Abstract
To the Editor:
I read with interest and alarm Bradford Washburn's 1962 NEJM Article “Frostbite: What It Is—How To Prevent It—Emergency Treatment”—Historical Background and Commentary by Rodway et al. 1 Some of the lessons from this “Lessons in History” were not those intended by the authors.
The choice of this article, 2 ostensibly by Bradford Washburn, from the Boston Museum of Science, is appalling to those who know its background. It was mostly a work of plagiarism that was printed in the New England Journal of Medicine (NEJM) without the permission of William J. (Bill) Mills, Jr, MD, who was responsible for all of the medical content and much of the rest of the information.
This “Lessons from History” suffers the further flaw of using the Wilderness Medical Society (WMS) Guidelines for the Prevention and Treatment of Frostbite 3 as the de facto gold standard for the management of frostbite. The WMS frostbite guidelines may turn out to be the current state of the art, but the guidelines appeared in the same issue of Wilderness & Environmental Medicine (WEM) as the “Lessons from History.” They had not yet had a chance to be evaluated by outside reviewers. Unfortunately, the fact that 2 of the authors of the “Lessons from History” article were also the authors of the guidelines gives them the appearance of promoting their own work.
What were some of the real lessons from history? Bill Mills in Anchorage, Alaska, did the pioneering work in North America on the treatment of frostbite. Mills had plenty of clinical experience and a grant from the Office of Naval Research. At that time, dog teams were being replaced by snowmachines. The dogs usually made it back home, but the same could not be said for the machines. Although there were many other causes of frostbite, this change resulted in a large number of cases.
In the 1930s, Ariev and Gargolav in the Soviet Union had found that thawing in warm water was the best method of rewarming frozen extremities. Their work was unknown to western researchers until it was translated into English in 1955. 4 Similar work was done in the late 1950s by Yoshimura in Japan. 5 Mills applied the physiologic work of Harold Meryman, MD, on cryopreservation of living cells at the US Naval Research Lab (and, later, the American Red Cross) 6 to the treatment of frostbite. Mills was always careful to acknowledge Meryman's contributions.
The 1960 article by Mills and Whaley 7 was the forerunner of many articles by Bill Mills detailing a comprehensive approach to patients with frostbite. Mills, an orthopedic surgeon, was the prime mover in this work. He included Robert (Bob) Whaley, MD, and Winthrop Fish, MD, (both internists) as “medical cover” because of his own perceived lack of knowledge of physiology. They thought the use of ultrasound to thaw deep tissue might be helpful. The article was published in 3 parts 7 -9 because the work was underway when the first part was published. Mills and Whaley had started a new journal, Alaska Medicine, for which they needed material. By the time the third part was finished, it was clear that ultrasonic warming damaged the tissue and was, therefore, harmful rather than helpful.
Initially, Bradford Washburn's relationship with the medical community in Alaska was quite friendly. In 1959, Washburn was in Alaska for one of his many expeditions to Mt. McKinley. He stayed with John C. Tower, MD, a pediatrician in Anchorage. Washburn staged an expedition from the Towers' garage. Washburn's relationship with Bill Mills was also cordial. Mills loaned Washburn his photos of frostbite for an article in the American Alpine Journal (AAJ), a publication of the American Alpine Club, a climbing organization.
Bill Mills was preparing an article on his own work to be published in a medical journal when the NEJM printed Washburn's article. The article subsequently also appeared in the AAJ and as a pamphlet (without the photos). Mills had never given Washburn permission to publish the photos in a medical journal and had never given Washburn permission to publish any of his work on frostbite. Mills contacted Joseph Garland, the editor of the NEJM, to complain that the article had been published without his permission. Garland, a personal friend of Washburn's, essentially told Mills that Washburn was a proper Bostonian and, therefore, would never have done such a thing.
Mills considered suing Washburn, but Meryman—among others—counseled against it. Meryman told Mills that Washburn would feel guilty about what he had done. This is, in fact, what happened. Washburn apologized many times to Mills. Mills told Washburn he would forgive him if Washburn would write him a letter of apology. Washburn never wrote the letter.
Washburn knew that he was persona non grata in the Alaska medical community. He never contacted John Tower again. Another Anchorage pediatrician and his wife found themselves hosting a priest from Boston. The priest mentioned that Washburn had asked him to talk to Bill Mills. The priest went to Bill Mills' house and asked him to absolve Washburn. The pediatrician was aghast at having unknowlingly aided this plan and, for years, continued to apologize to Mills.
Most physicians with an interest in frostbite saw through the NEJM article. They recognized that Mills had actually done the work. Wilderness & Environmental Medicine published a Lessons from History article, “‘From Larrey to Mills’: the road to rapid rewarming – a commentary” by Bruce Paton, MD, in 1998. 10
A further historical footnote, not related to the Washburn fiasco, has to do with the slow acceptance of rapid thawing of frostbite in warm water. A debate, known in some circles as the “Anchorage-Pontresina Debate,” took place at a cold injury meeting in Fairbanks, Alaska, in the early 1960s. Rudy Campell, an orthopedic surgeon from Pontresina, Switzerland, who was one of the founders of the International Commission for Alpine Rescue, believed in slow rewarming, while Mills advocated rapid rewarming. Mills challenged Campell to put one of his legs in ice water to be provided by the hotel, while Mills would do the same. Mills would then rapidly thaw his frozen extremity in warm water. Campell could rewarm his using whatever method he preferred. Unknown to Campell, Mills had lost his right leg in combat in the South Pacific in World War II. Of course, immersion in ice water cannot cause frostbite. Mills revealed his wooden leg before either of them had taken up the challenge.
I would like to thank Bill's wife, Elaine Mills, and Bob Whaley for their kindness in sharing their recollections. Bill Mills was too ill to contribute directly to this letter, but has been exceedingly generous to me for many years as a mentor and personal hero.