Volume 1

A system of medicine by eminent authorities in Great Britain, the United States and the Continent / edited by William Osler, assisted by Thomas McCrae.

Date:
1907-10
Catalogue details

Licence: In copyright

Credit: A system of medicine by eminent authorities in Great Britain, the United States and the Continent / edited by William Osler, assisted by Thomas McCrae. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

    104/986 (page 80)
    the skin, which is infiltrated, bursts, and the yellow-brownish fluid turns into crusts under which pus is accumulated. The third degree is charac- terized by death of the dermis and sometimes of the other underlying tissues. Elimination of necrosed tissue begins very soon. If it is moder- ate, the sloughing will leave a bleeding, ulcerated surface, under which is sometimes found diseased bone. Pathology and Pathogenesis.—Laveran and Cohnheim have studied the effect of cold, and found the bloodvessels to be the main tissue in- volved. The action of cold consists in narrowing the lumen of the blood- vessels, which may go even to its complete obliteration; the blood does not circulate and the involved area becomes white. Soon the capillaries dilate so that the circulation is slow and sometimes arrested. Thrombosis is the usual consequence, and small emboli may be detached and thrown into the general circulation. Changes in nerves are sometimes very pro- nounced; ruptures of the vasa nervorum and interstitial hemorrhages have been observed. Laveran and Tillaux speak of fatty degeneration of the myelin sheath, a fact which will explain muscular atrophy, pain, and trophic ulcers, with anaesthesia of the skin. The inflammation of the neuritis may sometimes ascend to the cord. Other lesions were observed. Mathieu and Gubler speak of visceral congestion caused by capillary emboli; Laveran, of loss of mobility of leukocytes. Prognosis.—The first and second degrees may run their course without general disturbances. However, in soldiers who suffer hardships, in aged people and cachectic individuals, oedema of the face and of eyelids, and albuminuria, were observed. Weak individuals, old people, children, those who overfatigue themselves, those who do not eat enough, those who use alcohol to excess, are all very readily predisposed to the effects of cold, and in such cases the prognosis is therefore always serious. During the stage of suppuration general septicaemia may occur. Recovery is usually slow; the cicatrization is very sluggish, and may be arrested from the slightest cause. This is particularly true in regard to individuals of lymphatic nature. Treatment.—Prophylactic measures are of utmost importance. The extremities (hands and feet) should be well protected. Sudden changes of temperature should be avoided. Dry astringent friction and massage are recommended. When the first degree is present, the congestion of the skin will be re- lieved by washing it with a stimulating fluid (alcohol and others). When ulcerations make their appearance, they should be protected from infec- tion. The third degree requires special attention. The greatest pre- caution is necessary to avoid extension of the inflammation. The old well-known friction of frozen limbs with snow or with very cold water is not to be neglected. In case of apparent death artificial res])iration is indicated. There are cases on record showing that individuals after having remained under snow for several days could be brought to life with artificial respiration. It is therefore important to have recourse to it in every case. Under normal conditions a temperature which is not very low will pro- duce rather an agreeable sensation; one feels more active, and the respira- tion becomes better. There is more oxygen taken in and more carbon dioxide exhaled. When the temperature is very low, and the organism