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.

    105/986 (page 81)
    is exposed to it for a long time, functional disturbances make their appear- ance. At first the circulation becomes more active, and the temjjerature rises; but soon this excitation disaj^pears, tlie limbs become numb, and the sight imjjaired. A general lassitude and an imperative desire to sleej) make their ap])earance; general sensations become obtunded, respi- ration is difficult, the heart rate is slow, and syncope, followed by death, may ensue. There are, however, cases on record showing that individ- uals remained four, six and even eight days under snow and neverthe- less continued to live. Before death occurs, the muscular fibers cease to contract voluntarily; the muscles of the neck and of the extremities become rigid, and thus im- mobilize the body in a position which it had assumed at the time it was overtaken by cold. This explains the bizarre attitudes in which the bodies of individuals who died from extreme cold are found. According to Desgenettes, muscular contractures may spread over the entire body, and epileptiform seizures may carry off the unfortunate victims. It has been also observed that in a certain number of cases the cold air entering the lungs produced excruciating pain and sudden arrest of respiration. In some cases there is a state of delirium, with a tendency to suicide. The degree of cold which is apt to cause death is difficult to determine, because there is a considerable difference in resistance in various individ- uals. A man in perfect health is capable of tolerating a very low tempera- ture which an individual in a state of fatigue or exhaustion is unable to resist. In Tagetthoff’s “Le tour du monde, 1896,” we see that the crew of the ship lived 812 days in a temperature alternating between 40° and 50° below zero. Other travelers reported similar facts. Adults are able to stand cold provided they are not under the influence of alcohol, because alcohol causes a dilatation of the cajiillariesand thus facilitates the deleteri- ous effect of cold. Children are less apt to resist low temperature than adults, because they produce less heat. Excessive mental and physical work and inanition are also causes of death from cold. It is interesting to note that insane individuals j)ossess remarkable resistance power; they never complain of cold. At autopsy the muscular tissue is found red; the blood is dark; the heart and bloodvessels are filled with blood; ecchymoses are found on the j)leura; the lungs are cither ana?mic or congested. The brain is either ansemic or congested. Wichniewski^ was the first to observe small hemorrhages in the mucous membrane of the stomach. Since then this sign has been considered ])athognomonic. Schrimpton observed an in- flammation of the gastro-intestinal tract in soldiers who died from cold during campaigns. I'he mechanism of death is as yet not satisfactorily ex])laincd. Ac- cording to iNIagendie, there is a contraction of the peripheral capillaries, with tliis result, that there is an increase of intravascular tension; con- gestion of Inngsand brain follows. Pouchet thinks that the blood becomes frozen and stagnant in the jicripheral bloodvessels, and this leads to embolism in central bloodvessels. According to Ilorwatt, weaknesses of the muscular .system and of the heart are the main factors in the causation of death. G Mcs.1. (le I'hyg. pubL ct m<d., h'(j. 1895.