Regardless of Washburn's mountaineering accomplishments, he is perhaps best remembered as mountain photographer and cartographer. The precision and artistry of his alpine photographic work has placed him in very select company, the likes of which include masters of the craft such as Ansel Adams and Vittorio Sella. As a professional cartographer, Washburn produced the most accurate maps yet accomplished of Denali, the Grand Canyon, the Western Yukon, and Mt Everest. In 1939, shortly after completing his graduate work at Harvard University, Washburn became Director of Boston's Museum of Natural History (later to become the Museum of Science). During his 41 years as Director, the Museum became one of the finest teaching museums in the world under his imaginative leadership and effective administration. To date, 4 published biographies or autobiographies have been dedicated to chronicling Washburn's very full life.

Washburn was, by 1962, already a legend in North American mountaineering. He had by that time completed 15 major expeditions into the mountains of Alaska and the Yukon Territory of Canada—several of which were undertaken in full winter conditions. His on-going relationship with Mt McKinley (Denali) had resulted in an exquisitely detailed map of the mountain in 1961. However, for all of his expertise in the Far North, Washburn's most significant early mountaineering experiences took place in the European Alps. As a young man, Washburn was one of the most accomplished American alpinists of his day.Perhaps his most notable alpine climb occurred when he was just 19 years old. Washburn achieved the first ascent of the sheer 1400 m north face of the Aguille Verte near Mont Blanc in the French Alps (accomplished with 2 Chamonix guides). This climb is still considered a fine exploit, even by today's standards.

Washburn's article was timely and perhaps even ahead of its time; the treatment of frostbite was then, and continues to be, controversial. Since the publication of Washburn's article, recommendations for frostbite have undergone some important changes. However, the essential tenets that Washburn described in 1962 are still the basis of present-day guidelines. In addition, Washburn included in the article useful practical knowledge and observations on coping with cold weather wilderness and high altitude expeditions.

In the May 10, 1962 issue of The New England Journal of Medicine,a rather unique phenomenon occurred: a “Special Article” titled “Frostbite: What It Is—How To Prevent It—Emergency Treatment” was published not by an MD or thermal physiologist, but by a cartographer, Boston native Bradford Washburn (1910–2007). Washburn was then Director of the Museum of Science in Boston. Somewhat more amazingly, the article was originally written for the American Alpine Journal (the annual publication of the American Alpine Club), which subsequently gave permission for the New England Journal to reprint it. Frostbite: What It Is—How To Prevent It—Emergency Treatment was also published as a stand-alone booklet by the Museum of Science in the 1960s, and went through 7 printings by 1978.

An escalation in Western frostbite research was prompted by the fears of the NATO-Soviet Cold War turning hot and the concern that Western armies might, once again, be fighting a large-scale war in the plains and mountains of central Europe (and elsewhere). By the early 1950s, the NATO medical handbook had adopted rapid rewarming in warm water as the treatment of choice for frostbite injury. From the early 1950s until the early 1980s, basic research into the pathophysiology of frostbite was intense,and 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 3 1960 to 1961 articles),which were later reprinted.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. When considering the clinical highlights of the 1960 Mills, Whaley, and Fish article,it is clear that major recognition is due their work for the proposal of:Mills, Whaley, and Fishalso noted the lethality to affected tissue of the second freezing episode in freeze-thaw-refreeze injury, and they suggested the time-honored description of first- through fourth-degree frostbite be changed to a more descriptive clinical diagnosis of “superficial” and “deep,” which is still favored by many authorities today as “mild” and “severe.”

Unknown to Greene and western medical science at this time, however, investigators at the Kirov Institute in Russia had begun a series of experimental studies examining frostbite treatment in the decade prior to World War II.In the course of testing a variety of rewarming methods, they found that rapid rewarming of the frozen body part in water provided improved treatment results compared to slow rewarming. Unfortunately for the Soviet troops during World War II, rapid rewarming was not practiced on any sort of wide-scale basis. The heating of water simply to provide hot drinks or soup was itself a major logistical issue in combat conditions. Moreover, these Soviet findings did not make their way to the West until after the Second World War.

Perhaps not surprisingly, due to Larrey's influence and authority, his suggested treatment for frostbite was accepted practice well into the 20th century. Even as late as 1942, the well-known British Himalayan mountaineer and physician Raymond Greene—who participated in the first ascent of Kamet (7756 m, in the Indian Himalaya) in 1931 and an early attempt on Everest in 1933—wrote in the Lancet that frostbitten parts should be kept cool and that only slow natural warming should be permitted without the addition of any external heat.

Washburn's medical contributions can be better placed in context after considering some of the noteworthy cold injury-related events that occurred before, and during, his lifetime. In the fall and winter of 1941 to 1942, shortly after Washburn had assumed control of Boston's Museum of Natural History on the eve of World War II, the German Army found itself utterly unprepared for the seasonal environmental conditions in the Soviet Union when it invaded and attempted to capture Moscow. This martial effort resulted in the Germans sustaining the greatest number of cold injuries in a single winter ever recorded in military history—over 250,000 cases of frostbite. Until that time, it is likely the troops who survived Napoleon's expeditionary advance on Russia in 1812 held the dubious honor of being witness to and participants in the world's biggest frostbite epidemic. Napoleon's 1812 invasion of Moscow, and his subsequent appalling retreat in the grip of the Russian winter, provided the Surgeon General of the Army, Baron Dominique-Jean Larrey, with ample opportunity to observe the destructive effects of frostbite injury. Larrey wrote a graphic account of the medical aspects of Napoleon's military misadventure.Terrible cold injury, on top of the disease, malnourishment, dehydration, and general exhaustion of the troops, contributed to a very high death rate in Napoleon's army as it struggled back to France. In a later memoir of the Russian campaign Larrey wrote:Larrey's less-than-scientific observations of the effects of rapid rewarming near open flame convinced him that very slow rewarming (eg, rubbing the affected part with snow) caused the least pain and did the least amount of tissue damage. In a somewhat fantastic, if understandable, leap in logic, Larrey suggested that:

Are Washburn's 1962 recommendations still relevant?

… [T]he great importance of an adequate diet for the production of body heat at all altitudes. Cold weather definitely increases caloric needs, and variations in diet can have equally definite effects on tolerance of cold. 1 Washburn B. Frostbite: What It Is—How to Prevent It—Emergency Treatment. Washburn was an ardent believer in prevention as well as treatment of frostbite: “Most of the time frostbite can be prevented by experienced leadership, good physical condition and adequate food and equipment, intelligently used.” 1 Washburn B. Frostbite: What It Is—How to Prevent It—Emergency Treatment. 1 Washburn B. Frostbite: What It Is—How to Prevent It—Emergency Treatment. 18 Pugh L.G.C. Himalayan rations with special reference to the 1953 expedition to Mount Everest. 19 Consolazio C.F.

Matoush L.O.

Johnson H.L.

et al. Effects of high carbohydrate diet on performance and symptomatology after rapid ascent to high altitude. 20 Askew E.W. Food for high-altitude expeditions: Pugh got it right in 1954—A commentary on the report by L.G.C.E Pugh: Himalayan rations with special reference to the 1953 expedition to Mount Everest. Given Washburn's practical experience with living and working in high and cold environments, it is perhaps not surprising that he discussed dietary considerations as well as frostbite:Washburn was an ardent believer in prevention as well as treatment of frostbite: “Most of the time frostbite can be prevented by experienced leadership, good physical condition and adequate food and equipment, intelligently used.”From his own practical experience, he was keenly aware that the first line of prevention of cold injury was proper clothing and equipment along with an adequate supply of food for thermogenesis. He was also aware that the most important fundamental consideration regarding fueling heavy physical work in the cold or in combination of cold and altitude is, as Washburn put it, “plenty of good food … .” “Good food” that is appetizing and served warm is likely to be consumed and therefore subsequently beneficial. Washburn commented upon the best source of calories during cold weather excursions, and was one of the first to clearly distinguish between diets for work in the cold at sea level vs diets for work in the cold at altitude.He stated that diets consisting of high levels of fat can be tolerated well by individuals doing heavy exercise in extreme cold environments at low altitude whereas dietary carbohydrate becomes particularly more critical as altitude increases above 10,000 ft. Washburn was a contemporary of fellow scientist/mountaineer LGH Pugh and was apparently in close agreement with Pughon the anecdotal benefits of carbohydrate in the diet of climbers; it was not until 7 years after Washburn's 1962 comments on carbohydrate that observations would be published by Consolazio et alidentifying carbohydrate as an important factor in lessening the initial severity of altitude illness.

[s]urgical intervention is rarely needed in less than two months [provided proper wound care is exercised and no infection occurs] … . Under normal circumstances in an extreme case in which loss of some tissue is inevitable, despite careful treatment, the necrotic material will simply slough off at the proper point and the proper time, with a maximum saving of the sound underlying tissue. 1 Washburn B. Frostbite: What It Is—How to Prevent It—Emergency Treatment. Because Washburn's article was originally aimed at mountaineers operating in a cold, high-altitude setting, his overview of frostbite and recommendations for treatment tended to have a very practical orientation for those in field environments. When describing basic differences between superficial and deep frostbite, for instance, he mentions that accurate prognosis of the extent of injury is often impossible immediately after the initial damage has been done and “time alone will reveal in retrospect the kind of frostbite that has been present.” This point of watchful waiting—discouraging hasty surgical procedures—needed to be emphasized rather strongly in 1962, and Washburn stressed that:

14 Mills W.J.

Whaley R.

Fish W. Frostbite, I: Experience with rapid rewarming and ultrasonic therapy. , 15 Mills W.J.

Whaley R.

Fish W. Frostbite, II: Experience with rapid rewarming and ultrasonic therapy. , 16 Mills W.J.

Whaley R.

Fish W. Frostbite, III: Experience with rapid rewarming and ultrasonic therapy. Unless you have an adequate method for transporting the patient down, either by helicopter or by sled so that he himself need not use his hands or feet, I think I would discourage thawing at 18,000 ft … . [H]e would be wise to stump his way down with frozen, unthawed feet even if it took 12–18 hours, as long as the objective was adequate shelter, reasonable comfort and a spot from which he could be flown or carried to a hospital. We have had a half dozen patients who have walked for three or four days with completely frozen extremities—some of whom have sustained no loss at all. Others lost toes only. In no case did any of them lose any more of the foot than toes. There appears to be an opportunity even to preserve all of the digits, provided that as soon as the patient reaches a place where thawing can be managed, it is done by the method of rapid rewarming, followed by the regular routine of aseptic hospital care. 1 Washburn B. Frostbite: What It Is—How to Prevent It—Emergency Treatment. Washburn's suggestion for thawing frozen extremities involved the use of a “large vessel of water” warmed to 42 to 44°C. Current guidelines submitted for publication in this journal suggest a slightly cooler temperature, 37 to 39°C. 21 McIntosh S.E.

Hamonko M.

Freer L.

et al. Wilderness Medical Society practice guidelines for the prevention and treatment of frostbite. 21 McIntosh S.E.

Hamonko M.

Freer L.

et al. Wilderness Medical Society practice guidelines for the prevention and treatment of frostbite. The exercise of extreme care during and after rewarming, so that the delicate injured part is not further damaged … [and] the prevention of infection, which becomes the paramount issue from the time of rewarming to the conclusion of the treatment. 1 Washburn B. Frostbite: What It Is—How to Prevent It—Emergency Treatment. Treatment recommendations of 1962 are perhaps the most interesting aspects of the New England Journal review article to examine in light of state-of-the-art present-day advice. The aforementioned series of 1960 to 1961 articles by Mills and his Alaskan colleagueswere 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. First and foremost, Washburn emphasizes that rewarming of frozen extremities should be delayed until the patient is in an environment where refreezing will not occur. It was rightly recognized that rewarming followed by refreezing could cause extensive damage—this had been observed, if not fully understood, at least as far back as Larrey's time. Furthermore, Washburn made a strong point of recommending no ambulation on thawed feet or toes, as this would likely greatly exacerbate any damage already suffered. In fact, a rather convincing personal communication with the era's leading frostbite expert, WJ Mills—commenting on freezing injury sustained on the high, cold peaks of Alaska—is quoted in Washburn's New England Journal article:Washburn's suggestion for thawing frozen extremities involved the use of a “large vessel of water” warmed to 42 to 44°C. Current guidelines submitted for publication in this journal suggest a slightly cooler temperature, 37 to 39°C.Likewise, pain relief recommendations during the rewarming process have not altered dramatically over a span of almost 50 years. Where Washburn suggested a standard dose of acetylsalicylic acid tablets and “if the patient is in good condition” (ostensibly concerned about respiratory depression given his reasoning) the addition of 25 mg meperidine, current recommendations suggest giving pain medications as needed (typically NSAIDs or opiate analgesics).However, the 1962 New England Journal article's recognition of frostbite treatment success depending largely on 2 factors still holds true today:

21 McIntosh S.E.

Hamonko M.

Freer L.

et al. Wilderness Medical Society practice guidelines for the prevention and treatment of frostbite. In fact, the Wilderness Medical Society (WMS) Consensus Guidelines for the Prevention and Treatment of Frostbitestate: “Protection of the frozen tissue should be undertaken to prevent further trauma. If at all possible, a frozen extremity should not be used for walking, climbing, or other maneuvers until definitive care is reached.”