Nongangrenous frostbite of the feet

Abstract

1. 1. An analysis of 200 frostbite casualties, observed during the fall and winter of 1944–1945 in a Communication Zone general hospital in the European Theater of Operations, is reported. 2. 2. Marked vasospasm of the feet was the chief morbid finding in this group. 3. 3. The etiological factors concerned in frostbite are reviewed in the light of present observations, more especially in relation to the development of vasospasm. The following conclusions are reached: 3.1. (a) Faulty foot care (extrinsic factors) is an important factor among very youthful, “green” troops unused to taking care of themselves under combat conditions. There is no apparent correlation with individual characteristics of leadership, responsibility, and military education which ordinarily predicate military assignment and rank. 3.2. (b) Some individuals are especially susceptible to frostbite (intrinsic factors). This is shown by a high incidence of one or more earlier episodes of frostbite and by the number of patients who complained of symptoms suggestive of pre-existing poor circulation. The nature of the circulatory difficulties is considered. A few of the patients may have had early unrecognized or mildly obliterative arterial lesions while sensitive vasoconstrictor reflexes may have been concerned in others. The likely role of emotional stimuli re-enforcing cold among the latter group is discussed. 4. 4. The clinical manifestations of nongangrenous frostbite are briefly described and two broad types differentiated. It was found that conditions conducive to relatively minor grades of local tissue anoxia, sustained during long periods, were likely to produce more severe and resistant vasospasm. The likely reasons for this are discussed.