Part 48

Sec. 460. When cold Weather is extremely severe, and a Person is exposed to it for a long Time at once, it proves mortal, in Consequence of its congealing the Blood, and because it forces too great a Proportion of Blood up to the Brain; so that the Patient dies of a Kind of Apoplexy, which is preceded by a Sleepiness. In this Circumstance the Traveller, who finds himself drowsy, should redouble his Efforts to extricate himself from the eminent Danger he is exposed to. This Sleep, which he might consider as some Alleviation of his Sufferings, if indulged, would prove his last.

Sec. 461. The Remedies in such Cases are the same with those directed in frozen Limbs. The Patient must be conducted to an Apartment rather cold than hot, and be rubbed with Snow or with Ice-water. There have been many well attested Instances of this Method; and as such Cases are still more frequent in more northern Climates, a Bath of the very coldest Water has been found the surest Remedy.

Since it is known that many People have been revived, who had remained in the Snow, or had been exposed to the freezing Air during five, or even six successive Days, and who had discovered no one Mark of Life for several Hours, the utmost Endeavours should be used for the Recovery of Persons in the like Circumstances and Situation.

Of Kibes, or Chilblains.

Sec. 462. These troublesome and smarting Complaints attack the Hands, Feet, Heels, Ears, Nose and Lips, those of Children especially, and mostly in Winter; when these Extremities are exposed to the sudden Changes from hot to cold, and from cold to hot Weather. They begin with an Inflation or kind of Swelling, which, at first, occasions but little Heat, Pain or Itching. Sometimes they do not exceed this first State, and go off spontaneously without any Application: But at other Times (which may be termed the second Degree of the Disorder, whether it happens from their being neglected, or improperly treated) their Heat, Redness, Itching and Pain increase considerably; so that the Patient is often deprived of the free Use of his Fingers by the Pain, Swelling and Numbness: in which Case the Malady is still aggravated, if effectual Means are not used.

Whenever the Inflammation mounts to a still higher Degree, small Vesications or Blisters are formed, which are not long without bursting; when they leave a slight Excoriation, or Rawness, as it were, which speedily ulcerates, and frequently proves a very deep and obstinate Ulcer, discharging a sharp and ill-conditioned Matter.

The last and most virulent Degree of Chilblains, which is not infrequent in the very coldest Countries, though very rare in the temperate ones, is, when the Inflammation degenerates into a Gangrene.

Sec. 463. These Tumours are owing to a Fulness and Obstruction of the Vessels of the Skin, which occurs from this Circumstance, that the Veins, which are more superficial than the Arteries, being proportionably more affected and straitened by the Cold, do not carry off all the Blood communicated to them by the Arteries; and perhaps also the Particles or Atoms of Cold, which are admitted through the Pores of the Skin, may act upon our Fluids, as it does upon Water, and occasion a Congelation of them, or a considerable Approach towards it.

If these Complaints are chiefly felt, which in Fact is the Case, rather on the extreme Parts than on others, it arises from two Causes, the principal one being, that the Circulation's being weaker at the Extremities than elsewhere, the Effect of those Causes, that may impair it, must be more considerably felt there. The second Reason is, because these Parts are more exposed to the Impressions from without than the others.

They occur most frequently to Children, from their Weakness and the greater Tenderness and Sensibility of their Organs, which necessarily increases the Effect of external Impressions. It is the frequent and strong Alteration from Heat to Cold, that seems to contribute the most powerfully to the Production of Chilblains; and this Effect of it is most considerable, when the Heat of the Air is at the same Time blended with Moisture; whence the extreme and superficial Parts pass suddenly as it were, out of a hot, into a cold, Bath. A Man sixty Years of Age, who never before was troubled with Kibes, having worn, for some Hours on a Journey, a Pair of furred Gloves, in which his Hands sweated, felt them very tender, and found them swelled up with Blood: as the common Effect of the warm Bath is to soften and relax, and to draw Blood abundantly to the bathed Parts, whence it renders them more sensible.

This Man, I say, thus circumstanced, was at that Age first attacked with Chilblains, which proved extremely troublesome; and he was every succeeding Winter as certainly infested with them, within Half an Hour after he left off his Gloves, and was exposed to a very cold Air.

It is for this Reason, that several Persons are never infested with Chilblains, but when they use themselves to Muffs, which are scarcely known in hot Countries; nor are they very common among the more northern ones, in which the extraordinary Changes from Cold to Heat are very rare and unusual.

Some People are subject to this troublesome Complaint in the Fall; while others have it only in the Spring. The Child of a labouring Peasant, who has a hard Skin, and one inured to all the Impressions of the Seasons and of the Elements, is, and indeed necessarily must be, less liable to Kibes, than the Child of a rich Citizen, whose Skin is often cherished, at the Expence of his Constitution. But even among Children of the same Rank in Life and Circumstances, who seem pretty much of the same Complexion, and live much in the same Manner; whence they might of Course be supposed equally liable to the same Impressions, and to the like Effects of them, there is, nevertheless, a very great Difference with Respect to their constitutional Propensity to contract Chilblains. Some are very cruelly tormented with them, from the setting in of Autumn, to the very End of the Spring: others have either none at all, or have them but very slightly, and for a very short Time. This Difference undoubtedly arises from the different Quality of their Humours, and the Texture of their whole Surface, but particularly from that of the Skin of their Hands; though we readily confess it is by no Means easy to determine, with Certainty and Precision, in what this Difference essentially consists.

Children of a sanguine Complexion and delicate Skin are pretty generally subject to this Disorder, which is often regarded much too slightly, though it is really severe enough to engage our Attention more; since, even abstracted from the sharp Pains which smart these unhappy Children for several Months; it sometimes gives them a Fever, hinders them from sleeping, and yet confines them to their Bed, which is very prejudicial to their Constitutions. It also breaks in upon the Order of their different Duties and Employments; it interrupts their innocent salutary Pleasures; and sometimes, when they are obliged to earn their daily Bread by doing some Work or other, it sinks them down to Misery. I knew a young Man, who from being rendered incapable by Chilblains, of serving out his Apprenticeship to a Watch-maker, is become a lazy Beggar.

Chilblains which attack the Nose, often leave a Mark that alters the Physiognomy, the Aspect of the Patient, for the Remainder of his Life: and the Hands of such as have suffered from very obstinate ones, are commonly ever sensible of their Consequences.

Sec. 464. With Respect, therefore, to these afflicting Tumours and Ulcerations, we should, in the first Place, do our utmost to prevent them; and next exert our best Endeavours to cure such as we could not prevent.

Sec. 465. Since they manifestly depend on the Sensibility of the Skin, the Nature of the Humours, and the Changes of the Weather from Heat to Cold, in Order to prevent them, in the first Place, the Skin must be rendered firmer or less tender. 2, That vicious Quality of the Temperament, which contributes to their Existence, must be corrected; and, 3, the Persons so liable must guard themselves as well as possible, against these Changes of the Weather.

Now the Skin of the Hands, as well as that of the whole Body, may be strengthened by that Habit of washing or bathing in cold Water, which I have described at large, Sec. 384; and in Fact I have never seen Children, who had been early accustomed and inured to this Habit, as much afflicted with Chilblains as others. But still a more particular Regard should be had to fortify the Skin of the Hands, which are more obnoxious to this Disorder than the Feet, by making Children dip them in cold Water, and keep them for some Moments together in it every Morning, and every Evening too before Supper, from the very Beginning of the Fall. It will give the Children no Sort of Pain, during that Season, to contract this Habit; and when it is once contracted, it will give them no Trouble to continue it throughout the Winter, even when the Water is ready to freeze every where. They may also be habituated to plunge their Feet into cold Water twice or thrice a Week: and this Method, which might be less adapted for grown Persons, who had not been accustomed to it, must be without Objection with Respect to such Children, as have been accustomed to it; to whom all its Consequences must be useful and salutary.

At the same Time Care must be taken not to defeat or lessen the Effect of the cold bathing, by suffering the Bather or Washer, to grow too warm between two Baths or Dippings; which is also avoiding the too speedy Successions of Heat and Cold. For this Purpose, 1, the Children must be taught never to warm their Hands before the Fire at such Times, and still less before the Stoves, which very probably are one of the principal Causes of Chilblains, that are less usual in Countries which use no such Stoves, and among those Individuals who make the least Use of them, where they are. Above all, the Use of Cavettes (that is, of Seats or little Stairs, as it were, contrived between the Stove and the Wall) is prejudicial to Children, and even to grown People, upon several Accounts. 2, They should never accustom themselves to wear Muffs. 3, It would be also proper they should never use Gloves, unless some particular Circumstances require it; and I recommend this Abstinence from Gloves, especially to young Boys: but if any should be allowed them, let the Gloves be thin and smooth.

Sec. 466. When Chilblains seem to be nourished by some Fault in the Temperament or Humours, the Consideration of a Physician becomes necessary, to direct a proper Method of removing or altering it. I have seen Children from the Age of three, to that of twelve or thirteen Years, in whom their Chilblains, raw and flead, as it were, for eight Months of the Year, seemed to be a particular Kind of Issue, by which Nature freed herself of an inconvenient Superfluity of Humours, when the Perspiration was diminished by the Abatement of the violent Heats. In such Cases I have been obliged to carry them through a pretty long Course of Regimen and Remedies; which, however, being necessarily various from a Variety of Circumstances, cannot be detailed here. The milder Preparations of Antimony are often necessary in such Cases; and some Purges conduce in particular ones to allay and to abridge the Disorder.

Sec. 467. The first Degree of this Complaint goes off, as I have already said, without the Aid of Medicine; or should it prove somewhat more obstinate, it may easily be dissipated by some of the following Remedies. But when they rise to the second Degree, they must be treated like other Complaints from Congelation, or Frost-biting (of which they are the first Degree) with cold Water, Ice-water and Snow.

No other Method or Medicine is nearly as efficacious as very cold Water, so as to be ready to freeze, in which the Hands are to be dipt and retained for some Minutes together, and several Times daily. In short it is the only Remedy which ought to be applied, when the Hands are the Parts affected; when the Patient has the Courage to bear this Degree of Cold; and when he is under no Circumstance which may render it prejudicial. It is the only Application I have used for myself, after having been attacked with Chilblains for some Years past, from having accustomed myself to too warm a Muff.

There ensues a slight Degree of Pain for some Moments after plunging the Hand into Water, but it diminishes gradually. On taking the Hand out, the Fingers are numbed with the Cold, but they presently grow warm again; and within a Quarter of an Hour, it is entirely over.

The Hands, on being taken out of the Water, are to be well dried, and put into Skin Gloves; after bathing three or four Times, their Swelling subsides, so that the Skin wrinkles: but by continuing the cold Bathing, it grows tight and smooth again; the Cure is compleated after using it three or four Days; and, in general, the Disorder never returns again the same Winter.

The most troublesome raging Itching is certainly assuaged by plunging the Hands into cold Water.

The Effect of Snow is, perhaps, still more speedy: the Hands are to be gently and often rubbed with it for a considerable Time; they grow hot, and are of a very high Red for some Moments, but entire Ease very quickly succeeds.

Nevertheless, a very small Number of Persons, who must have extremely delicate and sensible Skins, do not experience the Efficacy of this Application. It seems too active for them; it affects the Skin much like a common blistering Plaister; and by bringing on a large flow of Humours there, it increases, instead of lessening the Complaint.

Sec. 468. When this last Reason indeed, or some other Circumstance exists; such as the Child's Want of Courage, or its Affliction; the monthly Discharges in a Woman; a violent Cough; habitual Colics; and some other Maladies, which have been observed to be renewed or aggravated by the Influence of Cold at the Extremities, do really forbid this very cold Application, some others must be substituted.