Frostbite: An Analysis of Seventy-One Cases

Abstract

Though frostbite is a well-known and serious malady, knowledge of its pathogenesis and of the optimal methods of its management is far from complete. This is due in large part to the paucity of cases coming under the scrutiny of any single group of investigators. The war in Korea in the winter of 1950-1951 resulted in a high incidence of frostbite among our troops. Seventy-one of these patients have been cared for at the Murphy Army Hospital and form the basis for this report. All these soldiers suffered from true freezing of the hands or feet, with resultant necrosis involving at least small areas of deep tissues, and with gangrene of the digits and forepart of the feet in several patients. No cases of cold injury short of this extent are included. The climatic environment and the combat situation combined to form the epidemiological background of the disease. Most of the patients were frostbitten in north central Korea in the week between Nov. 27 and Dec. 3, 1950. According to information supplied by the Air Force, the temperature in that locality and time reached minimal levels of 12 F. The wind attained a maximalvelocity of 20 miles per hour. Our patients were mainly infantrymen. Their protection against the weather was adequate until they were attacked by overwhelming num¬ bers and forced to retreat. The effect of a more stabilized battle line and a more southerly position, which obtained after Dec. 3, served sharply to reduce the incidence of frostbite, though temperatures later dropped as low as -13 F.The chronology of evacuation is pertinent to the timing of observation and treatment. The time of removal from the field varied from 1 to 11 days after the first onset of symptoms. An aid station was reached in several hours to two days, where the patients usually remained for two to seven days. Further evacuation was by air, the pa¬ tients arriving at an overseas hospital within a few hours and remaining for about 20 days. Most patients reached the Murphy Hospital three to four weeks after freezing, exceptional cases falling in a range of 17 to 40 days. We shall describe the clinical picture of the disease, dividing it into acute, subacute, and chronic stages. The acute stage corresponds to the first three or four weeks spent in the overseas medical installations and was char¬ acterized by freezing, thawing, exudation, and the initi¬ ation of necrosis. Data on this stage were obtained from the patient's history and his medical record. The subacute stage was the one during which the patient was observed at the Murphy Hospital. It was marked by a resolution of the necrosis and the commencement of vasospasm and cutaneous acrosclerosis. From former ex¬ perience we may expect a chronic stage, consisting of a continuation of the vasospasm and sclerosis, as well as occasional recurrent ulcération.Data will also be presented bearing on certain un¬ settled aspects of the frostbite problem, namely, pre¬ disposing factors, factors determining severity, the effec-tiveness of anticoagulant therapy, the recognition of the...