PROGNOSIS. — With proper care and treatment, the vitality of a part actually frozen may be restored; unskillful treat ment may favor gangrene even when the parts are not in a state of congela tion.
-The indications are to restore gradually the heat-producing powers of the part and at the same time to repress any excess of reaction. The patient should be placed in a cold room, without fire, and the frost-bitten parts gently rubbed with snow, or cloths dipped in ice-water, and held between the hands of the operator; as reaction appears, the parts may be wrapped in flannel or absorbent cotton, and stimu lants and warm drinks may be cautiously administered. If gangrene is present, or if sloughing occurs during reaction, al low the dead portion to detach itself naturally, if it be of small size. Ampu tation may be required if the gangrenous part be of large size, and should be done as soon as the line of demarkation ap pears.
Constitutional Effects of Cold.—The effects of cold are at first stimulating, the pulse being increased in force and frequency. Then a feeling of heaviness and stupor comes on, which gradually changes to an overpowering desire to sleep. This, if yielded to, terminates in coma, and a speedy, painless death. "Cold-stroke," the opposite of "heat stroke," is a sudden chilling by intense cold in which death is produced by cere bral anremia; prolonged exposure to a less degree of cold induces death by cere bral congestion, while sudden exposure to warmth produces a fatal result from embolism; partial freezing causes capil lary embolism which is usually followed by fatal congestion or sometimes anwmia (Keen and White).
TREATMENT.—If the person exposed to cold be apparently dead, he must be placed in a cold room the temperature of which must be very slowly raised. Fric tions with snow or cloths wet with ice water must be made, and artificial respi ration begun. These means must be con tinued for several hours even if no sign of animation appear. Recovery after several hours of suspended animation is on record.
Keratosis Senilis.—This affection is a cornification of the skin of old people, general or partial, circumscribed or dif fuse, and often limited to definite re gions, most commonly the face and the dorsal surfaces of the hands and feet, and sometimes the forearm and chest. The lesions consist of light- or dark- yel lowish brownish points, dry scaling and horny, or scaling and greasy, aggregated in masses of an irregular circular or oval outline. The surface of these masses is insensitive, and may project about an eighth of an inch above the surface. These masses may be readily picked off, leaving a small, superficial, smooth, ex coriated surface or one covered with minute conical elevations (enlarged se baceous glands). This affection rarely appears before the fiftieth year, and may not claim attention until fifteen or twenty years later.