JAMES A. MILLER, JR. 231 



rediscovered many times by inhabitants of the colder climes and possibly 

 it was the first effective treatment for pain. Perhaps the earliest record 

 of the use of snow and ice water as a local analgesic was that of Ibn 

 Sina (Avicenna) in the 11th centmy (82). In 1646 Severinus (162) 

 reported the use of snow and ice in amputations and Napoleon's able 

 surgeon Baron Larrey rediscovered the value of low temperature in surgery 

 during the disastrous retreat from Moscow in 1812 (c.f. 144). Other 

 ninteenth century users of hypothermia as a local anesthetic include Currie 

 (51), Nunn (131), Arnott (24), Blundcll (35), Cooke (44), and Bright 

 (37). The latter considered cold superior to opium, morphine and other 

 narcotic agents. 



Evidence of the beneficial effects of hypothermia in asphyxia is scattered 

 but appears early and in toto forms an impressive sum. Spallanzani 

 is reported to have found in 1803 that hibernating bats and marmots 

 were unaffected by four hours' exposure to CO2 ; whereas, a bird and 

 rat placed in the same chamber died immediately (c.f. 141 ) . 



Among the early studies on hypothermia were experiments on the new- 

 born mammal. In 1824 Edwards (60) reported that newborn kittens 

 required longer to drown in water at 20° than at higher temperatures. Over 

 100 years later these findings received confirmation (57, 90) and recently 

 have been extended to show that the prolongation of life which occurs in 

 cold water is directly related to the body temiieratures of the animals 

 (80). 



The modern era dates from the late thirties when two independent groujis 

 became interested in depression of body temperature. In 1937 Allen 

 published the first of a series of studies in which he demonstrated the 

 value of local refrigeration both in experimental animals and in patients 

 (5-18, 47, 48). His studies generally have not been accorded the recog- 

 nition they deserve. In his first publication he demonstrated that no shock 

 or gangrene developed after 48 hours of total ischemia from a tourniquet 

 if the leg were packed in ice. Likewise, loops of intestine remained pink 

 and healthy for 16 hours when ligatured and packed in ice. Likewise, 

 in 1948 based upon his studies he made recommendations for the use of 

 hypothermia in obstetrics which are still years in advance of present 

 practices (17). 



At almost the same time as Allen was doing his first experiments. 

 Fay and Henny (65) became interested in low body temperature as a 

 result of observations that the distal portions of the extremities, whose 

 skin temperatures are from 3°-ll° below that of the body proper, are 

 not subject to metastases of bone malignancies. Inferring from these obser- 

 vations that neoplasms might require a higher temi^erature in order to grow 

 they tried 'crymotherapy' (= hypothermic therapy) on a woman with 



