JAPANESE EXPERIMENTS IN RESISTANCE TO COLD | AUGUST 1949 REPORT BY 6 HQ TECHNICAL INTELUfiPJfii DETACHMENT i, r \ •* Ptr r - / . - **• , ; .•!*.».— _'. v;ass ~int lusv -cs m::>onT . o. nu ■"apah'ggo ]2ra«r.*ii *atr> is. %*!|istance ' : ’oM r; * «rj* i'-'1J EVALUATION; DATE OF INFORMATION:.! LlfJ| "X# '1 . , A%g£atJi$49 incl—?,— prepared 3Y:JgfiSl::ii£gl- ifaaeag^-gffpaa SUMMARY OR SID REPOST: /P/p ,T j j : j 3 /vast 'Exec, >3-2 by iovv. j,- thod s? oft-'determining physical difference in eusoeptlbi'.itjr to cold by means of ? *.ng&r-free sing, blood agglutination, circulation, and other tests and also ways of increasing resistance, a. simple device called a cold sensation meter is described an / ' section on cooling power* Th:.s sector reportedly measures the combined cooling effect of wind and temperature and expresses the result ia terra of air temperature under windless conditions. Throughout the report the Japan©*© word wtosho,i! has been translated literally as ’freea© injury5 ia order to conform with the distinction made by the author between the mild and oevere forms of frostbit©. 2, Bequest following distribution on two copies this document: l copy to B & D Board, Office Surgeon General, U.S. 1 copy to E & D Board, QJ4G, U.S. For the Assistant Chief of Staff, G~3: page no—±. ■-rmutm * <•> -mtf^rr/nu 3»- MwssmeiHifWMSSr V * 3 document contains’ information 'scunj the n3* is: of the United States within the miming of iha Act. 50 US, 0,-31 and 32, as amended. Ur trar.s- ■ / GENERAL HEADQUARTERS FAR EAST COMMAND MILITARY INTELLIGENCE SECTION Technical Intelligence Detachment WPD/mlm APO 500 1 Aug 49 SUBJECT? Japanese Experiments in Resistance to Cold TO: Director, Military Intelligence Service Division, G-2, GHQ, FEC, APO 500 1, REFERENCES: a. Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," 15 liar 49 b. WD Ltr, WDGS, Intell Div, Washington, MID 400.112 Research, subject: "Foreign Scientific Research and Development," 23 May 47 ' c* General Order No. 4> GHQ, SCAP, "Intelligence Targets in Japan," 13 Mar 48 d* Staff Memorandum No, 5, GHQ, SCAP & FEC, "Reestablishment of Technical Intelligence Teams," 17 Jan 49 e* Current Research and Development Projects of the Quarter- master Corps f. Current Research and Development Projects of the Medical Corps g. Report, Quartermaster Analysis Section, 5250th Technical Intelligence Company, APO 500, subject: "Japanese Army Cold Weather Clothing," 9 Mar 46 2, PURPOSE: To prepare additional reports on Japanese research relating to the effects of extremely cold environments on man and methods of minimizing such effects. 3, SUMMARY OF INFORMATION: Two Japanese reports concerning research on cold climate operations, particularly cold injuries are inclosed. a. "Reference Data on the Prevention of Freeze Injury" (Incl l) is a summary of the results of and the conclusions drawn from extensive research conducted by a special detachment of the Japanese Kwantung Army Medical Department near the Manchuria-Siberia border from 1939 to 1944, Among the topics discussed in this report are the following: nature, causes, and development of cold injuries; personal differences in suscepti- bility to cold; factors comprising cooling power and their measurement; other factors which lead to casualties; parts of the body most susceptible to injurjrj symptoms and treatment of the various degrees of injury; cold endurance power and factors comprising it; comparison and Improvement of cold endurance power by psychological, physical, and material means (including clothing, individual warming devices, rations, and tents); methods of preventing sporadic and'mass outbreaks of injuries; death by freezing, including its definition, development, symptoms, and treatment. Especially interesting are the methods of determining'physical differences' in susceptibility to cold by means of finger-freezing, blood agglutination, circulation, and other tests and also ways of increasing resistance. A simple device called a cold sensation meter is described in the section on cooling power. This meter reportedly measures the combined cooling effect of wind and temperature and expresses the result in terms of air temperature under windless conditions. Throughout the report the Japanese word "tosho" has been translated literally as "freeze injury" in order to conform with the distinction made by the author betwen the mild and severe forms of frostbite. Much of the clothing mentioned in Table 37 (p* 60) is described and pictured in reference lg above. b. "Variation of the Cold Autohemagglutination Reaction Due to Cold Stimulation" (Incl 2) is a medical thesis prepared by Professor Teruyoshi HASHIBA of the Hokkaido Women1s Medical College.' This paper reviews previous research on cold autohcmagglutination, describes the author!s research, and compares his results and conclusions with those of his predecessors. Principal findings were: cold autohemagglutination was positive in all of the fifty subjects tested; titers were considerably elevated after cold stimulation, particularly those of cold injury and spontaneous gangrene patients; titers of patients which viere approximately the same of those of normal individuals under ordinary conditions were easily distinguished from the latter by an abnormal elevation after cold stimulation. HASHIBA concluded that a potentially high titer is an important factor to consider when determining susceptibility to freeze injury by the cold autohemagglutination test. 4. RECOMMENDATIONS: That this report be forwarded to Targets Branch, Theatre Intelligence Division, for collation. /O rrf /a/JL / f. lycm Col., ifs. Conatjanding 2 Incls: 1. Reference Data on the Prevention of Freese Injury 2, Variation of the Cold Autoheraagglutination Reaction Due to Cold Stimulation 2 R E FE R t No E DAI A ON tm£ PREVENTION OF FREEZE INJURY ARMY MEDICAL CORPS Incl 1, Report TID, GHQ, EEC, APO 500, subject: '’Japanese Experiments in Resistance to Gold,” dated 1 Aug 49 This pamphlet, written by Colonel Tsuneji OGATA (Medical Corps) attached to the Kwantung Army Medical Department, is considered to be a valuable reference for the medical services in extremely cold zones and is printed for distribution. September, 1944 Hiroshi KAMBAYASHI Chief Surgeon, Army Medical Corps 2 Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments m Resistance to Cold,” dated 1 Aug 49 REFERENCE DATA ON PREVENTION OF FREEZE INJURY CONTENTS Page No, CHAPTER 1 DEFINITION OF FREEZE INJURY 4 COPTER 2 GENESIS AND COURSE OF DEVELOPMENT OF FREEZE INJURY 7 Section I Onset and Progress of Freeze Injury 7 Section II Freezing Temperature of Parts Susceptible to 9 Freeze Injury Section III Various Theories on Cell Death Due to Freezing 9 CHAPTER 3 CAUSES OF FREEZE INJURY 13 Section I Cooling Power 13 Section II Susceptibility to Freeze Injury 23 Section III Factors that Increase the Effects of the Cooling 33 Power. Section IV Other Factors 35 CHAPTER 4 RELATIVE SUSCEPTIBILITY OF VARIOUS BODY PARTS TO FREEZE 36 INJURY CHAPTER 5 SYMPTOMS OF FREEZE INJURY 36 Section I First-Degree Freeze Injury 41 Section II Second-Degree Freeze Injury 41 Section III Third-Degree Freeze Injury 41 CHAPTER 6 TREATMENT OF FREEZE INJURY 48 Section I Treatment Prior to Appearance of Secondary Symptoms 46 Section II Treatment After Appearance of Secondary Symptoms 50 CHAPTER 7 COLD ENDURANCE PC"ER AND METHODS OF INCREASING IT 54 Section I Definition of Cold Endurance Power 54 Section II Factors Comprising Cold Endurance Power 54 Section III Standard for Comparison and Evaluation of Cold 55 Endurance Power Section IV Plans for Strengthening Cold Endurance Power 56 CHAPTER 8 PREVENTIVE MEASURES FOR FREEZE INJURY 91 Section I Instructions to Commanders on the Prevention of 91 Freeze Injury Section II Instructions for the Prevention of Individual 92 Outbreaks of Freeze Injury APPENDIX "TOGO” (TN: MORTAL FREEZING) 94 Section I Definition of the Term "Togo" 94 Section II Genesis and Development of Mortal Freezing . 94 Section III Causes of Mortal Freezing 95 Section IV Symptoms of Mortal Freezing 96 Section V Treatment of Mortal Freezing 96 Section VI Prevention of Mortal Freezing - aQ.cjnrn nnnr87 Power. .ncl 1, Report TIP, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to ColdM* dr ted 1 Aus 49 DATA ON PREVENTION OF FREEZE INJURY CHAPTER 1 DEFINITION OF FREEZE INJURY An accurate understanding of the causes, genesis, progress, symptoms, etc., is essential to the prevention and treatment of any disease. In practice, to facilitate diagnosis, even those diseases which are more or less analogous in their causes, genesis, symptoms, and progress, are nevertheless carefully cLassified, subdivided, and differentiated from one another by utilizing the slightest differences between them. There- fore, by knowing the name assigned to a specific combination of the factors mentioned a-bove, one may readily understand the essential methods of its treatment and prevention. The treatment and prophylactic measures for a specifically defined disease are practically the same whether the disease occurs in a tropical or extremely cold climate. However, this has not been the case with the disease known as "tosho" (freeze injury). Although the cold injury?- experienced in the Japanese home islands has a genesis and symptoms entirely different from that of the injury experienced in such extremely cold regions as Manchuria- and Siberia, the two arc usually treated under the same name because they both result from exposure to cold even though differences of cold intensity are admitted; Because of the apparent but misleading resemblances in their symptoms, up to now these injuries have been treated simile.rly and described by the same name, thus leading to the present confusion in the use of the term "tosho". Medical workers, lacking first- hand knowledge of freeze injury as it occurs in extremely cold regions, utilize the same preventive measures and treatment for it as they do for cold injuries suste-ined in the milder climate of the homeland. In other words, most Japanese have a very inadequate knowledge of this injury unless they have experienced it in extremely cold regions. Some of this confusion arises from the vague meaning of the word "tosho". Freeze injury is to cold climate operations what malaria is to tropical operations. Solution of the problem of freeze injury is essen- tial to national defense. First of all, the term "tosho" will be clearly defined so that there will be no confusion or mistake in its treatment and prevention. "Tosho" is defined by most Japanese medical textbooks as ua generic term covering the local pathological changes caused by the effect of low temperatures on the human body." Defined in this way, the term "tosho" denotes anything from the most serious cases of freeze injury which are sustained in extremely cold regions through the common "toso" (frostbite), "yukiyake" (snow burn), and "shimoyake" (frost burn) to such minor cases as the so-called "akagire" (cracked skin) and "hibi" (chapping). All these injuries have cold as a common cause, but they are entirely differ- ent in their courses of development because of differences in the inten- sity/- of the cold which causes them. When a part of the body is exposed to the extremely intense cold of frigid regions, its tissues freeze, become wax-white and, when thawed, show pathological changes resembling burns at the point of injury and in surrounding areas. These injuries my be regarded as a sort of trauma caused by exposure to injuriously intense cold. The cold injury known in the homeland, however, is the manifestation of pathological changes caused by a localized disorder of the blood circulation, which in turn is caused by repeated exposure to a somewhat less intense cold and does not involve freezing of the affected part. It is a localized malady Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 CONFIDENTIAL which tends to become worse under the cumulative effect of repeated exposure to cold. "Akagire" (cracked skin) and "hibi" (chapping) are a kind of desquamative erythematous eczema which causes cracks among the horny layer cells -when perspiration or moisture deposited on the skin surface evaporates due to cold wind, thereby removing heat from the skin and, at the same time, drying up the serum secreted there. Since Japan for the most part lies in the temperate zone, injury from cold involving freezing of tissue is unknown in the homeland except for a certain section in the northern part of the country. Hovrever, the cold injury which develops without the accompaniment of frozen tissues is a common malady in all parts of'the country and is given different names in different districts, e,g„, "yukiyaki "snow burn) in one district or "shimoyaki" (frost burn) in another. This is so common that nearly everyone experiences it at least once in his lifetime. Since the terms snow burn and frost burn carry too much of a colloquial flavor, medical workers have given them the more dignified name "toso" (frost wound). This new name, however, has caused further confusion and misconception. In actual practice medical workers stretch the meaning of the term and apply it to the more serious type of cold injury known as "tosho" which appears only in extremely cold regions and has an entirely different genesis. As a result of this, medical workers utilize conceptions of the milder cold injury, "toso" in the prevention and treatment of cold region freeze injury. Our Army, however, has profited by the experience of past wars and makes a distinction between the cold injuries of the frigid regions and those of the homeland, KAMAE has pointed out the importance of distin- guishing between the frozen-tissue type injury and the non-frozen-tissuc type. This confusion in terminology can be eliminated by assigning the name "tosho” to the frigid region cold injury involving frozen tissue and "toso” to the injury encountered in the homeland which docs not involve frozen tissue. The term "tosho" will be applied to the trauma resulting from the direct injury of tissue cells resulting from freezing and also the indirect injury sustained during thawing or rewarning. The term "toso" (frost bite) will lx applied to the localized malady which results from the aggravated disorder of local blood circulation due to repeated exposure to a somewhat i.iilder cold. This differentiation will facilitate the treatment and prevention of the respective injuries. To improve our understanding of the two injuries, their main differ- ences have been contrasted in the following. TABLE 1 Tosho (Freeze Injury) Toso (Frost bite) 1» Develops very shortly after ! exposure to extreme cold. ! 1. Develops gradually as a result of repeated exposure to milder cold. 1 2. First symptom appears after thawing the frozen part. 2. Symptoms appear even though freezing has not occurred. 3. Severe pain precedes freezing. 3. Patient is affected without knowing it. 4. Fingers and toes are affected first, then the backs of hands and insteps of feet. 4. As a rule, backs of the hands and insteps are affected first. Incl 1, Report TID, GHQ, FGC, APO 500, subject: "Japanese Experiments m Resistance to Cold,” dated 1 Aug 49 Tosho (Freeze Injury) Toso (Frost bite) 5* Bullae appear from the 5* Bullae seldom appear at the beginning. beginning. 6. Gangrene often develops. 6. Gangrene seldom develops. 7. Functional disturbance is 7* Functional disturbance is often involved. seldom involved. With these differences in mind, the two injuries may be concisely defined as follows: "Tosho" (cold injury of extremely cold regions) is characterized by localized pathological changes that appear when tissue which has been frozen by the rapid cooling of intense cold begins to thaw, "Toso" (cold injury of milder climates, i,e., the homeland) is characterized by pathological changes that appear after repeated and cumulative cooling by moderate cold, entailing no freezing of tissue. It is against ’’tosho", not "toso," that prophylactice measures must be taken for sub-Arctic military operations. "Tosho", not "toso", is the subject of this booklet. Incl 1, Report TID, GHQ, FEC, APO 500, subject: ’’Japanese Experiments in Resistance to Cold,” dated 1 AUg 49 CHAPTER 2 GENESIS AND COURSE OF DEVELOPMENT OF FREEZE,INJURY Section I Onset and Progress of Freeze .Injury The course of development of freeze injury, a lesion caused by progressive freezing, may be graphically represented as follows: TABLE 2 Intense Sensation of Cold Pain Accompanying Freezing Local Anesthesia Freezing |Thawing Thawing Frozen for a Short Period Frozen for a Long Period Pain Pain First Aid Recovery Freeze Injury Under the stress of temperatures low enough to freeze its tissues, an exposed part of the body loses heat gradually; when cooled to a certain point, the person first feels a sensation of intense cold, end then a peculiar pain. This pain is a portent of freeze injury and must bo recognized if further development of the injury is to be prevented. For this reason, a new term "totsu” (TN: lit., painful sensation accom- panying freezing) was specially coined, for this sensation. With a further drop in the affected part’s temperature, the pain lessens, local anesthesia occurs, and the part becomes frozen hard, presenting a wax- white appearance. If suitable first aid is administered within a short time after freezing occurs, the part begins to thaw, sensation is recovered with the accompaniment of another severe pain which,'however, is gradually alleviated during the course of further treatment, end the injury finally heals. If the frozen part is left untreated for a long time, however, emergency treatment vail serve only to thaw the part, leaving partially paralyzed or dulled local sensibility, while the patient will suffer severe pains and develop unmistakable symptoms of freeze injury. In Tables 3 and U, the relationship between the decline of skin temperature, a.nd the progress and symptoms of freeze injury is plotted. Roughly stated, when the skin temperature falls to 5°C, "totsu" (painful sensation of freezing) is felt; as the temperature falls further, the pain becomes more intense until local anesthesia occurs. The tissue freezes at a skin temperature of about -5°C. 7 Incl 1, Report TID, GKQ, FEC, APO 500, subject: ”Japanese Experiments in Resistance to Cold," dated 1 Aug 49 TABLE 3 SKIN TEMPERATURE AT WHIOH THE HAND FREEZES .Beginning of Gold Sensation Eeglnning of painful Sensation Intensified Painful Sensation i of Freezing Sensation of Stinging 4 Pains Anesthesia of the Parii injury o / Affected Part; Trip of Bight Index Finger Air Temperature: -20°C Wind Velocity: I.76 m/sec TABLE 4 SKIN TEMPERATURE AT WHICH THE FOOT FREEZES Intensified Painful Sensation 1 of Freezing Freeze Injury- Time (minutes) Affected Parts Second Toe, Bight Foot Air Temperature: -20° C Wind Velocity:1 m/sec CONFIDENTIAL The human body is like a thermostat, and when exposed to intense cold it immediately endeavors to maintain body temperature by utilizing all its functions. To assist this adjustment, the internal body heat' production increases and the peripheral blood vessels contract. Thus, unlike the case of inanimate objects, the cooling process of the human body is not steady, but irregular. When the skin becomes pallid as its temperature declines, a stinging pain is felt at the affected part. This pain, however, is temporarily relieved -when the skin regains its color and the temperature rises; but the skin soon becomes pallid .again, and its temperature falls. The body counteracts the menace of freeze injury by the alternation of those two phenomena; but when this resistance fails, serious freeze injurjr develops. Majv Gen0 MURAKAMI (MC) called this state of resistance to severe cold "localized agony" and emphasized that it is an important physiological phenomenon from the standpoint of the human bodyTs protection from severe cold. Having noted that such a physiological phenomenon is'evoked by a somewhat milder cold an well as by injuriously intense cold, HISANO, YOSHB-iURA, and others termed it the "reaction of blood vessels to cold." Section II Freezing Temperature of Parts Susceptible to Freeze Injury The temperature at vhich the more susceptible parts of the body, such as toes, fingers, ear lobes,'and nose tip, freeze tf/as'found experi- mentally to be approximately -5°C, as shown in Tables 5, 6, 7, and When the skin temperature falls to about -5°C, freezing occurs and freeze injury develops. If the air temperature is above -5°C, freezing occurs with difficulty, and there is little danger of freeze injury developing. It has been observed, however, that dry fingers exposed to a temperature of -10°C when there is no wind seldom lose enough heat to freeze, even though apparent symptoms of the so-called "local'agony" are present. When the fingers are wet or when there is a wind, they readily lose enough heat to freeze. Of the susceptible parts mentioned above, the toes, fingers, and ear lobes were found to freeze when exposed to a comparatively mild cooling power, but a very intense cooling power, below -70 G equivalent temperature (equivalent temperature will be ex- plained later), was required to freeze the nose tip. This significant fact should be noted when determining the critical cooling power for the prevention of freeze injury. Section III Various Theories on Cell Death Due to Freezing Many physiologists have studied the problem of the death of cells due to freezing, but because of the multiplicity of causes, they seem to have arrived at different conclusions. The principal theories are described below. Molisch studied the progress of freezing in anoebas, using a special- ly designed apparatus placed under a microscope, and noted that there were three different types of freezing: formation of ice inside the cells; formation of ice outside the cells; and formation of ice both inside and outside the cells. He explains that ice is formed outside the cells when the cooling is gradual, but that in rapid cooling ice forms both inside and outside the cells. In any case, the most distinctive phenomenon is the dehydration of the protoplasm during the course of the freezing. He refutes the earlier theory which stated that the freezing of tissue entails the regular formation of ice in the tissue cells, proceeding as follows: ice form first in the interstices of the cells; grows in size by absorbing water from the cells, sometimes becoming as large as 1 cm (TN: sic); and finally, expands the interstices of the cells to such an extent that the cells are eventually destroyed. 9 Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 TABLE 5 FREEZING TEMPERATURE OF FINGERS 1 ' 2 1 3 4 — - 5 6 7 0 9 10 | Mean Freezing Temperature, °C -6.9 -5.5 -4.6 L** — -6.9 -4.6 -3.0 -5.5 -5.2 r m -5 d ... - -J -4.1 -5.2 Freezing Time, minutes 2:05 . -| 3:00 r 3:00 6:05 — -21.o 4:20 4:55 2:25 2:40 K 2:30 Air Temperature, °C -24.6 -22,4 _ - -22,1 ' -24.0 -22.1 ■ i ro -f- ! • L -22.2 -24.2 -22.2 Wind Velocity, ni/sec 0.02 "— 1.10 1.32 1.30 1.02 1.32 1.85 2.70 2,39 2.47 Freeze-Meter Drop Time, sec 29.0 30.0 27.0 20.0 25.0 20.0 25.2 24. C 27.8 22.0 Equivalent * Temperature, C -44 -42 -47 -45 -50 -45 -50 —— -50 -45 -53 TABLE 6 FREEZING TEMPERATURE OF TOES 1 —— . 2 3 4 5 T ! 7 1 0 9 O i—1 iean Freezing Temperature, °C -6,9 -7.2 -7.6 -7.9 -9.1 -7.5 I -6.5 -9.0 -5.9 -7.2 1-7.5 . .. . Freezing Time, minutes 6:00 11:30 32:00 14:40 7:20 10:40 |L0:20 11:00 10:40 6:00 lT Air m 0 Temperature, C -31.0 -20.0 -21.5 -21.5 -30.0 -30.0 -29.0 _ _ .. -29.0 Q r'.. r' -30.0 -37.5 Wind [Velocity, m/sec 1-2 1-2 1-2 1-2 1-2 3-1 0-1 0-1 0-1 3-1 Freeze-Meter Drop Time, sec 26,0 45.0 33.0 33.0 39.0 39.0 30.0 30.0 24.5 30.4 Equivalent Temperature, °C -4S - -30 -39 ... -39 -34 L. ■ ' 1 I -34 -43 1 -43 -50 i -43 ! Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 TABLE 7 FREEZING TEMPER.-TURE OF EAR LOBES n~- . ... L. .... rn 3 4 T 6 Ho an Freezing Temperature, C -5.0 -5.0 -5.5 -6.0 -6.0 -6,6 -5.7 Freezing Time, minutes 7:00 r 1:40 1:40 7:40 4:00 5:40 Air Temperature, °C ... -29 -35 -35 -26 -26 -26 Wind Velocity, m/sec 1-2 1 1 3.71 3.71 1 3.60 4.66 4.05 Freeze-Meter Drop Time, sec 33,0 ,3. 13.0]13.0 i 17.0 16.0 10.0 Equivalent 0 Temperature, C r • below _~70_ below -7° . -65 -60 -63 TABLE 8 FREEZING miERATURE OF NOSE - 1 2 3 4 5 6 7 0 9 — 10 Mean Freezing Temperature, °G -5,0 -4.6 -4.0 -3.4 -5.4 -5.0 -5.4 -5.3 -4.6 -6.6 -5.0 Freezing Time, minutes 5:00 2:37 1:00 2:45 2:00 1:15 2:00 5:00 0:50 2:40 Air o Temperature, C -35.0 -35.0 -35.0 -29.0 -20.0 -20.5 -20.0 -24.0 -35.0 -35.0 Wind Velocity, m/sec 6,64 6,64 6,64 6-7 6-7 6-7 6-7 6-7 3.71 3.71 Freeze-Meter Drop Time, sec 11,0 10.5 11.0 11.0 12.0 12.0 11.2 15.2 13.0 13.0 Equivalent Temperature, C below -70 below -70 below -70 below -70 below -70 below -70 J 0 -O M 0 9 ±1 -70 below -70 below -70 Incl 1, Report TID, GKQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 mug 49 To understand the genesis of freeze injury, it is important to know how the vitality of the cell is impaired or destroyed as a result of freezing. The first problem is to determine whether the cell is des- troyed during the process of freezing or at the time of thawing or re- warning . Botanists Sachs and Dctomea asserted that in the frozen state a plant is not destro3red, but dies only when it thaws, Therefore, if it is allowed to thaw gradually, the frozen plant will continue to live; if it is thawed too rapidly it dies, Other researchers, however, do not agree with this opinion. Geppclt and Lieuller maintain that the cell dies at the time or in the course of freezing and that the speed of thawing has no effect on its death. This view is shared by Molisch* The consensus is that in the plant world, the death of tissue is cruised by the process of freezing and is independent of the speed of thawing* Next we will review the theories concerning the causes of the death of cells by freezing. Geppclt, Caspery, Sachs, and Ncgeri assert that the death of cells by freezing is attributable to the breakdown of the cell membranes due to the growth of ice within the cells. In addition to the damage in- flicted by ice in the cell, Molisch asserts that the cell is squeezed to death by the forr.ia.tion of ice in the cell interstices, Lieuller and Turgow state that in freezing, the death of cells is caused by the rapid adsorption of the greater part of the cell water. Pfeiffer and Metz modify the above opinion by saying that the cell dies when this dehy- dration is accompanied by a certain decrease in temperature, the degree of which differs with different plants. Beleladic consolidates these differing opinions according to the following: 1, Breakdown of cell membranes by the formation of ice inside the cells, 2, The formation of ice is harmless, in itself, but when the ice thaws the cell is destroyed, 3, Even if no ice forms inside the cell, the cell is damaged by ice which forms around the cell in one of the following three ways: the cell is destroyed by the mechanical pressure of the ice around the cell; when the ice forms, it absorbs water from the cell and increases the density of the protoplasm to such an extent that detrimental colloidal changes occur; the ice formed around the cell destroys the outer layer of the cell protoplasm, 4, Ice is formed simultaneously both inside and outside of the cell, mechanically damaging the cell and also causing hardening of the protoplasmic colloid by cooling. These divergent opinions concerning the cause of coll death by freezing may be roughly grouped in two major categories: mechanical damage inflicted by the formation of ice; damage due to dehydration when ice is formed. Incidentally, these theories are based'mostly on studies of plant cells, and little is'known about animal cells, especially the cells of warm-blooded animals. Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 CHAPTER 3 CAUSES OF FREEZE INJURY Section I Cooling Power The human body is like a thermostat which must maintain a temperature of 36*5°C if it is to perform its normal functions and maintain its health. For the maintenance of life or as the result of physical exertion, heat is continuously produced inside the body. Due to the radiation and con- duction of heat from the body’s surface and the evaporation of moisture, the loss and gpin of heat are balanced so that there is no excessive elevation of body temperature. If for some reason this balance is dis- turbed, pathological changes occur. For example, under atmospheric con- ditions permitting only a small loss of heat, i.e., when the cooling power of the atmosphere is small, any sustained physical exertion will cause an increase in the amount of internal heat. The body then attempts to dissipate this heat by perspiration in order to check undue elevation of temperature. If the body fails in this heat adjustment and an excess of heat accumulates, symptoms of heatstroke begin to appear and in serious cases death will result. In this instance the critical body temperature is known to be about 43°C, Similarly, if the loss of heat is greater than its gain, as when the body is exposed to extremely intense cold, it attempts to decrease the surface heat loss by contracting the peripheral blood vessels and, at the same time, by increasing the internal heat production through involuntary movements such as shivering, etc. If the heat balance is not restored, the body temperature will gradually decline until death by freezing occurs. The critical body temperature in this instance is known to be about 30°G, If tissues are heated above 60°C, the albumin coagulates and symptoms of burns appear. If, on the other hand, tissues are excessively cooled, e.g., to -5°C, they freeze, and serious damage is inflicted on the tissue cells. When thawed, the tissues develop symptoms of serious freeze injury. Thus, the vital functions of the human body arc closely related to the cooling power of the atmosphere. To a large extent this same cooling power determines not only food, clothing, and shelter, but also the psychological and physical efficiency of men. In this sense, environment determines the mode of living. The cooling power of the surrounding atmosphere upon the human body' consists of four factors: air temperature, air current (wind), humidity, and radiation. 7/hen speaking of low temperatures, we call this cooling ' power "kan-i" (TN: lit,, cold menace). In determining the cooling power, not only the air temperature, but ail of these four factors must be taken into consideration. In the following we will discuss each of the factors individually and then proceed to the problem of how to measure the cooling power, 1. Air Temperature a. Measurement of Air Temperature An ordinary thermometer is generally used in measuring air temperature, but for the measurement of low temperatures the liquid must be specially selected. The mercury thermometer cannot be used for temperatures below -35°C, since the freezing point of mercury is -33.89°C* For temperatures below -35°C, thermometers containing ethyl alcohol, toluene, or pentane must be used. Ethyl alcohol thermometers can measure temperatures to as low as -100°C: toluene thermometers, -90°C; and pentane, ~200°C, '.Then these special thermometers are used, it is impor- tant to avoid direct sunlight and to choose well-ventilated places. If a thermometer is not available, the temperature may be roughly estimated, using the following as a guide. Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 TABLE 9 Temperature Observation — — Below -20°C Breath freezes on mustache or board0 Below ~30°G 1 Eyelashes freeze and breathing becomes somewhat difficult. Below -40°C Moisture in the air condenses, producing a misty snow which greatly reduces visibility b. Air Temperature in Manchuria and Siberia Although Manchuria and Siberia arc not in very high lati- tudes, they arc two unique areas in the world, being especially noted for their exceedingly low air temperatures. As shown in Figure 1 (Ed, N: ■ Fig, 1 was blurred and not reproducable), the isothermal lino of -16 C, an average January temperature in those areas, runs between Suping and Kaiyuan and comes out across Greenland, passing through the center of Kamchatka on the east, continuing north from the vicinity of Ural'and running into Spitsbergen on the west* According to this, Finland, Sweden, Norway, and Kamchatka, and the southern end of Greenland, which are normal- ly considered to be the coldest countries in the world, all have higher air temperatures than the part of Manchuria north of Suping, This fact is not generally known, In other words, northern Manchuria and Siberia have the lowest air temperatures of any civilized country in the world and may be considered extremely cold zones. In 1012 the invading forces of Napoleon I were defeated in the vicinity of Moscow after the most disastrous casualties laiown in history were inflicted on them by the extreme cold. In December 1939 "the Soviet Army was defeated’ by the Finns in the Karelian Pass because many Russian soldiers were frozen to death or disabled by freeze injury. Incidentally, the area around Moscow and txhe Karelian Pass have tempera- tures corresponding to those of SOUTHERN Manchuria. c. Fluctuation of Air Temperature in Extremely Cold Zones During Winter The daily temperature cycle has its lowest point at dawn, gradually rises with the advance of day, reaches its peak around noon, and then steadily declines in the afternoon, making a sharp fall at dusk. Bar- ring slight seasonal and geographical variations, the range of temperature fluctuation is on the average a little over 10°C, but it should be noted that sometimes it shows a sharp drop of over AO C, In northern Manchuria and Siberia, it is only during the months of July and August that the temperature does not fall below zero. During the period from the latter half of December to the first half of February the temperature often falls below -40°C. In the winter tamo c peculiar climatic cycle, known provincially as "after a throe-day cold spell a warm day returns," occurs in those cold zones, On these occasions the temperature rises from 10 to 20°C above the average,, making life less difficult to endure. This cycle is a climatic freak and cannot bo depended upon. Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 2. Air Current (Wind) a. Measurement of Wind Velocity The wind velocity can best be measured with an anemometer0 However, when the temperature is extremely low ice forms in the instru- ment and freezes the lubricant, making the rotation irregular. The Biram-type (?) anemometer has the disadvantage that any excessive change in wind direction makes it impossible to indicate wind velocity accurately. The wind never blows with a constant force, being interspersed with gusts and lulls, and the intensity of the gusts rises with the increase of wind velocity. If no anemometer is available, the following table will be found convenient for an estimate. TABLE 10 Wind Velocity m/sec. Natural Objects Wind Velocity n/sec. Wind Flag Below 1,5 (calm) Smoke rises straight upward from stacks* plant leaves remain still 1.0 on an upright pole hangs limp; only tip stays away from pole and moves slowly 1.5 to 3.5 (light breeze) Slight wind is felt. Plant leaves stir slightly 3.0 Flag hangs open so that its tip stands at an angle of about A5°C to pole and sways slowly and wide 3.5 to 6.0 (moderate breeze) Plant leaves stir constantly 5.0 Flag stretches to its full width and its tip keeps fluttering b. Wind Velocity in Manchuria and Siberia As shown in Figure 2, (Ed, Note: Fig. 2 was blurred and not reproducable), the prevalent i/iind during winters in Manchuria and Siberia is northwesterly and its velocity is far higher than the winds in Europe, Furthermore, this wind is extremely cooled when it passes through the Belhoyansk (?) district, which is known to heave the lowrest temperature in the world. The winds in Europe, however, arc warmed while passing over the Gulf Stream, c. Fluctuation of Wind Velocity in Cold Zones, It is commonly believed that during the winter the wind velocity is low in extremely cold zones. However, this is only relative, because it is often greater than 10 m/sec, in such areas as eastern Manchuria, Prinokskaya rand Karafuto, It is, however, an established fact that in those districts where the air temperature falls as low as -40°C, the wind very seldom blows. Even in the more windy districts, when the temperature reaches its lowest point there is often a lull; but when the temperature rises the wind blows again. Incl 1, Report TID, GHQ, FEC, APO 500, subject: '’Japanese Experiments in Resistance to Cold," dated 1 Aug 49 3 • Humidity Humidity is difficult to measure during periods of extreme cold, but by using an ordinary hair hygrometer one finds that it is normally o„bout m%. Accompanying the drop in tempered,ure, the humidity approaches its saturation point at an increasingly high'rate when the air temperature falls below -35°C. Thus during cold periods, humidity is always high and shows little fluctuation. 4* Radiation The radiation of the sun also influences the cooling of terrestrial objects. Given the same air temperature, the cooling rate of objects varies according to whether they one under direct sunshine. Thus sunshine or shade influence the degree of cooling power. 5. Methods of Measuring Cooling Power As explained in'the foregoing sections, of the four* factors comprising cooling power, humidity is fairly constant and may be dis- regarded for our purposes, though it is greatly affected by the air ' temperature. Besides ; sun’s radiation, this leaves two variables, air temperature and air current, to be considered in determining the cooling power. In the following we will review some examples of the convention- al methods which are based on the air temperature and air current. a. Theory of "Dokan” (TN: Isothermal sensation or subjectively the same cold (or warm) sensation) Temperature Proposed by 01IAE. It has been pointed out by OMAE that a man can experience the same degree of cold' sensation under two apparently different atmos- pheric conditions, e.g., with the air temperature -15°C on a windless day and -4°C in a gale. The subjective cold sonsa.tio*i is tabulated according to different wind velocities an follows: TABLE 11 Wind Velocity Dokan Temperature No "wind (calm) Light Breeze Mild Wind Fresh Breeze High Wind Gale 1111 -15°C -12°C -10°C - 8°C - 6°C - 4°C b, QThoory that Claims that 1 m/sec, of Wind Velocity Corres- ponds to 1.2 C Drop in Temperature. , Although the source of this theory is not known, it is so commonly accepted that almost everyone is familiar with it. 'Probably it is derived from the following equation proposed by Bansan, a Belgian: P - 26.5 + 0,3t - l#2v-+ - 0.2x Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 where P = skin temperature t = air temperature v = wind velocity, m/soo„ x - degree of temperature rise in a black bulb thermometer Wc know from experience, however, that a wind velocity of 1 m/scc,; t'r.os not always correspond to a temperature drop of arrosponti-'o of the air temperature. For example, wc notice a mankod difference between the conditions of -16°C with no wind and -10°C with a 5 m/scc0 wind, tho former being far more endurable. c. Calculation Using Bansan 1 s Equation Bansan expressed the relationship between skin temperature, air.temperature, and wind velocity by the following equation: P = 31,0 4- 0»2t-v(4«12 - O.X3t) where P = skin tenperature t = air temperature v = wind velocity, m/scc. If we use the above formula to calculate the relationship between cooling power and wind velocity, we will find that at 0°C a wind velocity of 1 m/sec corresponds to a temperature drop of 20,6° and at -30°C it corresponds to a drop of 40c 1°>• This does not quite agree with fact. Moreover, when the skin temperature declines in response to the action of the cooling power, it docs not follow a straight line downward but rather an irregular zigzag curve due to the self-protective action of the body, Considering these points, BansanTs formula is not readily acceptable. d. Freezing Power Meter (Designed by KAMAE) Improving upon the ,:KATAM thermometer devised by Hill, which is not suitable for the measurement of low temperatures, KAMAE designed a new thermometer useful for low temperatures by using a different liquid and changing the calibration so as to make the dcscension speed slower and the measuring errors less. He gave it the name, "Toryoku" meter (Freezing Power Meter), Taking 500 as a factor, he divided it by the descension time in seconds, and let the quotient express the degree of freezing power* Theoretically'it sounds reasonable, but its practical significance seems far-fetched* For example, when we say that the freezing power is 5 or 10 we cannot readily understand how cold it is. Moreover, it fails to express clearly any biological relationship, especially with tho human body. e. Wet-Type KATA Thermometer Under various conditions artificially produced by altering the temperature and wind velocity at low temperatures, the values of the wet-type KATA thermometer were calculated for each condition. Then ' calculating the cooling power from them, using the following formula, we plotted the relationship of cooling power to air temperature end wind velocity in Table 12, Cooling Power - Body Temperature-^Value of Wet-Type KATA thermometer Where Body Temperature = 3605°C Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 We attempted to determine the true cooling powr by taking full account of the three component factors, air temperature, wind velocity, and humidity, but because of the freezing of the wet cloth in the meter and the difficulty of accurately measuring the wind velocity'in extremely low temperatures, some errors were inevitable. Moreover, since the bulb was wrapped with a wet cloth, the effects of the wind on the instrument were somewhat diminished as compared with the exposed parts of the human body. From the values of Table 12 the following empirical equation was formulated and is in practical use (NOMOTO). Cooling Power = Air Temp. + AAP. ToI-1.Paq~ ffpfclorcg* YJ±ncL Velocity Where Body Temp, - 36°C On tho basis of this empirical equation, a cooling power calculation chart (Fig. 3) and a special slide scale (Fig. 4) were prepared to facilitate the determination of cooling power. f. Relationship Between Wind Velocity and Cooling Power (Equivalent Temperature) When a Man is Clothed (Essentials of Hygiene in Extremely Cold Areas) The relationship between wand velocity and cooling is shown graphically in the Manual of Hygiene for Extremely Cold Arens and is reprinted in Table 13* It should be borne in mind, however, that this relationship is valid only when a mail is clothed in standard winter suit, two woolen shirts, and standard cotton underwear. We have seen that there are many different methods of measuring cooling power and that the results obtained from each care not in agreement even when conditions are identical. We arc often at a loss in deciding which method can best be used. Moreover, it is natural that a marked difference should exist between the effects of cooling on the natives of an extremely cold country and on the immigrants from a warmer country. This poses another problem; namely, which is the most adequate method for application to the Japanese who care reared in the temperate zone. To solve those problems we have devised an instrument for measuring the cooling power based on the known cold resistances of the Japanese, wrhich we have called "Kanto Kei" (TN: Cold Sensation Meter or Freeze Meter), g. Uses, Construction, and Operation of the "Kanto Xei” (l) Uses of the Cold Sensation Meter This instrument is designed to facilitate the deter- mination of cooling power (or coldness), which is composed of all the factors that remove heat from the human body, expressing the degree of the power (TN: the author calls it equivalent temperature or corres- ponding temperature) in terms of air temperature under windless conditions. 18 Incl 1, Report TID, GHQ, FEC, APO 500, subject: ’’Japanese Experiments in Resistance to Cold,” dated 1 Aug 49 TABLE 12 RELATIONSHIP BETWEEN WIND VELOCITY AND COOLING EFFECT Air Temperature (°C) Inclined straight lines represent wind velocity FIG. 3 CHART FOR COMPUTING COOLING EFFECT. 19 Incl 1, Report TID, GHQ, FEC, APO 500} subject: "Japanese Experiments in Resistance to Copd." dated 1 Aug }■;) TABLE 13 Clothing: Standard Winter coat and trousers; 2 woolen shirts; standard cotton underwear Amount of Radiated Heat o K millicalories/c® , sec. (2) Construction (See Fig, 5) The above-mentioned cold sensation meter ("Kanto Kci") and an ordinary thermometer (graduated from 0 C to —50°C) arc supported by a metal bracket fixed in a small wooden case. A calculation chart is gluod on the interior of the case for reading the cooling power after the doscension or drop time has been measured. (3) Operation First open the case and expose the cold sensation meter. Then hold the larger of the two bulbs with a warm hand until the red solution inside the bulb expands with heat and rises to fill one-fourth of the upper bulb. (This can be done even when the air temperature is -ZiO°C«) Next, holding the instrument upright, expose the meter to the air, The red solution will.contract and begin to fall. The time in seconds required for the solution to pass between the upper and lower gradu- ations is measured and is called drop time, (A chrono- meter, stop-watch, or wrist-watch can be used for this purpose,) From the drop time the cooling power, i.c., the equivalent temperature, can be read from the com- puted cooling power chart, shown in Table 14. From this table the freezing time of motionless toes and fingers, both bare and when protected with cold climate gloves, mittens, and shoes, can be obtained. This freezing time is expressed in'minutes. Xncl 1, Report TID, GHQ, F3C, APO 500, subject: "Japcncse Experiments in Resistance to Cold,” dated 1 Aug 49 For example, when the drop time is 32 the cooling power corresponds to ~40°C under windless conditionso Under-this condition, according to the accompanying table, motionless bare fingers remain unfrozen for'6 minutes; when protected with cold cli- mate mittens, for 90 to 120 minutes. The attached thermometer is used to measure the air temperature. (4) Precautions in Using the Instrument Ca.ro must be taken to keep the red liquid free of air bubbles. If an air bubble enters the liquid it can be easily removed, either by exposing the meter to the cold outdoor air, causing the solution to contract, or by -warming the bulb so as to expand the solution. In this way the bubble can be easily eliminated from either the upper or lower expansion bulb. If the red solution remains in the upper expansion bulb, it can be returned to its normal position by replacing the meter in the case and shaking lightly two or three times. Mien measuring the cooling power, hold the instrument as far away from your body as possible to avoid its heat, and also be sure that your position mil not block tho wind. Since the meter is highly sensitive to the influence of wind, and the wind velocity is not always constant, it is necessary to repeat the measurement several times to obtain the mean value. It must be stated whether the measurement was made in sunshine or shade. When the air temperature is -4°C or higher the instrument is impracticable, and one majr rest assured that there is no danger of incurring freeze injury. FIGURE 5 Incl 1, Report TID, GHQ, FSC, APO 500, subject: "Japanese Experiments in Resistance to Cold/1 dated 1 i*ug 49 ’TABLE 14 j Average Freezing Times (minutes) Drop Time (seconds) Equivalent Temp., °C ! Bare Fingers or Toes Fingers With Light Glove Fingers With Arctic Gloves Toes With Arctic Shoes, Stockings, & Light Stockings 200 -10 Above 30 Above 120 Above 120 100 -15 70 -20 12 55 1 -25 10 45 -30 8 20-30 90-120 90-120 37 -35 7 32 -40 6 28 -45 5 25 -50 4 10-20 60-80 70-90 22 -55 3 19 -60 2 17 -65 2 15 -70 1 3-5 30-50 40-60 (5) Caution in Carrying the Instrument The instrument should be carried in a carrying case or in the pocket of the uniform. Since it is made of glass, special care must be taken to prevent damage to it. (6) Examples of Cooling Power as Measured by the Cold Sensation Meter The air temperature and the cooling power as determined by the cold sensation meter were continuously measured during the coldest season at a certain place in northern Manchuria (Ed, Note: probably Hailar) and plotted in Table 15. The cooling power (equivalent temperature) proved to be greater than expected. Comparing the cooling powers measured by this meter with those calculated from the values obtained by using the wet-type KATA thermometer, it was found that the effect of the wind is more pronounced in the former than in the latter. Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 Section II Susceptibility to Freeze Injury It is said that as a rule natives of cold countries arc loss sus- ceptible to freezing than natives of warm countries. It is believed that this point can be easily proved by evidence« People often cite the case of two groups of soldiers, one organized from the inhabitants of a cold country and the other from those of a warm one, who were engaged in almost the same military action. While the former group suffered no casualti.es from freezing, the latter suffered heavy casualties. It is also said that the natives of frigid zones can easily endure all types of outdoor labor in cold weather even though they are poorly protected with clothing. On the strength of this evidence, it is concluded that inhabitants of cold countries have naturally strong resistance to cold. This however, is only a superficial view. We already know that many factors are involved in the development of freeze injury and it is not only difficult but misleading to determine susceptibility or resistance to this injury on the basis of only one or two factors. To correct this erroneous conception one has only to road the following passages from the Medical History of the Siberian Expedition. TABLE 15 f OUTDOOR AIR AND EQUIVALENT TEMPERATURES (18 JAN - 22 EKB) "The Russian soldiers and the prisoners from the German and Austrian Armies generally seemed to have strong resistances to cold* Though they were all poorly clad and mostly engaged in cold outdoor labor, they suffered few casualties from freezing* Only the tips of their noses were affected, being colored dark purple. In our opinion, however, their strong resistances are attributable more to their conditioned preparedness against cold than to their inherited physical resistances. Moreover, by force of long-standing habit or training, they seemed to be able to take good care of themselves against the danger of freeze injury. In contrast to them, the situation of the Russian laborers was miserable. The nose tips of many laborers were badly affected by the cold, having turned black or showing scars of old freeze injury. Some were even affected on their checks. In some rare cases ulcers had developed or the noses were de- formed from the injury, but most of the symptoms were of second-degree Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 injury* Natives whose fingers or toes hue. fallen off or with amputated logs were often seen on the road, many of whom were undoubtedly casualties of freeze injury, Wo heard of the incident of a driver who was frozen to death while waiting outsd.de at midnight, A medical ‘officer in charge of the German and Austrian prisoners once told the writer that German and Austrian prisoners were affected by cold most frequently on the logs and then on the ears and nose, while the Russians were injured most frequently on the ears and nose and seldom on the legs. We have already noted in reference to those prisoners that parts of their bodies protected with winter clothing seldom sustained freeze injury because of their habitual precautions against freezing and the efficient administration of emergency treatment. Actually, we know of no evidence that Europeans have a. strong- er natural physical resistance to cold than the Japanese soldiersW; The practical significance of the above historical extract is that more freeze injury casualties result from inadequate protective measures than 'from high natural susceptibilities to cold. However, we do not mean to deny the existence of individual cr racial differences in physical resistance to freezing. The existence of such differences is undeniable. We know from experience that when different persons are doing the same work under the same conditions, equally dressed with protective clothing, and under the stress of the same cooling power, sane sustain freeze injury sooner than others, and some con endure the work for a long time without showing any signs of suffering. Upon investigating the co.usos of freeze injury, we observed some cases where no reasonable cause for the injury other then the person’s physical susceptibility could be found. Therefore it is important to determine the nature of physical susceptibility to freeze injury and then seek data on the body’s tolerance to cold. 1, Critical Cooling Power at Which Physical Resistance Yields Inasmuch as tissue freezing is a prerequisite of freeze injury, a man whose tissues are easily frozen may be regarded as being more susceptible to freeze injury than one whose tissues arc less easily frozen. From this standpoint, we investigated individual and racial differences in cold susceptibility by the finger-freezing test and then went on to determine the critical intensity of cooling power (cold), a. Individual Differences Some 15,000 men were given the finger-freezing test under varying intensities of cold, and their freezing times were observed. By gradually increasing the intensity of the cold up to the point at which the individual differences between the two groups disappeared, we ascer- tained the limit of these individual differences. An example of this is plotted in Tables 16 and 17* These show that at the equivalent tempera- ture of -20°0, individual differences are pronounced, but at -57°0 they completely di sappear. b, Racial Differences A comparative study of the finger freezing time between Japanese and Mongolians showed that the freezing times of Japanese are shorter than those of Mongolians at the equivalent temperature of -36°C, but at -55°C there arc no differences between them. (See Table IS) In short, the limit of cooling power at which strong or weak resistances to freeze injury are revealed is about ~60°C equivalent temperature, and below this limit, neither individual nor racial differ- ences appear. In other words, these differences appear only when the equivalent temperature of the cooling power (cold) is above -60°C. Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold,” dated 1 Aug 49 TABLE 16 COMPARISON OF THE FINGER FREEZING TIMES OF SUSCEPTIBLE AND RESISTANT PERSONS AT-2C°C EQUIVALENT TEMPERATURE Air Temperature -200 to -210 Wind Velocity Equivalent Temperature -20t Resistant Susceptible Pain of Freezing Acute Pain Freezing Pain of Freezing TABLE 17 COMPARISON OF THE FINGER FREEZING TIMES OF SUSCEPTIBLE AND RESISTANT PERSONS AT -57°C EQUIVALENT TEMPERATURE Air Temperature —21°0 Wind Velocity 4.2 m/se0 0 Equivalent Temperature ca. -57 C Resistant Susceptible pain of Freezing Freezing -Pain of Freezing -Freezing, | , , Time (minutes) Incl 1, Report TID, GHQ, FAC, APO 500, subject: "Japrncse Itoerinents in Resistance to Cold,” dated 1 Aug 49 2. Fundamental Nature of Physical Susceptibility to Freeze Injury A large number of researchers have studied the fundamental, nature of physical resistance to freeze injury in many different -ways, but they do not seem to have obtained any conclusive results, Tne main points of their research may be condensed to the following; a8 Differences in the Circulation o.f Blood at the Body1- Extremities b, Differences in the Blood Itself The practical object of their studies has been to determine how much heat is lost when parts of the human body are exposed to intense cold, and then on the basis of these studios to determine if there is such a thing as physical susceptibility to freeze injury, "Jq have already seen that, prior to freezing, the tissues of the living body arc always super-cooled when exposed to a cooling power of ~5°C or below, It seems, however, that as yet'no one has studied the nature of suscep- tibility to this super-cooling, a precedent to freezing. The extent of the super-cooling may be determined by studying the tissue structure and the composition of the protoplasm. a. Differences in the Blood Flow at the Body* s Extremities It has already been noted above that under a comparatively moderate cooling power, Mongolians who live in cold zones sustain frozen fingers less frequently than Japanese who conic from a warmer climate, A comparative test using Moschcowitz’s test showed that the circulation of blood in the lower limbs was far bettor among Mongolians than among Japanese. Our findings arc shown in Table 19. Moschcowitz*s test was applied in the following manner: The subject was placed on his back after removing the clothing from the lower part of his body to expose his legs. One of his legs was straightened and raised upright by an assistant and held in that position until the skin of the leg became pale (this required about 5 minutes). Then a point between the upper and middle thigh was tightly bound with an Esmarch bandage to stop the flow of blood. As soon as the toes become wax-white the log was laid back on the bed, the band quickly removed, and the return of blood circulation to the leg observed, From the moment the band was released, the time required for blood to reach the end of the toes was measured with a stop watch. The speed of this reaction is indicative of the condition of the blood circulation. We also ascertained experimentally that with healthy persons, the freezing time was approximately the same for both the fingers and toes. Using two groups of sixty Japanese each, one group comprised of those classified by the finger-freezing test as strongly resistant and the other poorly resistant, we subjected them to the same test described above. The results showed that the average time required for the return of circulation in both legs was 5,9 seconds for the strongly resistant group and 6*4 seconds for the poorly resistant group. This confirms our opinion that individual differences in blood circulation do exist, even among persons of the same race, and suggests that these differences coincide with the differences noted in finger freezing time, -Moschcowitz’s test was carried out in a warn room even though it was winter, so that we still do not know whether the same results can be obtained under differ- ent test conditions, such as when exposed to a cold environment. How- ever, this problem was studied by YOSHIMURA and IIDA, The results of Incl 1. Report TIT), GHQ, FEC, A?0 500, subject: "Japanese Experiments in Resistance to Cold." dated 1 Aug 49 TABLE 10 COMPARISON OF THE FINGER FREEZING TIMES OF JAPANESE AND MONGOLIA'S No. Nationality Freezing Time Ratio Japanese Mongolians r . . - . Remarks « < 1 Japanese Mongolian 00 sec 113 sec ■ 1 I 1 : 1.41 ! 1 ; 2 Japanese Mongolian 105 sec 100 sec 1 : 0.95 Air Temperature ' -306C i I Wind » Velocity 3.65 m/sec i i i ! ! 1 1 3 Japanese Mong©lian 50 sec 52 sec 1 : 0.90 4 Japanese Mongolian 64 2*3 c 76 sec 1 : 1.9 5 Japanese Mongolian 56 sec 160 sec 1 : 2.86 6 Japanese Mongolian 108 sec 90 sec . 1 : . 0.83. .. 7 Japanese Mongolian 75 sec l/[0 sec . . 1 : 1.87 8 Japanese Mongolian 44 sec 86 sec 1 .1. 1-21 , 9 Japanese Mongolian 44 sec I36 sec 1 : 3.09 10 Japanese Mongolian 93 sec 118 sec 1 : 1.47 . . Average Japanese Mongolians 72.8 sec 107.1 sec 1 : 1.47 Mote: The tine is measured from the instant finder tin temperature is 10°C until the skin is perceptably j frozen TABLE 19 COMPARATIVE STUDY OF BLOOD CIRCULATION IN THE LEGS OF JAPANESE AND MONGOLIANS ... ... ■■ —— * Race m ■ IL r"1 m""1 r r * ■ Japanese Mongolians Leg Right Left Right Left Time Required for Return, of Circulation . - 1 (2.3?;) 14 (31.gS) 15 (34.15?) 12 (27.35?) 2 (4.5?) 1 .(2.3?) 20 (45.5?) 15 (34.1?) 6 (13.6?) 2 (4.5?) -r—r- - - 26 (59.1?) 17 (36.6?) 1 (23?) 0 0 25 (56.8%) 19 (U3.2%) 0 0 0 0-5 sec 5 -10 sec 10 -15 sec 15 -20 sec 20 -25 sec Xnol 1, Report TID, GHQ, FeC, APO 5GO, subject: bcperbeents in Resister.ee to Gold," dated 1 Aug 49 thqip research is reviewed below. Y0SHIMURA and IIDA approached the problem of susceptibility of freezing from another angle; namely, the physical resistance to freeze injury, calling it "Freeze Injury Resistibility," After an exhaustive examination of the fifty odd conceivable factors that influence this resistibility, they singled out as most important the anti-freeze action of the skin resulting from the reflex action of the local blood vessels in response to cold. When exposed to low temperatures, all living bodies (warm blooded animals) react by contracting their peripheral blood vessels so as to physically maintain their body temperature. Alien the heat loss is so large that the skin temperature cannot be maintained above 0°C, however, the system attempts to fight off the danger of freeze injury by reflexively dilating the peripheral blood vessels to allow more blood to circulate, and thus raise the skin temperature. Two different theories have been proposed concerning the mechanisms of this reflex action: the reflex action of .arteriovenous anastomosis (KUN0); and the reflex action of the capillary blood vessels. In any case, one thing is certain: there are appreciable individual differenebs in the reaction of the blood vessels to cold. Terming this the "Blood Vessel Reaction to Cold," those researchers went cn to determine physical resistibility on the basis of this reaction. They devised a method of measuring the resistibility known as the "Point Tost of Freeze Injury." The procedure for the "Point Test" method is given below. The required apparatus consists of: Thermoelectric Pyrometer (millivoltmeter with sensitivity greater than 1/20 millivolt) Copper-Constantan Thermocouple Dewar Vessel for a Cold Junction Ice tank to Lamersc Fingers The thermocouple is attached to the back of the last knuckle of the left middle finger with adhesive tape and coated with vaseline to make it waterproof, The finger is then immersed in the tank of ice at 0°C for 30 minutes. The temperature of the finger tip is taken every minute during the test. The plotted curve of the skin temperature is then analyzed and evaluated by a point system according to the standard given in Table 20, In order to prevent the laboratory room temperature from affecting the reaction, it should be maintained about 10 to 23°C, The sum of the points is called the index of freezing resistibility, 8 to 9 points are an index of the strongly resistant, 5 to 7 the fairly resistant, and 3 to 4 the poorly resistant. This is further evidence of the close relationship existing between blood flow at the extremities and resistance to freeze injury. b. Differences in the Blood In determining physical resistibility to freeze injury, not only the blood circulation, but also the blood itself must be examined, T'Ihen exposed to cold temperatures, the blood itself plays the most important role in maintaining the temperature of tissues at the extremi- ties, If a man’s blood circulation is easily disordered by exposure to low temperatures, his extremities mil soon lose heat and sustain freeze injury. At 0°C, the blood gradually loses its heat, giving rise to a Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 phenqmonon in the blood vessels known as cold aut c herna g glut inn t i e, wt,i *:h occludes the capillary blood vessels and obstructs the flow of bl;od> This hematological action was first studied by Ascoli, who called it the cold autohemagglutination reaction. Since than a number of Japanese scholars have studied this subject, KUBO, for example, attempted to explain the death of tissue in terms of this reaction, and P.TAI attaches importance to it as a possible cause of Raynaud*s disease, 2nd Lt„ WATANABE (MC) examined various ailments in which intense'cold acts either as a direct or indirect cause, such as Raynaud’s disease, spontaneous gangrene, frostbite, and cases of the special physical condition in which the extremities are abnormally cold, known as "Mattan ketsurei shon (TN: lit,, disease of cold extremities), He concluded that this reaction always plays a prominent role. Summarizing the conclusions of these researchers, we understand that the agent which causes this cold autohcnagglutination exists in the globulin of warm-blooded animals and that the agglutinating power of the agent increases vdth the decline of temperature to zero and "weakens with the rise of temperature. Furthermore, this agglutination reaction is reversible, i,e., once agglutinated, blood corpuscles can be made to separate by heating. This agglutinin has little specialty and is both an autohemagglutinin and a homogeneous hemagglutinin. It is .also a heterogeneous hemagglutinin. A comparative investigation of this reaction between natives of cold zones who are strongly resistant to freeze injury and people of warmer climates who arc poorly resistant gave us very interesting results, as shown in Tables 21 and 22, These results showed that outstanding individual and racial differences do exist. The agglutination titers arc highest among freeze injury patients and become lower in the order of Japanese, Mongolian, Manchurian, and Russian. The speed of this reaction is also highest among freeze injury patients, declining in the order of Japanese, Manchurian, Mongolian, and Russian, During the winter Japanese have higher agglutination titers, and the reaction occurs more quickly than with natives of cold zones. TABLE 20 Points 3 Lla n 1 Average Skin Temperature (5 min to 30 min) Above 7.1°C 7.0° to 4.1°C Below 4.0°C Time Required for Blood Vessel Reaction Less than 7 minutes 0 to 11 minutes More than 12 minutes Temperature at Instant of Blood Vessel Reaction Above 4.1°C 4.0° to 1.6°C Below 1.5°C Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dented 1 Aug 49 TABLE 21 COMPARISON OF THE COLD AUTO HEMAGGLUTINATION REACTION VALUES .’LONG JAPANESE, MANCHURIANS, MONGOLIANS, AND RUSSIANS Dilution of Blood Serum 1 i ‘ * . 1:4 1:8 1 1:16 ■ 1,32 1:64 Remarks j _ Race — L* -— ■ i Japanese 0% (S 17% s« 17? j i .... Manchurians 10% 1 ■ 10% 40% i ! vo o ; ea i .. io? o? ■ Mongolians 0% 0% 30% /O 0 30% 10% ..... {Russians 30% u.% J l/° —— 0% 2» 9 persons examined TABLE 22 COMPARISON OF THE COLD AUTOHEMA GGT LTINA IT ON REACTION VELOCITY AMONG JAPANESE, MANCHURIANS, MONGOLIANS, AND RUSSLIMS Cooling Tine After One Hour After Two Hours Total Race Japanese 66% 25% 91% Manchurians 100 0% 70% Mongolians 20% 50% 70% Rus sians 0% 10% l&% Freeze Injury Patients (Japanese) &0% 20% 100% 30 Incl 1, Report TID, C-HQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 TABLE 23 RESULTS OF THE COLD AGGLUTINATION REACTION TEST COMPARING THOSE SUSCEPTIBLE** TO FREEZE INJURY AND THOSE RESISTANT** (43 PERSONS TESTED) No. S or R Equiv, Temp. °C L - Freezing Time Agglutination Titers 1:2 1:4 1:8 1:16 1:32 1:64 1:12£: 1:256 I _:512 jl:1024 1 R L 19’00” 4-4- H- -4— — — — ... — S •3*00" ■H- j-H* -H- fr- — •—— j 2 R -35 ''“38*00" nr H- —)— ■gtr ...... —— — — -S- I. 3*00” ftf m r-H -H- n4- —f— ram." i —— „ »„ , 3 R -40 . 15!00n -Hi —r H— -n- — — — ———-4- — — £> 3*00" n+ +H- tt~ nr nn- >r* — — 4~ R -40 • - 15*00" ■ht -rr r—7—— rm — — —- — S ~tT2QTT -jn ~rr m nr ~t+- nr r±r — — — 5 R -45 15!25" -H- 3T — — — — — o TTTTTr* -4-- -+t -tr rr- -H— —■ -n— ........ 6 R r -45 *69*00" *+t — — — —_ — -— b TOP'’ —w- nr+ n*- -r- —— -r- r— *n— 7 R -45 12*00" •ft ft -+r ——| -H- — nr —1- — — — 6 “"2*00" ' -ft ~Of r+t ■rtr nr *r— j —4— —i— rtr 8 R -40 25*00" •*r —1— -t— 232 | ■ -~l,“ — — 8 . 2*30" -Hr rtt i-r -4- —♦— —— — — 9 R -40 *25*00" -r -n —r r- 1±1 — — — 8 4*00" " nr ■tr nf- -rr— nr -H- — rtr —» — 10 -§- -45 15*00" 11- -tr —r- r- — — —- — ~H4 1 -Mr n* —•H*- rr nr *n— —r- 11 iJL s "wi _I2UQQ!L, -it -4+ -4— n— rtr. — — — — . ... 1*40" •Hr —H- -rr nr nr n— zh. rtr — — 12 ■ R -35 *45*00" -tf -r —T —t— — — —— — — — S ‘ 2T307r "1 •■H+ it* n-H« nr —H—• -n- — ■—1— — — 13 R -25 *20*00" f~ —r —t- — — — — — — — 47®" H *nt -it- nr nr nr- -r rfc — — — 14 R -45 15*35" -r -T —r- ~r~ — — — — — S 4*00" Hit ~trr nr nr nr nr- — r±r — — 15 • R ! An 12*05" -jT rr —H —r- — — — — — — s 2T55U •ft t+“ -tr n— -t- •n— nr — — — 18 R -40 11*35” nr ~r —r n- ~r — — — — — 3T no71— Hft - t nr- rr r n— — itz — — 17 , R . -40 21*30" n- -IT- •r n_ — — — — — — 3T30" -ir ~*r —r r n— —r — — — — 18 R -35 19*00" tit it* fr m — — — — — — s3 1*30" n+~ ~tr nf- nr n— — — — —— 19 R -35 *20TOO" +4 •fr -r -r n— — — — — —* s3 3 *5 O'” -Hr -H- -tr -H- -44- -n- — r±r — — 20 R -35 *20*00" -r —t* n- — — — — — — — 8 TOO"—1 -Hf '*4 -•H4- -nr — nr — — 21 • -EL. s -30 60*01" -+f —I— 122 — — — — — — 4*30" Hit n+ -tr nr nr nr — — — 22 R ~52r,tXJn— ir •tr -tr* 7H2Zir — — — —— S " 5"’ 00" ' Ttt rr -tr nr nr nr —r ] nr — 23 R -^0 30*00" trt- rr n— ~r — — ! — — S —PU H 2*50" •+H* rr- ~*r n— iW* rtf* j —— 24 l _s_ JLJ -30 52*00" -t- -T -r- — ; " 1-11 — : — — 4*00" h4 -H+ nr- nr nT* nt— -r- I — — S = Susceptible; R = Resistant **(TN: May be also translated as easily frozen vs. difficulty frozen; or weakly resistant vs, strongly resistant) *(TN: An illegible character preceded these numbers. Apparently it refers to cases where the test was prematurely suspended wiicn the subject was forced to leave because of military duties.) 31 Incl 1, Report TID, GHQ, FEC, AP0 500, subject: "Japanese Experiments in Resistant to Cold,” dated 1 Aug 49 When the same comparison was repeated among Ja.panesc, we found that there was a conspicuous difference between the agglutination titers of the men who had been classed as strongly resistant by the finger- freezing test and those who had been classed as weakly resistant. The average titer of the strongly resistant was 1:29, while that of the weakly resistant was as high as 1:200. In this test we used 51 men from each ' class, selected out of a total of 1500 men, and followed H0NNA!s method, an improved version of the conventional cold autohemagglutinntion reaction test method. Any doubt concerning the occurrence of this agglutination reaction in the blood vessels can be clarified by the following animal test. Two rabbits were selected on the basis of the test tube test, one with a high titer and the other a low. Their eyeballs were irrigated with cold water, and the appearance of the agglutination reaction was observed by examining the capillary blood vessel of the ocular conjuntiva through a corneal microscope. Agglutinative thrombi appealed in the blood vessels of the rabbit with a high reaction titer a few minutes after the cold water irriga.tion was begun, and the blood vessel became occluded. In the case of the rabbit which had a low reaction titer, the agglutinative thrombi did not appear even after hours of cold water irrigation, and the flow of blood was never obstructed. 3. Method of Eliminating Persons Susceptible to Freeze Injury From the standpoint of efficient utilization of personnel, it is advantageous to predetermine which soldiers are particularly suscepti- ble to freeze injury, so that they may be given special attention in their outdoor duties in extremely cold climates or be given special consideration in their duty assignments. It is important that some means be found to measure increases in the physical endurance against cold of those persons susceptible to freeze injury. Therefore, it is necessary to secure a reliable method of identifying persons susceptible to freeze injury. It is also imperative that such a method should be easily appli- cable, so that a large number of men may be tested in a short time. In the following we will mention the method we are using at present. Under conditions of ~10°C air temperature and -30u to ~50°C equivalent temperature, the soldiers are subjected to the finger-freezing test to determine their susceptibility. After donning cold climate clothing indoors lining up outside, they remove their cold climate hand- wear, expose their arms up to the elbows, and spread out their fingers. Their arms are stretched forward and their hands held shoulder-high. Starting from the moment the hands are exposed, the time required for the fingers to freeze is measured. In determining physical resistance to freezing by the finger-freezing test, the freezing times for bare fingers given on the table accompanying the cold sensation meter are taken as the standard. Men whose fingers begin to freeze within a minute of the mean time are classified as fairly resistant, those whose fingers freeze in a longer time as strongly resistant, and the remainder whose fingers freeze in less time are classified as poorly resistant. The last class is regarded as being susceptible to freeze injury. In applying this test, one must be sure that the fingers are exposed to a constant cooling power by giving special attention to the wind direction and the cxistance of buildings in the vicinity, since these factors may interfere with the accurate appraisal of the test results. Sunshine must also be carefully considered to determine the effect of radiation. Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 If time and materials are available, the ’’Point Test" devised by YOSHIMURA and IIDA should be utilized as a double check. In determining susceptible persons, the following indications care known to be useful: Freeze injury, frostbite, and skin diseases sustained in the past; Any trauma sustained on the limbs in the past especially on the extremities; Dysidrosis and dysidrosis olea of the feet. The latter case may be easily detected by observing the inside of the person.1 s shoes. If the inner soles are wet and soiled black, we know that the person’s feet sweat too much. Another method is to let the person stand barefooted on a clean floor (preferably linoleum-covered); if his feet leave distinct marks after 20 or 30 seconds, we know that his feet swoat excessively. Weakened condition from convalescence; Poor blood circulation at the extremities of the limbs; Roared in a. warn climate; Easily overstrained sympathetic nerves; Aged or infant. These are the conventional aids in the determination of potential freeze injury casualties, but we believe our finger freezing test is more accu- rate and reliable. Section III Factors That Increase the Effects of the Cooling Power Even under the same cooling power, the loss of body heat is often accelerated by other factors such as physical and atmospheric conditions, eventually resulting in the freezing of tissue. In the following we will examine these factors and determine to what extent they intensify the cooling power. 1. Moisture We are often reminded that moisture is an important factor in the development of freeze injury. Since the extent to which the loss of body heat is accelerated by moisture was unknown, the following experi- ment was conducted. An index finger was wetted by dipping it in lukewarm water (20°C), while the middle finger of the same hand was left dry. Then both fingers -were exposed to the same cooling power to sec how long it would take them to freeze. The results, as tabulated in Table 245 show that the wetted finger froze'in about half the time required to freeze the dry finger. In other words, the effects of the same cooling power upon the wet finger were twice as great as upon the dry one. Incl 1, Report TID, GHQ, FSC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 There are'two sources of such moisture; one is external, u .v as rain, snow, ice, and water; and the other is internal, -pci spirat.io*ic Of the two, the external source requires our special attention. 2, Obstruction of Blood Circulation We have already noted that when the easily frozen extremities of the human body arc cooled, the blood circulating in those parts supplies the heat required to counteract further cooling. Should this blood flow be obstructed in one way or another, the anit-cooling action is weakened or ceases, and continued loss of heat will load to the onset of freeze injury. In this connection, one may recall that a wounded leg dressed with a tourniquet or a foot in an undersized shoe is easily frozen. The influence of a tourniquet in inducing freeze injury can be seen from Tables 25 and 26. Thus the use of a tourniquet doubles the speed of body heat loss. VJq obtained this result from experimentation with healthy persons. Needless to say, in the case of a wounded limb, the loss of heat is further accelerated by bleeding. 3. Contact with Cold Metal Most weapons and equipment are made of metal, and since the thermal conductivity of metal is far greater than that of air, if cold * metal is touched with a bare hand or one covered with only a thin glove, the hand will be rapidly cooled and often frozen and will develop freeze injury. If the hand is moist, it will be frozen feast to the metal and mil be difficult to remove. TABLE 24 FREEZING TIME OF FINGERS, DRY AND WET No, Freezing Tine 1 Air Temp, °C 1 Equiv, Temp. Ratio of Wet Finger (Index) ; Dry Finger (Middle) freezing Times 1 1*42" 3f00" -35.4 -50 1 : 1.8 2 2*12,f 4* 42" -36.2 -50 1 : 2.1 3 1*32 2*33 -36.0 -55 1 : 1.8 4 2*05" 3*10" -35.0 -60 1 : 1*5 5 1*14” 2*17" -36.3 -60 1 : 1.9 / 0 1*58" 3*07" -33.8 -60 1 : 1*6 7 l'ov 2*27" -36.4 -60 1 : 2.2 8 1T1611 2*40" -34.6 -60 1 : 2*1 9 1T 21n 4*15" -35.0 -62 1 : 3.4 10 1*06" 2*10" -34.4 -67 1 : 2.0 11 40" 1*13" -35.0 -70 1 : 2.9 12 20” 38" -35.0 -70 1 : 1.9 13 38” 1*04" -37.3 -70 1 : 1.7 14 33" 1*03" -36.4 below -70 1 : 1.9 15 52”(ring) 1*50" -36.5 below -70 1 : 2.1 16 25" 52" -36.4 below -70 1 : 2.1 Remarks: 1, Temperature of immersion water: ' 20°C 2, Avera gc Ratio of Freezing Time: 1 :' 2.1 Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 TABLE 25 FREEZING TIME OF FINGERS WHEN TOURNIQUET IS APPLIED TO LEFT UPPER ARM No. Tourniquet Applied to Left Am Right Arm Tilth out Tourniquet Air Temp. °G Wind Vel. (m/soc) Equiv. Temp. °C 1 2*30" £*00" -34.0 1.00 -55 2 4'35" 9*10" -34.0 1.00 -55 3 1*44” 3t44” -36.0 0.46 -53 4 1*56” 2*21" -36.0 0.46 -53 5 1*30" 2*07” -36.0 0.46 -53 TABLE 26 FREEZING TIME OF TOES WHEN TOURNIQUET IS APPLIED TO LEFT THIGH No. Tourniquet Applied to Loft Thigh Right Leg Without Tourniquet Air Temp. °C Wind Ve 1. (n/scc) Equiv. Temp. °C 1 2*38" 4T5i" -34*4 0.94 -55 2 4f 50" 9,05" -34.4 0.94 -55 3 4f 00” 9*10" -34*4 0.94 -55 4 4*00" 6*00" -34.4 0.94 -55 5 4'35" 7*09" -37.7 1.29 -65 Section IV Other Factors Cold climate clothing is important in the prevention of body heat loss. If it is not thick enough to insulate the body from the cold, mis- fits the wearer, has open scans, or is wet, it often induces the develop- ment of freeze injury. Food is an important source of heat to make up for heat lost through cooling; hence malnutrition naturally induces freeze injury. Hunger often entails physical and mental exhaustion, weakens the will power, and destroys thinking ability. In such a mental state, non inadvertently neglect to take proper precautions against freezing. Likewise, fatigue and lack of sleep lessen a resistance to cold, and indirectly cause the development of freeze injury* Incl 1, Report TID, GHQ, FSC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dcated 1 Aug 49 CHAPTER 4 RELATIVE SUSCEPTIBILITY OF VARIOUS BODY PARTS TO FREEZE INJURY Bece.use of the relatively large ratio of surface area to volume when compared with the rest of the body, the appendages, such as fingers, toes, car lobes, and nose are'naturally more susceptible to freeze injury. Of the four parts named above, which is most susceptible? A review of the medical records of past vers and incidents reveals that the toes are most frequently affected by freeze injury, as shown in Tables 27 to 31* Among the toes, the first and fifth toes are most often affected. Some- times the calcanei are also affected. CHAPTER 5 SYMPTOMS OF FREEZE INJURY The symptoms of freeze injury develop after the frozen tissues have thawed. Even though no external abnormalities are detected immediately after the frozen tissues have thawed, various symptoms usually begin to appear in the course of time. We know of cases where bullae appeared while thawed tissues were being treated. In retarded cases the bullae did not appear until 24 hours after thawing. The stages in the develop- ment of serious freeze injury are illustrated in Plates I to VI. In any case, it is impossible to predict whether symptoms of freeze injury will develop immediately after the thawing of the frozen tissues, end it is extremely difficult to appraise the seriousness of the symptoms once they have developed. Usually, various symptoms, differing in seriousness, appear in a certain time after the frozen tissues have thawed. In prac- tice, freeze injury is classified into three degrees according to the relative seriousness of the symptoms; namely, first-, second-, and third- degree freeze injury. The distinction between these is not so clear-cut, however, as third-degree freeze injurjr always entails the symptoms of the TABLE 27 FREEZE INJURY CASUALTIES DURING SINO-JAPANESE W/iR Part Number of Cases Percentage Feet 2,901 86.5 Hands 339 11.6 Ears 32 1.0 Nose 8 0.2 Penis 16 0.5 Others 9 Oil . TABLE 28 FREEZE INJURY CASUALTIES DURING RUSSO-JAPANESE VJAR FREEZE INJURY .-1 Part Number of Cases Percentage Toes 370 93,0 Fingers 27 6 Nose 1 - ... 0.2 „ Total 398 100.0 Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 TABLE 29 FREEZE INJURY CASUALTIES DURING SIBERIAN EXPEDITION Part Number of Cases — - ■— Percentage Face 1 0.2 Ears 5 1.2 Toes 167 39. e Fingers 54 12.9 Penis 2 0.5 Hands and Fc )et 191 45.5 Total 420 100.0 TABLE 30 FREEZE INJURY CASUALTIES DURING MANCHURIAN INCIDENT Part Number of Cases Percentage | Face 10 0*7 Face and Hands 1 0.1 Face and Feet 13 0.9 Face, Hands Feet 5 0.4 Hands '129 9.2 Feet 1,048 74.5 Hands and Feet 200 14.2 Total 1,406 100.0 TABLE 31 FREEZE INJURY CASUALTIES DURING CHINA INCIDENT Part Number of Cases Percentage Foot 44C S3.9 Hands 44 8.2 Hands and Fe< 3t 37 6.9 Ears 2 0.4 Ears and Feet 2 0.4 Ears, hands, Feet 1 0.2 Total 534 100.0 Incl 1, Report TID, GHQ, FEC, APO 500, subject: ”Jappjiese Ebqperiments in Resistance to Cold,” dated 1 Aug 49 PLATE I PLATE II Incl 1, Report TID, GHQ, FSC, AFO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 PLATE III PLATS IV Incl 1, Report TID, GHQ, FEC, -*.P0 500, subject: "Japanese Itcoerieients in Resistance to Cold,11 dated 1 **ug 49 PUTS V PUTS VI Incl Report TID, GHQ, '-P0 subject: "Jap me sc Experiments in Resistance to Cold," dated 1 Aug 49 first and second degree, and the second degree those of the first degree. Hence it cannot be decided whether freeze injury can be rigidly classified into these three degrees. Some people attempt such a classification in the early stages of the injury, but at present it is still difficult to do so. Section I First-Degree Freeze injury When thawed, the frozen parts become swollen and inflammed, accom- panied by an itchy sensation, slight pain or local anesthesia. These symptoms will disappear in a few days and no functional disorder will result. Section II Second-Degree Freeze Injury In addition to the symptoms of first-degree freeze injury, serous or blood-serous bullae appear, and the patient complains of irritation or pain (sec photographs). As a rule this freeze injury is rather easily healed and does not leave any trace of cicatrix; but sometimes the bullae break, and an ulcer develops. The latter is accompanied by acute pain, and healing is prolonged. Freeze injury in this degree may be regarded as a transition to the third-degree injury. Section III Third-Degree Freeze Injury After the frozen tissues have thawed, this degree of freeze injury- takes one of two courses. Either it develops with the same external symptoms as the second-degree injury and then the tissues become gangrenous, the symptom of fully developed third-degree freeze injury; or the tissues remain pallied and cold after thawing and develop gangrene directly without presenting any intermediate symptoms such as bullae. Even in the former case, the affected parts have dark purple bullae which arc very cold and without sensation. In any case, in the course of tine the affected parts gradually turn black, presenting unmistakable signs of gangrene with a clear-cut line of demarkation between the injured and healthy parts. TOKURA investigated the time required for the major symptoms of gangrene to develop and the line of demarkation to form. His findings are given in Tables 32 and 33. The injury turns black about one to three weeks after onset, and about two to three weeks are required for the line of demark- ation to form. After studying the subject from the histological stand- point, SHIMADA concluded that it requires at least a week for the demark- ation line to develop. The gangrene may be exhibited in two ways: either as dry gangrene where the affected tissue is black and dried he>rd like a mummy or soft and infected with bacteria. In the former case normal inflammation occurs at the junction of the affected parts and the sound, usually inducing desquamation of the gangrenous parts. In the latter case, however, the inflammation at the line of demarkation usually becomes more serious and, by putrid intoxication through the absorption of degener- ated tissue or incurring serious phlegmon, develops dangerous general symptoms. The following photographs show the symptoms of third-degree freeze injury. 41 Incl 1, Report TID, GHQ, FEC, A?0 500, subject: '’Japanese Experiments in Resistance to Cold," dated 1 Aug 49 CONFIDENTIAL E?ir Face Face and Wrist 42 Incl 1, Report TID, GKQ, FEC, APO 500, subject: "Japanese jjbqporiiaents in Resistance to Cold/1 dated 1 Aug 49 Hands Hands Feet Incl 1, Report TID, CrHQ, ¥ZC, ISO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 49 TABLE 32 TIME ELAPSED FROM ONSET OF FREEZE INJURY UNTIL DISCOLORATION OCCURS Tine Elapsed (Days) Number of Patients 5-10 15 11 - 15 34 15 - 20 29 Over 21 i— . TABLE 33 TIME ELAPSED FROM ONSET OF FREEZE INJURY TO FORMATION OF JUNCTION Tine Elapsed (Days) Number of Patient s Within 10 3 11 - 15 13 16 - 20 31 21 - 25 19 26 - 30 k Over 30 8 Unknown 2 Face and Neck Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold,” dated 1 Aug 49 Hands Feet JL V> \J Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 CONFIDENTI Hoc! Genitals Incl 1, Report TID, GHQ, F3C, AFO 500, subject: "Japanese 3::perinents in Resistance to Cold," elated 1 Aug 49 Hands and Foet Thus it is not so difficult to classify the symptoms of freeze injury into various degrees by observing the subsequent course of development. However, for an accurate prognosis, it is often imperative to decide with- out delay which degree the symptoms indicate. As stated before, this is on extremely difficult task. The symptoms listed in Table 34 mil assist one to make an approximate diagnosis of the injury without the risk of too large an error. TABLE 34 METHOD OF DIFFERENTIATION IN THE EARLY STAGES OF FREEZE INJURY Second-Degree Freeze Injury Third-Degree Freeze Injury 1. Red or light purple appearance 1. Pallid, dark red, or dark purple appearance 2, Affected part is warn 2. Affected part is cold 3, Sensation exists but tends to 3# Anesthesia of the pert become dull 49 Contents of bullae are serous 4* Few bullae exist and any and can bo easily removed by extant bullae are very inconspi- pricking with a pin point cuous, Contents ore cither dark purple .and bloody or colloidal •and difficult to remove 3. Painful sensation when pressure 5. No painful sensation when is applied pressure is applied 6, Bleeding occurs when the skin 6, No bleeding occurs even when is cut the skin is cut to the perios- teum. The soft tissues present the appearor.ee of putrid flesh 7. Surface of the bullae is tense 7. Surface of the bullae is small ennd soft; feeling of vacuity Remarks: 1. Incision is important, not only for diagnosis but also for treatment 2. Bleeding is judged by r rtcrial b3ood In cl 1, Report TID, GHQ, FEC, A PO 500, subject: "Japanese Experiments in Resistance to Cold,” dated 1 Aug 49 CHAPTER 6 TREATMENT OF FREEZE INJURY We have already pointed out the common but incorrect practice of regarding any frozen port of the body that has turned wax-white in color as freeze injury. At the same time we stressed the need of describing the pathological changes that appear after thawing as a sign of the develop- ment of freeze injury. With living tissues, and even with dead tissues, the extent to which they arc damaged varies with the method of thawing, Though different parts may be frozen to the same degree, some develop symptoms of serious freeze injury while others do no. For this reason, it is imperative that freeze injury bo treated in the following two steps, each adequate for each stage of development: Treatment prior to appearance of secondary symptoms (treatment of frozen tissues); Treatment after appearance of secondary symptoms (treatment of the injury)i The two methods arc described in detail below. Section I Treatment Prior to Appearance of Secondary Symptoms This is a treatment for the frozen tissues prior to the development of freeze injury. In this treatment the tissues are thawed by previously known procedures which are comparable to emergency or first .aid treatment, The object of this treatment is to thaw the tissues in the most rational way so as to mitigate the injury to then. It is the most important stop in the cure of freeze injury. Success or failure at this stage of the treatment determines the seriousness of the subsequent'course of the injury. If the frozen tissues arc incorrectly treated, serious freeze injury, which would not otherwise occur, will result. The accompanying photograph shows how frozen fingers, in which serious freeze injury could have been prevented by correct treatment in the early stage, were injured to such an extent that all digits except the right thumb were lost. Note: Air Temperature -13,9°C, no wind. The right thumb ms saved by thawing at 50°C for about 10 minutes. Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Ibcperimcnts in Resistance to Cold,” dated 1 Aug 49 It should be noted that the victim himself or his comrade must frequently administer this pro-symptomatic treatment without the assis- tance of medical personnel* Inasmuch as the important factors involved in serious freeze injury are the length of time the parts arc frozen and the intensity of the cooling power. it is always foolish and dangerous to waste tine awaiting the arrival of modi.cal personnel* Therefore. medical personnel should insure that all men are thoroughly familiar, with the application of the thawing treatment. The essentials of this thawing treatment for frozen tissues are twofold: first j to bring heat bo the affected part (at a temperature close bo that of the body) to start the thawing; and second* by some mechanical stimulus to restore the flow of blood in the affected part so that production of natural heat will be accelerated* One point ox difference is that in the ccnvcntional treatment thawing is begun at a low temperature and the temperature is gradually raised.* Since this is o, much disputed point we wil' review sexto of the arguments about cold thawing During the -Siberian Expedition, lumps of snow or cold compresses wore used in the cold thaving treatment* In the Manchurian Incident this practice was discarded by Majt. Gon, TANARA (MC) and 11aj© KUNTEDA (MO) on the grounds that massage with lumps of snow or cold compresses inflicted mechanical injury on the frozen parts, They suggested instead that the use of dry cloths or bare hands would achieve a more satis- factory resulte Various papers published in Japan recommend the use of lumps of snew and cold compresses for rubbing the frozen parts of the body* This idea, rcc-emncndod as practical by such authors as Lexer and Schushiden, is discredited by Behring for tno reason that the loss of heat resulting from the application of lumps of snow is greater than the heat produced by rubbing and that thawing of the frozen parts is there- fore difficult,, He recommended a gradual warming of the parts* Many explorers of the frigid zones arc said to have discarded the method of massaging with lumps of snow because it is harmful. in the author•s opinion, these conflicting conclusions wore influ- enced by trie different'intensities of the cooling power that induced the freezing, as well as by the localities at which the thawing treatment was administ-crodt Inasmuch as the average temperature at which tissues freeze is below -5°C, it goes without saying that effective thawing requires a temperature above zero*. Once wo froze our fingers experi- mentally in the open air during the coldest season and then rubbed them with lumps of snow* As a result the frozen parts, instead of thawing, swelled. YOSHIlfJRA obtained very valuable experimental results by the use of lukewarm water 7C0) to thaw til? frozen tissues , Satisfactory results were also obtained when wo conducted the sane experiment. Warning the frozen parts by immersion in lukewarm vr,tor is a suitable method of. emergency treatment end often helps arrest at the first or second degree freeze injury which would otherwise progress to the third degree-. The optimum water temperature is 37°0 , but anywhere between 20° and 40°C is deemed satisfactory.. Immersion for about 30 minutes is sufficient.,- In the ovonrh that warn water is not available., it is imperative that any object, available be quickly warmed end applied to the frozen part to start the thawing- In no case should water heated above 50°C or an open flame be used© Practical suggestions concerning steps to be taken as soon as freezing is noticed are as follows: Incl 1, Report TIB, GHQ, FEC-, APO 500* subject: ,?Jnprncse Experiments in Hesj.bt.-mco to Cold/’ dated 1 Aug 49 1. It is imperative that the victim be sheltered in a building or tent away from the cooling power ("kan-i”) which has caused the freezing. In the event that there is no shelter, as when the victim is in an open field, he should be immediately protected from the wind and covered with rail the clothing available so that his body heat can be utilized. 2. Thaw the frozen tissue by massaging with a piece of dry cloth or bare hands. This massage should begin at the unaffected area and gradually proceed to the affected part; it should be light enough not to damage the skin. 3. The massaging should be continued until the frozen parts thaw and warmth returns or until the formation of bullae prevents continuation of the treatment. Tihen bullae form discontinue massaging and strive to keep the parts warm. Symptomatic treatment should be administered against any pathological changes which might develop later. An attempt to thaw the frozen parts by heating over a. stove or fire is dangerous as iu often invites the development of serious freeze injury. 5, Care should be taken not to use wet cloths or lumps of snow in treating freeze injury as this is not only ineffective but often aggra- vates the injury. 6. Satisfactory results are often obtained by immersing the frozen parts in lukewarm water (37°C) sufficiently long to thaw the frozen tissue and then wiping off the water. This procedure should be carried out if circumstances permit. The duration of the lukewarm water immersion, though varying according to which parts of the body are frozen and their area., is 30 to 60 minutes, 7# It is also important that the victim be fed verm food a,nd be given general physlotherapy. Consequently there are two methods of treatment: verm water immersion and massaging. The method to apply depends on the place where treatment is given, a.vailability of supplies, and other circumstances. One should always attempt to choose the best possible method for a given set of conditions. Section II Treatment After .Appearance of Secondary Sy.r atoms Unlike the treatment utilized prior to the onset of the freeze injury which determines the subsequent course of development, this treatment'is admir.ist.: •' ’ according to the symptoms of the developed freeze injury, and its me •: jective is to shorten the time of recuperation. In this treat- ment tii* ggravation of symptoms may be checked by preventing further complications, but one cannot hope to alleviate the symptoms of freeze injury once it has fully developed. In priciple this treatment comes under the same category as wounds (trauma). Hence it is important to disinfect thoroughly to prevent bacterial infection; to eliminate disturbances of the blood circulation and to accelerate this circulation; as well as to keep the affected parts elevated, rested, sufficiently warmed, and protected from further exposure to the cooling power. Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 1, Treatment of First-Degree Freeze Injury The affected area should be disinfected with alcohol, tincture of iodine, or 2% tincture of mercurochrome, and then covered with a thick coating of camphor salve and protected against further exposure to cold. Alcohol is the most effective disinfectant for freeze injury. 2, Treatment of Second-Degree Freeze Injury The affected area, should be first thoroughly disinfected with alcohol, 5/o tincture of iodine, or 2% tincture of mercurochrome. Then the edges of the bullae should be punctured once or twice to remove the fluid. In doing so, care must be taken not to strip off the membrane of the bullae. After the fluid is removed, the affected area is dressed with an antiseptic bandage and kept warm. The Hubs should be elevated to stimulate the blood circulation. If the swelling is excessive, the application of 0.1?o rivanol (liochst) gauze will help. If any secretion collects under the noli, remove the nail as soon as possible ana allow the bed to dry. If the bullae collapse by themselves end are badly soiled, remove the membranes, thoroughly disinfect the area with the disinfectants mentioned above, and dress with rivanol gauze. Premature application of the salve is not advisable since it allows the secretion to collect and putrefy. 3. Treatment of Third-Degree Freeze injury The essential point of this treatment is to keep the affected area as dry as possible and then perform an amputation as soon as the line of demarkation is distinct. There are three methods of performing the amputation: by cutting off the gangrenous parts at an early stage; by waiting until spontaneous amputation occurs; or by adopting a method between these two extremes. It has been a point of argument as to which method should be used, •Thile studying this problem during the Manchurian Incident, Lt, Cols. I3UKA (MC) and MURAKAMI (MC) come to the conclusion that in adopting a method between that of early amputation and that of waiting for spontaneous amputation, a relatively early operation will mitigate functional disorders of the body and shorten the time of recovery. The treatment of third-degree freeze injury will be divided into three steps in order to give details of the treatment for each stage of develop- ment . a. Treatment Prior to Formation of the Line of Demarkation Needles to say, all types of physiotherapy should be utilized to promote the circulation of blood in the affected parts, but it should be remembered that a lengthwise incision of the parts at an early stage sometimes brings about satisfactory results. Furthermore, the question arises as to whether dry or wet compresses should be used. The main points, however, are to keep the affected area clean, thoroughly treating it with various dermal disinfectants; to remove the fluid from the bullae; to properly dress the injured part with dry antiseptic bandages to prevent secondary infection; to watch for the necrosed area to segment and develop dry gangrene; and to wait for the line of demarkation to form, About the time the line begins to form, the victims often complain of acute pain, groan continually, and sleep poorly. At this point the wet dressing treat- ment may be utilized, either by applying 5% tincture of iodine to the affected region and dressing with a disinfected wet cloth soaked in 2% boric acid solution, or by applying 5$ tincture of picric acid and dress- ing with rivanol gauze. This treatment should bring satisfactory results, but if the pain is not alleviated by any other treatment, an analgesic or narcotic may be used as a last resort. Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 b. Performance of Operation (l) Time of Operation The optimum time for operating varies with the extent of the necrosis, i.e., whether it be relatively superficial, that which has penetrated deeper, or that which has reached the bone. In the case of superficial necrosis or one of shallow penetration, an early removal of the blackened end hardened parts mil prevent obstruction of the blood circulation in the deeper tissue, eliminate pain, and eventually promote healing* Alien the necrosis has penetrated to the bone, however, amputation should bo performed about the time the bone is exposed, .1 c, three to five weeks after the freeze injury was sustained If the unaffected parts are severely inflamed, the ampu- tation should be delayed until this symptom has disappear od. If there is danger of a general infection, the ampu- tation must be performed without delay, regardless of the time, as in the case of ordinary wounds. (2) Point of Amputation It is a matter of great importance to choose the proper point at which to amputate, since this not only deter- mines the time required for healing, but has a profound effect on the comfort of the victim after inis recovery, Needless to say, the amputation should be restricted to the smallest area possible. In deciding which parts are to be amputated me should rely chiefly on visual exami- nation, supplemented by fluoroscopic or radiographic observation of the blood vessels. In the softer parts the amputation may be performed along the line of de- markation; but at the bone, the point of amputation should be determined after a careful examination of symptoms at the periosteum and bone narrow. : a j, Gen. IiIURAKALi (l.IC) has suggested that the amputation should be performed along the lines graphically shorn in Table 35. T!here the bone is affected, the amputation should be performed at the most advanced point of the affected part, whether it be the periosteum or the marrow. then the periosteum is injured, the degree of its damage ranges from a tarnished yellow-brown discoloration to a complete desquamation in which no vestige of the'perio- steum remains. When the bone marrow is affected, not only is its fresh bright color lost, but some morbid granulation or suppuration appears in its place. v3) Operation Procedure The operation should follow the same procedure as an ordinary operation. In the event that the part to be amputated lies near a joint, disarticulation is performed by removing the surface of the articular cartillage so that the granulation tissue can'cover the bone surface. If the joint itself is affected, disarticulation is performed immediately and the central epiphysis is removed. Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 c. Postoperative Care Differing from other wounds* freeze injury entails the dis- turbance of the local blood circulation* and the tissues of the injured parts are atrophied due to the temporary retrogressive degeneration which produces unsatisfactory growth of granulation tissues. Hence .after the operation it is necessary to promote the growth of granulation tissue by some means. For this purpose* warm creosol baths* infra-rod and sun treat- ments* massaging* etc.* are valuable aids. An effective mechanical means of promoting recovery is the widely accepted surgical stimulation or the injection of alcohol in the sympathetic nervous system. TABLE 35 Injured Part ] II III 1 - Bone Marrow 2 - Periosteum 3 - Soft Part I - Point of amputation corresponds to line of demarkation II - Point of amputation lies before the outer line of demarkation HI — Point of amputation lies beyond the outer line of demarkation 53 Incl 1* Report TID* CrHQ* F3C* AFO 500* subject: MJapanese Sbqperiments in Resistance to Co3d," dated 1 Aug 49 CHAPTER 5j COW) ENDURANCE PCF’JER AND METHODS OF INCREASING IT Section I Definition of Cold Endurance Power The conception of cold endurance power is popularly interpreted both in the narrower and broader sense. In the narrower sense it means only physical capacity to endure cold; but in the broader sense it'is extended to include all factors that contribute to cold enduracc power, such as knowledge of protection against cold injuries, the use of cold climate equipment, etc. From the standpoint of combat operations, the intelligent approach to this subject is to consider all factors related to cold endurance power, such as the personal experiences and knowledge of'the officers and men concerning cold, their physical cold endurance power, and their pre- paredness against cold, A survey of the past records of casualties re- sulting from freezing should also be made* In other words, men who, when exposed to cold of a certain intensity, can perform certain actions with greater physical agility and know how to make full use of cold climate equipment without sustaining cold injuries are said to possess greater cold endurance powers than others. Thus defined, cold endurance power means: "The ability to protect oneself against cold injuries and to perform required duties agilely when exposed to intense cold," This precise definition of the term enables us to understand more clearly how to increase the cold endurance power and also provides us with a definite criterion for comparing the cold endurance power of different men. Section II Factors Comprising Cold Endurance Power We have seen in the foregoing that cold endurance power in its broader sense is comprised of many different factors, including the direct and indirect causes of all freeze injury casualties. In the light of a survey based on records of the causes of casualties, these diverse factors may be grouped into three categories: psychological (mental) cold endu- rance power; physical cold endurance power; material cold endurance power. Each of these factors will be discussed in the following. 1. Psychological (Mental) Cold Endurance Power:§ * ' This important factor accounts for the large differences in cold endurance power between inhabitants of cold climates and those of warmer climates. This factor may be subdivided into the following five elements: a. Accurate conception of cooling power . b. Recognition of the limits of cold endurance povior * c. Knowledge of the factors which increase the cooling power d. Knowledge of the protective measures against the cooling power e. Knowledge of the proper use of cold climato clothing We know of numerous cases of freeze injury casualties which can be attri- buted to insufficient recognition of these factors. 54 Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold,” dated 1 Aug 49 CONFIDENTIAL 1 ' i . i , ■ ... ! * . 1 • ft / ■ ' \ •" ' ,,■■ . , s'' ' ■ ‘ f * ® v ' ' % • ; ' \ / CONFIDENTIAL Physical Cold Endurance Power I!any of the medical papers published to date report that there is considerable difference between the physical cold endurance power of inhabitants of cold climates and those of warmer climates. This statement is true only when the cooling power is comparatively mild; when the cool- ing power becomes intense, the difference becomes negligible or disappears. For this reason it is now understood that physical cold'endurance power plays a less important role than ms previously thought. 3, llaterial Cold Endurance Power This factor is comprised of the follordng four elements a. Cold climate clothing > f b. Rations c. Tents d. Heating equipment The quality of and the maintenance given these materials undoubtedly influence the extent of eventual freeze injury casualties. However, one important point should be noted; no matter how satisfactorily materials of good quality arc maintained, their value will be lost if the men lack the suitable psychological (mental) cold endurance power to make full use of them. Thus the psychological (mental) and the material cold endurance powers are closely related to each other. Section III Standard for Comparison and Evaluation of Cold Endurance Poorer A definite, fixed criterion is needed for the determination and comparison of the degrees of cold endurance power and also for the evalu- ation of any plan for strengthening'it. Inasmuch as cold endurance power is comprised of three factors, i,e,, psychological, physical, and material, it is difficult to compare and evaluate the degree of cold endurance power by a single method. These three factors must be examined and evaluated separately before a final generalized evaluation can be rede* Psychological cold endurance power can be evaluated on the extent of a person’s knowledge of the important elements of this factor and the ability of his will poYier to put such knowledge into action. Physical cold endurance power can be evaluated by the method we have already described in detail in the section on the method of eliminating persons susceptible to freeze injury. In determining and evaluating material cold endurance power, the heat insulating quality of the materials and their utility will be considered. Thus, when we evaluate the efficacy of any new plan for increasing cold endurance power, we must know which of the three factors is affected most and then proceed to compare the proposed plan with the conventional method as described above. If, for example, a new drug is prepared for the purpose of strengthening the physical cold endurance power, the efficacy of the drug must be evaluated in terms of its effects upon this factor alone. It would be a mistake to condemn the drug as ineffective on the grounds that although the drug was used, many freeze injury casual- ties occurred during combat in a cold environment, because factors other Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold,” dated 1 Aug 49 than physical cold endurance power are involved. Likewise, a now type of cold climate clothing designed to have a high heat insulation quality and allow freer movements of the wearer should not be discarded as inade- quate on the grounds that many of the wearers of the clothing, who took part in military maneuvers sustained freeze injuries. Section IV Plans for Strengthening Cold Endurance Power In preparation for the planning of military strategy in frigid zones, one of the essential programs is to build up resistance against the dangers of freeze injury. The main points of this program are graphically reproduced for the readers guide in Table 36. From the ta,ble is self- explanatory that any complete plan should include measures to strengthen each of the three different factors comprising cold endurance power. 1. Strengthening of Psychological (mental) Cold Endurance Power In this program, the first thing to be emphasized to the officers and men is the importance of maintaining a strong sense of responsibility and continuing resourcefulness, both of'which are likely to be weakened under the stress of intense cold. Next, the men should be thoroughly familiar with the proper use of the freeze-meter (cold sensation meter) by which they can judge the intensity of the cooling power which causes freeze injury and which leads to death by freezing. At the same time, be sure that they know what degrees of cooling power have previously re- sulted in many casualties and also the cooling power in all parts of the frigid zone. Finally, by letting the men themselves experience freezing, an understanding of the limits of their own physical cold endurance power, a knowledge of the factors that intensify the cooling power, and the emergency treatment procedure can be indoctrinated in them. This compul- sory training should be conducted .according to the following program: (See photographs) Incl 1, Report TID, GHQ, FSC, APO 500, subject: "Japanese Expcrinents in Resistance to Cold/1 dated 1 Aug 49 Incl 1, Report TID, GHQ, PEC, APO 500, subject: ’’Japanese Experiments in Resistance to Cold,” dated 1 Aug 49 Table 3 6 Sense ef Responsibility and Resourcefulness 1-Utilization of freeze meter of freeze injury sustained under different cooling powers 3-Cooling power in expected field of operations Accurate Conception of Cooling Power Recognition of the Point when the Body’s Resistance to Cold Has Been Overcome -1-Limited to sensation of freezing pain STRENGTHENING OF PSYCHOLOGICAL (MENTAL) COLD ENDURANCE POWER ,1-Wind has great effect on / the cooling power /2-Moisture doubles the effect _of the cooling power 3- with high heat conductivity should not be 'handled directly 4- cognizance of disturbances of the circulatory system Improved Conception of the Cooling Power -factor INSTRUCTION FREEZE METEft Thoroughness of Pre- ventive and iibiergency Training •1-Treatment when the freezing pain sets in 2-Treatraent while still frozen z 1-Proper wearing of cold climate clothing ' 2-Inspection of cold climate v clothing 3-Ease of donning and removal to prevent perspiration and cooling _ Utilization of Cold Climate Clothing , 1-Balance between combat ~— requirements and prevention of cold injuries ‘ 2-Cultivation of cold climate discipline to the same degree as combat discipline Thorough Combat Training; in Cold Environment s TRAINING Strengthening the Cold Endurability of Parts Subject to —freeze injury STRENGTHENING OF •HUMAN FIGHTING - EFFICIENCY DURING ■3MESB 1-Cold acclimatization training for hands and feet STRENGTHENING OF COLD ENDURANCE POWER STRENGTHENING OF PHYSICAL COLD --ENDURANCE POWER' Determination and Treatment of Men Susceptible to Freeze In b>rv 1-Determination by the finger freezing test r-> 2-Injections of Lebanarin to weak men INJECTIONS LEBANARIN Supply of Hot Food 1-Supply of hot water at suitable times and if necessary, supplemented by sugar and tea . 10T WATER VEHICLE; ICE AND SNOW BELTING EQUIPMENT 1- climate hat effective protection in high wind 2- is easily, donned and removed and allows freedom of movement 3- insulated, water-resistant, cold climate shoes Cold Climate Clothing) 1- ration 20-3($ larger than for temperate** climates 2- of vitamin deficiency 3- of frozen food STRENGTHENING OF MATERIAL COLD ENDURANCE POWER Rations Tents 1-Portable, easily erected tent with effective heat insulation Heating Equipment d ( a. Procedure for Compulsory Training Dry hands with the fingers spread are exposed to the cooling power (below -10°C) until the tips of the fingers are frozen wax-white. The frozen parts are then restored to normal by rubbing the bare hands together or with a piece of dry cloth. Let the men learn by experience how the same fingers, when wet or exposed to the wind, freeze more quickly. The same experiments are then repeated with the feet. In the course of this instruction the relation of the degree of cooling power to the in- ducement of freeze injury is taught with the freeze meter(cold sensation meter). b. Main Points of Instruction (1) Let the men learn by first-hand experience how freeze injurjr progresses, what the painful sensation of freezing ("totsu") is like, and what the frozen state is like. (2) Emphasize the importance of prompt emergency treatment upon the onset of the freezing pain (3) By first-hand let them learn how such factors as wind, moisture, obstruction of the local blood cir- culation (chiefly the pressure of under-sized shoes), and contact with metal (in addition to low temperatures) accelerate the freeze injury. (4) By training, teach them how to prevent the development of freeze injury end how to administer emergency treat- ment . In the following paragraph we will discuss when and how preven- tive measures can best be undertaken. The main point of the prophylactic treatment is to administer it prior to actual freezing while the man still feels the painful sensed,ion of freezing. Once freezing has occurred, it requires a long time and many men to e,dminister even the emergency treatment. If the freezing pain does not abate but rather increases in intensity, the following steps should be ta,ken immediately, and any detrimental factors present which intensify the cooling power should be looked for and quickly removed. (a) If freezing pain is felt on the nose or ears they should be rubbed lightly with the gloved hounds, (b) If freezing pain is felt on the fingers, they should be exercised by opening and closing the gloved hands or by rubbing the hands together. If necessary, the hands should be placed in the trouser pockets (through the overcoat pocket slits) to rownrm them. (c) If freezing pain is felt on the toes, they should be exercised by moving them inside the shoes or by ‘lightly stamping the feet on the ground. In the latter exercise it is important that the toes strike the ground first. If the shoes are wet or too tight they should be exchanged immediately. Incl 1, Report TID, GHQ, FEC, APO 500, subject: '’Japanese Experiments in Resistance to Cold," dated 1 Aug 49 Inasmuch as cold climate clothing is absolutely indispensable in the field during the cold season, the wearers must learn by experience the proper clothing 'for protection against a given degree of cooling power and how to don the clothing most efficiently. They should also be thoroughly acquainted with the methods of checking the fit and detecting flaws in the clothing. In Tables 37 and 36 instructions concerning the correct methods of wearing and using the clothing arc tabulated* Also, standards are tabulated so that one may know at a glance which pieces are required for protection against a given degree of cooling power. The instructions given in Table 37 are self-explanatory and may appear simple to follow, but one wall be surprised to learn how difficult it is to carry them out in extremely cold areas where the meteorological conditions are very changeable (recall the popular saying: "Every fourth day is warm”) (TN: "San kan shi on” in Japanese) and the temperature fluctuation, even during the daytime, is extreme, If men on a march are more heavily clothed than is necessary to protect them from the existing cooling power, they have to bear an unnecessarily heavy load, which causes them to sweat and makes them more susceptible to freeze injury. In extreme cases some men suffer heat stroke even during the coldest season. If insufficiently clothed, many of the men will sustain freeze injury. Thus, excessive clothing is just as dangerous as insufficient clothing. The important thing is to issue adequate protective equipment, study the best means of carrying it, and be always ready to don it correctly when it is needed. Recently the relationship between freeze injury casua.ltios and cold climate clothing was investigated for 594 cases of freeze injury, and it was found that the larger percentage of casualties was attributable to insufficient clothing. (Sec Table 39). The results of a study on the relationship between cooling power and cold climate clothing obtained by reviewing a large number of freeze injury cases are shown in Table 40. TABLE 37 DRESSING AND THE USE OF COLD CLIMATE CLOTHING Article Dressing and Use of Article Cold Climate Hat 1. Cold' climate hr.ts are supplied in tliroo sizes, large, medium, and small. Large size for those who wear army caps in sizes 1-3 Medium size for those who wear army caps in sizes 4-6 Small size for those who wear army caps smaller than size 7 It is important to got the proper size, since oversize is cumbersome during combat and undersize docs not provide proper heat insulation. Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 2. In the case of complete cold climate dressing, the flap is turned down and buttoned under the chin. The chin strap is normally tied under the chin when the flaps are turned up in order to prevent the hat from coming off during double time marches, etc. In case the visor obstructs the view when firing, the strap should be passed through the earholes and tied at the back of the head. 3. The nose mask fits the face lengthwise and is fastened to hooks with one of the straps to prevent-it from coming off. When the temperature falls below -30°C, a handkerchief is inserted into the mask and changed often to prevent freeze injury due to freezing of exhaled air. When the mask is not in use it is turned around to the back and fastened to the hooks there, 4. When the hat flaps are not in uso they are turned up and tied together over the hat after the ma.sk has been hooked at the back. 5. The ear fla.ps are normally fastened'by the lower button to cover the earholes. For listening, the earholes are opened by fastening the ear flaps to the upper button. Hearing is not impaired with the car fla.ps down provided they are not fastened to the lower button, 6. The hat can be used simultaneously with the steel helmet, gas mask (Type A), and cold climate hood. 7. When used simultaneously with the steel helmet, the straw in the helmet lining should be removed to insure proper fitting, 8. 'When it is used simultaneously with a gas ma.sk (Type A), the gas ma.sk is put on first, a.nd then the hat. 9. The lining can be removed a.nd should be washed often. Cold Climate Hood 1. The hood is worn under the combat cap, steel helmet, or cold climate hat, with its lower end covering the collar of the uniform and tied with a strap in such a manner that it does not cover the eyes, nose, and mouth. The remaining strap ends are tucked inside, 2. When the combat cap or steel helmet is worn, the hood is secured with the chin strap, and the cold climate hat is tied cither with the flap or by thb inside strap under the chin. 3. When worn simultaneously with the gas riir.sk (Type A), the gas mask is put on by loosening the face opening strap of the hood, momentarily exposing the head. Then the hood is restored to its original state. Cold Climate Overcoat 1. Worn over the military uniform* Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 2. Cold'climate overcoats are supplied in thr3o sires large, medium, and small. Large size for those who wear uniforms in s..:.zo3 1-2 Medium size for those who wear uniforms in s:';ser 3-4 Small size for those who wear uniforms in sizes 5-6 3. Under suitable conditions the front of the collar may be opened by unbuttoning. 4. The overcoat car be buttoned either right over left or loft over right, depending on the direction of the wind, etc, 5* The mist pockets on both sides can be used to warm frozen hands. 6. During foot marches, either the bottom corners of the front flaps should be folded up and hooked to tho belt to allow froor leg movement, or the overcoat should be re- moved and carried in the pack. 7. When resting during bivouac the overcoat should bo put on, and tho bottom flaps at the rear buttoned. 5. If the sleeves (auxiliary sleeves) are detachable, they should bo taken off when working or when the tempera- ture permits. When re-attaching the sleeves, care should be taken not to confuse the large vdth the small ends or tho right with the loft. Cold Climate Short Trousers 1. The cold'climate short trousers are worn over the military trousers. The cuff straps are tied so as not to interfere with the bending and spreading of the knees. 2. The fly should always bo buttoned. 3. Those trousers are used chiefly bv mounted soldiers but when the temperature is lower than -3Qe, dismounted soldiers can wear them during ski marches, sentry duty, or bivouac. 4* There are two fly buttons but unbuttoning one is sufficient for urination. 5. The short trousers should be worn over cold climate long boots or cold climate leggings in such a way as to prevent snow from entering the tops of the latter during snowstorms or when exposed to wind-blown snow. Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 Cold Climate Mittens 1. Cold climate mittens care worn over the regular cold climate gloves. (TN: Japanese usually make no distinction between glovo and mitten, the former being a "sack for the hand" and. the latter a "largo sack for the hard.") The strap attached to the right mitten is passed through the supporting strtap of tho cold climate overcoat (strap beside the shoulder pa.tch) cand tied to tho left mitten, allowing sufficient length to permit freedom of bonding and spreading the hards. 2. During firing, tho forefinger of tho hard is in- serted in the forefinger of the mitten. 3. The cold climate mittens are worn over tho sleeves of the military uniform and inside the sleeves of the cold climate overcoat, 4. When the cold climate mittens care not being worn they should bo put in the waist pockets of the overcoat with the strap hung over both shoulders* 5. Don't hesitate to use those mittens. It is necess- ary to bo come accustomed to them during normal times. Cold Climate Undershirt end Drawers 1. Cold climate undershirt and drawers are worn over the winter undershirt and drawers. Excessive sleeve or leg lengths are folded back to a comfortable length. Cold Climate Gloves 1. The cold climate gloves are worn directly over the ordinary gloves. 2. These gloves are likely to get wet from sweat or melting ice and snow. While resting after working conti- nuously on construction, etc., freeze injury is very easily sustained because of the freezing of the sweat in the gloves. Thus, the herds should be placed in the pockets during rest periods and after completion of the work the wet gloves should be exchanged for a dry pair, 3. When the gloves care worn in temperature below -30°C, the fingers arc apt to become frozen and numb. If this occurs the fingers should be rubbed together slowly with the tips re looted end with the gloves on, or the herds should be placed in the pockets, or cold climate mittens worn. If necessary can individual pocket warmer is placed in the cold climate mittens. 4. The left and right gloves should be interchanged often. As a protective measure against freeze injury, care should be taken to prevent the gloves from becoming wet or torn. Cold Climate Socks 1. Cold climate socks are worn under the ordinary socks 2. Two pairs of cold climate socks are usually worn. When more than three pairs are worn, the middle pairs are likely to become crumpled, causing foot sores and inviting freeze injury due to interference with the blood circulation. Incl 1, Report TID, GHQ, FEC, APO 500, subject: '’Japanese Experiments in Resistance to Cold," dated 1 Aug 49 3. Freeze injury readily develops when the socks .are wet with sweat due to foot activity. They should be ex- changed for dry ones when preparing to rest at bivouacs, etc. 4. When soiled with sweat, etc., the socks become good heat conductors .and therefore should be washed thorough- ly* 5. The socks being worn should be interchanged fre- quently to reduce wear; holes should be repaired when they are still small, special care being required at the toes and heels. Cold Climate Boots 1. Cold climate boots are worn in place of regular boots by mounted personnel. 2. Boots are supplied in three sizes, large, medium, and small, large size for those who wear boots of sizes 12 mon 3 bu and 12 mon. Medium size for those who wear boots of size 11 mon 7 bu, 11 mon 3 bu, and 11 mon. Small size for those who wear boots smaller than 10 mon 7 bu. 3. The straps attached to the inside of the boot tops are tied under the knee to prevent the boots from falling down 4 4* When the inner soles (felts) become moist they should be exchanged with the dry spares. 5. Under certain conditions the ankle region should be constricted by tightening the spur-holding leather straps, in order to ease foot action, as when on a foot march. 6. Care must be taken not to carelessly burn the boots while warming near c. fire, 7. Frequent and careful dubbing should be done to prevent the leather, especially the mud-guards from harden- ing. Cold Climate Shoes 1. Cold climate shoes are worn in place of regular army shoes by dismounted soldiers. 2. Cold climate shoes are classified into six sizes, from 12 mon 3 bu to 10 non 7 bu. Size 10 non 7 bu are for those who wear army shoes smaller than 10 non 7 bu, and sizes larger than 10 mon 7 bu are for those who wear array shoes of the corresponding sizes. 3* "lien walking, snow is likely to collect on the instep of the shoe and become moist due to conduction of heat from the foot. Consequently, the shoe freezes when the person rests, resulting in failure of the shoe and sub- sequent lessening of the protection against freeze injury. 64 Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Gold," dated 1 Aug 49 4, Due to the sweating of feet during marches, first the socks and then the shoes become wet. Since the foot may-freeze and develop freeze injury while the man is rest- ing, footwear should be changed or dried an soon an possible, 5, Two sets of inner soles (felts) are supplied with the shoes so that when one becomes damp it should be re- placed with the spare set, 6, Special precaution should bo talien against burning the shoes while the wearer is warming himself during bivouac. 7, Special care should be taken to prevent hardening' of the leather parts of the shoes, particularly the uppers, by the frequent application of sufficient dubbing. Cold Climate Leggings 1, Leggings are worn in conjunction with cold climate shoes chiefly by foot soldiers during combat and when bivouacking at temperatures below -30°C, 2, Leggings are worn with'puttees. The leggings are worn directly over the trousers, and if the circumstances require, with and over the short trousers, 3o Leggings are supplied in three sizes; large, medium, and small, Lange size for those who wear trousers of size 1 and 2, Medium size for those who wear trousers of size 3 and 4* Small size for those who wear trousers of size 5 and 6, 4, The buckle is fastened on the outer side of the log. 5. The legging stirrup is used to prevent the gaiter from creeping up the leg. Wind Mo.sk 1, The wind mask is attached to the visor of the hat, 2. When not being worn it is carried in the pack after rolling it tightly. It may sometimes be turned up to the upper side of the visor without being removed from the hat. 65 Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 Temperature Foot Marches Mounted or at Rest j Remarks About -10°C Cold climate clothing is not [ i essential. If worn* it should • be as follows: cold climate gloves; cold climate undershirt and drawers; cold climate socks. Cold climate gloves M undershirt " drawers M socks " masks When stopping at one place for a long time, the cold climate shoes (cold climate boots for mounted personnel) arc required About -15°C In addition to the above, the cold climate hood should be worn. i ; . : In addition to the above, cold climate shoes (boots for mounted troops), cold climate mittens, and cold climate overcoat (without sleeves, if not required). About -20°C 1 In addition to the above, cold climate hat (substitute for cold climate hood), cold climate overcoat, cold climate shoes (cold climate boots in the case of mounted personnel), cold climate mittens. In addition to the above, cold climate short trousers, if required. Cold climate short trousers are designed chiefly for mounted troops. About -30°C In addition to the above, cold climate mask (to be worn with the hat); cold climate short trousers; cold climate leggings. Same as above It is not advisable to use the cold climate overcoat, short trousers, and gaiters while marching at temperature above -30°C; however, this depends on the circumstances. \ \ TABLE 33 Incl 1, Report TID, GHQ, FEC, APO £00, '’subject: Japanese Experiments in Resistance to Cold, dated 1 Aug i|9 TABLE 39 Comparison of Freeze Injury Casualties Between Sufficiently or Inadequately Clotted Personnel 1' Temperature ca. ca. mi mi i. i ca. ca. Total *-10°C -i5°c -20°C | -30°C Classification ! First Hand Sufficient * 2 i 3 ! Inadenuate 2 6 19 27 . Degree Foot S’ iffieieiit 1 7 2 10 Inadequate 1 1 1 11 lU Others! Sufficient ~T~ h 9 Inadequate 3 3 11 To£al j 2 12 16 hh 7h Second Hand Sufficient 1 3 3 7 Inadequate 9 i;l 82 Degree Foot Sufficient T 17 ~~2E~ 31 79 Inadequate 3 h6 hh 51 lUU Others Sufficient 10 6 l6“" ■ Inadequate 9 33 h2 Total ■ 9 72 133 206 b20 Third Hand Sufficient 3 3 Inadequate 1 8 9 Degree Foot Sufficient h i i 10 Inadequate 2 5 23 h2 72 ... Others Sufficient 1 1 Inadequate 2 3 5 Total 2 9 35 » ... 5U 100 Total Sufficient Actual No. 7 30 ft hi 138 Percentage 53.9 32.3 29.U 15.5 23.2 Inadequate Actual No, 6 63 130 257 U56 . Percentage hS.2 67.7 70.7 3Lu5 76.8 I Incl 1, Report TTD, GHQ, FEC5 APO 5>00, subject? u Japanese Experiments in Resistance to Cold,” dated 1 Aug h9 TABLE hO Area of Occurrence Date No. of Casualties i Temp.& Wind Vel. —:— Equiv, Temp. Cold Climate Clothing I AngangkL and Tsitsihar Areas 17-19 Nov 1931 101*7 (19.3?) 17 Nov: -12.2°C 17 m/sec 18 Nov: -9.7°C 12 m/sec -95°C -6U°c Issued, but not worn by any of the units. (See separate table.) II Jehol Area 23-2U Feb 1933 sRight 2 9k (8.1?) sMiddle 190 (27.9?) »Left UU (2.1?) 23 Feb: -25°C 10 m/sec -86°C Cold climate over- coats, cold climate mittens, and shoes were turned in and not used. III Houtao Area 31 Jan- 3 Feb and lh Jan- 29 Feb 19^0 325 (739)(sio) -31°C Breeze -6l°c Complete cold climate clothing, but worn out due to prolonged use, and unfit. *‘(TN: These refer to areas: Right, Kolachin Chungchi; Left, Kolachin-Tsochi.) -Yuchi; Middle, Kolanchin- During periods of extreme cold it is necessary to take special precautions with respect to field maneuvers and the wearing of cold climate overcoats, Down to the equivalent temperature of -60°C, body heat loss was high vdth the men who removed their cold climate overcoats and wore other cold climate clothing (TN: presumably while at rest); this was also true during marches where men who wore their overcoats lost more heat than those who removed and carried theirs. From this study it was concluded that the cold climate overcoat should be removed when physical activity becomes necessary so as to allow freer body movement and less drain on strength. In short, during extremely cold periods, special care must be taken vdth regards to the wearing of the cold climate over- coat , Next we will describe seme of the important points to be noted when inspecting the fit of cold climate clothing. Cold Climate Hat The hat must bo large enough to cover the top third of the ears with- out pressing tightly against the head; the side flaps must be long enough to cover the chin neatly when they are down and buttoned, but not so long as to leave a large space around the cheeks and chin. Incl 1, Report, TED, GHQ, FEC, APO 5>00, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug h9 Cold Climate Shoes According to army regulations one pail’ of cold climate socks and one of ordinary cotton socks mil be worn during combat. However, when fitting new shoes, an extra pair of cold climate socks should be worn to make sure that the shoes arc Large enough to allow free exercise of the toes* The following flaws will be looked for when inspecting cold climate clothing: missing buttons* torn or worn-out tips of gloves; torn or worn-- out soles and heels of socks; tears'in the canvas cover of the shoe in- step, along the canvas-Leather seam, in the stitching of the sole leather, in the fur lining at the H?ol, and finally any deformation of the whole boot. 2, Strengthening of Physical Cold Endurance Power We have already pointed out that unlike psychological (mental) cold endurance power, there is not much difference between the physical cold endurance powers of inhabitants of cold climates and those of warmer ones* Various medical authorities have been equally interested in knowing how to strengthen physical cold endurance power. During World War I French Army Surgeon Chateau announced that the cold endurance power of the feet could be improved by frequent washings in cold water and by rubbing. Mongolian soldiers of the Soviet Army always wash their feet in cold water after a march or drill. Professor KUNO expresses the same opinion: by immersing the feet in cold water (-5°C) (TN: sic) for an hour daily, their cold endurance power will be improved to a marked extent in two weeks. He says that this is attributable to collateral circulation. He advises that a rubber sack bo used in this cold water foot bath so that the skin mil not be in direct contact with the water. Recently, medical authorities have been shoving great interest in the problem of strengthen- ing physical cold endurance power but so far no effective standard method has been established. When compo-ring the physical cold endurance powers of strongly resistant and weakly resistant, we noted that a few unmistakable differ- ences existed between them. On the basis of these differences wo will make suggestions on how this power can bo improved. a. Improvement of Peripheral Blood Circulation Cold baths arc conventionally used to stimulate the peri- pheral blood circulation and increase the cold endurance power of these parts. We re-examined this method by conducting the following experiments The thermocouple of the HIDEHIRO (TN: EIKO?) dermatothermo- metcr was attached to the tip of the forefinger and the hand immersed to the elbow in city supply water (about 15°C) for 20 minutes dri.lv. Another hand, similarly fitted with the thermometer was immersed in ice water (about 3°C). The influence of training in each of these baths was com- peared by noting changes of the skin temperature. The results are plotted in Tables 41 to 44* The city supply water bath did not exert much influ- ence on the skin temperature, the latter being almost equal to the water temperature on both the first and eighth days. As seen in the graphs, the influence of the ice water bath was considerable. Although the finger was cooled to the same temperature as that of the water on the first day, its temperature rose above that of the bath on the eighth day. This is evidence of the active protective function of the living body. Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold,” dated 1 Aug 49 TABLE 41 1st Day- Water Temp. 12.0°C -Right Hand “Left Hand Before Immersion During Immersion • After Immersion TABLE 42 Before Immersion 8th Day- Water Temp. 13 • 1°C •Right Hand Left Hand / After Immersion During Immersion Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 TABLE 4 3 1st Day- Water Temp. 3.5°C -Right Hand "Left Hand Before Immersion After Immersion During Immersion TABLE 44 Before Immersion 8th Day- Water Temp, 3.0°C - Right Hand ' Left Hand After Immersion During . Immersion, Incl 1, Report TID, GHQ, FSC, AFC 500, subject: "Japanese Ibcocrinonts in Resistance to Cold," dated 1 Aug 49 Similar results were obtained when the experiment was repeated using certain infantry troops as subjects. In this experiment the men’s legs were immersed in cold water (about 0°C)_ up to the lowest part of the thighs, or were exposed to low air temperatures for about 1> minutes every day. After exposure the legs were rubbed with dry cloth for 5 ninutos- This experimental training was continued for about a month. The condition' of the blood circulation'was examined by Moschcowitz’s test before, during, and after the experiment, and a comparison of the results was made. As shown in Table 45 the blood circulation was notably improved by both the cold water and cold air training. However, the cold water bath method is not practicable for training a Large number of men because cold water at 0°C is difficult to obtain and a large installation is required. There- fore the cold air method which docs not require ary special"equipment is recommended since it can be conducted anywhere in Manchuria, Best results may be achieved by using the cold water method during the summer and the cold air method during tno winter. TABLE 45 RESULTS OF COLD ACCLIMATIZATION TRAINING 1. Water Training Time Personnel Right or Left Average Prior to Training 256 Left 21.5 sec. Right 22.4 sec. Interim Period 256 Left 18.4 sec. Right 18,3 sec. After Completion 256 Left 11.7 sec. Right 11.9 sec. 2. Cold Air Training Time Personnel Right or Left Average Prior to Training 251 Left 10.8 sec. Right 10,3 sec. Interim Period 251 Loft 7,8 sec. Right 7.7 sec. After Completion 251 Left 5,8 sec. Right —— 5.9 sec. b„ Treatment of Blood We have already mentioned how the cold agglutination titers differ between men whose fingers are easily frozen and those whose fingers are not* The drug Lebanarin, prepared by WATANABE and XUMABE, is effec- tive in checking this agglutination and can be used to improve the blood of easily frozen persons, It was experimentally proved that the subcu- taneous injection of 2 ml/day of this drug for five consecutive days checks the agglutination reaction and improves the resistance of the fingers to freezing,. The effect of these injections Lasted for three months. The physical cold endurance power is strengthened by the injection of this drug and weakly resistant persons can be raised to the coverage class or bettor0 (TN: See Table 46), Incl 1, Report TID, GB3, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold,” dated 1 Aug 49 Birth- Test' Period, Days Freeze Meter Drop Time, sec. 1 Equiv. Temp., °C Standard Freezing Time. min.&sec. Freezing Time. min.&sec. Cold Ag glutination Titers (1: — —, .j -) \ ... i Name Age place Anamnesis 2 4 g lb 32 64 128 256 512 1024 S.W. 31 Oita 1. Apt to catch cold readily Before in.iection 24 -52 3*4on 3130" -4 44 -4 4 4 — — — — 17 After in.iection 60 11*00" 19*00** 4 4f- 4- 4 ± — — — — 34 After injection 32 -40 6*00" 6*05*’ •ft* -tt 4 4 ± — — — — — C.M. 23 Kuma- moto 1. Healthy Before in.iection 32 ~4c b*00» 4* oo" +H 4*4 44- 44- 4 4; — — — — 1 17 After injection 33 -39 6*13” 3*45" 4- -4 t — — — — — — 34 After injection 32 “24b b* 00" 7* 20" 44- 44 -4 4- 4; — — — — — S.Y. 25 Kuma- moto 1. Dysidrosis 2. Frostbite Before injection 32 -4o 6*oo” 3’ 35" 14 44 44 -H- 4 ± — — — — 17 After injection 2b -4o 4* 20" "6»2oT* -ft 1 -4 -h 4- — — — — — — 34 After injection 29 -43 5*15" ' 7*15** 44 j 44 4- d: 4 — — — — — T.M. 29 Kuma- moto 1. Susceptible to colds Before injection 34 -3S 6*25° 3*4511 +H 4*4 44 44 4 4 — — — 2. Peripheral parts sensitive 17 After injection 33 -39 — m 4 4— 4 — — — — — to cold 34 After injection 35 -37 6*38" b«ooM 4 4- 4- -b — — — — — T.H. 24 Kuma- moto 1* Susceptible to colds Before in.iection 34 -3S 6*25" 4*30*’ 44 -44 4- 4- 4 4 — — — 2. Second degree freeze injury 17 After injection 33 -39 6* 13" 1514011 4b ± — — — — — — — — 34 After r> •? ■? r»n 33 -37 b«38u lb* 20" *4 -f- i. ± — — — — I ABLE 46 Incl 1, Report TID, GHQ, FSC, APO 500, subject: 11 Japanese Experiments in Resistance to Cold, Birth- place Test Period, Freeze Meter Drop Time,sec. Equiv. Temo. °C Standard Freezing Time, Freezing Time, Cold Agglutination Titers 3U (1: --) i Nam% Age Anamnesis days min, & sec, min. & sec. 2 4 i 8 16 32 64 128 256 j 512 1024 ! — H.K. 28 Kuma- moto 1„ Susceptible to colds Before injection 34 -38 6*25" 4*20’* -H+ 4B- * — ■ ■ ■ - 44 —H* 4b -4- 4 — - 2. Peripheral parts sensitive 17 After injection 60 —-23 , 11*00" 22*00'* 44 4*4 4- 4- — — — — — — to cold 34 After injection 32 -40 6*00*' 6*45" t i i ITT 4H- 44 -h • 4* •4 — — — — S.H. 27 Kuma- moto 1. Susceptible, to colds Before in jp.c.tinn 34 -38 6'25" 4*00” 4*4 44 •Ht — 44 — 44 4- ± — — - 2* Peripheral parts sensitive 17 After injection 60 -23 11*00" 26*50" 4H- 44 -4— 4 — — — — — to cold 34 After injection 32 -40 5*00" 6*05" 414 44 4- ± — — — — — — K.T. 30 Kuma- moto 1* Susceptible to colds Before injection 32 -40 6*00" 4*40" •Ht +»+ 4f 44 4~ 4~ •4 — — — 2* Peripheral parts sensitive 17 After injection 33 -39 6*13" 5*15" -H- 44 4- ± — — —- — — — to cold 34 After in je ction 36 -37 6*38'* 6*40" 4+ -4 4- 4 — — — — — S.S 23 Kuma- moto 1. Healthy Before injection 32 -40 6»00n 3*30" 4b *4 -H- 44 4- 4- ir — —* — 3-7 After injection 26 -40 4*20** 11*55" 44 4+ 4- 4“ ± — — — — — 34 After injection 29 -43 5'15" 5*15" tH~ 44 4- ± — — — — — S.K. 24 Kuma- moto 1, Susceptible to colds Before injection 32 -40 6*00’* 3*40" -t+f- 4H- 44 44 44 4“ ± — — — 2* Frostbite 17 After injection 26 -40 4*20" 6*55" -fH- 44 4- 4- 4 — — — — — 34 After injection 26 -40 4*20" 9*00" 44 4~ 4 4~ ± — — — — — Incl 1, Report TIL), GHQ, FEC, APO 5 j or* +.n nn 34 -36 6,25n 3*40" j+4- ; 1 +H ft i-H- T*~~ __ j ! t~ 3 — 1 i 17 After injection 26 -48 4T20» ! 7I20» 1 : ! ! t+ ; it-; -f- i i t- T I t , , ; ___ | ] i —— i i 34 After ..i nj eat. ion. 26 -46 ! iTT 4' 20" 14*40" ~l+~, "t_ | +1 “f ! -! I- I- i. 4 j 1 s.o. i 24 Kuma- moto 1. Susceptible to colds 2. Second, degree freeze injury Before injection * 34 -36 T i | j 6*25” ! 3*50" ~!+)* ; rrt-l -r+-| Tt" t- ! ! it- — ; — ] !_a 17 After injection 33 -39 6* 13” 7 r r~ 7120" ; 1+ j n-j ~f~ r p— • -- -1 ; 5 1-5 l m 34 After j nrj 35 -37 6 *30' 6*25" -tr-f-M-f- .. . i _ j . -+ ■+ ____ ; - ~ T i - T| - - s.s. 23 Kuna- moto 1* Second degree freeze injury Before injection 32 ... f* -40 3»30» j -Ht -Hi m tn tr - -H — J —n 17 After injection 26 -46 - 4* 20" l I 5' 25" * -H-! +• * : _! _ .. _ , 1 34 After —iniecti-o-n- 29 -43 15s* 7*40" -m j -tt -n r -*i +- f . .t. j n " I ' \ 1 M.Y. 26 Kuma- moto 1. Second degree freeze injury Before j n j pfr- +.jon . 32 -40 6*00” 3,40" tn ; -HJ trf L__ r — >.;.p tjt* —,— it j 1 17°After injection 26 -46 4,20» 5135.1 i_. 4 -H- i -t— tf- t~ -t ± 1 1! 34 After 1 pier, t.ion 26 —4-8 4*20" 16*00" tn — ~h *t~ ■ } 1 — ~~ j A.M. . 31 Kuma- moto 1* Kip gout Before _Jj3j.ec.tioi]L_ 32 -40 6*00" 3*20" M+ ! fhb _ _L tt- -H- T~t~ +r 17 After injection 26 -48 4*20“ 6100" Hi- tt -H- -H- F-r-j- - - 34 After 26 -48 4*20” 8*05" ~TT*~ ~t+t -tf -r- tr *1 t„ I 1 — i Incl 1, Report TID, GKO, FEC, APC 500, subject: “Japanese Experiments in Resistance to Cold." dated 1 Aug 49 Te st Period, days Freeze Meter Drop Time, sec. Equiv. Temp., on Standard Freezing Time, min. & sec. Freezing Time, min. Sc sec Cold ation Titers (1: - - j j liSML- Age Birth- place Anamnesis 2 4 8 16 32 64 128 256 / 512 1024 _ K.I. 29 Kuma- moto 1. Pleurisy Before injection 32 -40 6100" 3’15” 444 1 4H ft Hf 44- 44 t 4 — — 17 /ifter injection <£.0 --4B 4’20” 5’40” 4H- -44 44 4- ± — — — — 34 After injection 26 -48 4'20 ” 5 ’40" +H~ ++- j— +4 4- 4 ± — — — — N.M* 23 Kuma- moto 1. Susceptible to colds Before injection 32 -40 6’00” 4’35" 444 4H- -ff -H- -t -f •4 — — 17 After Injection 33 -39 6'13" 28’10" iff- 44— -ft > -f t — — — — 34 After injection 32 -40 6’00” 5'40" fft “H~ 4f -f ~ir — — — — — T.N. 23 Kuma- moto 1. Peripheral parts sensitive to cold 2. Weil’s disease Before injection 34 -38 6’25" 3 ’ 50” 4H- 44+ Hf Ht ft 44- H4 t ± — 17 .After in j 0 ct i on 33 -39 6’13" 24’20” -Hf 44- +4 -t — — — — — — at age of 16 34 After injection 32 -40 6’00” 6’20” Hf 44- ft ~t 4- — — — — H,T • 23 Oki- nawa 1. Frostbite Before injection 32 -40 6 >00” 3’55" -Hf fit Ht ft ft ft -H- + •4 — 17 After injection 33 -39 6’13” 8’50" 444 irh Hf ft 44- -4- — — — — 34 After injection 35 -37 6’38” 9’15” iff- Hf ff t t — — - O.M. 31 Kuma- moto 1. Peripheral parts sensitive Before injection 24 -52 6'25" 3’30" 4+4 44+ Hf iff Hf 44 Hf 44 44 -4 to cold 17 /ifter injection 33 -39 6’13" 10’55" -Hi" Hf ft ft ft Hf -4 ± — — 34 Af'ter injection 35 -37 6’38” 10>20” 4+4 •Hf Hf Ht ft ft 4 4 - — 76 Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug A9 c. Intake of Hot Food The great effect of hunger on the physical strength of soldiers engaged in sustained .activity under the stress of a cold environ- ment,. especially when the activity is continued for days is self-evident. On such occasions, if the men are fed hot food their physical and mental fatigue are alleviated, their will and thinking powers are revived, and the blood circulation in their extremities is improved. In short, their seriously weakened physical cold endurance power is promptly restored. To determine how this hot feeding affects the skin tempera- ture, tests were conducted with different lands of food, and it was discovered that among other items, hot shiruko (TN: red bean soup with heated rice cakes) was the best, A number of men protected with cold climate clothing remained motionless exposed to the cooling power until the skin temperature at the tips of their first toes fell to a certain temperature. Each man was then fed 500 milliliters of preserved shiruko which had been thawed in hot water at' 80°C .and cooled to 60°C. Changes in the skin temperature wore observed, and in 8 cases out of 12 the skin temperature had definitely risen, (Sec Table 47). TABLE 47 Mo. j Part!Tcnp. of jSkin while pn Sentry Duty lamp, of Skin During Feeding Time Elapsed Before Temp. Rises max. Temp. Reach- ed Tome. Diff. After F ceding Duration of Temp. Rise 1 right 11.2 9.4 38 min. 10.6 1.2 20 min. left 10.4 4.8 38 min. 11.6 6.8 (-)32 min. 2 right 10.6 5.8 0 min. 16.2 10.4 (—)62 min. left 10.4 9.6 14 min. 15.0 5.4 (-)48 min. 3 right 11.4 3.2 22 min. 13.0 9.8 (-)30 min. left 13.0 6.0 22 min. 13.6 7.6 (~)30 min. 4 right 12.4 4.2 8 min. 9.4 5.2 (-)42 min. left 1 11.2 4.4 4 min. 16.2 11.8 (-)48 min. 5 right 11.4 2.7 6 min. 7.4 4.7 (-)34 min. left 11.5 2.3 0 min. 5.2 1 2.9 (—)40 min. 6 right 28.8 2.6 10 min. 5.6 3.0 (~)32 min. loft 16.2 1.8 20 min. 8.2 6.4 (~)24 min. 7 right 15.6 4.2 20 min. 16,6 12.4 (-)44 min. left 12.4 4.0 30 min. 8.0 4,0 (-)42 min. 8 right 21.6 2.4 0 min. 5.0 2.4 36 min. loft 22.0 4.8 4 min. 5.6 .... 0.8 .. . 16 min. REMARKS: (-) indicates that the skin temperature did not decrease during duration of rise. 77 Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 Effective as they are, the methods of increasing the peripheral blood circulation, treating the blood itself, and the feeding of hot meals play only a supplementary role in strengthening the physical cold endurance power. The principal point of this training program is to emphasize the importance of the psychological (mental) cold endurance power and to put into practice the known facts concerning cold endurance power by combining combat training in cold environments under a single principle so that the men mil always be prepared to withstand the cold as effectively as the enemy. 3. Strengthening of Material Cold Endurance Power The strengthening of this factor requires oho preparation and maintenance of adequate cold protective equipment (clothing), the es- tablishment of a feeding plan, and finally, a sufficient supply of tents and hecating appliances with which temporary shelter can be readily pro- vided to warm the soldiers and prevent excessive loss of their physical strength. a. Cold Climate Clothing Combat is a series of activity and inactivity, and it is during periods of rest that soldiers suffer greatest from the cold* While they are active, the effects of cold are felt to a lesser ezetent, There- fore, during periods of inactivity protective clothing with the best thermal insulating capacity is required; but during action this is given secondary consideration, and freedom of body movement becomes the first requirement. To take care of this double demand, some means of adjusting the clothing so that it can readily be altered to meet cither requirement as the occasion arises is needed. In the following paragraph some of the pertinent findings of our studies on the use of the cold climate overcoats during vdntcr marches will be discussed. A troop of soldiers dressed with standard cold climate clothing (refer to outline of clothing) was sent on a 12 kilometer march over level terrain lasting three hours. The air temperature was -18° to -26cC and the wind velocity 1 to 2 meters per second. Half of the troops wore overcoats, and the other half went without overcoats carried sand- bags in their packs equivalent to the weight of the coats. The load in each case was 1+0% of the body weight. The body heat loss was examined before, during, and after tjio march, and the results were compared. As seen in Table 48, soldiers who went without their overcoats lost body heat at a higher rate in the early part of the march, but labor the rate of loss became less than for those who wore their overcoats. During rest periods, however, the situation was different. Examinations made at the end of a 30 minute rest showed that the robe of heat loss was smaller for the wearers of overcoats. This indicates that body heat loss can be lessoned by wearing the overcoat while at rest ond removing it for march- ing. Furthermore, the wearing of the overcoat during marches induces profuse sweobing which causes an excessive body heat loss when the wearer pauses to rest and makes a long rest impossible. Incl 1, Report GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Co.'* i.v- dated 1 Aug 49 TABLE 48 COMPARISON OF BODY HEAT LOSS DURING A MARCH BETWEEN MEN WHO WORE COLD CLIMATE OVERCOATS AND THOSE WHO DID NOT Air Temporalure -18 to -26°C Wind Velocity 1 to 2 m/sec. Units in cal/hr/m. Time At Rost injOutside Mongolian ! Tout Before Tent (Pao) |March jAfter One Hr. March |After j Two Hr, |March i After Three Hr, March After 30 Min. Rest No. \ Clothing \ i 41,07 56.15 j 207.1 200.9 240.3 46,61 2 34,57 51.72 200.4 225.5 147.6 56.48 3 46.78 41.58 141.8 188.2 175.1 50.41 VVJ.onOU.li P.O A 4 35.70 49.57 212,0 208.3 177.5 37.57 ooxa 5 37.45 49.05 179.9 196.2 214.2 42.96 U±J_1;1'.LG 6 53.22 50.10 187.5 189.3 206.2 41.87 Ovcrc 0c\t 7 37.8? 64.24 195.4 201.3 182.2 58.05 8 35.10 48.78 191.1 199.3 127.4 40.47 9 34-50 44.85 178.3 165.3 185.8 38.93 10 37.40 53.44 173.3 167.7 150.3 58.13 11 38.32 72.81 180.1 141.9 133.9 65.00 av. 39.32 52.94 186.1 189.3 176.5 48.77 1 43.61 43.46 187.1 197.4 226.8 4-2.77 2 38.23 42.11 157.4 182.3 156.1 58.33 3 45.46 69.36 199.9 182.0 187.1 65.15 With 4 42.21 61.01 237.4 177.9 204.4 37.66 Cold 5 45,48 41.41 180.5 174.0 171.2 46.15 Climate 6 46,66 51.12 213.6 347.6 202.6 37.18 Ovcrc ant 7 32.69 52.85 144.8 180.7 189.5 39.94 8 41.00 46.68 213.5 183.9 192.8 59.58 9 38.04 39.12 199.5 191.2 187.2 35.48 10 45.72 44.76 189.5 194.1 181.2 53.24 11 43.85 59.99 204.2 234.2 203.0 68.60 av.j 41.45 ’50.17 193.4 195.0 191.3 49.91 The results'of an experiment conducted by SHIR'II, civilian employee of the Army, are in agreement with ours. In his test, a group of men clothed in the standard army winter uniform (except for cold climate drawers) and another group wearing the standard cold climate overcoals over their uniforms were marched under a temperature of -24° to ~27°C and a wind velocity of 1 m/scc, and a comparison was made of their gaseous metabolisms. Two important facts were disclosed: although the two groups showed no difference in regards to the amount of consumed, the wearers of the overcoa.ts walked about 7 meters per minute slower than the others; the group wearing overcoats perspired profusely and the others scarcelyat all. SHIRAI concluded that when exertion is required, as on a, road march, the cold climate overcoat should be carried as a part of the pack instead of being worn. Incl 1, Report TID. GHQ, FEC, APO 500, subject: ’’Japanese Experiments in Resistance to Old ’ dated 1 Aug 49 The importance of altering the cold climate attire to fit the situation (depending on whether the soldiers arc resting or active) has been experimentally demonstrated. Therefore, all cold climate clothing should be designed to facilitate rapid changing. Cold climate shoes, like the overcoats, must have good thermal insulation in order to keep the feet warm when the wearer is at rest; at the same time, however, they must in no way hinder the movements of she feet when the wearer is ambulant u When a long .rest period is called, the tips of the shoes should be covered with floss silk, fur, wool, etc. in order to preserve the heat of the feet.. This is unnecessary when a men is moving since the temperature of the toes is noticeably raised, as is shown in Table 49c The cold climate shoos are easily damaged by wetting and freezing, and when in such a condition they have poor thermal insu- lating capacity, To maintain the thermal insulating capacity of the cold climate shoes, the wearer must be careful and resourceful'in protecting them from wetting and freezing; if any damage is detected, repairs should be made without delay6 The problem of wet feet is .important as they may readily leaci to freeze injury, it should oe noted that the feet become wet more often by water penetrating through the shoes than by sweating. TABLE 49 skih temperature of the feet while marchihg Fine line - Temperature of Left Big Toe Thick line - Temperature of Right Big Toe Start: 0857 0 Air Temp.: -26 C Wind Velocity: 0.8 m/sec Humidity: 89 $ Dry ttKATArt: 35 meal Finish: 1225 Air Teap.: -19°C Wind Velocity: 2-7 m/sec Humidity: 75 $ Dry 11 KATA": The protective hood must be designed so that the wearer can easily move into the wind* Incl 1, Report TID. GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to 0:1 3. ' dated 1 Aug 49 In order to use the items of cold climate clothing to the best advantage, one must be familiar with the correct and rational use of them for all situations and be resourceful enough to remedy any defects found in them in the best possible way. b. Rations During the cold season it is important that the soldiers be fed ample nutritious food and that this field rations'bc kept from freezing. It is obvious that if the field rations become frozen, hunger and the sub- sequent lessened physical endurance power vdll follow. Soldiers who are mentally and physically depressed vdll lose their power of concentration, their morale vdll- be lowered, and they will neglect to protect themselves from freeze injury. Many studies have been made on the protection of field rations from freezing, but so far no effective methods have been found. There are two ways of approaching this problem: first, to study the rations themselves; and second, to study the different wrapping mate- rials. To determine which of the two methods will most satisfactorily solve the problem, a comparative test was conducted using various kinds of food and wrapping materials under air temperatures between -30° and -40°C. The results of the test arc shown in Table 50. Some foods which were specially processed, such as bread mixed with soya bean paste, toasted rice balls with soy sauce, are known to withstand freezing slight- ly better than others, but under such low temperatures as -30° to -40°C, this processing is not effective. Simple wrapping of the food with news- papers or similar material seemed to serve as a much better protection against freezing. It should bo remembered that the bodyfs heat is a valuable means of protecting field rations against freezing. c, Tents In extremely cold and barren lands, the tent is the only shelter in which the soldiers can rest and regain their physical and mental strength in order to maintain'their fighting efficiencies. How- ever, during periods of extreme cold, tents do not afford the soldiers sufficient protection from the cooling power and their sleep is disturbed; in a prolonged field encampment the officers and men become mentally and ' physically exhausted, and their fighting efficiencies decline. Therefore, an improvement on the method of field encampment will be an important contribution to the maintenance of morale. In selecting a caraping site, the raost important consider- ations are usually obsovation by the enemy, being in his fire, protection from a constant wind, supply of water and fuel, etc.; but during periods of extreme cold, the maintenance of heat and ventilation are considered to be of primary importance. However, heat and ventilation are two con- flicting requirements: good ventilation means poor heat insulation. In the following we will discuss some of the important results of our tests with the Type 95 portable tents, (l) Heat Insulation of a Tent During Windy Weather and Calm Weather During an overnight period 40 kg, of charcoal was burned in the stove (a component of the tent outfit) for heat- ing. The inside temperature was measured by an Aussman (TN: ?) ventilation thermometer, and the degree of 81 Incl 1, Report TID, GHQ, FfC, APO 500, subject: '’Japanese Experiments in Resistance to Ccld,” dated 1 Aug 49 RESULTS OF EXPERIMENT ON FREEZING AND EDIBILITY OF FOOD v ~ 1 2 3 .. l t Degree of Freezing' n. and edibility Type of Food x. — *r Extent of Freezing | Edibility n [Extent of Freezing Edibility Extent of Freezing -P •H rH •H rQ 3 w r [Extent of Free , ng Edibility ; j Extent of Freezing i - | Edibility 1 Bread containing soya ewd 6h) : ne bean paste | i j 2 Ordinary bread w ewd ne i ! 3 Bread containing soya e |f*i ewd j(nt-)ine bean paste (miso) 1 j wrapped in three , layers of newspaper 4 Ordinary bread wrappe< e (-*-) ewd (wri ne with three layers of i newspaper 5 Bread containing soya (-) e (-) e (V e (-»-) ewd tit ne bean paste wrapped in one layer of newspapei * and packed in covered i ' ii ' ■ ' 1 IS . mess kit 6 ■ Ordinary bread wrapped (~) e (-) e (i-) e (-»*■) ewd ) ne in one layer of news- paper and packed in covered mess kit 7 Boiled rice flavored W e A ewd with soy sauce and packed in mess kit B Boiled rice flavored e (+6 i ewd with salt and packed in mess kit 9 Boiled rice flavored f+3 e M ewd | j i with soys, bean oil ) 1 and packed in mess 1 i kit 10 Ordinary meal packed w e i it) j ewd i i i i in mess kit 1 i i i 1 11 Boiled rice flavored (-) e ! H| i e i (-1+) ewd with soy sauce and t i * i packed in covered 1 i ! mess kit - j 1 1 i 12 Boiled rice flavored (-) e (-JI i e : J 1 { w! ewd * with salt and packed j i ! in covered mess kit 1 i 13 Boiled rice flavored (-) e 1 (-) e i ewd with soya bean oil i and packed in covered 1 I i mess kit i i .14i Ordinary meal packed (-) e (-) i e i Wj ewd Ll in covered mess kit —.— J ... Incl 1, Report TID, GiHQ., FEC, AP0 500, subject: MJapanese Experiments in Resistance to Cold," dated L Au TABLE 50 (continued) 15 Toasted rice balls (■+*") ewd | ne ! "I I ! flavored with soy i I ! sauce ! i . i 1 ! 16 Toasted rice balls (■¥) cwd * \ t » ! vh'*) ne i i * flavored with salt, ( - i ; 1 17 Plain toasted rice ("H") ewd 1 :**-'] ne • ; balls i i 18 Toasted rice balls M-A _ v. ■ ; e ! ewd tf) no ; ! flavored with soy i ! sauce and wrapped in i i ! i three layers of news- * ! ! [ paper 1 ... ! i i 19 Toasted rice balls (T) e (j<) ewd ptr) ne i i ! flavored with salt * ' ! 1 i and wrapped in three I I layers of news pa 'per i 1 20 Plain toasted rit e (+) e (+*■} ne balls wrapped in three i i i layers of newspaper I | 21 Toasted rice balls (-? e V*) o ! Ct+“) ewd flavored with soy 1 ! 1 sauce wrapped in one i i i layer of newspaper and 1 packed in covered ness 1 kit : . 22 Toasted rice balls ( ♦ ) e (~ ) 0 (•tf) ewd flavored with salt wrapped in one layer of newspaper and packed in covered mess kit 23 Plain rice balls (-)e (tt) ewd wrapped in one layer of newspaper and packed in covered mess kit REMARKS: ( -t") represents freezing of the surface Ifyer (■*+•) represents freezirjg to the intermediate zone (+*f) represents freezing to the center »»en represents edible "nen represents not edible "ewd” represents edible with difficulty This experiment was carried out at -30 to -!±0°C Prior to freezing the temperature of the fo$d was about 20°C. Incl 1, Report TID, GHQ, EEC, APO 5>00, subject: "Japanese Experiments in Resistance to Cold." dated 1 Aug h9 cooling by both dry and wet bulb thermometers placed at the height of the face of a sleeping man, one meter from the stove. The results obtained during windy and calm periods were "compared. (See Table 51). Although the same quantity of fuel was burned, the rate of cooling and the humidity were greater and the"inside temperature lower during the high air temperature; vjindy period as compared with the low air temperature, calm period, (The results of the test as shown in Table 51 were obtained with only one observer in the tent.) (2) Temperature Within a Tent Accomodating Many Persons Table 52 shows the air conditions which existed within the tent when IS persons were accommodated and 45 kg of charcoal were burned during an overnight period. These tests disclosed that during periods of extreme cold, fuel will be conserved and satisfactory heat insulation maintained if the present standard tents are protected from the wind. As long as a stove is used, no special attention to ventilation'is required; but if an open fire is used for heating, the situation is different. d. Heating Devices Various types of individual -warming devices are in use to heat parts of the body which easily lose heat, A comparison of the efficiency of these devices is given in Table 53. When the conventional type of charcoal dust sticks,' designed for use'in pocket warmers', are mixed with potassium chlorate, urotropin, etc., and pressed hard, their burning time and heating efficiency are greatly improved. The platinum pocket warmer is not recommended for use in extremely cold zones as it is difficult to light in the open, burns out quickly, and lias poor heating efficiency. Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 Windy Period i Time j u Cooling Rato Within Tent \ i ! Temperature ’Within Tent Humidity Within Tent Air Temp. Wind Velocity Entrance! Left Right Center 1— Wet !Dry Wet Dry I Wet | Dry Wet T Entrance Left Right Center Entrance Left Right Center 1 ! 2100 | { j 16 — 29 17 29 18 29 | 16 29 f -15°C -15°C -life -15°C % % -18.5°C 1.56 m/sec i 2200 1 n 25 9 21 9 i 22 10 21 j -4 +3 ►3 ►3 j 2300 J 11 24 11 23 n 23 11 22 -6 0 -1 -1 froze 63 97 97 -20.0 2.00 | 2400 1 8 ! 21 8 22 8 20 10 21 ►3 +3 ►5 +3.8 82 97 97 97 -19.2 2.34 i 0100 i i i13 26 9 20 12 25 11 25 -8 +4 -1 +•0.8 55 62 66 85 ■ -20.0 7.18 j 0200 1 9 i 23 4 18 7 20 7 21 -2 +8 +6 * +7 froze 61 45 48 -21.5 7.58 j 0300 10 23 6 18 8 20 6 19 +1 ►11 ►6 ►6 97 75 71 71 -21.7 7.67 0400 10 25 6 18 8 22 6 18 +5 +8 +'7 +8 56 61 59 49 -22.5 6.93 0500 12 25 5 IS 10 23 9 22 0 ►8.5 +6 68 60 » * -22.5 6.40 0600 12 26 7 18 9 21 9 22 -1 -*•8 +4 6l 61 54 56 -22.5 7.63 0700 13 27 11 17 10 23 9 22 -6 +9 +3 +6 froze 51 67 58 -22.0 5.00 Average 11 25 8 19 9 22 9 21 -1.8 j 4-6 .2 +4.3 +5.6 70 65 67 69 -21.4 5.3S T.vBLE 51 Incl 1, Report TID, GHQ, FEC, APO 5>00, subject: ■' Japanese Experiments in Resistance to Cold," dated 1 Aug U9 Calm Period Cooling Rate Within Tent En' trance Left p— Right Center Temperature Within Tent, °C Humidity Within Tent /Or Temp. Wind Velocity Tima Dry Wet Dry Wet Dry Wet Dry Wet Entrance Left Right Center Entrance j Left A Right Center 1830 17 29 19 31 ia 29 17 19 -16.5 -16.0 -1 —— -16.5 -16.0 » i cf * -20.0°C !~ — 4.19 m/sec 1930 5 17 7 19 5 16 7 18 4-13.0 +11.0 +14.5 +16.0 | 67.0 ? 1 77 7 i | >4*0 6i.0 -20.5 2.55 2030 5 16 6 18 5 17 6 17 +16.0 +16.0 +18.0 +20.0 48.5 \ 44.-7 1 47.0 57.0 -20.5 2.58 2130 6 ia 7 ia 5 16 7 18 4-15.0 +14.0 -17.0 -18.0 ' 51.0 49.0 46+0 55 .0 -20.2 3.70 2230 6 16 7 19 6 ia 5 17 4-15.5 +13.0 +17.0 +17.5 51.5 48.0 49.5 50 o0 -21.0 1.98 2330 6 18 6 16 6 1a 7 18 4-15.0 tl4.0 +14.5 +17.5 42 v>0 49.01 46 „0 46,5 -210 5 3-17 0030 6 17 5 17 6 1a 6 18 +16.0 +19.0 +16.0 +18.5 78.0 56 .0 i 78,0 71-5 ( -22 0 5 0,70 0130 7 ia 6 17 7 19 7 17 4-15.0 +14.0 +15.0 +15.5 51n0 49,0 47.0 | 48.0 | -27.0 0.25 0230 a 20 7 19 6 19 8 20 4-12.0 +12.0 +14.0 *14.5 46.0 46,0 49*0 1 50.0 -26.5 0.10 0330 10 1a a ia 12 20 9 21 +8.0 +10.0 +8.5 +10.5 54.5 43 -0 50.0 43.5 -26.0 0+0 0430 4 17 9 19 5 16 7 16 +18.5 +8.0 +21.0 +15.0 84*0 66,0 73*0 55.0 -29.0 0.46 0530 7 18 5 1a 7 16 6 17 +13.0 +14.0 +15.0 +17.5 48.0 42+0 0 46.5 -30,0 0 O63O 5 15 5 16 4 17 6 17 +20.0 +11.0 +18.5 +17.0 i 43.0 49*0 j 40,0 57*5 1 -31.0 0,95 0730 6 17 4 15 5 17 6 16 +15 .0 +13.0 +18.0 +20 o0 | 73+0 39,0 1 71,0 43.0 i -81.0 0,33 Average 17 7 1a 6 17 7 i 18 } l *14,7 +13,0 +15-9 ■'-16.7 | - . 56.7 50.0 j 43 .2i 52,6 j| -25+1 1,52 TABLE 51 (cant.) Incl 1, Report TID, 3HQ, FEC, A,:0 £00, subject: " Japanese Experiments In Resistance to Cold," dated 1 Aug b9 RESULTS OF EXPERIMENT ON TYPE-25 TENT DURING FIELD ENCAMPMENT Time Wet "KATA" Value Temperature , °C Air Temperature Wind Velocity Entrance Left Right Center Entrance Left Right Center 1830 33 34 25 31 -20.0 -20.0 -19.0 -19.0 -26.2°C 2.00 m/sec 1930 23 22 25 20 2.0 6.0 1.0 7.0 -26,5 3.00 2030 19 1 18 22 IS 13.0 15.0 10.0 12*0 -27.3 2.25 2130 26 20 25 . 22 1 12.0 15.0 9.0 12.0 ! -28*6 26.0 (TNrsic) 2230 24 23 25 ! 21 7.0 18.0 1.0 S.5 -28,6 28.6 (TN:sic) 2330 20 23 27 21 11.0 9.5 0 12.0 -30.6 2.20 0030 20 19 27 21 13.0 13.0 5.0 13.0 -30,1 1.40 0130 24 22 24 21 6.0 5.5 0 7*0 -30,0 3.60 0230 23 24 21 22 11.5 9.0 4.0 11.0 -31.0 3-00 0330 27 25 24 20 5.0 7.0 0.5 8,0 -•31*6 3.30 0430 24 24 27 19 10.0 6.0 -3.0 12*5 -32.0 1.60 0530 20 23 29 22 14.0 5.0 -3.0 12.0 -33 .0 3.30 0630 21 24 31 22 3.0 4.0 -3.0 7.5 -33.2 3.50 0730 22 25 25 22 5.5 7.0 -3.0 10.0 -34,0 2.50 Average 23 22 26 21 8.2 9.2 1.4 IQ-1 -30*5 2,69 TABLE 52 87 Incl 1, Report TID, GHQ, EEC, APO 500, subject: "Japanese Experiments in Resistance to Ccld," dated 1 Aug h9 ATM0SPH1 SEE WITHIN TYPE-25 PORTABLE TENT Time COp Content Amount of Dust Wind Direction and Velocity Air Temperature 1900 1.089% East Northeast 0.75 m/sec -34.0cc 2100 1.323 19.07/cc Southwest 0.80 m/sec -33.2°C 2300 2.089 20.38/cc Southwest 2.70 m/sec -32.0°c 0100 1.805 19.01/cc South Southwest 3.30 m/sec -3'+.6°C 0300 1.479 23 •06/cc Southwest 2.70 m/sec -33.4°C 0500 1.168 19.69/cc OOUlo lx. St 1.70 m/sec -34.2°C TABLE 52 (cont.) 88 Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 119 TABLE 53 COMPARISON OF THE HEATING CHARACTERISTICS OF VARIOUS POCKET WASHERS TYPE OH BRAND DURATION OP HEATING (hours and minutes) MAXIMUM PROPORTION OF JUEL REMAINING AFTER COMBUSTION HAS CEASED 3 _ • m 55 00 2 3-56 Eh O Eh h 0 OT 03 *25 63 cu 0 So Eh « B § H O O O Q to t-5 co ll 9 S 3 fL° *>• P*te M 5 SIZE AND COMPOSITION OF POCKET WARMER CHARCOAL DEGREE OF WARMTH FELT BY USER m 1 & Eh w 02 u • © P5 -*■> to © EH S as +> 3| a »~H © O O to u « +» . © S3 to « ►4 0 COMPOSITION 525 sis % p n o 2 PLACED IN TROUSER POCKET —, PLACED IN OVERCOAT POCKET 2 @ 1! @ Q £3 *4 323 B P4 S3 *-* &j| ass «< W O 2 0 2 2 ale 388 Pi BAt c!> «co to f*j <1 0 ils^ to to Eh O Nojibosu 1:45 2:20 16 39 3/4 3/5 3 -34.0 1.70 -50.0 to -60.0 5.0 1-5 10 • warmth when placed in trouser pocket, hut none when placed in overcoat pocket N 2:00 2:00 13 34.5 3/5 3/5 2 -32.0 1.35 -50.0 to -60.0 5.0 1.4 10 • a Haru-Biyori (commercial) , 2:00 2:00 42 48 nil nil . 1 -19oO to -31-0 2.70 to 3‘80, -40.0 to -50.0 3.5 1.5 9-5 Ordinary Pocket Warmer Charcoal Some warmth when placed in trouser and overcoat pockets Koko Brand Modern Charcoal (commercial) 5:30 6:30 22 59 1/4 1/10 l -35»0 to -37*0 1.27 to 2.39 -60.0 to -70.0 6.3 1.7 9-5 Hard-Paste of Ordinary pocket Warmer Charcoal and Potassium Chlorate Ample warmth when placed in trouser pocket, hut only slight warmth when placed in overcoat pocket Asahi Brand Modern Charcoal (commercial) 4:00 5:00 37 48 nil nil 1 -29*5 to -33.5 3.50 to 6.02 -60.0 to -80.0 5-1 1.4 8.6 R Some warmth when placed in trouser pocket, hut only slight warmth when placed in overcoat pocket Koko Brand Semi-Paste, . (commercial) 4:15 5:00 17.5 50 1/5 nil 1 -29.5 to -33.0 1.85 6.97 -60.0 to -80.0 5-3 1-7 9.5 same* except Semi-Paste Ample warmth when placed in trouser pocket, hut no warmth when placed in overcoat pocket Choju Brand Pocket Varmei Charcoal (Ring Type) Prepared by Military Medical Supply 7:00 8:00 55 64.5 nil 1 -35.0 2.30 to 4.30 —65*0 to -70.0 10.2 1.1 15.6 Ring-shaped hard paste composed of paulownia ash and potassium chlorate Ample warmth produced R 8:00 8:00 50 80 nil nil 1 -40.0 0.95 to I.85 -70.0 to -80 ► 10.3 1.1 15-6 Ample warmth produced; when placed in trouser pocket, hot feeling is produced. Platinum Pocket Warmer 0:45 0:45 23 25 dies out dies out 40 -20.0 to -22.0 0 to 3-78 -23.O to -50 30 cc added Kerosene No warmth in either trouser or overcoat pocket R 2:00 6:00 25 35 R nil * 10 -22.0 to -24.0 1.29 to 5-74 -45.0 to -65.O 30 cc added Gasoline R H 2:30 3:00 27 42 n dies out 3 -34.0 1.70 -50.0 to -60.0 30 cc added Gasoline Some warmth when placed in trouser pocket, hut none when placed in overcoat pocket Experimental Charcoal Pocket Warmer 4:00 7:00 44 51 1/4 1/3 1 -I5.0 to -21.5 3.50 to 11.14 -50.0 to -65.0. 6.4 1.1 10.5 Potassium chlorate, 2%; Urotropin, 7# Moderate warmth when placed in trouser pocket, and somewhat less warmth when placed in overcoat pocket. M * 6:30 7:00 38 62 nil nil 1 -20.0 to -22.0 0 to 3-78 -23.0 to -50.0 6.6 1.2 10.6 20# solution of casein ciddsdf snd dried Ample warmth when placed in trouser pocket; little warmth when placed in overcoat pocket 6:30 7:00 51 56 nil nil 1 -19.0 tc -21.0 3.70 to 3.80 -40.0 to -55-0 7.8 1.1 9-6 Ample warmth when placed in trouser or overcoat pockets R 3:00 8:00 38 38 1/4 1/4 1 -22.0 tc -24.0 1.29 to 5.74 -45.0 to -68.0 6.5 1.2 9.6 Little warmth in either trouser or overcoat pockets R 6:30 6:00 39 64 nil nil 1 -29.0 tc -33.0 1.85 to 6.97 -60.0 to -80.0 6.5 1.1 10.5 Ample warmth when placed in trouser pocket, hut little when placed in overcoat pocket R 7:30 4:00 37 60 1/2 . 1/2 1 -29.5 tc -33.5 3.5O to 6.02 -60.0 to -80.0 6.7 1.3 10.6 R The Riku-i-ei (TM: Army Medical) type heating device is designed to electrically heat the limbs of soldiers on outdoor-duty during the extremely cold season. The directions for its use arc as follows: (See Fig, 6.) (1) After donning the cold climate undershirt and drawers, the too heating caps arc put on the feet and covered with the ordinary socks and trousers. The heating caps for the fingers arc held on each hand and then the coat is donned so that the coat sleeves cover the wires. The heating caps with the longer vires are worn on the left hand and foot, and those with the shorter •'.vires on the right, Tnc connection plug (E) is passed through the slit in the cold climate wereoat and hung on the right outside of the waist* (2) The belt is passed through the slit in the strap of the generator and the latter fixed on the right side of the waist of the overcoat. The generator and heating caps are connected by plugging (B) into (A). (3) When a freezing pain is felt, the handle of the generator should be slowly revolved with the right hand for about 3 minutes to heat the caps on the fingers cud toes so that the pain till be alleviated and warmth restored. Under an air temperature of about -30°C one heating operation every hour is considered sufficient. (4) Precautions in the Use of the Apparatus Except in the case of need, do not turn the handle; Begin cranking cautiously and slowly; Lubricate the rotating parts occasionally for smooth operation; The heating caps should be handled carefully when not in use, and the wiring cord should not be bent forcibly. Fig. 6 Incl 1, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold, CHAPTER § PREVENTIVE MEASURES FOR FREEZE INJURE Freeze injury outbreaks are either collective or sporadic. Collective outbreaks occur when the commander misapplies his anti-cold orders, and sporadic outbreaks occur when the individual soldiers neglect the protective measures against cold or when the non-commissioned officers have failed in their supervision and guidance of the men with regard to these measures. The precautionary measures for each of these two cases are given below. Section I Instructions to Commanders on the Prevention of Freeze Injury 1. Strive to cany out completely all the instructions for increasing the cold endurance power and to maintain the necessary protective equipment and materials for this purpose. At the same time consider ways and means to utilize all available resources and materials for replacing or supple- menting defective equipment. 2. Thoroughly inspect the men’s cold climate clothing, especially the fit and condition of the cold climate shoes and the adequacy of the various man-packed equipment and materials. 3. Strive to inspire the morale of commanding officers and their men, and encourage them to carry out their duties at all times with an undaunted fighting spirit. When suffering from insufficient sleep or increased fatigue, they often tend to neglect details of the necessary precautions against freeze injury. Company commanders and their subordi- nate officers should be reminded of the necessity of instructing every man, if circumstances permit, to carry out faithfully the precautionary measures against freeze injury. U* In anticipation of sudden unexpected meteorological changes, a supply of protective equipment sufficient to meet all situations should be on hand. Endeavor to make the proper use of this equipment, and devise satisfactory methods of transporting it. Minute attention should be paid to the prevention of freeze injury. Feed the officors and men well, especially warn food and adequate extra food between regular meals. 6. Carefully coordinate the amount of protective clothing worn with the activity of the officers and men to avoid sweating, which is often the cause of freeze injury. When they sweat too much, do not call them to a sudden halt; either allow them to continue their activity at a slower pace until their perspiration dries or instruct them to wipe it off immediately, 7. | Drinking liquor must be discouraged as much as possible because it causes dilation of the blood vessels and hastens the loss of body heat. 8. The possibility of collective freeze injury is great on the occasions enumerated below. a. When the quivalcnt temperature as measured by the freeze meter is below -70°C. b. When the feet are v c. Prolonged lack of sleep; fatigue and hunger. df Long periods of halt, especially at night. e. Advancing into the wind. Incl 1, Report TID, GHQ, FEC, APO £00, subject: '“'Japanese Experiments in Resistance to Cold,11 dated 1 Aug h? 9. The following extra protective clothing should be carried. a. A pair of cold climate gloves and cotton gloves for each man. b. A pair of cold climate socks and cotton socks for each man, c. At least one pair of cold climate shoes per man. d. At least one pair of inner soles for the cold climate shoes per man. In addition, strive to collect as much data as possible on the meteoro logical conditions during the winter in extremely cold regions, and be prepared for unpredictable meteorological changes which can instantly undermine the fighting efficiency of the men. Section II Instructions for the Prevention of Individual Outbreaks of Freeze Injury The main point of these measures is the faithful execution of the instructions for strengthening the psychological (mental) cold endurance power. Noncommissioned officers are responsible for directing and supervising their men in adhering to these instructions. 1. Caution for the feet. a. Always check the fit and condition of the cold climate shoes. If defects or damage are noted the shoes should be repaired or replaced immediately. b. Try to prevent the shoes from getting wot, since wet shoes are one of the main causes of freeze injury. The shoes are likely to become wet while working in the kitchen, handling water, or from getting snow on the instep. Instead of trying t'o dry the shoes by continued wearing or by direct warming, neither of which is satisfactory, it is better to cover the canvas part with a piece of cloth or some other im- provised insulating material to prevent the shoes from freezing. Frozen shoes become brittle and are easily damaged. c. If possible, prevent the snow from entering the shoes at the top or through damaged openings, since this often induces freeze injury. As a precautionary measure, before donning the leggings the outer socks should be turned down to cover the shoelace holes. d. When you dry your shoes, do not forget to remove the inner soles. e. An additional pair of inner soles made from snake gourd fiber or many layers of paper should be placed under the regular inner soles. f. Do not wear dirty socks. Only two pairs of socks should be worn, with the cotton socks fitting over the cold climate socks. If three or more pairs of socks are worn, the intermediate socks often become wrinkled and cause foot injuries or impair the blood circulationj the latter often induces freeze injury. g. When riding on horseback, in av truck, or on a sled, some supplementary protective measures must be taken. lor this purpose the front of the legs should be wrapped with floss silk, fur, or paper. Incl 1, Report TED, GHQ, PEC, APO £00, subject; "Japanese Experiments in Resistance to Cold," dated 1 Aug Ij.9 h, When riding in an automobile, wrap the knees and legs in blankets and put dry grass or straw under the feet. Line the inside of the car with blankets. 2, Cautions for the hands and feet. a. Freeze injury.is easily sustained during firing maneuvers, while repairing battle damaged equipment, and while horseback riding. b. Rubber gloves should be worn while cooking and handling water. If the hands do get wet, wipe them off promptly. c. Do not handle any metal objects with the bare hands. d. Try to prevent th* cold climate gloves from becoming wet or damaged. e. Whenever possible warm yourself by putting a pocket warmer in a trouser pocket or inside the cold climate mittens. 3. Precautions for the head, face, and neck. a. To protect the ears, let down the flaps of the cold climate hat; if necessary, fasten the ears covers with buttons. b. Protect your face by using the cold climate mask correctly. Raise the collar of the cold climate overcoat, fasten the mask tightly, and then let the neck guard of the mask down in order to protect the neck against cold. c. When moving during extremely cold weather, especially into the wind, try to protect your nose by the correct use of the nose piece of the mask. At the same time, protect your eyes and other parts of the face by using a piece of woolen cloth, flannel, etc. d. Because the secretion of nasal mucus is stimulated by the extreme cold, and the breath often freezes to the moustache, you should wipe your nose and mouth occasionally. e. Hie visor, primarily designed to protect you from snow blindness, is also essential for protection when advancing into the wind or in a blizzard. f. If necessary, use the wind mask or dustproof goggles. In Precautions for the regions. a. Defecating in an open field often leads to freeze injury. b. Since urination is often made difficult by the trousers and drawers, care should be taken not to let incompletely discharged urine wet the inside of the trousers. c. Be sure to button up your trousers after urination. d. Prevent the penetration of the wind by placing floss silk or paper inside the trousers. Incl 1, Report TID, GHQ, EEC, APO 5>00, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug h9 APPENDIX "TOGO" (IN: MORTAL FREEZING) Section I Definition of the Term "Togo" The term "togo" has not yet been clearly defined. Death resulting from exposure of the entire body to. extreme cold is referred to by various names, such as Mtoshin(death by freezing), "togo-shi" (death from mortal freezing), and general freeze injury. When a condition of apparent death results, it is called "togo-kashi" (apparent death from mortal freezing). However, in practice, only when symptoms of freezing develop at the extrem- ities of the four limbs is the case diagnosed as "togo" and the required emergency treatment administered. Precautionary measures to prevent "togo" are not usually taken unless the temperature is sufficiently low to freeze the extremities of the four limbs. Because of this, delayed recognition of mortally frozen persons or incorrect emergency treatment has often brought about disasters which could otherwise have been avoided. The term "togo" must first be unequivocally defined before any satisfa toiy countermeasures can be devised. We propose the following definition: "Togo" (mortal freezing) means the general pathological changes of the entire body resulting from the decline of the general body temperature •" through a sudden loss of heat. "Togo-kashi" (apparent death from mortal freezing) means a condition into which the patient falls when the symptoms of "togo" are fully developed. "To-shi" (death by freezing) means death from "togo." These definitions clarify the relationship between "togo" and "toshi." When all the necessary conditions for the excessive decline of body tem- perature through a sudden loss of heat are present, "togo" will occur. It is also made clear that the development of "togo" does not necessarily require temperatures low enough to freeze the tissues. Thus clarified, the accepted idea of diagnosing "togo" when the extremities of the four limbs are frozen is misleading* The following diagram will help to cor- rect the generally accepted but incorrect idea about "toshi" (death by freezing). Death from loss of heat (unaccompanied by freezing of tissi Death by freezing Death from freezing w (accompanied by freezing of tissue) In its broader sense, "toshi" includes two types of death j death from loss of heat unaccompanied by freezing of the four limbs ; and death from freezir. of the tissues. Taking the air temperature of ~5>°C as the criterion, death occuring through loss of heat above this temperature is death by freezing in the broader sense, and that below this temperature is death by freezing in the narrower sense. The general pathological change of the body resulting from loss of heat due to immersion in cold water come, therefore, under the category of "togo". Section II Genesis and Development of Mortal Freezin Since the human body reacts like a thermostat to prevent the loss of heat under stresses of low temperature, wind, or moisture, the whole body attempts to defend itself by speeding up the generation of body heat and by avoiding radiative heat loss from the body. There is, however, a Incl 1, Report TIT), GHQ, EEC, APO £00, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug k9 a limit to this self-perservation action beyond which the vitality of the body slows down, accompanied by a lessening of the body heat and disturbed metabolism, until the general symptoms of mortal freezing begin to appear. When the body temperature falls below a certain limit (about 30°C, rectal), the functioning of all the organs begins to fail; finally the vitality of the whole body is weakened, and the body can no longer maintain life. Death by freezing may be thought of as the result of the suffocation of the tissues brought about by the interruption of the metabolic func- tioning of the organs due to a decline of general body temperature. The respective body temperatures involved in heat exhaustion and mortal freezing, both ox which result from the influence of environmental conditions and conditions of physical exertion of the body temperature, are shown in the following: (Heat Exhaustion) Uo°c (Normal Health) 36.5°C (Mortal Freezing) 30°C Heat exhaustion occurs even in extremely cold environments when a person overexerts himself while wearing too much clothing. Section III Causes ox mortal Freezing These general pathological changes incurred by loss of heat have two types of causes, internal and external. 1. The external causes are comprised of the following four points, all of which induce a sudden loss of body heat: a. Low temperature b. Wind c* Toisture (clothing wet by rain or snow) Since these factors have been thoroughly discussed in the chapters on freeze injury, the reader should refer to them there. d« Cold Water Water near its freezing point removes heat from the body veiy rapidly. Heat removal by running water is faster than by still water. 2, The internal causes are comprised of the following factors, all of which accelerate the decline of body temperature by slowing the heat generating and insulating functions of the body, when the heat removing effect of external conditions is relatively mild. a. Hunger b. Fatigue c* Lack of Sleep di Vitamin C Deficiency e* Excessive Drinking of Liquor f. Convalescence Incl 1, Report TID, GKQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug h9 Misjudgment of the cooling power and improper protective clothing often result in the outbreak of cases of mortal freezing. Incidentally, a survey of recent freezing casualties reveals that they are most frequently sustained during periods of seasonal change. Even at an air temperature of 0°G there is a possibility of many mortal freezing casualties occurring when both the internal and external factors mentioned above are present. Section IV Symptoms of Mortal Freezing The color of the skin first changes to a bluish purple or pales, and the whole body is chilled; then excessive drowsiness overcomes the person. Next his voice becomes hoarse, and his articulation is affected* When he walks, he staggers like a drunkard. Sometimes he becomes frenzied and utters incoherent speech or loud cries. His four limbs become slightly stiffened, his body temperature declines, and his pulse and respiration slow down. As these symptoms appear one after the other, the patient falls into a coma, his pulse and respiration become weak and slower. In most cases the patient dies after developing rigid spasms. These symptoms may be roughly divided into the following stages: 1. Fxcited stage Variolas actions of the body are accelerated in response to the cold. The cold sensation of the entire becomes acute when the lowerin of body temperature is compensated by accelerated heat adjustment. 2. Paralytic State Paralysis of the brain center and decline of respiratory func- tioning will appea-r at this stage, followed by disturbance of the heat regulating function of the body. The patient feels excessive drowsiness. 3. Mortal Agony The blood circulation is obstructed, causing various organs of the body to cease functioning, finally the patient loses consciousness (apparent death). h• Death Immediately prior to death, the circulatory function often undergoes a sharp decline which results in a deficiency of oxygen in the brain centers and results in rigid spasms. 'Whether or not mortal freezing is accompanied by the symptom of frozen limbs depends upon the air temperature. Special precautions must be taken since symptoms of mortal freezing often appear before the symptom of frozen extremities even at temperatures' low enough to induce freezing. (TN: The same word "toketsu" was used here for freezing and in the compound, frozen extremities; "togo" was used for mortal freezing.) Depending upon the relationship between cold climate clothing and physical exertion, either mortal freezing or heat exhaustion may be sustained under the same cold environment. Therefore a correct diagnosis of each case is imperative so that the required emergency treatment can be satisfactorily administered. Section V Treatment of Mortal Freezing Mortal freezing can be easily, simply, and satisfactorily treated if it is discovered in time and if the proper treatment is administered. Hence early diagnosis and. treatment are imperative. The first step in the treatment of mortal freezing is to quickly remove the patient to a warmer Incl 1, Report TTD, GHQ, ESC, APO 5>00, subject: '"''Japanese Experiments in Re sis -banc e to Cold/1 dated 1 Aug 1*9 place away from the cooling power which caused the condition. After having been removed to a warmer place (preferably at a temperature close to that of the body), the patient should be massaged through his clothes or with a piece of dry cloth all over his body. At the same time his limbs should be carefully exercised to stimulate the blood circulation and promote the heat generating function of the body. If necessary, artificial res- piration should be performed and the patient given a cardiac or a drug to stimulate the respiration. TIhen these symptoms are relieved and the patient regains his ability'to swallow, he should be given'hot tea, coffee, or other stimulating drinks, warmed with more covering and, if necessary, with a pocket warmer or hot'water bottle. It is risky to move the patient before his body temperature, pulse, respiration, and other general function! are restored to normal. It is always better to treat a mortal freezing casualty on the spot or in the immediate neighborhood. If circumstances demand immediate re- moval , special care should be taken to keep him sufficiently warm. In any event, transportation over a long distance is not recommended. Note: In the opinion of the research committee, the results of the research conducted by the Ammunition Section of Unit 731 and Unit B3500 of the Manchurian Army indicate that mortal freezing can bo satisfactorily treated by a immersing the patient in a warn bath at 37°C. Section VI Prevention of Mortal Freezing Since mortal freezing and freeze injury result from the same causes (the only difference between them being that freeze injury involves a local loss of heat, and mortal freezing a general loss of heat), the preventive measures for oach are approximately the same. The reader should refer to the preceding chapters on this subject. 97 Incl 1, Report TID, GHQ, ESC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 INCLOSURE NO. 2 EXPERIMENTAL STUDIES CONCERNING THE EFFECTS OF LOW TEMPERATURES ON THE LIVING BODY (REPORT —)* VARIATION OF THE COLD AUTO HEMAGGLUTINATION REACTION DUE TO COLD STIMULATION Tcruyoshi HASHIBA Surgical Department Hokkaido Women’s Medical College ---(Ed* Note: This is a handwritten manuscript, to become part of a numbered series published by Hokkaido University Medical Department) Incl 2, Repeat TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold." dated 1 Aug 49 CHAPTER 1 INTRODUCTION It is well known that local freeze injury (TN: "tosho" in Japanese) is, histologically speaking, a necrosis of tissue due to some disturbance of blood flow resulting from'the action of cold* Its cause admittedly lies in a stoppage of circulation, but Samul’s theory that this is caused by the simple solidification of blood within, the vessel is incorrect, as was pointed out in Kubo's report* Kubo attributed the stoppage to the reaction of cold hemagglutinins in the blood in response to cold. In his experimen- tal study of Raynaud's which is also known to be caused by cold, Iwai arrived at the same conclusion and stated that the'phenomenon of cold autohcmagglutination is the chief cause of this disea.se. On the basis of tests which compared differences in the cold autohemagglutination titers of spontaneous gangrene patients and normal individuals, Honna concluded that the patients' titers are generally higher, but that;extremely high titers are sometimes found even among normal individuals. He believes that spontaneous gengreno patients have some innate causative factor in addition to their high titers. Furthermore, he suggests that some inti- mate relationship possibly eadsts between susceptibility to freeze injury and the cold autohcmagglutination titers of normal individuals. Watanabe is known to have investigated this problem for the Kwantung Army during the Chinese Incident, but because of its secret classification, the report of his results has not yet been published.* In view of the fact that low agglutination titers are sometimes found in patients of freeze injury or in persons highly susceptible to it, the author assumed that in addition to high or low agglutination titers proposed by Honna and Watanabe, some fluctuant factor must exist in a latent state which allows low aggluti- nation titers under normal conditions but becomes active under the influ- ence of cold to cause extremely high titers. The experiments reported in this paper were undertaken by the author in an attempt to discover the camsativc factor of freeze injury and to verify this assumption. Very satisfactory results were achieved. CHAPTER 2 LITERATURE The phenomenon of cold autohemagglutination is caused by the presence in the blood of some sort of agglutinin, which when stimulated by the action of cold causes the blood corpuscles to agglutinate, Ascoli dis- covered this phenomenon in 1901, Later Landsteincr and Klein, observing the phenomenon in horses as well as humans, asserted that it is a physio- logical phenomenon, Bialosuknia and Hirschfeld stated that the phenomenon is observable in about 50$ of mankind, In his'experimental studies, Iwai observed the reaction in nine cases out of ten, and'Higuchi in seven cases out of seven, The number of cases examined by them, however, is too small to warrant any generalization. On the other hand, Koita reported the reaction to be positive in 42 out of 50 subjects examined. According to Ascoli, landsteincr, and Klein, the phenomenon occurs at a temperature of around 0°C, but it was shown by later researchers that it takes plo.ee over a wide temperature renge. For example: according to Hirschfeld, 0 to 5°Cj Kishi, 0 to 12°C; Yamagami, Kubo, and Fujino, 0 to 15°C; Setoyama and Nagasako, 0 to 20°C; Mino, 0 to 15°C; end Honna, 0 to 30 or 32°C, All agree that the phenomenon is most pronounced around 0°C. Cases were reported by L.J. Unger (1921), H.F, Brewer (1933), and W*D* Belk (1935) where blood was 3ccn to agglutinate even at room temperature during blood * (Ed, Note: See Section II, Chapter 3 of Incl 1 for some of txhesc results) 2 Incl 2, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Orlc./: dated 1 Aug 49 transfusions. At the present time it is generally admitted that the development of agglutination is determined by the agglutination titers, but it is also obvious that the titers vary with individuals, as was reported by Honna, As for the variation of titers with differences in age, Higuchi reported that they are higher in older persons. This vias later contradicted by Iwai1s study. It has been observed that the follow- ing diseases cause elevation of the agglutination titers. Syphilitic cirrhosis Paroxysmal hemoglobinuria Secondary anemia Chronic leukemia Pernicious anemia Trypanosomiasis Jaundice Spleen tumor Bronchopneumonia Bone tuberculosis Pernicious tumor Raynaud*s disease Spontaneous gangrene Substances known to cause elevated titers are: Raw milk Extract of testa/ Extract of brains Extract of fetuses Blood transfusions In addition, Honna, Yfetanabc, and Kumabc Reported that the agglutination titers were approciably elevated after the therapeutic use of sulfa drugs.* At the same time they stated that an extract of bovine liver ms effec- tive in lowering the titers and that it could be used satisfactorily in the treatment of freeze injury and of the pain paroxysms in spontaneous gangrene. By means of a serologic study of the phenomenon of cold auto- hemagglutination, Kubo found that the reaction can be recognized both in vivo and in vitro, Yamagami reported that the agglutinin does not lose its activity even when the blood is heated until the scrum coagulates, but that in physiologic saline solution it is inactivated after being heated at 65°C for an hour and a half. He further reported that the agglutinin is not absorbed by kaolin or bone black; shows faint albumin reaction in pure physiologic saline solution; and can be removed together with globulin when the latter is removed from the blood scrum. More recently, the phenomenon has been utilized as an aid in diagnosis and treatment. Hisatomc reported that in such illnesses as bone tuberculosis and pernicious tumor, the titer rises with the progress of the disease and aids in a more accu- rate prognosis. Using'the agglutination test as an aid to the diagnosis of atypical pneumonia, L.E. Young reported that 51$ of the patients had titers of 1:128 or higher and 80$ 1:32 or higher. Koita stated that the average titer of normal individuals is 1:8, but Honna contradicted him and asserted that since all earlier investigations were carried out at room temperature, the results wore not accurate and should be reexamined by his method, which employs a thermostatic room maintained at 40°C and 100$ humidity. CHAPTER 3 EXPERIMENTS Objectives. The present experiments were undertaken with the following objectives: a. To make a general surve2r of the cold autohemagglutination titers of normal individuals and freeze injury patients using Konna*s method, and then to compare the results with those obtained by other investigators, * (Ed. Note: See Incl 4, Report TID, GHR, FEC,'APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 15 Mar 49 Incl 2, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49 b. To clarify differences in susceptibility to freeze injury by comparing changes in the agglutination titers of normal individuals and freeze injury patients evoked by cold stimulation. Persons Tested, Subjects wore comprised of fifty persons selected from the nurses and patients of the hospital attached to the Holds?.!do Women*s Medical College, They wore divided'into throe * groups: Group A, normal individuals; Group B, freeze injury, frostbite, and digital cyanosis patients; and Group C, spontaneous gangrene patients. Method. The agglutination phenomenon which is evoked by cold occurs over a wide temperature range. According to Honna’s report3 it begins to appear at 30 or 32°C, while others have reported that it may occur at room temperature during blood transfusions, For this reason, one may say that the results of experiments obtained by earlier investigators at room temperature are very inaccurate. Since Honna and his associates obtained consistent results by the use of a thermostatic room maintained at 40°C and 100$ humidity, the author performed his experiments under equally controlled conditions. (1) All procedures from the separation of cells and plasma to the addition of the coll suspension to the plasma -were performed in the thermostatic room mentioned above, (2) Collection of Blood In the majority of cases cold stimulation and collection of blood were carried out early in the morning when the room temperature ms about 15°C, Venous blood ms drawn into a 5 cc sterilized syringe containing 0,5 cc of 5$ citrate solution which had been preheated to 40°C. After the needle had been removed, the contents were slowly emptied into a centrifuge tube, (3) Separation of Plasma and Cells After the blood-citrate solution had been centrifuged in the thermostatic room, 1 cc of the upper clear solution ms removed by a pipette and the remaining solution removed with an aspirator and discarded. The blood clot ms then washed three times with 10 cc of physiologic saline solution, (A) Serial Two-Fold Dilution of Plasma Serial two-fold dilutions of the plasma from 1:1 to 1:1024 were prepared in twelve small test tubes in such a manner that each tube contained 0,5 cc, (5) Blood Cell Suspension A % blood cell suspension was prepared by adding 10 cc of physiologic saline solution to 0,5 cc of blood colls, (6) Agglutination Test ' 1 To the diluted plasma in each of the twelve test tubes the author added 0,1 cc of the 5$ blood coll suspension and then shook the tubes thoroughly. The tubes were placed upright in an ice solution at 0°C and stored in a refrigerator for Incl 2, Report TID, GHQ, FSC, APO 500, subject: "Japanese Experiments in Resistance to Cold,’’ dated 1 Aug 49 six hours prior to examination. After this period the tubes were lightly shaken and then examined macroscopically for the degree of agglutination. The following symbols were used in this grading; •H4 • •••• Solidly agglutinated cell masses were sus- pended in the solution, the upper part of which remained clear, 44 ,*••• Many agglutinated cell masses were present, but the upper solution was colored red, f The presence of agglutinated cell masses could be detected only with a hand lens, - ..... The presence of agglutinated cell masses could not bo detected even with a hand lens. CHAPTER 4 RESULTS OF EXPERIMENTS I. Cold Autohemagglutination Titers of Normal Individuals end Freeze Injury Patients as Determined by Honna*s Method Table 1 shows the results of the test on the 35 normal'individuals' of Group A, Four persons had maximum titers of 1:4; twelve, 1:8; seven, 1:16$ and twelve; 1:32 which was the highest. The average percentage curve falls sharply after the titer of 1:4 (See Treble 4)* In the author*s tests, agglutination was positive in all subjects between the dilutions of 1:4 and 1:8. Table 2 shows the results of the test on the 13 subjects of Group B, which was comprised of freeze injury, digital cyanosis, and frostbite patients. At the maximum titer of 1:256 one subject was positive; at 1:128, four subjects; at 1:64, seven subjects; at 1:32, ten subjects; at 1:16, twelve subjects; and 1:8 or less, all subjects. The percentage curve falls sharply after 1:8 (See Table 4), and the average lies between 1:32 and 1:64. Table 3 shows the results obtained with Group C, i.e., the two spontaneous gangrene patients who were receiving medical treatment at the hospital. Both had maximum titers of 1:16. Comment. Among the agglutination tests carried out at room temperature, those involving the largest number of subjects were Koita*s with fifty, Iwai*s with ten, and Higuchi* s with seven. While Koita reported the average titer to be 1:8, the results of the author1s tests showed it to be between 1:4 and 1:8, In addition, Koita agreed with Honna in stating that some normal individuals have extremely high titers, but in the author*s experi- ments the maximum titers in this group were only 1:16 or 1:32, The titers of patients, however, were higher than, those of normal individuals, averaging 1:32 to 1:64, the maximum reaching 1:256. In a fow cases (two or three patients) the maximum titers were found to be only 1:8 or 1:16, which are almost as low as the average titer of normal individuals. Incl 2, Report TID, GHQ, FEC, APO 500, subject: ’’Japanese Experiments in Resistance to Cold,” dated 1 Aug 49 TABLE 1 CROUP A (ORDINARY CONDITIONS) Dilutions i$l I i CM * rHi i i ! 1 I 1 — 1 to r—i t— — H 1:32 + 4- 4 4 4 4 t 4. 4 4 4 4 CO « -3- CO vD i—1 i—1 4- 4: * * 4- * -L t £ 1- 4 4 4 4 4 + ± 4 4 4 CO • -4- tO to *• r-1 3 j. •+ 3. i JL T 4 * ..J £ 4- 4 4 4 4 4 4 4 4 4 + * 4 4 4 4 4 4 4 1 + to • to -4- • • H 4 * t H- J- 4 4 •y* a. £ t 4 4 4 i -? * 4 4 4 t 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 i 4 1 02 H * 4 4 ± ! 4 f 4- 4 4 $ $ 4 ± 4 4 4 4 4 4 4 4 4 t 4 4 * 4 4 4 4 4 4 4 4 1 H »—1 $ i j 4 4 i i j. *r 4 $ T H 4 $ 4 4 4 4 t 4 4 4 4 4 4 4 4 4 4 4 4 f 4 4 4 4 9 • O 55 OH W LJ_ 02 co -4" U-> VO -to o 9 H 3 a 3 a vT) rH o rH t» rH o H 8 rH C\2 02 02 04 c? tr 02 vO 02 j> 02 CO 02 o 02 P\ H CO 02 CO ro CO H- co P "£ tuO O rd O O Jh I> o 4 pH Incl 2, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold,” dated 1 Aug 49 TABLE 2 ffiOUP B (ORDINARY CONDITIONS) Case No, & Type Dilutions, 1: — i 2 — 4 8 16 32 64 122 256 Freeze Injury 1 •Hf fH- ff ff f Frostbite 2 -Hf -ff ff f ■ Frostbite 3 fff -Hf* +Hr 41-1 ITT fH ff ff f Frostbite 4 -B+ -Hf ff ff f Freeze Injury 5 -fff -Hf ftf fH ff Hf H -H- f Frostbite 6 -m- -Hf -Hf fH ff ff H Frostbite 7 fH -H+ ftf -Hf fH- ff ff f Digital Cyanosis 8 -Hf -Hf ftf -Hf Hf Hf f Digital Cyanosis 9 +H- -Hf -ttt* ff Hf H~ Digital Cyanosis 10 -Hf ftf ff -ff ff ff f Digital Cyanosis 11 -Hf fH- -Hf ff ft- f Digital Cyanosis 12 +H- ■Hf fH- ft ff f Frostbite Cyanosis 13 +H- fit fff -w ftf ff ff- f AVERAGE % 100% 100% 100% LOO^ >94.6: IS £>- -Aft-I 54% 30% 7.7? TABLE 3 GROUP C (ORDINARY CONDITIONS) Case No, Dilutions 1:1 1:2 1:4 1:8 1:16 1:32 1:64 1:120 1:256 1 tl+ -Hr -ft- -H- H- 2 -Hi- tH* -H- -K- -t" Average Per Cent 100SS 100$ 100$ loo?; 10C$ Incl 2, Report TID3 GHQ, FEC, AFO 500, subject: "Japanese Experiments in Resistance to Cold,” d ated 1 Aug 49 The author*s results coincide with the findings of Honna, Iwai, Watanabe and others in that patients suffering from digital cyanosis have elevated titers. However, the high titers such as were reported by Iwai and Honna were not found in the two spontaneous gangrene patients examined by the author. In these the maximum titer observed was only 1:16, but this may possibly be the result of the medical treatment they were then receiving. All fifty subjects examined by the author showed the presence of cold autohemagglutinins in their blood; The relationship of the average percentage of titers among Groups A, B, and C is plotted in Tabic 4» The difference between the average percentage of normal individuals and patients was about 50% when the titer was greater than 1:8, and the difference reached its maximum at 1:64. II, Variations of Cold Autohemagglutination Titers in Response to Cold Stimulation Method. a. Honna*s method as described in the foregoing ms used in the determination of the titers, b. By exposing the same groups of subjects who took part in the first part of the experiment to a standard cold stimulation, the author ' investigated the effect of this stimulation on their agglutination titers, and then made a comparison of the titers before and after stimulation. The subjects immersed their hands and forearms in ice water (0°C) at room temperature for five minutes; Blood was collected five or ton minutes later. During the immersion, all of the patients complained of pain and developed conspicuous local morbid changes, and some presented symptoms of aggravation. Local anesthesia was observed in the group of normal individuals, Results of Experiment Table 5 shows the results of cold stimulation on the 35 normal indi- viduals of Group A. Maximun titers were: one subject with 1:64; eighteen with 1:32; twelve with 1:16; and four with 1:8. The percentage curve drops from the titer of 1:8 (See Table 8), and the average titer lies between 1:8 and 1:16, Table 6 shows the results of cold stimulation on the 13 patients of' Group B. Throe subjects had a maximum titer of 1:512; six, 1:128; three, 1:64; and none below this. The average titer lies between 1:128 and 1:256. Table 7 shows that after cold stimulation the two spontaneous gangrene patients had a maximum titer of 1:128. Incl 2, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug A9 TABLE 4 DILUTIONS, I I GROUP A GROUP B GROUP C Incl 2, Report TID, GHQ, FBC, APO 500, subject: "Japanese 'jbeperiments in Resistance to Cold," elated 1 Aug 49 TABLE 5 GROUP A (AFTER COLD STIMULATION) Dilutions Case No. 1:2 1:4 1:3 1:16 1:32 1:64 1:256 1 i -1 .! - ! “ H-H- 4H— .1 » 1 ■ I I ’ HH-H Lt 4 +"5— j. 1 2 -f-M— r ? t -t-fH H-H- -444- i-H 1 I T“ -4-H— -h-h- -H— 4— 1 . 4 —i~IH— k -hPH" 4-4—1— -1 .. I 1 I 5 -HH- ~HH— -—fr— l—* -H ~S -H-h *__j i t j -1- IT , H-tH HH" —1— 4 - 7 H-H- -H-H -H-H- *444- ~rH I 8 1 1'! TH-H “H— —1— 9 H-H- ■H i~f— -H-t- H-H- -4- 4 .10 . i-H- H-H— H*t"H 4H"l- rr 4- 11 ■f1 H- . ' -'H ■H-t- —i — I. H _ TTT -HH- 44— -H -12 t-H- -H-t— -] t i- J » H-H- -I- 13 H-H- HH- -H-t— hh- 4-t- »■" |» ■* . -_14 4H-H HH— --1 t| t j - -HH- -H- 4— .. -15 -HH- -HH -H-- , i t-1— fr* -HH— 16 -H-t- -t-M— -Pf-4- t i i % rn -H-H h-h 12-.. “HH- “Hi- --i t- . J 1 -j4- H— . la H-H- -HH- 4-H- 44- -H 19 —HH— 1 -1-1 , trr \ -i j . V TT —H- 4~ 20 H-H- H-H— -H-H ■j1 4 1 4- 21 —+-H-- —H-j— —Hh- —H— H— 22 ■H—HH- -H-H H-H- HH-H t i'" H- 4H~4 • -H-t— ~TFP'" HH-H H-H -H ”25 -j—h-i— h-H— -fH— -fi- H~ 25 -HH- i-|H— H4-f ■■■ Hh—i h-h- 4“ 2.6 HHH- -I-H— -HH- H-t— 4- -2.7 -I-H- -H-t* - l L_- 4- 28 -MH- —!—H— *-{ *H- H-H- 4— ._2£_ H-t- H-H— 4- 30 —«—i— -HH— -HH— -Hi- -4-4- —H 31 • -H-t- ■ H-H— H-H- ~H— -4— .32 —HH- H-H- -H— —H - 33 -H-f- H-H— i-H-- 4-H- 44- 4- 34_ -H-H -HH- H4H- -44— -H .31.. -H-H -HH- —H— -4- Average Fer Cent 100^ 100? 100* 100? 85.7? 54? 2.8/0 Incl 2, Report TID, GHQ, FSC, APO subject: "Japanese Experiments in Resistance to C jo.." dated 1 Aug A9 TABLE 6 GMOUP B (AFTER COLD STIMULATION) Case No. Dilutions 1:1 1:2 1:4 1:3 1:16 1:32 ' 1:64 1:128 1:256 : 1:512 1 i-i i. _ nT t. i Ti ' Rtt Rtf- -ft- Rft — Rtt Rt* t- 2 i 11 jTT -+H- Rtt- >1 1 Tit R+t T- RR- -4- 1 3 Rtt Rtf- J.i 1 TT 111 rti 111 in HR Rtt -Hf- -ft- -t 4 Rtf- Rtf- Rtf 111 TT i-i i IT* -HR- -HR" Rt- 5 Hf * ■H+- > i > TTT j 1 J RHR Rtt- ,RRt Rtt Rt R- 6 Rtt Rtt- i i i PT -HR- -H+- ii+- Rtt- Rtt Rt 7 ■+H- 111 1 t r - i i-i ftj Rtt Rtt HH- RR R- -Hi- -H4- ill Ttl +H- Rtt | | | - 11 1 HR- R- 9 -H+- III Itr L -I-I TTT Rtt -Hi- It R— 10 -Vr +h- 4+f -HH Rtf- -H- R~ 11 Rtt -Hi- +H- -H4- -HH RR- t 12 Rtt Rtf- Rtt- ■tIT 4H- Rti Rt* R” 13 Rtt- -H+- -m- TH HH- -+H- RR~ R- Average Per Cent 100$ 100$ 1 100$ 100$ 100$ i 100$ 100$ 77$ 30.8$ 23$ TABLE 7 GROUP C (AFTER COLD STIMULATION) Case No. Dilutions 1:1 lr2 1:4 1:6 1:16 1:32 1:64 1:120 1:256 1 i i i M ! 11 i i"H~ *+H~ 11 i rn -H- '•ft 2 -fH- f If -H+- ~Ht tth -ft" -+t -f- Average Per Cent 100$ 100$ 100? 100$ 100$ 100$ 100$ 100$ 0$ Incl 2, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to CoDE,'1 dated 1 Aug 49 From a comparison of the titers before and after cold stimulation, it is evident that in all three groups'the titers after stimulation were higher than before (See Tables 8, 9, and 10). The difference in the titers before and after cold stimulation has been provisionally called "fluctu- ation amplitude" by the author. The amplitude was found to be greater in patients than in normal individuals. The titers of some of the patients in Groups B and C which did not differ much from those of normal indivi- duals under ordinary conditions became extremely elevated after cold stimulation. For example, in Group A, the standard cold stimulation did not appreciably affect the average titer which increased, only from between 1:4 and 1:8 to between 1:8 and 1:16, With Group B, however, the average titer increased from between 1:32 and 1:64 to between 1:128 and 1:256. One conspicuous case was No, 1, whoso titer went from 1:16 to 1:512. No, 4Ts titer rose from 1:16 to 1:128, Such extremely large fluctuation amplitudes were not observed in any of the subjects of Group A. Under normal conditions the spontaneous gangrene patients had only slightly' higher titers than the normal individuals, but after cold stimulation, the titers of the former rose to 1:128, a very large amplitude. Comment (1) It was experimentally demonstrated that cold stimulation caused elevation of the agglutination titers in all groups. This elevation was relatively small in normal individuals but large in spontaneous gangrene and freeze injury patients* (2) The change in a person’s agglutination titer due to cold stimulation is called "fluctuation amplitude" by the author. A large fluctuation amplitude ms found in both groups of patients but not in any of the normal individuals. It is note- worthy that those in the former groups who did not differ substantially from normal persons under ordinary conditions showed a large fluctuation amplitude after cold stimulation. From this the author concluded that those persons whoso titers are normally low but show a large fluctuation after cold stimulation may be said to possess potentially high titers.' When we undertake the problem of abnormally elevated titers, such as have been observed by many investigators in various diseases and reported by others as the chief cause of freeze injury, it may be reasonable to consider the potential elevation of titers discovered by the author as another important factor. CHAPTER 5 SUMMARY AND DISCUSSION First observed by Ascoli, Klein, and Landsteincr in isolated instances, cold autohemagglutination was not given official recognition until Ottenberg and Lattes described it in their reports. Later, Mino used the term pseudo-agglutination to distinguish it from true.aggluti- nation, The idea that this phenomenon exists physio logically in all human has been only recently introduced by Yamagami, Kubo, Fujino, et.al., following Higuchi’s work. Prior to their studies, there had been only a few scattered reports: Hirschfeld asserted that the phenomenon was 12 Incl 2, Report TID, GHQ, FEC, APO 500, subject: "Japanese liqperiments in Resistance to Cold," dated 1 Aug 49 TABLE 8 GROUP A (NORMAL INDIVIDUALS ) DILUTIONS, I: BEFORE COLD STIMULATION AFTER COLD STIMULATION 13 Incl 2, Report TID, GHQ, FEC, /iPO 500, subject: "Japanese Experiments in Resistance t® Cold,” dated 1 Aug 49 TABLE 9 GROUP B ( PATIENTS ) DILUTIONS, I : BEFORE COLD STIMULATION \after cold stimulation Incl 2, Report TID, GHQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aur 49 TABLE 10 GROUP C (SPONTANEOUS GANGRENE) DILUTIONS, I: BEFORE COLO STIMULATION AFTER COLO STIMULATION 1 2, Report TID, GBS, FSC, .‘JO 500, subject: lesistanc q to Cold,w dated 1 Aug 49 observe1^0 akout one-half of mankind; and in Japan, Iwai observed it in nine1 cases ten, and Koita in forty-two cases out of fifty. In those (3arlier days when the existence of cold agglutinins ms a matter of disPu^e> ms inevitable that experimentation on the subject should brinp i°rth conflicting results. Later Honna pointed out that inadequate- ly controlled experimental conditions were the cause of failure among earli cr researchers, and stressed the need of conducting the experiment in a thermostatic room at 40°C and 100$ humidity. Following Honna1 s methe thic author undertook a sample experiment and obtained very satis- factory results. Thereupon he conducted all his experiments by the seme method and compared his results with those obtained by other researchers, rfhe cold agglutination'titers of normal individuals were found to average between 1:4 and 1:8, which is lower than the average of 1:8 -rted by Koita, Furthermore, in the author*s tests, agglutination was' positive'in all subjects, which coincides with the experiments of Higuchi, lamagarni, Kubo, Fujino, and others, and testifies that this reaction appears as a physiological phenomenon in all human beings when the tem- perature is in the neighborhood of 0°C. The titers of the two spontaneous gangrene patients were not elevated to the extent reported by Iwai, presumably because of the effect of the medical treatment which they were then receiving. The author observed that the titers of freeze injury, frostbite, and digital cyanosis patients were higher than those of normal individuals, which coincides with Iwai1s findings. Some patients had titers which did not differ greatly from those of normal persons. How are such cases to be explained; arc they to be treated only a-s exceptions? This problem cannot be resolved on the basis of the viewpoint taken by Honna, Iwai, Watanabe, and others, but in the light of the author’s experi- mental results it can be satisfactorily explained. His'conviction was further confirmed by tests on spontaneous gangrene patients, whose titers were low under ordinary conditions but conspicuous- ly elevated after cold stimulation. For purposes of comparison, the some cold stimulation was given to patients of freeze injury, frostbite, and digital cyanosis, as well as normal persons. In comparing the results, the titers of the latter were taken as the criterion. Although the titers of normal individuals were only slightly elevated, the titers of the patients were elevated to a large degree, thus demonstrating the existence of a large fluctuation amplitude. It is noteworthy that the titers of patients which were as low as those of normal persons under ordinary conditions became highly elevated after stimulation. On the basis of these results the author believes that same of the patients may bo regarded as having potentially elevated titers. In relation to the problem of susceptibility to freeze injury, the author feels that the existence of potentially elevated titers is an important factor and shoi" be considered in addition to the apparently high or low titers which wort utilized by Honna, Watanabe, and others as the index of susceptibility. -- exclusions (l) By investigating the cold autohemagglutination titers of - normal individuals and freeze injury patients by Honna*s method, the author found that the titers of normal individuals averaged - between 1:4 and. 1:8, while those of freeze injury, frostbite, and digital cyanosis patients were always higher. Agglutination was positive in 100$ of the subjects examined. Incl 2, Report TID, GHQ, F3C, APO 500, subject: "Japanese Fxperinonts in Resistance to Cold,” dated 1 Aug 49 (2) Titers were abnormally elevated after cold stimulation phenomenon tut-s especially conspicuous in patients of f: injury, frostbite, digital cyanosis, and spontaneous ga.,_ (3) Some of the patients, whose titers under ordinary conditioi not differ greatly from those of normal persons, showed abn> elevated titers after cold stim.ula.tion* [k) The change in titers due'to cold stimulation, termed "fluctuai amplitude" by the author, was found to bo extremely large in cases of potentially elevated titers. (5) In the problem of the relationship between cold autohcmaggluti- nation ticers and susceptibility to freeze injury, the presence of apparently high titers as suggested by Honna and Watanabe is admittedly an important consideration, but in addition to this, the importance of potential (latent) titer elevation with a large fluctuation amplitude cannot be overlooked. LITERATURE 1. Samul, Vcrsuch uber die Blutcirculation in der Acutcn Bntzundung: Virchow1s Archiv.. Bd XI, s, 213, 1867 ' 1 2. Kubo, Effect of Cold on the Living Body: Hokkaido Medical Journal, A, No. 2 3. Iwai, Pathological Significance of Raynaud*s' Disease: Hissin Medical Journal, No. 7; 1946, Korean medical Journal. No. 66 A. Honna, Cold Hemagglutination Reaction in Spontaneous Gangrene; J. Japan Surgical Society 5. Ascoli, Isoagglutininc und Isolysinc Menschlichcr Sera: ilunich mod, Woch*. s. 1239, 1901 »» 6, Landsteiner, Hour Agglutinations Erscheinung der normalen menschlichen: Wien Klin. Woch., s. 1132, 1903 7* Bialosuknia, Handbuch der Biochemie des iuenschen und Tier 8. Klein. Beitrag zur Kembris der Agglutination rotcr Blutkorpcrchen: Wien Klin. Woch., Nr. 16, 1902 9. Hirt’.chfeld, Uber die KS Iteagglutination der roten Pint’ ’ Zeitschr, f. imm. u. exp. Thorap.-, Bd. A3, s. 521 10* Higuchi, On the Cold Autohcmag.glutinin and the Autohemolysjj.il National Medical Journal, June 19AA 11. Koita, Cold Aut©hemagglutination Reaction: Keio Nodical Journal., 8, No. 8 12. Kishi, Stucfy- 0.n the Hemagglutination Reaction at Lower Temperatures: Juzen-kai Magazine. 31. No. A Incl 2, Report TID, 0-HQ, FEC, APO 500, subject: "Japanese Experiments in Resistance to Colc^H dated 1 Aug 49 13* Yanagarni, Kubo, & Fujino, Supplementary Report of the Study of the ' Two Typos of Autohemagglutination: Hokkaido Medical Journal, No. 2, 1927 14. Setoyama & Nagasako, Supplementary Report of the Study of the Cold Aut©hemagglutination Reaction: Hokkaido Medical Journal, 20, No. 5 15. Mino, Deutsch. Med, Woch,. No. 45. 1924 16. L.J. Unger, 1921 17. H.F. Brewer, 1933 18. W.D. Belk, 1935 .9. Honna, Watanabe, & Kuma.be, Experimental Study of the Effect of Sulfa. Drugs on the Cold Autohcmagglutination of Rabbitst Blood: J. Ja.pan Surgical Society, 43. No. 6 20. Young, L.E., Clinica.l Significa.nce of Cold Hemagglutinins: A.J, Medical Science, 211, No. 1, 1946 21. Mino, Deutsch. med. Tvochonschrift. Nr. 45, 1924 22. Ottenberg, Medico-legale'Application of Human Blood Grouping: J, Ain. Med. Soc.. p. 681, 1921 tt Lattes, Die Individualitat des Blutes; Berlin, 1925 18 Incl 2, Report TID, GHQ, EEC, APO 500, subject: "Japanese Experiments in Resistance to Cold," dated 1 Aug 49