Some aspects on death in the cold and concomitant frostbites

The most important risk factors and findings of acute accidental hypothermia and concomitant local frostbites are reviewed. Both external and internal risk factors are usually present when exposure to cold is leading to death. The external factors are alcohol and psychic drugs, too light a clothing for the circumstances and wetness. Important internal factors are leanness, physical exhaustion and traumas in young persons and illnesses and degeneration of physiological heat conserving and production responses at old age. The signs caused by cold on the body are variable. In immersion hypothermia cases there are almost no changes, since the death occurs rapidly, most frequently from drowning. On the victims of dry frost first degree congelations, showing up as purple oedematic skin areas or spots, can be observed on the face and extremities. Stress ulcerations or haemorrhages in the stomach mucosa develop in ca. 70% of dry hypothermia cases. In long lasting exposures to cool temperature haemorrhagic pancreatitis, lung oedema and myxomatous skin oedema have been the characteristic signs. Frostbites developing concomitantly with fatal hypothermia show only oedema and hyperaemia, but no blisters or inflammation in the skin, which are the most conspicious vital reactions of frostbites after thawing.