The flattest rise of the body temperature was to be observed when the subject was merely dried off, wrapped in warm cover, and left to himself after removal from the water. The recovery is greatly accelerated if the subject is placed in a hot bath as soon as possible after the removal of the wet articles of clothing. Warming under a light cradle assisted the temperature rise. Vigorous massage had a favorable effect, however, only if it was preceded by treatment in a hot bath or light cradle. In no case was it established that there was any indication of bad effects from the hot water or the light cradle, or that the subject had been harmed in any way. On the other hand, it was observed in three cases that a hot bath had doubtless a life saving effect. In two of these cases there had been complete cessation of heart and breathing action, and in one case the heart had stopped for several seconds after a markedly slackened irregularity before the subject was placed into water of not more than 50° C. [122° F.]. As a result of this we can discard all traditional objections to a sudden rewarming.
The favorable effect of a hot bath is still clearer in the observation of the general condition of the subject than in the temperature curves, although it cannot be presented objectively. The breathing very often becomes “freer” immediately upon introduction into the hot water. The hot water releases a strong stimulus; the unconscious subject often reacts with an outcry. Soon thereafter there occurs a distinct lessening of the severe rigor. The return of consciousness occurs sooner, and indeed at temperatures at which it did not usually happen under other methods of treatment.
In the first experiments with hot water treatment, this was continued only for 10 minutes; after that the subjects were removed and vigorously massaged. Under these circumstances it could be established that the temperature rise continued during the rubbing, indeed in one experiment the rise became steeper. As already indicated, this favorable effect of dry rubbing was not so pronounced without preliminary treatment by heat. It is important, too, that the rubbing be done when the severe spasm of the peripheral vessels has already passed.
In view of this, the hot hath is the best method of treatment of the severely cooled person. However, in the practice of sea rescue service it will not be possible to carry out this method, since the necessary means are not available in aircraft and boats. Under these circumstances we must consider next only the rapid rewarming with light cradle or electrically heated sleeping bag. Therefore a sleeping bag as now used in the sea rescue service was also tested. It was evident that the temperatures which can be developed by this means are not sufficient for heat therapy. With those it was possible to reach a temperature of only 32° C. [90° F.] over the skin, with the heat turned on fully. Besides this, the wall of the foot-section of the sleeping bag is only partly heated; on the outer sides it remains completely cold. As long as no improvement and strengthening of the heating equipment of the sack is carried out, the sleeping bag can be considered only as a substitute for wrapping in warm covers.
The warming by means of the light cradle is more uneven than with a hot bath. With warming by light one might expect severe local vessel expansion with danger of collapse. Actually the subjects often complained of dizziness and nausea after reaching consciousness if the treatment lasted longer than 15 minutes. Occasionally vomiting occurred. In these cases it is indicated to switch off the light cradle and to pack the subject with covers. Apart from this it must be remembered that during unconsciousness the subject should be protected against direct contact with the lamps by means of covers, otherwise burns could occur during clonic-tonic convulsions.
This suggests that “short waves” be employed to supply heat, since it was shown in animal experimentation that by this means it is possible to bring about a thorough warming of the whole animal, which leads to a recovery of the animal with puzzling rapidity. We did not have the proper equipment for a thorough warming of a human being by this means. For this reason the short wave therapy of the heart was tried. This did not have any demonstrable effect. Above all, it is necessary to advise against a practical application of this method, since there exists the danger of prolonged burning even in full consciousness, as the result of cold anaesthesia, even if the treating physician carefully tries to avoid this.
The severe difficulty in breathing as well as the formation of foam before the mouth, which reminded one of incipient lung oedema, seemed to indicate oxygen therapy. Therefore this therapy was tried in four experiments. It showed no effect on either the breathing or the heart action. It has been pointed out that the arterial blood appears especially light red.
VI. Death After Cooling in Water
Practical and Theoretical Considerations
Reports to the effect that those who have been rescued at sea are imperilled for a considerable time after rescue has aroused special attention. It has been reported especially that sudden cases of death occurred as much as 20 minutes to 90 minutes after rescue, and that in mass catastrophes these sudden deaths could amount to mass-dying (rescue collapse). These observations have set off far-reaching discussions. Bleeding in the rewarming periphery, break-downs of neural and humoral correlations and similar ideas have been brought up.