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July 16, 1949


JAMA. 1949;140(11):974-975. doi:10.1001/jama.1949.02900460044022

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To the Editor:—  Dr. Frederick M. Allen's great contribution toward the proper management of suddenly or gradually devitalized limbs lies in his insistence on the deleterious effects of increased temperatures on the viability of ischemic extremities.Daily one encounters heat cradles, hot water bottles and electric pads applied after occlusion of arterial circulation. These measures accelerate gangrene and often necessitate amputation which could have been avoided.It is also true that the ischemic, pregangrenous or frankly gangrenous extremity, when packed in ice, will become painless; absorption from such extremities is slowed or interrupted, as evidenced by the drop in the patient's temperature. As pointed out in my discussion, this is a valuable procedure, allowing the surgeon time to control the patient's diabetic status, his depletion of blood or electrolytes. Where I thoroughly disagree with Dr. Allen is in his advocacy of using refrigeration as anesthesia for amputation and for maintaining

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