IV. Blood, Spinal Fluid, and Urine During Freezing
The differential blood smears showed no special features during cooling. On the other hand the number of white and red blood corpuscles shows a regular change. The number of leukocytes rapidly increases, roughly with the beginning of the steeper temperature drop at about 35° C. [95° F.] rectal temperature to values of from 25,000 to 27,000 per cu. mm. After one hour a maximum may be reached and a falling-off begins in the number of leukocytes, while the body temperature falls still further. The number of red corpuscles undergoes an increase, though to a relatively small degree, which in its course resembles the change in the number of leukocytes. We saw increases up to 20 percent. This increase is interrupted even earlier than the increase in the number of leukocytes, so that both curves give no reflection of the temperature curve. The increase of the erythrocytes corresponded to the increase of the hemoglobin of from 10 to 20 percent. A reduction of the fragility of the red corpuscles could not be demonstrated with certainty, on the other hand, although in three experiments a definite hemolysis occurred.
The viscosity regularly increases with the beginning of the fall in temperature. The rise can reach values up to 7.8. This rise occurs very early, indeed, already at body temperatures of 35° C. [95° F.]. After that the values remain relatively constant with further temperature falls. The albumen content of the plasma was likewise increased after the experiment, on the average by 1 percent of the absolute value. Since these measurements could not be made as often as those of viscosity for technical reasons, the connection with the progress of the viscosity remained unclear. Such a connection could not be recognized from the absolute values obtained.
With the acceleration of the temperature drop, there always occurs a more marked increase of the blood sugar to maximal values which may attain an average increase of 80 percent and in a few cases may reach an increase of over 100 percent. According to that, the maximal value of about 27.5° C. [81.5° F.] is reached and is maintained for some time. It is to be observed that as long as the temperature drop continues, in no experiment was it possible to observe a decrease in these high blood sugar values. It is usually to be observed that a relatively rapid drop of the blood sugar values sets in when, after removal from the water, the temperature drop ceases and goes over into a temperature rise. We consider these findings to be of theoretical significance. During the isolated cooling of the neck and back of the head which was described in section III the blood sugar remained constant.
In striking contrast to the increase of the blood sugar, there was never established a corresponding glycosuria in the urine collected immediately after the experiment or withdrawn through a catheter, although considerable quantities of urine averaging 500 cc. were found in the bladder; in only two cases could traces of sugar (0.5 percent) be demonstrated. This paradoxical behavior can, perhaps, be explained in this manner: during the time of great blood sugar increase, a blocking of the kidneys had occurred, and that the associated urine quantities were formed before or after this blocking under reflex polyuria. Acetone and acetic acid, likewise, could not be demonstrated in the urine.
The alkali reserve in the arterial and venous blood was regularly very much reduced at the end of the experiments. Experiments concerning oxygen saturation could not be carried out. According to the color of the venous blood withdrawn from the arm veins, the saturation of this blood must have been very greatly reduced; the blood was virtually black as it came into the syringe. Noteworthy in this connection are the autopsy findings which were undertaken directly after death. In these, the blood in the right heart appeared very dark, and in the left heart very bright red. According to this, one must calculate upon an increase in the saturation differential between the arteries and veins.
Sodium chloride and nonprotein nitrogen in the blood were not clear in the blood at the end of the experiments or increased within the limit of error. Sodium chloride in the urine was generally less, corresponding to a reduction of the specific gravity. On the other hand at the end of the experiments traces of albumin could regularly be demonstrated in the urine and moderately increased leukocytes, occasional erythrocytes, and epithelial cells in the sediments. In particular cases, albumin casts were also observed. The reaction of the urine remained identical before and after the experiments virtually without exception. The studies of the bile yielded no results.
Lumbar and suboccipital punctures immediately after the experiments showed a considerable increase in fluid pressure. On the average it amounted to between 50 and 60 mm. In one case, an increase to 420 mm. was seen. The protein values were always normal. Cell increases did not appear, likewise no abnormal deviation of the colloidal gold curve was observed. The meaning of these findings for therapy is still to be discussed later.
V. Recovery After Cooling and Its Dependence Upon Physiotherapeutic Measures
The important fact has already been referred to that after rescue from the cold water, the body temperature sinks further and so a further temperature reduction of 4° C. [7° F.] may take place. As was likewise emphasized, this may occur as a postphenomenon not only when low temperatures have been obtained already during the experiments, but it can be noted also at final temperatures of 35° C. [95° F.]. A dependence of this after-drop on the duration of the experiment could not be established; as a result it is difficult to calculate in advance. This fact becomes of great importance for practical measures; on the other hand it makes it difficult to gain an insight into the manner in which various physiotherapeutic measures affect the arresting of this after-drop and the recovery of the body temperature. Only because of the large number of the experiments was it possible to obtain well-founded concepts of this.