H03 (P45): Chilblain: a brief history of cold comfort remedies

Amy Wai Ying Wong, Harry Edmund Gordon White and Alexa Rose Shipman

Portsmouth Hospitals University NHS Trust, Portsmouth, UK

Chilblain, also known as pernio, has gained publicity in recent years as a result of its association with ‘COVID toes’ during the COVID-19 pandemic. Long before this, chilblain had left its mark throughout history and literatures. The word ‘chilblain’ has Anglo-Saxon roots. ‘Chil’ comes from Old English ciele meaning ‘chill’ or ‘frost’, while ‘blain’ comes from the Old English blegen meaning ‘inflammatory swelling’ or ‘sore’. The two words were brought together in the 1540s. The choice of words somehow acknowledges that cold is the aetiological factor that brings on this painful swelling. The Victorian novel Jane Erye, written by Charlotte Brontë in 1847, described the physical hardships that children had to struggle with through the winter at Lowood, the charity school for poor and orphaned girls. Her work masterfully sculptured the essence of chilblain and its effects on the children. Multiple notable figures proposed various remedies to treat the bothersome symptoms of chilblains. Pedanius Dioscorides, a Greek physician and botanist whose monumental work De Materia Medica in the first century ad compiled a list of topical remedies for chilblains, including quince oil, fenugreek oil, frankincense gum, burnt figs in wax, a mixture of gentian, crab ashes and honey, burnt ass hooves, bear grease and decoction of turnip as a warm pack. To cure chilblains, Nicholas Culpeper, an English herbalist, advised grating horseradish and applying it as a mustard plaster. We now know grated horseradish root produces a powerful mustard oil that acts as a rubefacient, which irritates the skin and increases its blood flow. Dr Lewis Johns was a recognized medical officer in the field of medical electricity in charge of the Electrical Department of St Bartholomew’s Hospital. He noted a reduced incidence of chilblains in children with poliomyelitis who were treated with a warm electric footbath in 1899. The beneficial effects most likely originated from the warm bath rather than the electricity itself. Sir Thomas Lewis, a British cardiologist, investigated skin responses to injury and vascular reactions of the skin to cold exposure. His careful observations and descriptions of chilblains published in the British Medical Journal in 1941 remain true to this day. Practices such as praying to the statue of St Benignus of Dijon with chilblains, wearing electric patent socks (invented in 1882) and using an electrical vacuum tube in 1922 had also made their way into the lives of sufferers as a potential cure. Despite the epidemiological study of chilblain of over 3000 servicewomen carried out by the Auxiliary Territorial Service in the winter of 1942, no specific remedy was found. When it comes to chilblain, prevention is better than cure by keeping the hands and feet warm and dry and staying active, and chilblains usually resolve spontaneously within a few weeks.