To provide adequate foot protection which shall not at the same time be cumbersome is not an easy matter, for things which are loose about the feet are unwieldy. Woollen socks which enmesh the air in their stitches provide a good insulating air space. In low temperatures two, three or four pairs may be necessary. To prevent constriction of the feet it is of importance that each outer pair of socks should be a size larger than the one inside, and so they should be supplied in series. The cramming of a foot with too many pairs of socks into a boot too small for them is bad, for the circulation of blood to the toes is restricted and the air space is lost. Cold feet have often been cured by telling the wearer to remove a pair of socks.
All possible steps must be taken to see that the air space is not replaced by moisture, i.e. the feet and coverings must be kept dry. This is a difficult problem; coverings which allow of ventilation allow access of damp from the outside, and waterproof coverings retain perspiration. It is usually impossible to ensure absolute dryness, and therefore socks should always be changed before turning in to sleep. This should be made an inviolable rule, yet it is one which is often broken. Damp socks should not be placed in a freezing atmosphere, for the moisture in them will freeze and render difficult the putting of them on in the morning. They should be kept in the sleeping-bag or placed under the jersey. By this means they dry rapidly. Sennegrass may be used for taking up perspiration; it has the property of rapidly giving up its moisture. Some people prefer to use pieces of flannel instead of socks; the pieces are wrapped about the feet, and have the advantage that when taken off they can be spread out and thus dry more rapidly.
All tight fittings and all constrictions which serve to impede the circulation should be avoided. Success in preventing frost-bite is attained only by continued and careful attention to detail.
Precautions which are carried out by men in good condition are liable to be ignored by those who are exhausted or weak from any cause, and under these conditions frost-bite occurs frequently. A frost-bitten part becomes waxy white in appearance. If treated at once no harm results, if neglected death of the part ensues. Treatment on the spot consists not in rubbing the part with snow (men have been killed for less), but in applying dry, gentle warmth. Very light massage may be used, but violent rubbing, especially of the face, is liable to remove the cuticle and leave a weeping sore. Fingers can be thrust inside the affected man’s own clothing next to the warm skin. A frozen toe can be similarly nursed back by a “Good Samaritan” placing the toe against his skin and enfolding the ankle—a most unpleasant job, but most excellent treatment. A hand taken from a warm mitt can be placed on the face, nose or ears. Recovery is accompanied by an intense feeling of “pins and needles.” A part that does not immediately come back to normal must be kept warm and dry, and the application of a little methylated spirit or turpentine is good.
It is essential to avoid grease and wet. I have, in the Antarctic, the Italian Alps, and in Russia, made extensive tests of oils, fats and grease, and have come to the conclusion that the application of vaseline or ointment is the worst treatment possible, especially if the part is liable to be again exposed to cold. Too great heat is bad. The circulation must be coaxed back gently. Too sudden a return leads to exudation and choked capillaries, just as theatre passages are choked at the cry of “Fire!”
Non-recovery leads ultimately to gangrene. If superficial, the part may separate of itself, leaving a good new skin underneath which is at first very tender; if deeper, judicious amputation may be required. The gangrene may be dry or moist. In the former case the part shrinks and becomes black and scaly, the condition having little effect upon the general health. It is dry and inoffensive. In the case of moist gangrene the part becomes septic, is very offensive, and absorption of poisons leads to impaired health. The amount of the limb that requires amputation depends upon the severity and extent of the frost-bite. It must be emphasized that in examining a part for frost-bite the waxy appearance may not be present. It does not follow that the part has not been frost-bitten or is not seriously affected. There is a more slowly produced condition, due to the action of prolonged cold, in which blood returning into the capillaries which have been damaged by the continued constriction due to the cold sets up inflammation and exudation, which may lead to death of the part. Signs of mottling, at first pinky white, later blue-grey, should be looked for, and if they appear the parts must be treated with the greatest care. If circumstances permit, the limb should be raised, rested, and dry, warm (not hot) dressings applied. For unbroken parts I use cotton wool which has been thoroughly dried, bandaged lightly; for cases when the skin is broken, lint which has been warmed and the surface scorched to render it sterile, covered with warm, dry wool, and again lightly bandaged. This simple treatment can be applied under any conditions in which it is possible to produce a flame. Cases take a long time to recover fully. Ointments, hot wet dressings, and poultices should be avoided. A milder though similarly produced effect leads to an irritable condition resembling chilblains. It affects commonly the tips of the ears. The momentary exposure of bare skin does not lead to immediate frost-bite, but the length of time that it can be exposed depends upon the temperature, the amount of moisture present, and the strength of wind. It is often necessary in carrying out a piece of work to expose the hands, which may require periodical warming up. Much depends upon the circulation, for if a job is attempted after the body has been for some time at rest frost-bite sets in quickly. If, on the other hand, the individual has been working hard, walking or running, and the blood is pulsating actively, the hands and other parts can be exposed for comparatively long periods without harm.
As a result of unrecognized and untreated frost-bite strong men have been crippled for life. Constant watchfulness is required; its danger cannot be over-estimated, nor too much emphasis placed upon measures for its prevention.
Notes on Oils and Grease
It is commonly believed that fats, oils and grease are good non-conductors of heat and if placed on the clothes or on the skin help to keep one warm. There was never a greater fallacy, for it is common experience of polar explorers that the reverse is the case. Circumstances do not permit of regular laundrying or even of regular hot baths, and situations are not rare at this work in which men have spent several months without a wash or a change of clothes. After the loss of the Endurance the party had neither for a year. The clothes inevitably became greasy, especially about the elbows and thighs. The cold could be felt “striking through” the greasy parts.
It was often necessary to kill and cut up seals. In the process the left hand grasped the blubber and became very greasy, whilst the right hand, which wielded the knife, very largely escaped. Usually it was possible only to wipe with snow, which had little effect to remove the grease, before replacing the hands in mitts. Subsequently the left hand felt colder and was more liable to frost-bite. Socks which have been worn for some time and become slightly greasy are less warm than clean, dry socks. There are socks of a type manufactured by certain firms which have been deliberately imbued with grease to make them warmer. The wearing of them produced the opposite effect. During the war I made experiments upon myself and with troops, in which two stretcher-bearers massaged the feet of each man, the left foot with whale oil and the right by rubbing only. Both were done at the same time and for the same length of time. The results were greatly in favour of the dry rubbing. I collected also a number of socks which had been worn (and were therefore greasy) and dried them thoroughly. I acquired some absolutely new socks, and issued one dry, greasy sock and one new sock to each man. Evidence in this case was not unanimous, but was numerically in favour of the clean sock.