Canada Medical Journal and Monthly Record of Medical and Surgical Science

A Paper on Frost-Bite and its consequences, read before the New Brunswick Medical Society. BY WILLIAM BAYARD, M.D., Edin., President of the Society, &c., &c.

GENTLEMEN. In compliance with the wish expressed at our last meeting, I shall proceed to give you a few observations upon "Frost-bite and its consequences." It has been rightly suggested that papers read before this Society should be concise, and as a proof of my concurrence in the suggestion, I shall make my remarks as brief as possible. I do not pretend to have exhausted the subject. If I succeed in eliciting the opinions of my professional brethren respecting it, my object will be accomplished. Therefore, I trust that no gentleman will hesitate to express disapproval, or approval, as his judgment may dictate, of any statement put forth in this paper. Free and enlightened discussion should be our aim; without it, our meetings will produce small results.

I need not tell you that man possesses, in an eminent degree, the power of resisting the influence of cold, and that when the body, or a part of it, has been exposed to severe and long-continued cold, serious local and constitutional effects may, and oftentimes do, ensue.

The exact temperature required to produce such effects cannot readily be arrived at, so much depends upon the age, vigour, and habits of the person exposed. The very young, the aged, and those whose circulation is languid from any cause, being predisposed to the injurious consequences of it.

High wind increases the effect of cold upon the body, but generally the range of cold must be brought to 16° below freezing-point on Fahrenheit's scale, before actual freezing takes place.

The mean temperature of man in health is 98° of Fahrenheit. The limbs are flexible and moveable at 96°, reduce the temperature a fewVOL. VIII.

5th stage. Return to natural state. Nervation of vessels. Reduction of vascularity. Temperature 96° Fahr. Natural sensibility.

The cerebrum of a living animal may be frozen. In this state the consciousness of the animal is lost, but the functions of organic life remain the same. The animal thus placed is in a state of hybernation from which it may recover; on recovery the brain does not seem to have lost power. The phenomena are simply those of awaking from profound sleep.

Having frozen the brain and nerve-substance of pigeons and cold blooded animals, Dr. Richardson attributes the phenomena of disturbed natural function to the transference of the water from a fluid to a solid state. He says: "In freezing nerve matter we take from the water its "heat of fluidity, or the force which, holding its molecules apart and "giving them motion, supplied the condition for that mobile and active 66 state, which is the fluid state of water. We reduce it by this means "from activity towards inertia; therewith we deprive the structure of its 'power to maintain what is called life."

He further adds that, " In speaking of the crystallization of nerve"matter by cold, I have ventured to insist firstly and chiefly on the soli"dification of the water: but in nerve-substance there is also a consider"able per cent. of fatty matter, which, when heated, is fluid like water, "and which also like water loses its heat of fluidity, crystallizes, and "becomes solid by cold. When, then, we freeze the brain, we solidify the "fat also, and what is more we solidify it at a temperature at least 30 "degrees higher than the freezing point of water; and as that fat solidifying first, becomes a bad conductor, so it impedes and limits the freezing "of the whole mass of nerve-substance. In hybernating animals I should "think the fatty matter of the brain and cord is intensely solidified by "the cold."

His experiments have proved" that if the freezing extends to the "medulla oblongata, death results from arrest of the respiratory power." Also that in proportion to the rapidity of the freezing, so the reaction diminishes.

Let us now proceed to the practical part of this subject. It is seldom that the surgeon sees a case of Frost-bite before the frost has been removed from the part, and so much depends upon the manner in which it has been extracted, that the mischief is generally done before he is called.

I need not tell you that the affected part should be restored to its natural condition, in the most gradual, cautions, and gentle manner, not violently, lest over-action be produced in a part already greatly weakened.

The person should be placed in a cool room, the part immersed in iced water or very gently rubbed with snow. If ice or snow cannot be obtained, the coldest water should be used, repeatedly changing it, until the circulation and sensibility are thoroughly restored. The patient should not approach the fire, and all warm applications should be scrupulously avoided. These precepts should on no account be neglected, for by so doing, mortification would in all probability be the result.

Sooner or later after the part has been restored to its natural temperature and sensibility, capillary congestion takes place, accompanied by the usual symptoms of reaction: heat, redness, pain, and swelling. If the part has been exposed to severe or long-continued cold, effusion under the cuticle appears; this generally takes place in from 12 to 24 hours; the vesicles may be filled with a colourless serum, or a mixture of blood (or the hæmatin of blood) and serum.

In the milder form of inflammation the contents of the vesicles is colourless, in that where the part has become disorganized, the contents of the vesicle is very dark coloured and if the dark colour of the vesicle is accompanied by the falling of the nails, we may conclude that such an amount of disorganization has taken place, that gangrene must be the result.

The treatment of Frost-bite after reaction has commenced, consists in endeavouring to prevent the inflammation from running to such an extent as to induce sloughing of the structure. The necessity no longer exists for keeping the patient in a cool room. The part should be placed in an easy and elevated position, lightly covered, and slightly stimulating lotions applied. If local reaction threatens to be severe, painting the part with the compound Tincture of Iodine has been found most serviceable. If vesicles appear they should be opened by small punctures, and lint applied, spread with a mixture of equal parts of lime water and cod-liver oil, which has the effect of relieving the burning and smarting sensation, probably by protecting the ulcerated surface from the action of the atmosphere.

Should the part lose its sensibility, become colder, assume a purplish, mottled or greenish-black hue, vesicles filled with dark fluid rise upon the surface, and the swelling, at first hard and tense, put on a doughy character; then we have gangrene to deal with, and should treat it accordingly, by mild local antiphlogistic treatment: and if there is much local tension, by free incisions. When fotor appears, it should be diminished by antiseptic applications, such as carbolic acid, the chlorides and charcoal. If the gangrenous parts are large, these substances may be applied in the form of solution, or the charcoal may be dusted upon the part; if small, they may be used in poultices.

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Canada Medical Journal and Monthly Record of Medical and Surgical ..., Volumen7