Abstract
To the Editor:
We would like to thank Dr Zafren for his letter regarding our historical treatment of Bradford Washburn's 1962 New England Journal of Medicine article on frostbite. The information Dr Zafren relates is not common knowledge among the general scientific community, and the Alaskan views he expresses regarding this 1962 article are most fascinating. Medical history is not usually spiced with controversy, but differing interpretations are what, at times, make the pursuit of history particularly interesting and worthwhile. However, there are a few points to which we feel we should respond.
The Wilderness Medical Society (WMS) Frostbite Guidelines were peer-reviewed and endorsed by the WMS. They were referenced, in part, because the Guidelines were published in the same issue of Wilderness & Environmental Medicine as the Washburn commentary. Therefore, the reader of our commentary could easily refer to the Guidelines for literature that was reviewed in the process of formulating recommendations. The WMS Frostbite Guidelines simply represented the latest peer-reviewed article on the subject and, perhaps more importantly, it represents the first such publication on frostbite to attempt to grade the available evidence in an objective fashion.
As to Washburn's 1962 New England Journal of Medicine article being a work of plagiarism, a substantial component of the work is devoted to practical prevention and care of frostbite. Washburn was an experienced mountaineer. His field experience served as a basis to suggest practical ways to prevent and manage frostbite in challenging field conditions, not to mention his practical recommendations concerning diet in cold weather. These perspectives were certainly not borrowed from the work of Mills et al. This information (contained in the first 4 pages of the text) is a major part of Washburn's article, and is likely the reason that the American Alpine Journal published it as a practical article for high altitude and cold-weather mountaineers.
We do agree that Washburn could have done a better job of referencing or attributing the work of Mills et al in his review. Mills' 3 important 1960 to 1961 articles 1 –3 are, however, found in the reference section. Washburn also states, after discouraging the practice of walking on recently thawed feet or toes, that “it would be wise to quote directly from a recent letter of a top authority [Mills] in the treatment of frostbite…” and subsequently cited personal communication with Mills. Washburn also mentioned Mills et al in the article's acknowledgement paragraph at the bottom of the title page. Of course, even though Washburn stated on the title page that “All illustrations are … kindly provided by William J. Mills, M.D. of Anchorage, Alaska,” if the images were in fact published without permission, no reasonable excuse for that exists. Nonetheless, we have to assume that the New England Journal of Medicine required copyright permission releases for such images in 1962. But, of course, we cannot speak with any authority on that particular topic. It did not, at any rate, occur to us that a reader familiar with cold injury would presume that Washburn did any of the original science he discusses since he had no qualifications to do so. Why a journal like the New England Journal of Medicine published a review article on this subject from a cartographer with no medical background is somewhat remarkable and adds to the intrigue surrounding the article's “backstory.”
In regard to Washburn misrepresenting the work in his review, we find it hard to fathom that the editors and peer reviewers at the New England Journal of Medicine thought Washburn might have been performing original cold injury research when he had no formal medical background. And it is most interesting that Washburn's article, when originally published in the 1962 American Alpine Journal, apparently had Dr Mills' blessing (according to Dr Zafren's account related here). Did this only become an issue of great animosity when it was reprinted—in essentially identical form—in the New England Journal of Medicine?
We hope that we made it clear in our commentary of the Washburn piece that Mills and his Alaskan medical colleagues were responsible for the major discoveries discussed in the 1962 New England Journal of Medicine article. For instance, we mention “… the first (published) major clinical experience with rapid rewarming was a report out of Alaska in 1960—which happened to be the vanguard of a series of important papers by Alaskan clinician-investigators (the series of three 1960 to 1961 articles). 1 –3 Washburn's 1962 New England Journal review would not have been as important as it was nor had the impact it did without the original work of Mills, Whaley, and Fish published 2 years earlier”; and “The … series of 1960 to 1961 articles by Mills and his Alaskan colleagues were fundamentally (and clearly) responsible for a paradigm shift in frostbite treatment, and these papers must have, in large part, provided the impetus for Washburn to write his review in the first place.” And the first sentence of our conclusion states “Washburn's practical 1962 review of frostbite and its treatment highlighted the ground-breaking original work from Mills, Whaley, and Fish that emerged from Alaska in the immediate years prior to the New England Journal article.”
Lastly, for the upset the Washburn article apparently caused in parts of the Alaskan medical community, why was there no subsequent published response, such as a letter to the editor of the New England Journal of Medicine or elsewhere, which detailed Washburn's transgressions as stated in Dr Zafren's letter?
In conclusion, we wish to emphasize that we have the greatest respect for the work Dr Mills and his Alaskan colleagues did in the 1950s and 1960s to elucidate the effectiveness of rapid rewarming of frostbite injury and other aspects of cold injury treatment. In providing a commentary on the historical impact of the 1962 Washburn New England Journal of Medicine article, we were in no way attempting to take any credit away from Mills et al. The ground-breaking results from the studies of Mills and his fellow Alaskan clinician-investigators served to solidly establish not only rapid rewarming of frostbite as the initial therapy of choice for freezing cold injury, but many other foundational aspects of modern frostbite treatment as well.