In addition the following drugs were given: Strophanthin i. v.; Cardiaz 1 i. v. and i. c.; Lobelin and Coramin i. v. and i. c. In other experiments alcohol or grape sugar was given.
A part of the experiments was begun under narcosis (8 cc. Evipan i. v.).
III. The Clinical Picture of Cooling
The clinical picture as well as the behavior of the body temperature showed certain regularities in the general course; the time of appearance of certain phenomena was, however, subject to very great individual variations. As one might expect, a good general physical condition delayed the cooling and the concomitant phenomena. Further differences were conditioned by the position of the subject in the water and the manner of clothing. Furthermore, differences showed up between experiments in which the subject lay horizontally in the water so that the nape of the neck and the back of the head were splashed with water, and others in which neck and head protruded freely out of the water.
Peculiarly, the actual water temperatures between 2° C. and 12° C. [35° and 54° F.] had no demonstrable effect upon the rate of the cooling. Naturally such an effect must exist. But since besides the already mentioned individual differences and those due to experimental conditions, the various subjects cooled on different days at different rates of speed, the effect of the actual water temperatures between 2° and 12° disappears behind such variations.
If the experimental subject was placed in the water under narcosis, one observed a certain arousing effect. The subject began to groan and made some defensive movements. In a few cases a state of excitation developed. This was especially severe in the cooling of head and neck. But never was a complete cessation of the narcosis observed. The defensive movements ceased after about 5 minutes. There followed a progressive rigor, which developed especially strongly in the arm musculature; the arms were strongly flexed and pressed to the body. The rigor increased with the continuation of the cooling, now and then interrupted by tonic-clonic twitchings. With still more marked sinking of the body temperature it suddenly ceased. These cases ended fatally, without any successful results from resuscitation efforts.
In the course of the narcosis experiments the evipan effects in a few cases went directly over into a cold narcosis; in other cases one could determine a transitory return of consciousness, immediately following the awakening effect already described; at any rate, the experimental subjects were dizzy. Cold pain was not expressed.
Experiments without narcosis showed no essential differences in the course of cooling. Upon entry into the water a severe cold shuddering appeared. The cooling of the neck and back of the head was felt as especially painful, but already after 5 to 10 minutes a significant weakening of the pain sensation was observable. Rigor developed after this time in the same manner as under narcosis, likewise the tonic-clonic twitchings. At this point speech became difficult because the rigor also affected the speech musculature.
Simultaneously with the rigor a severe difficulty in breathing set in with or without narcosis. It was reported that, so to speak, an iron ring was placed about the chest. Objectively, already at the beginning of this breathing difficulty, a marked dilatation of the nostrils occurred. The expiration was prolonged and visibly difficult. This difficulty passed over into a rattling and snoring breathing. However, the breathing at this point was not especially deep as in Kussmaul’s breathing nor were any Cheyne-Stokes breathing or Biot’s breathing to be observed. Not in all subjects, but in a great number, a simultaneous hindering during this breathing through very profuse secretion of mucous could be established. Under these conditions sometimes a white, fine-bubbled foam appeared at the mouth which reminded one of an incipient lung oedema, though it was not possible to determine this symptom with certainty by clinical auscultation; only a sharpened unclean breath sound was audible. This foam might occur early, that is, at rectal temperatures of 32° C. to 35° C.; [90°-95° F.]. No special significance was to be attributed to this regarding the outcome of the experiment which is the opposite of the described relaxation of rigor. The rate of breathing increased at the beginning of the experiment, but after about 20 minutes it decreased to something like 24 per minute with slight variations.
In general a definite dulling of consciousness occurred at the dropping of the body temperature of 31° C. [88° F.] rectal temperature. Next, the subjects still responded to speech but finally answered very sleepily. The pupils dilated markedly. The contraction under light became increasingly weaker. The gaze was directed overhead with a compulsive fixation. After withdrawal from the water an increase in the reflexes was evident in spite of the rigor, and regularly a very marked drawing up of the testicles occurred which practically disappeared into the abdomen. Early in the experiment the face was pale. After 40 to 50 minutes cyanosis appeared. With this the face appeared redder, the mucous membrane bluish-red. The skin veins were not maximally collapsed and were virtually always penetrable.