Although military operations are attended by the greatest incidence of cold injury, many persons in civil life may be suddenly exposed to frostbite or immersion foot as a result of a cyclone, flood, or occupational hazard.1 The danger is increased if the person exposed has an appreciable degree of peripheral arteriosclerosis. In the production of tissue damage, it was formerly believed that the associated vascular changes were secondary to the cold injury, but it now appears that the tissue damage is secondary to such vascular changes as vasoconstriction, vasodilation, sludging of blood, and thrombosis. The feet are especially vulnerable because of their dependent position. The damage may be aggravated by immobility, which favors sludging of the blood, as well as by walking. That the exact pathogenesis of cold injury is complex and not fully understood is shown by the fact that some animals can hibernate without incurring cold injury
COLD INJURY. JAMA. 1954;156(1):44–45. doi:10.1001/jama.1954.02950010046016
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