Hypothermia: A history

Shackleton's Endurance
Shackleton’s Endurance

With much of the US experiencing colder than normal temperatures, a timely post about hypothermia is in order. This post won’t talk about therapies though, instead it will discuss a neat little article from Resuscitation published as free open access on Pubmed Central.

When you think about hypothermia, it seems like it would be pretty intuitive. But since we didn’t have accurate or easy ways to measure temperatures until basically the middle of the 19th century, all people had to go by were the feelings of coldness. Certainly, the idea that people died from the cold is ancient. It is mentioned by Herodotus in 492 BC, but then again, he also attributed deaths to sea monsters, so take from him what you will.

Even by the time of Shackleton’s first expedition to the Antarctic, the thermometer on the expedition only went to 94.2° F, so they could not determine degrees of hypothermia. All that could be said was that 3 of the men were below that measurement, and they knew that was not ideal. RF Scott observed and described severe hypothermia in another party as:

He was badly frostbitten … and though a good deal confused, as men always are on such occasions, he was otherwise well… His tale is confused, but … the fact that he did not [hit land as he intended], but attempted to wander straight on, is clear evidence of the mental condition caused by that situation. There can be no doubt that in a blizzard a man has not only to safeguard the circulation in his limbs, but must struggle with a sluggishness of brain and an absence of reasoning power which is far more likely to undo him… It is a rambling tale to-night and a half thawed brain

In fact, the majority of historical cold injuries are from the military literature. From Hannibal to Napoleon’s retreat, the observance that severe cold=death was there, but the concept of why was lacking. This lead to ineffective or inappropriate treatments, including giving alcoholic beverages as a warming agent.

Pierre Jean Moricheau-Beaupré, one of Napoleon’s doctors, had some of the better ideas about rewarming. He had probably observed hypothermic patients going into ventricular fibrillation by aggressive actions, as he recommends against strong actions. He attributes this to “exhausting the remaining vitality”, which isn’t too far from the truth. He also correctly noted that you didn’t want air currents. He wasn’t completely right about everything, though. He did want you to remove clothing, and rewarm in “reverse order” with sequential snow, iced water, cold water, then successively warmer water. After some degree of resuscitation, then he recommended stimulating by tickling, friction, or even shocking with batteries. Thankfully we don’t do all of this anymore. Another contemporary of 1815, J Curry, knew that putting a bladder of hot water on the stomach was effective.

Curry went on to do simple isolated experiments on human subjects, but better experiments didn’t start until the 1930s. Of course, most weren’t on how to treat hypothermia, but how to use it to treat other conditions. The first uses of therapeutic hypothermia were for fever, malignancy, pain, and schizophrenia. WWII caused more research as soldiers and sailors died of hypothermia. Sadly, some of what we know was carried out on subjects who weren’t volunteering.

In all a fascinating read about the history of the human condition known as hypothermia.

Guly H. History of accidental hypothermia. Resuscitation. 2011 Jan;82(1):122-5. [PMC3060344]

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EBM Gone Wild

Wilderness Medicine

Emergency physician with interests in wilderness and prehospital medicine. Medical Director of the Texas State Aquarium, Padre Island National Seashore, Robstown EMS, and Code 3 ER | EBM gone Wild | @EBMGoneWild |

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