have been awarded to Professor Middeldorf, of Breslau, who with his akidopeirastic (needle-test) was able to detect signs of life some time after the sound caused by the movement of the heartvalves had ceased to be audible with Andral’s stethoscope.
Up to the present day this method is the most reliable one for ascertaining whether death has occurred or not. It is surer than the cutting of the sole, the burning with sealing-wax, or any other test. A long needle is thrust (between the fifth and sixth ribs) into the heart, a proceeding that is not at all dangerous, provided that the needle does not enter below a certain depth. The needle must be of such length that about one half of it projects from the chest ; the slightest movement of the heart will cause that part of the needle which is visible to vibrate.
But no one need fear that those soldiers of Napoleon who were thus buried alive ever awakened in their graves. As surely as there can be no question but that by careful treatment quite a number of them could have been saved, just as confidently can it be asserted that their numbness, provided no careful attempts were made to restore them to life, resulted in actual death. Unfortunately, it has not yet been ascertained how long this trance-like condition may last with the frozen—whether five or six days (many such cases are known), or whether it may not continue even longer.
We have already, at the beginning, referred to the danger of an incautious warming of the frozen. If the warming be accomplished too quickly, a sudden reaction will set in, which the patient will not be able to survive. Blood which has been frozen and then thawed is still red, but of a different shade. The coloring matter of the blood has become separated from the blood-cells. Blood of this description causes congelation in blood which is in its normal state. One can kill an animal in sound health by injecting such blood into its veins. But the process takes a different turn in cases where the frozen are gradually warmed and restored. If a very minute quantity of the frozen blood is again brought into solution and sent into the system, this small amount of poison will be taken care of. This is the reason why, in all attempts at revivifying persons who have been frozen, the warming and the restoring of the juices to their normal condition must be gradually done. The best way is to lay the patient into snow, to rub him with snow (which should be renewed several times), and then to follow this treatment up with very cold water. Then give a cold bath in an unheated room, rub the chest and the region of the heart thoroughly with fresh water, and finally put the patient into a cold bed, cover him with cold cloths, and give an enema of cold water.
Some blow fresh air into one of the nostrils by means of bellows, while the other nostril and the mouth are kept firmly closed. But, as far as my experience goes, by this treatment the air is much more likely to get into the stomach than into the lungs. If it is necessary to induce artificial respiration, it is better to alternately press the arms of the patient firmly to his chest and then to raise them above his body, or, what is even more simple, squeeze together every two or three seconds both chest and abdomen with the hands.
As soon as faint signs of life, such as a twitching of the eyes, a change in the color of the lips, or an attempt at breathing are noticed, the nose should be tickled with a feather, and a few drops of some stimulating fluid, either wine, brandy, or ammonia, should be poured into the mouth and throat. When the symptoms of returning life become more marked, pour a few teaspoonfuls of one of the above-mentioned liquids into the mouth and give an injection with a spoonful of wine or brandy, and also use one of the liquids to rub the skin ; then put the patient into a warm bed. After this, some warm soup or a cup of coffee will be in place. Should the excitement become too great, it is advisable to give a lukewarm bath and some soothing potion.
In the every-day happenings of our life such accidents occur but rarely. However, complaints of frozen fingers, toes, ears, and noses, and chilblains, are frequent.
Many people think that fingers, toes, and noses are apt to be frozen because they are so distant from the heart, and are in consequence not so plentifully supplied with warm blood. Although I do not wish to dispute this entirely, the main reason seems to be that these parts are very thin and small and come more directly in contact with the air. When such small parts are exposed to intense cold, the veins contract and drive the blood toward the interior. The backs of the fingers and toes freeze first ; they become pale and devoid of feeling, and the joints benumbed and stiff. After a while the blood in the veins congeals, all tissues grow brittle and break easily. But frozen joints are not dead. If gradually warmed they can be restored entirely ; if, however, they have been exposed to intense cold and are then suddenly warmed, a strong inflammatory reaction sets in, the same as when normally warm parts are exposed to a temperature as high as that of boiling water. Cold alone can produce numbness and insensibility ; but an inflammatory reaction is alone due to too rapid a warming. To such careless treatment only must the troubles which are known as frozen joints, chilblains, etc., be ascribed. Chilblains, where the skin and tissues are inflamed, cause a disagreeable itching in warm weather.
The first stage of such an inflammation makes the joints appear bluish-red, violet, and swollen. Frozen joints are at the beginning cold and difficult to move ; they cause a stinging pain, particularly in the evening during damp, cold weather. During spring and summer the trouble often disappears entirely, but sometimes it appears even in midsummer. During the first winter the pains are more severe than in the following years.
A second and more advanced stage of localized freezing takes place where the cold was more intense, or where the organs were subjected to a more sudden warming. All symptoms are then more severe ; the skin of the fingers cracks, and painful cuts, blisters, and sores result.
As the third stage of freezing, those instances are denoted where the frozen joints become immediately mortified, or where they are at first greatly inflamed and then become mortified. The mortification, however, rarely penetrates deeply ; it is mostly restricted to the outer skin, which turns gray, black, and dry. Beneath this superficial mortification there is generally found an ulcer that can be cured.
When a frozen joint grows warm, and the congealed blood again becomes liquid, the blood can enter for a time into the open vessels ; then the question arises if the blood-vessels and the tissues can perform the necessary transformation, or whether, as we have already suggested, the blood which had been frozen will act as a poison, induce the normal blood to congeal, and interrupt its circulation. This will then give rise to an insufficient supply, and will even induce dangerous poisoning. This is no doubt the main reason why the sudden warming of frozen individuals or frozen joints proves to be so dangerous.
The best advice, and the counsel to be given, above all, is, guard against freezing ! In looking over what has been said so far, the best safeguard against this danger proves to be a strong, healthy, wellnourished body and a sound heart. Furthermore, for very cold weather, warm, common-sense clothing, which does not fit closely, and hence does not impede the circulation of the blood, is to be recommended.
Dresses of woolen goods are naturally warmer than those of linen or silk, the latter being better conductors of heat. During intensely cold weather, particularly when a dry wind is blowing, woolen gloves will not be amiss.
A certain robustness of health should be acquired by every one, and effeminacy of any kind should be avoided. Healthy children should go out in any kind of weather, and they should be rendered more hardy by cold washings daily. On wet days, if garments and shoes become damp, they should be replaced by dry ones immediately on returning home.
But if one has actually met with the misfortune of having a joint frozen, so that it is white, stiff, cold, and devoid of feeling or power of motion, the principal advice, not to be forgotten, is, not to warm the frozen part too quickly ; rub the joint in a cold room with snow or ice until some sensibility returns ; then rub it with cold wrater, and wrap it up in fine linen rags, which should be moistened with a mixture of five parts of Goulard’s solution and one part of spirits of camphor, and then tie it up in a rubber sheeting or oiled silk. Quite useful, too, will prove, after some feeling has returned, a hand or a foot bath with bleaching-powder. For this purpose a tablespoonful of bleaching-powder is dissolved in a basin of cold wrater. In order to be sure of doing everything that can be done, on going to bed at night, wrap up the frozen joints in flannel, and drink something that will cause perspiration.
If a hand or foot, even though it may have been entirely frozen, be rubbed with snow until the return of feeling, and is then at night brought into perspiration, the injury wdll in most cases have been entirely cured, and no relapse need be feared.
The few directions that have here been given will, if carefully followed, suffice. Of course, there are legions of cures and curatives that are recommended for frozen joints. These, however, are in place only where, through careless treatment, after-effects of the freezing, such as ulcers, chilblains, etc., remain. The frequent occurrence of such ills proves how rarely a frozen joint has received the right attention in the first place, when it would have been entirely restored.
There are some physicians who believe it impossible to prevent chilblains when a joint has once been frozen. It is, of course, true that severe cases of freezing will occur where even the best of care is powerless to prevent serious trouble, and wrhich may sometimes even involve the loss of some part of the frozen joint.
All things considered, however, it may be said that one can guard against permanent injuries through frost if the right treatment be adopted immediately after the freezing has occurred ; and even that those injuries which have been caused by too rapid a warming and other wrong treatment can be materially improved by attentive and correct care.
For the removal of those red spots wffiich appear principally on the nose, and which may prove quite disfiguring, we used to employ hotwater vapors, followed by washings with a solution of dilute hydrochloric acid (one to six), or a solution of bleaching-powder in water. Lately, however, I advise, and with better results, the application of hot-water vapors, and at night the putting on of a salve made up of one part of ichthyol and eight parts of vaseline.
Unfortunately, the ichthyol has a brown color, but this can easily be removed in the morning by using warm water and soap. If any one is particularly sensitive respecting his appearance, he may repeat the treatment with the ichthyol in the morning, after having employed the water-vapor, thus using the remedy twice in twenty-four hours, which will materially hasten the desired effect.
Among the large number of things that have been recommended, each one has its peculiarities ; some natures derive more benefit from the one ; others, again, from another, a fact which makes it advisable to leave the choice of the agent to be used to some physician who is acquainted with the constitution of the patient ; for all agents which are powerful and useful may cause great injury if indiscreetly applied. — Translated for the Popular Science Monthly from Die Gartenlaube.