Dull Brains and Frozen Feet: A Historical Essay on Cold.

This essay will review historical and medical aspects of cold exposure, hypothermia, and frostbite during the Napoleonic era. The 19th century writings of Dominique Jean Larrey, Pierre Jean Moricheau-Beaupré, and others are used to provide an evocative supporting narrative to illustrate some of the cold illnesses, physiology, and theory of both an earlier era and the present time. Medical care for over a century followed the how but not the why of treating frostbite and hypothermia slowly with snow or cold water rather than heat. There were 2 main reasons: First was a practical attempt to limit gangrene. Less known, and long forgotten, is a major rationale based on the erroneous theory of heat called "the caloric." Because of these 2 reasons, the slow method of "cold warming" remained standard medical practice well into the 20th century. Although these recommendations are now known to be flawed, some of the reasons behind them will be discussed, along with early but correct observations on afterdrop and circumrescue collapse. There is a long backstory of treatment from 1812 to the present.

A Renaissance Pope with arthritis following frostbite.

Pius II, a 15th century Pope, developed chronic foot pain following frostbite at age 30. Later in life he was progressively disabled by arthritis elsewhere and by colic, which may have been due to kidney stones. The differential diagnosis of his rheumatic disease and its effect on his career are discussed.

Frostbite and other cold injuries in the heroic age of Antarctic exploration.

Frostbite and other cold injuries on the early polar expeditions were common. This paper explains how frostbite was described, prevented, and treated on the Antarctic expeditions of the heroic age, comparing them with modern recommendations. Nonfreezing cold injury probably also occurred but was not differentiated from frostbite, and chilblains were also described.

Belaya smert: the white death.

In the late autumn of 1939, shortly after Second World War had commenced, the Soviet Union invaded Finland. This act of military aggression, henceforth known to history as the Winter War, was ostensibly carried out to secure a buffer state and better protect major urban areas such as St. Petersburg (then known as Leningrad). The Red Army's attack through the forests of northern Finland was a poorly calculated operation-in the little more than 3 months that the conflict lasted, the Soviets suffered extensive losses. The hit-and-run tactics of the small, winter-savvy Finnish Army resulted in a not significant number of Red Army casualties. But from the Soviet perspective, the Finnish soldiers were merely an annoyance compared with the real enemy--the environment. Cold injury reached epidemic proportions in the Red Army during this short conflict, apparently caused in large part by ignorance of environmental realities by the Soviet high command. Paradoxically, the Soviets arguably possessed the most extensive and sophisticated body of knowledge about cold injury prevention and treatment on earth by the late 1930s. There were significant lessons learned by the Soviets during the Winter War, however. When Germany invaded the Soviet Union in 1941, the Red Army very successfully applied these lessons during 4 years of vicious winter battles on the Eastern Front.

The immediate treatment of frostbite in the American and German armies in Europe during World War 2: an historical perspective.

This historical account, based on a survey of 250 medical articles written during and immediately after World War II, reviews the immediate treatment of frostbite in the American and German ground troops in Europe from 1941 to 1945. The American management was simpler and more conservative than the elaborate treatments reported in the German publications. Because the German patients' injuries were more severe than those of the American soldiers and because neither Army carried out strict clinical trials nor prolonged follow-ups, it is impossible to judge what treatment was superior.

["Teruel feet". Care and treatment of frostbite wounds in the hospitals of Navarra during the civil war]. / "Los pies de Teruel". Asistencia y tratamiento de las heridas por congelación en los hospitales navarros durante la guerra civil.

The care of combatants with lesions caused by frostbite during the battle of Teruel, which was fought in extreme weather conditions and in temperatures as low as twenty degrees below zero, was the period of greatest medical activity and the highest rates of occupation in the military hospitals of Navarre during the civil war of 1936-1939. From November 1937 to March 1938, 375 cases of frostbite were registered in the provincial establishments, amongst which there was a predominance of cases of dry gangrene partially affecting the lower extremity, which was popularly known as "Teruel feet". Some of the medical staff, conscious of the exceptional nature of the casuistry, registered statistics, clinical cases and personal impressions of the evolution of the lesions and the effectiveness of the treatments. In treating this affectation they employed medicines, surgical techniques and novel therapeutic procedures that were not widely used in the medical milieu of the time. However, the limited duration of the problem, the inconclusive results of the treatments and the differing opinions on their effectiveness -questions that are considered in this article- restricted the subsequent medical repercussion of the experiences of frostbite developed during the wartime period in Teruel.

'Los pies de Teruel'. Asistencia y tratamiento de las heridas por congelación en los hospitales navarros durante la guerra civil / 'Teruel feet'. Care and treatment of frostbite wounds in the hospitals of Navarra during the civil war

La atención a combatientes con lesiones por congelación sufridas durante la batalla de Teruel, desarrollada en condiciones meteorológicas extremas y temperaturas de hasta veinte grados bajo cero, supuso la etapa de mayor actividad asistencial y tasas de ocupación más altas en los hospitales militares navarros durante toda la contienda civil de 1936-1939. De noviembre de 1937 a marzo de 1938 se registraron en los establecimientos de la provincia más de 375 casos de congelación, entre los que predominaban las gangrenas secas con afectación parcial de la extremidad inferior, lo que popularmente se denominó 'pies de Teruel'. Algunos facultativos, conscientes de la excepcionalidad de la casuística, registraron estadísticas, casos clínicos e impresiones personales sobre la evolución de las lesiones y la efectividad de sus tratamientos. En ellos, emplearon fármacos, técnicas quirúrgicas y procedimientos terapéuticos novedosos en el tratamiento de esta afección y poco difundidos en el entorno médico del momento. Sin embargo, la limitación temporal del problema, los resultados poco concluyentes de los tratamientos y las opiniones controvertidas sobre su efectividad, cuestiones que se analizan en este artículo, limitaron la repercusión médica posterior de las experiencias sobre congelaciones desarrolladas durante la etapa bélica turolense

The care of combatants with lesions caused by frostbite during the battle of Teruel, which was fought in extreme weather conditions and in temperatures as low as twenty degrees below zero, was the period of greatest medical activity and the highest rates of occupation in the military hospitals of Navarre during the civil war of 1936-1939. From November 1937 to March 1938, 375 cases of frostbite were registered in the provincial establishments, amongst which there was a predominance of cases of dry gangrene partially affecting the lower extremity, which was popularly known as 'Teruel feet'. Some of the medical staff, conscious of the exceptional nature of the casuistry, registered statistics, clinical cases and personal impressions of the evolution of the lesions and the effectiveness of the treatments. In treating this affectation they employed medicines, surgical techniques and novel therapeutic procedures that were not widely used in the medical milieu of the time. However, the limited duration of the problem, the inconclusive results of the treatments and the differing opinions on their effectiveness –questions that are considered in this article– restricted the subsequent medical repercussion of the experiences of frostbite developed during the wartime period in Teruel

Otolaryngologic aspects of the Lewis & Clark Expedition, 1803-1806.

Medical difficulties related to otolaryngology that occurred during the Lewis & Clark Expedition (1803-1806) are highlighted. These difficulties included ear and face frostbite, upper respiratory infections, temporal vessel laceration from an air gun accident, neck scrofula, and a pediatric neck mass. The custom of Clatsop Indian head flattening is also described. These descriptions also aim to illustrate the state of otolaryngology during the early 19th century in America.

[New studies on the history of anesthesiology--(7). What anesthetics were given to soldiers of the fifth regiment rescued from death march on Mount Hakkoda?].

Two hundred and ten soldiers belonging to the fifth regiment of the Japanese Imperial Army started their march on Mount Hakkoda in the early morning of January 23rd, 1902. In the afternoon, they unfortunately met with a bad weather of violent gale, heavy snowfall and biting coldness to lose their way to proceed to a small village Tashiro. In the following several days, many soldiers were frozen to death and only seventeen were rescued. They were brought to the Aomori Military Hospital for admission. Among them the First Lieutenant Kuraishi and two officers were almost free from frost bite but the Major Yamaguchi died next day and a soldier died two days after his admission without any surgical treatment. The remaining eleven underwent amputation of their frostbitten extremities under general anesthesia by open drop method with a mixture of chloroform and ether, because chloroform anesthesia per se was considered much more injurious than ether to patients with poor physical status. The Military Hospital announced that the Major Yamaguchi had died due to sudden cardiac arrest, but a lay view that he had committed suicide with his gun has widely prevailed, particularly since Jiro Nitta, a novelist, referred to it in his novel "Death March on Mount Hakkoda" in 1971. According to newly discovered manuscripts written by a military surgeon Ki-ichi Murakami who served in the rescue services, both hands of the Major Yamaguchi were heavily frostbitten and his fingers were strongly flexed unable to move the trigger of his gun. Considering situations including the dates of Sadae Nakahara's visit to Aomori who was a military surgeon of the Yamagata Military Hospital, the mysterious content of a telegram to Gentaro Kodama, the War Minister, from the General Shobun Tachimi, the 8th division commander and the sudden closure of the Hospital on February 2nd, when the Major Yamaguchi died, there is a possibility that high concentrations of chloroform vapour might have been compulsorily administered to the Major Yamaguchi to cause him cardiac arrest, which the executive members of the Japanese Imperial Army would have secretly expected.

[Medical aspect of the winter march of the Fifth Regiment of the Eighth Military Division in the winter of 1902 - particularly concerning the cause of Major Yamaguchi's death].

Two hundred and ten military soldiers of the Fifth Regiment of the Eighth Division of the Japan Imperial Army joined a marching practice in the end of January, 1902, but 193 soldiers out of 210 died due to severe frost-bite during stormy weather and only seventeen, including Major Yamaguchi, were rescued to survive and brought to the Veteran's Administration Hospital at Aomori. This accident was most tragic and world-shaking for the Japanese people as well as for the Japanese Imperial Army. In December of 1991, an admission record of the Veteran's Administration Hospital at Aomori was found in the residence of Dr. Murakami of Aomori City. Judging from its handwriting, this record was written by a military physician Ki-ichi Murakami, Dr. Murakami's uncle. The record describes the details of seventeen patients, most of whom were severely injured and frost-bitten during the winter march. The content of this newly discovered record is similar to the report written by the military physicians of the Fifth Regiment which appeared in the Japan Imperial Military Medical Journal, but a more detailed description about Major Yamaguchi's vital signs, and symptoms of his frost-bite were found in the former. In the journal, Major Yamaguchi was reported to have died because of sudden cardiac arrest but Jiro Nitta described in his novel "Death March on Mount Hakkoda" that he committed suicide using his gun. However, this record strongly tells us that both of his hands, as well as both lower extremities, were severely frost-bitten and swollen and that he could not pull the trigger of his gun with his fingers. Since Jiro Nitta's novel has been published, it is widely accepted that Major Yamaguchi committed suicide with his gun. But we do not have any definite proof to substantiate his suicide. The present detailed survey on the medical references strongly suggests that he could not have pulled his gun's trigger by himself.