1915 Boston Medical and Surgical Journal  
we published an item describing Larrey's personal experience in the Battle of Waterloo. The British Medical Journal in commenting on the frequently of frost bite during the present trench warfare in Flanders has recently referred to Larrey's experience on this subject. In the third volume of his Mémoires de Chirurgie Militaire, Paris, 1812, Larrey devotes a special chapter to the subject of gangrene caused by cold. "This gangrène de congélation, as he calls it, was one of the worst troubles the
more » ... worst troubles the surgeons had to deal with after the battle of Eylau, which was fought on February 8th, 1807. Only a small number of the men of the advanced guards escaped. In some the gangrene was limited to the epidermis of the toes or heels; in others the mortification attacked the tissue of the skin more deeply over a greater or smaller extent, causing the loss of toes or of the whole foot. Larrey notes that although for some days before and after the battle the men had been exposed to the most severe frost, they did not suffer in their extremities. The Imperial Guard, in particular, had stood in the snow, hardly moving for more than twenty-four hours, yet not one of the men had his feet frozen. Then suddenly the temperature rose several degrees and a thaw set in. At once a number of the men felt intense pain in the feet and numbness, heaviness -and tingling in the extremities. The affected parts were dark red in color, but not much swollen. In some cases there was slight redness towards the base of the toes and on the dorsum of the foot; in others the toes, had lost movement, sensibility, and heat, and were already (blackened and dried up. Those who went to the fires of the bivouacs to warm themselves suffered most; the wounded in the field hospitals escaped because they had no chance of doing this. The progress of the disease was rapid, but it seldom extended beyond the toes and only rarely spread above the malleoli. Larrey insists that sphacelus of the foot must not be confused with gangrene of the skin. Tt often happened, he says, that a greater or less extent of the skin of the foot became mortified, without the vessels, deep nerves, tendons, ligaments or bones becoming gangrenous; in that case thef patient felt pain when the subjacent parts were touched, but he could move his feet, and the internal heat was preserved. Sphacelus, on the other hand, deprived the limb of movement, sensibility, and all the properties that characterize life; the patient could not feel his foot, and it seemed to him that a foreign liody hung to his leg. If the mortification was superficial, the eschars usually became detached between the ninth and thirteenth days, leaving a sore which quickly healed. If the whole of the limb was necrosed the patient succumbed to the sepsis which followed the separation of the eschars. "Larrey expresses the belief that unless the patient has been exposed to the influenc of the cold long enough to produce local asphyxia, and unless a second 'sedative or narcotic cause' such as alcohol is cooperating with it internally, the partial or general gangrene does not occur while the cold lasts. Travellers pass the Alps and the Pryenees in the most rigorous cold without evil consequences as long as the temperature does not change. The Poles choose the time when the frost is likely to last to go on long and diffi-cult journeys by caravan, but they dread such journeys at the times when the temperature is variable. During Napoleon's campaign in Holland a large number of men had their feet 'frozen,' but this happened only when thaw set in. Larrey, therefore, holds that cold is only a predisposing cause, the sudden application of heat being the determining factor. When the affected parts have already lost mobility and natural heat, and sensibility is blunted, frictions with snow and melted ice are the best means of exciting the paralyzed vessels to healthy action. He recommended that the circulation should be maintained by the successive application of spirituous and camphorated tonics, the gradual administration of cordials internally, dry and hot friction over all the body, and continuous but moderate exercise. If there were no snow or melted ice handy he advised that coarse cold red wine, vinegar, and camphorated brandy, made cold by plunging it into spring water should be used instead. In hopeless cases amputation when the line of demarcation had formed was, he said, the only course open to the surgeon. ' ' EUGENICS AND MODERN WARFARE. Boston, August 27, 1915. Mr. Editor: In an editorial in the issue of the Journal for Aug. 20 you present most ably one side of the question of the eugenic, or rather dysgenic, effect, of modern methods of warfare. On the other hand, it is probably true that other aspects of the question ought also to be considered. For better or for worse civilization has hitherto advanced, and on the whole grown better, in spite, if not as a result, of war. War bel ween nations Is nfter all only one manifestation of the animate straggle for existence, so impersonal, relentless, and cruel among the lower animals, yet nevertheless a biologic phenomenon even among men. As a matter of fact war does not kill or hopelessly cripple all the best men who engage in it. Some of the young and vigorous survive to have children, and some have left issue before going to their death. It is commonly alleged that a war injures the victorious nation more than the vanquished, yet there are examples in history to the contrary. Caesar found the Belgians the bravest of all Oauls; yet, though their land, the cockpit of Europe, has been drenched with blood for nineteen centuries, their race has remained prolific, hardy, and seems to have lost none of its virile and sturdy physical and moral qualities. Moreover, the example of France has shown the tremendous
doi:10.1056/nejm191509021731016 fatcat:mbozku7kqzci3jtb24w5qlt5sm