“Mountaineering and health” (9)

"The pass in sight" 
(Original title from the Badminton Library Series on Mountaineering)

Advice from a mountaineering medic of the silver age

Frostbite is a trouble that the mountaineer is less likely to meet with if he recognises the necessity for taking precautions against it. The mildest form is merely a deadness or numbness of the fingers or toes. The part affected becomes white the skin a little wrinkled, and sensation is lost. As the symptoms pass off, the part swells a little and becomes of a blueish-violet colour. Return of sensation is characterised by itching and tingling. 

The more quickly artificial warmth is induced the more pronounced are the after effects. It follows that in the treatment of slight, or, indeed, any degree of frostbite, the temperature of the part should be very gradually restored. The frost-bitten part being numb, the sensations of the sufferer cannot be trusted. Gentle friction or 'massage', the part being well anointed with oil or vaseline, will restore vitality. 

If the friction is too vigorous, and the superficial skin rubbed off; troublesome after consequences may result in the form of superficial sores difficult to heal. Friction with snow is a time-honoured remedy, but apt to damage the part and favour the formation of blisters. The hand or foot may be immersed in cold water, of which the temperature is only to be raised very gradually indeed to a warmth of 50 to 60° F. 

Avoid, especially, warming the affected parts at the fire, or placing them in contact with hot bottles. After rubbing, wrap up the frost-bitten part loosely in cotton-wool. A more severe degree of frost-bite is associated with the formation of blisters after a few days. Here the after-consequences may be serious as regards the frost-bitten extremities. The blisters may be pricked and the fluid gently pressed out. 

It is often impossible in the early stages to judge of the extent of frost-bite. After a severe frost-bite complete sensation will often not return for weeks or months. On the other hand, a part that appears gravely frost-bitten will frequently recover entirely, or perhaps with the loss of a nail or two, after days or weeks. 

The most profound stage of frost-bite is a complete freezing or stiffening of the whole body. The sufferer loses consciousness and falls into a state of suspended animation. This third degree is especially likely to occur when a man is overcome by fatigue and cold and lies down. The most gradual raising of the temperature must be resorted to. 

Gentle friction of the limbs towards the heart may be made for several hours. Artificial respiration (and every traveller should learn how to perform artificial respiration) may be necessary. A common error is to make the movements too quickly. Fifteen movements per minute is about the right number. So long as there is the slightest trace of heart-beat the efforts should be continued. 

If the frost-bitten parts become very painful as they recover vitality, it is a sign that the warmth has been applied too rapidly, and they may then be wrapped in cloths dipped in cold water. In applying any remedies to a hand that has been attacked, take care not to make any pressure on the sides or webs of the fingers. Such pressure is very likely to be made if the fingers are wrapped up separately and a bandage placed over the whole hand. 

The fingers and toes and tips of the ears are most liable to frost-bite. The point of the nose may be attacked. Tight boots especially favour frost-bite of the feet. Cold wind and moist cold are the most to be dreaded. In still dry air there is much less likelihood of the trouble. It is essential, therefore, to keep dry the parts that are likely to be attacked. 

The utmost attention must be given for days afterwards to any part that has been attacked by even the mildest degree of frost-bite. In mountaineering, the fingers are more often affected than any other part, especially after climbing on rocks in bad weather. 

Reference

C T Dent’s Chapter III in the Badminton Library Series on Mountaineering, third edition (1901).