Persons who are subject to chilblains should be careful to avoid exposure to cold without sufficient clothing. Warm, lined gloves should be worn, and the feet should be encased in lined overshoes. On entering a warm room after exposure to cold, one should be careful not to approach a fire ; and, if the hands or feet are numb and cold, they should be bathed in cold water or rubbed with snow. If chilblains appear, the old-fashioned remedy of brandy and salt (two tablespoonfuls of brandy and a large pinch of salt) may be used. More fully developed chilblains may be painted with com pound tincture of benzoin or with tincture of iodine. Many physicians prefer a i•roo solution of carbolic acid. If the part is very painful and inflamed, lead and opium lotion \ -ill give relief. If the chilblain is sluggish and becoming chronic, dilute citrine ointment or resorcin ointment should be applied. The part should be wrapped in absorbent cotton, and kept from the air.
Frost-Bite.—This is a more severe form of interference with the nutritive processes as the result of exposure to low temperatures. The extremities (hands, feet, fingers, toes, nose, ears, and cheeks) are the parts most com monly affected. Occlusion of the capillary circulation, with interruption of the nervous and nutritive processes, if not relieved, may lead to gangrene, and sometimes to death by septicemia.
When a part is frozen it becomes white, stiff, shrunken, and parchment like. If submitted to the influence of heat it becomes discoloured, first blue, then purple, then black, and gangrenous. If the part is frozen very hard, it may be broken off when handled ; care should, therefore, be exercised in dealing with such a case to handle it gently. As soon as reaction sets in, the part becomes red, hot, and swollen ; and if the arrest of the nutritive and nervous processes is complete, a line of demarcation is set up, separating the dead portion from the living tissue. .A slough is formed, and the frozen or dead portion will drop off ; but, as the surgeon is usually called upon to intervene, amputation is performed. Cases are recorded where it has been necessary to amputate both hands and feet on account of frost-bite.
Slighter forms of frost - bite are characterised by whiteness, loss of sensi bility, and stiffness, followed by reaction, which is indicated by redness, swelling, tenderness on pressure, vesication, and the formation of a scab of varying thick ness which, when healed, leaves a bluish discolouration. Parts which have been frost-bitten remain sensitive for a long time, and are more easily and quickly affected, even for years after.
General Congelation.—If the forma
tion of internal heat is not kept, there is a gradual abstraction of heat when one is exposed to severe cold. Soon painful burning and pricking sensations are experienced in the extremities. The joints feel stiff, and there is a general feeling of numbness, and dull, aching pain. The person becomes irresistibly drowsy and indisposed to exertion. Should this not be combated, the individual passes into a deep sleep, ending in coma and death. The blood recedes from the surface, and accumulates in the internal organs. The circulation of the blood slackens, respiration becomes laboured, and the patient either becomes asphyxiated from congestion of the lungs, or the blood is driven to the brain, causing apoplexy. In the latter case the patient dies very suddenly.
Cold-Stroke.—Dr. Hartshorne of Philadelphia has described an effect of cold which has been named cold-stroke, because of the train of symptoms caused by sudden exposure to low temperatures. For example : A fire broke out during a hard frost, and a boy threw open a window and stood in the draught to watch it. Next morning he complained of severe headache, dizziness, vomiting, and general indisposition. His temperature rose, the pulse-rate increased, he became delirious, and spasmodic contrac tion of the fingers and of the muscles of the jaws took place. These symptoms were followed by cold sweats, weak and intermittent pulse, and death.
Treatment must primarily be directed toward restoring the circulation and re-establishing the nutritive processes. If a part has been frozen for some hours before the circulation is restored, its death will result, because the vessels have become permanently occluded and the functions of the nerves destroyed. The part must first be vigorously rubbed with snow, the patient remaining outdoors or in a cold room. He should then be bathed with ice cold water, the temperature of which should be raised very slowly. After that, some stimulating lotion, such as camphorated oil or compound soap liniment, may be used. When reaction takes place, local inflammation may occur, as shown by swelling, redness, heat, and tenderness. The part should then be painted with tincture of iodine or with compound tincture of benzoin. Superficial ulceration is best treated with an ointment of ichthyol (one part) and vaseline (three parts) ; or with benzoated collodion. If a slough forms, it should be poulticed with slippery-elm bark or linseed meal, and the part dressed with carbolised oil. The part should be kept from the air by wrapping it in absorbent cotton and oiled silk, which should be held in place by a gauze bandage.