A FEW REMARKS ON SUN-STROKE. Bx W. K. Walleb,
M.R.O.S., Eng.,
and
L.S.A.,
Lond.
I feak that when a case of sun-stroke has to be treated, it is more often under circumstances in which the use of the thermometer is inconvenient, as in the field or on the march, and that, if in hospital or private practice, the urgency of the case appears to demand the application of remedies without delay. But it is desirable that the temperature of the body of a patient,
suffering from this disease, should be noted, if only in satisfaction of a praiseworthy curiosity, and spirit of enquiry, because it will
be found that the disease is so far unlike other diseases marked by high temperature, as to be singularly amenable to the effects of cold water;?I mean that the temperature once lowered by this means remains permanently at, or a very little above, tho natural standard until full convalescence has taken place. How different this to the effect produced in fevers in which the temperature rises after tho cold bath or sponging, which
does not remote, the inward heat. of rheumatism with high temperature recently treated at University College by repeated cold baths, tho torn"
moderates, but In
a
case
May l, 1871.]
A MIREOE OF HOSPITAL PRACTICE.
89
perature, 'which fell during immersion, rose again at a variable, not long period after removal, and so far as I remember, the cooler the bath, the quicker and greater was the ro-action. so in suu-stroke; ouce lower the temperature and it
In all such cases, I feel certain that quinine would be useless. The method I adopt is to give by the mouth, if the patient can swallow, twenty grains of quinine, and repeat this dose every half an hour or hour, till the temperature falls ; the respiration becomes fuller and easier, and the pulse, which at first could
My experience circumstances.
be counted, becomes full, regular, and slow. of profound coma, when swallowing might bo difficult or impossible, the injection by the hypodermic syringe of five grains of quinine should be repeated as often as above, are mitigated and consciousness fully until all the
but
remains low.
is
decidedly opposed
to
bleeding
under any
In cases
In an advanced stage of the disease 'when cerebral effusion has taken place, bleeding from the temporal artery may for a time relieve the deep coma, aud to the inexperienced give
delusive hope.
I have seen a man bled from the right temporal artery, open his eyes as if awaking from a deep slumber, converse with those aiound him, and anticipated his recovery, but when the flow of blood was stayed, he speedily relapsed into deep insensibility. After a time he was bled from the left temporal artery, with
precisely
the
same
effect of relief and
relapse,
and in the end he
died. The relief in this case was clearly mechanical, the rapid flow of arterial blood relieved for the moment the effect of the serous effusion, and doubtless increased the tendency to it in return. I never did bleed, nor can I imagine any case of sunstroke in which it would be of the least avail, or at all events in which the patient would not have recovered without it. On this point, Dr. MacLeau says,?" when blood-letting was the rule, recovery was the rare exception." Dr. Aitken empha-
sizes his direction by printing it in italics? "
Depletory measures are not to he thought of"? Longtnore, than whom no one has ever written on this subject with a better knowledge or more thorough justice, condemns the practice. It would be a retrogression to try it, and I sincerely hope no one will be induced to put this evil-working remedy in and Mr.
practice.
Read the analytical and tabular digest of cases following Mr. Hill's paper ou Sun-stroke, in the Indian Annals of Medicine. There are 46 cases. 20 cases treated by Y. S.?19 deaths.
Altogether there were 32 deaths out of the 46 cases ; so that of the remaining 26 cases which were not bled, there were 13 recoveries ; total recoveries, 14 out of 46 cases. There can be no better proof of the fallacy of ordinary out
methods of treatment than the above. Emetics and cathartics do not usually act at all in these cases. I have tried them. I
should be sorry
induce vomiting, because I regard its occurof the disease as a very ominous symptom. The treatment which I have proposed I have used, so far as
rence
in the
to
course
opportunities would permit, since 1856. The method is simple that any one could perform the trifling operation, and that its effects are tolerably certain, may be deduced from my
so
the facts that of 31
cases tabulated in the Indian Medical Gazette for July 1869, 28 cases treated in this way recovered; 3 cases treated otherwise died.
A report of two cases successfully treated by Assistant Surgeon O' Sullivan of H. M.'s 96th Regiment at Dum-Dum, will be found in the pages of the same periodical for August or September ]869. At the General Hospital in Calcutta, two cases occurring in
wards, treated by injection of quinine, died; but I believe that these and similar cases occurring during the hot winds in the wards of up-country hospitals, are merely semblances of the
sun-stroke,
but iu
reality
avert.
modes of death which
nothing
could
We know the temperature of the body rises at or after death in many diseases. The mode of death in cases of rheumatism with high temperature before alluded to, is precisely the mode of death of sun-stroke, and the disease might be mistaken for the latter of a man, who was
scarcely
easily by one ignorant of the previous history only called to witness the closing scene.
symptoms
restored j the pressure of convulsions would not prevent the usa of the syringe, they would almost certainly be relieved within half an hour of the injection. Chloroform inhalation under the same circumstancos, I should think a dangerous remedy and likely to lead to loss of time. When the convulsions are severe, it is impossible to say that any one may not be the last.
pulmonary and cerebral congestion accompanying them is likely to be relieved by chloroform, while it certainly will be by the use of quinine. In a case of great gravity I would defer the use of the cold douche uutil one or two doses of quinine had somewhat relieved the oppression and strengthened the circulation. In case of a milder type the douche may be dispensed with, if its application is inconvenient, the attendant may confidently trust to quinine. There are cases occurring after exposure to the sun of quite a different character. In these there is a cool or cold, and perspiring skin, a feeble, but not irregular pulse, and a tendency to faint; headache is intense. The recumbent position, and 20 grains of quinine, repeated if need be, will relieve these The not
symptoms. The first question asked will be for an explanation of the modus operandi of quinine. No absolute explanation can be given. Without doubt, quinine powerfully relieves local congestion, but whether its primary action is that of a nervine tonic, or
whether it restores to the altered blood something wanting, and nervous system to re-establish its control over
then enables the
circulatory and muscular system, I cannot say. This preknowledge should cause no hesitation in applying the remedy. Every day we use remedies, found to be useful by experience, but of whose mode of action we are ignorant. Calcutta, April 18, 1871. the
sent want of
M.R.O.S., Eng.,
and
L.S.A.,
Lond.
I feak that when a case of sun-stroke has to be treated, it is more often under circumstances in which the use of the thermometer is inconvenient, as in the field or on the march, and that, if in hospital or private practice, the urgency of the case appears to demand the application of remedies without delay. But it is desirable that the temperature of the body of a patient,
suffering from this disease, should be noted, if only in satisfaction of a praiseworthy curiosity, and spirit of enquiry, because it will
be found that the disease is so far unlike other diseases marked by high temperature, as to be singularly amenable to the effects of cold water;?I mean that the temperature once lowered by this means remains permanently at, or a very little above, tho natural standard until full convalescence has taken place. How different this to the effect produced in fevers in which the temperature rises after tho cold bath or sponging, which
does not remote, the inward heat. of rheumatism with high temperature recently treated at University College by repeated cold baths, tho torn"
moderates, but In
a
case
May l, 1871.]
A MIREOE OF HOSPITAL PRACTICE.
89
perature, 'which fell during immersion, rose again at a variable, not long period after removal, and so far as I remember, the cooler the bath, the quicker and greater was the ro-action. so in suu-stroke; ouce lower the temperature and it
In all such cases, I feel certain that quinine would be useless. The method I adopt is to give by the mouth, if the patient can swallow, twenty grains of quinine, and repeat this dose every half an hour or hour, till the temperature falls ; the respiration becomes fuller and easier, and the pulse, which at first could
My experience circumstances.
be counted, becomes full, regular, and slow. of profound coma, when swallowing might bo difficult or impossible, the injection by the hypodermic syringe of five grains of quinine should be repeated as often as above, are mitigated and consciousness fully until all the
but
remains low.
is
decidedly opposed
to
bleeding
under any
In cases
In an advanced stage of the disease 'when cerebral effusion has taken place, bleeding from the temporal artery may for a time relieve the deep coma, aud to the inexperienced give
delusive hope.
I have seen a man bled from the right temporal artery, open his eyes as if awaking from a deep slumber, converse with those aiound him, and anticipated his recovery, but when the flow of blood was stayed, he speedily relapsed into deep insensibility. After a time he was bled from the left temporal artery, with
precisely
the
same
effect of relief and
relapse,
and in the end he
died. The relief in this case was clearly mechanical, the rapid flow of arterial blood relieved for the moment the effect of the serous effusion, and doubtless increased the tendency to it in return. I never did bleed, nor can I imagine any case of sunstroke in which it would be of the least avail, or at all events in which the patient would not have recovered without it. On this point, Dr. MacLeau says,?" when blood-letting was the rule, recovery was the rare exception." Dr. Aitken empha-
sizes his direction by printing it in italics? "
Depletory measures are not to he thought of"? Longtnore, than whom no one has ever written on this subject with a better knowledge or more thorough justice, condemns the practice. It would be a retrogression to try it, and I sincerely hope no one will be induced to put this evil-working remedy in and Mr.
practice.
Read the analytical and tabular digest of cases following Mr. Hill's paper ou Sun-stroke, in the Indian Annals of Medicine. There are 46 cases. 20 cases treated by Y. S.?19 deaths.
Altogether there were 32 deaths out of the 46 cases ; so that of the remaining 26 cases which were not bled, there were 13 recoveries ; total recoveries, 14 out of 46 cases. There can be no better proof of the fallacy of ordinary out
methods of treatment than the above. Emetics and cathartics do not usually act at all in these cases. I have tried them. I
should be sorry
induce vomiting, because I regard its occurof the disease as a very ominous symptom. The treatment which I have proposed I have used, so far as
rence
in the
to
course
opportunities would permit, since 1856. The method is simple that any one could perform the trifling operation, and that its effects are tolerably certain, may be deduced from my
so
the facts that of 31
cases tabulated in the Indian Medical Gazette for July 1869, 28 cases treated in this way recovered; 3 cases treated otherwise died.
A report of two cases successfully treated by Assistant Surgeon O' Sullivan of H. M.'s 96th Regiment at Dum-Dum, will be found in the pages of the same periodical for August or September ]869. At the General Hospital in Calcutta, two cases occurring in
wards, treated by injection of quinine, died; but I believe that these and similar cases occurring during the hot winds in the wards of up-country hospitals, are merely semblances of the
sun-stroke,
but iu
reality
avert.
modes of death which
nothing
could
We know the temperature of the body rises at or after death in many diseases. The mode of death in cases of rheumatism with high temperature before alluded to, is precisely the mode of death of sun-stroke, and the disease might be mistaken for the latter of a man, who was
scarcely
easily by one ignorant of the previous history only called to witness the closing scene.
symptoms
restored j the pressure of convulsions would not prevent the usa of the syringe, they would almost certainly be relieved within half an hour of the injection. Chloroform inhalation under the same circumstancos, I should think a dangerous remedy and likely to lead to loss of time. When the convulsions are severe, it is impossible to say that any one may not be the last.
pulmonary and cerebral congestion accompanying them is likely to be relieved by chloroform, while it certainly will be by the use of quinine. In a case of great gravity I would defer the use of the cold douche uutil one or two doses of quinine had somewhat relieved the oppression and strengthened the circulation. In case of a milder type the douche may be dispensed with, if its application is inconvenient, the attendant may confidently trust to quinine. There are cases occurring after exposure to the sun of quite a different character. In these there is a cool or cold, and perspiring skin, a feeble, but not irregular pulse, and a tendency to faint; headache is intense. The recumbent position, and 20 grains of quinine, repeated if need be, will relieve these The not
symptoms. The first question asked will be for an explanation of the modus operandi of quinine. No absolute explanation can be given. Without doubt, quinine powerfully relieves local congestion, but whether its primary action is that of a nervine tonic, or
whether it restores to the altered blood something wanting, and nervous system to re-establish its control over
then enables the
circulatory and muscular system, I cannot say. This preknowledge should cause no hesitation in applying the remedy. Every day we use remedies, found to be useful by experience, but of whose mode of action we are ignorant. Calcutta, April 18, 1871. the
sent want of
