Fighting Frostbite

To most Americans, frostbite may seem like a remote risk. Yet as more and more people venture outdoors in winter--skiing, hiking, mountain climbing--it has become an increasingly common health hazard.

Fingers, toes or the nose and cheeks usually become vulnerable first. As the body tries to conserve heat for vital internal organs in bitter cold, it reduces the flow of warming blood to the extremities. Eventually, if the temperature in the tissue drops low enough, tiny ice crystals begin to form in the watery spaces between the cells. Expanding outward in all directions, the ice ruptures cell membranes and kills the tissue, which turns white, stiff and insensitive to touch.

As late as the 1950s some doctors and first-aid manuals were recommending massage of a frostbitten limb with snow or ice, a treatment that traces back to Baron Larrey, Napoleon's chief surgeon on the Grand Army's disastrous retreat from Moscow during the bitter winter of 1812-13. Larrey believed such therapy reduced the likelihood of infection. But the experience of American doctors during the Korean War and more recently in Alaska has shown that the best treatment for frostbite is not more cold but rapid warming.

Alcoholic Solace. Dr. William J. Mills Jr. of Anchorage, Alaska, an orthopedist and consultant to the U.S. Army on cold-weather injuries, is a pioneer of the new therapy. Writing in Emergency Medicine, he describes a typical course of treatment. If the victim is still out in the field several hours away from professional help, says Mills, rescuers should quickly attempt to thaw the frostbitten part; one method is to tuck a frozen hand, say, under the rescuer's armpit. The temperature, in any case, should be about 100DEG F.; anything much higher than body temperature can cause further harm, as can refreezing. To protect the fragile tissue, it should be wrapped in clean padding; fingers or toes are often splinted to keep them from bruising contact or pressure.

In the hospital, Mills usually uses a whirlpool bath (temperature: 100DEG to 108DEG) to warm and rinse the frozen area. To encourage healing, no dressing is used on the injured area. Sheets are sterilized, and attendants wear masks and gowns to prevent infection. Whirlpool baths are continued at slightly lowered temperatures. Mills also encourages exercises, not only to make frostbitten limbs flexible again but to give patients a psychological boost; they are often frightened by the appearance of the injury (blisters, swelling, discoloration). Mills allows alcohol because "it does offer solace" but forbids tobacco, which tends to constrict blood vessels and impede blood circulation.

If the frostbitten tissue swells severely and blood flow is blocked, Mills sometimes makes a surgical incision to relieve pressure. But he warns his fellow doctors against more drastic measures, especially premature amputation. "Keep your hands off," he says sternly, "and don't be discouraged by the appearance of the injury: clean, healthy tissue may be forming below." Unless complications occur, Mills adds, this cautious approach to frostbite usually ensures the victim's recovery in only weeks.

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