ON INSOLATION. number

we published the commencement of a (to be continued hereafter,*) by Surgeon Barnard, on the Pathology and Treatment of Coup-de-soleil or Insolatio and the subject has likewise come under discussion, at a meeting of the Bengal Branch of the British Medical Association," in

In our

April

paper, "

"

Calcutta. The

profession

is

under

Barnard for drawing attention

asphyxia, which,

we

considerable to

a

obligation

to Mr.

mode of treatment, in heat

believe, has not, in that disorder, been adoptperhaps, might have been : although we

ed to the extent that it, venture to

predicts

think that the

for it is

hardly

amount

to be

of success which the author

recovery in nine Mr. Barnard speaks of the condition, which he would treat in this way, under the synonymous terms " coupbut we take leave to designate it de-soleil" or *' insolatio cases

out of ten.

under, what heat

anticipated, viz.,

we

conceive to

be,

the more

appropriate

head of

asphyxia.

The treatment of

a

disease should

always,

where

possible,

be based upon its pathology ; and, although different causes may lead to the same results, requiring much the same treatment in the main, it is

absolutely necessary that we should separata clearly in our minds, as a due consideration of each may lead to more correct notions of their individual pathology. Asphyxia, for example, is a condition which may be produced in several ways : the lungs may become engorged from cobra, or like, poisoning ; from drowning ; under the influence of heat alone ; or of heat plus drink or a vitiated atmosphere, &c., &c. It may be good practice to keep up artificial respiration in each of these cases, but, with reference to the agent which, immediately or remotely, has produced the asphyxiated condition, something more may be required, too. If it be a case of ardent fever, quinine in large doses may be absolutely called for. It strikes us that Mr. Barnard lays too much stress se. Were it not that we satisfied upon artificial respiration, per ourselves, at the discussion which took place at the meeting of the Medical Society, that the author of the paper quite intended to include, in his category, what is sometimes spoken of as "ardent fever" synonymously with insolation, we should have inferred, from a perusal of his paper, that he had not so intended ; for, in none of the cases cited by him is the characteristic feature?the pathognomic sign of the disease?viz., We are to understand, pungent lieat of the skin, once mentioned. the remedy on which then, that artificial respiration would be ardent in fever, as much as he most would rely Mr. Barnard would in pure ictus solis, coup-de-soleil, or sunstroke, where the individual had been simply struck down, his nervous system prostrated under the influence of the shock, but where thert was no pungency of skin. This brings us to the question?What is insolation ? We these

causes

,

*

We have

reviewed Mr. Barnard's paper, without waiting for his final we understood, doea not affect the text.

communication, which,

THE INDIAN MEDICAL G-AZETTE.

joq have

always

been led to believe that it was sun,

and something

or

heat stroke ;

more.

It so happened that, at the meeting referred to, a medica^ officer, who ha3 recently gone through the course at Netley, other stated that he had never, when there, heard any

assigned for insolation than mere heat : and an opinion, generally, was expressed at the same meeting, that heat alone, excepting, perhaps, the occasional complication of liquor or opium, was the cause of it. Now it may be well to invite the attention of the profession throughout India to this important question,' as, a few years ago, when insolation was investigated for the first time more deeply than in times gone by, and a more rational plan of treatment was laid down than venesection, and the antiphlogistic regimen, there were some who thought that insolation, with its pungent skin, (ardent* fever), was the result of something in addition to heat. Heat, in their estimation, was simply the exciting cause. We have not space to enquire into the arguments for and against this opinion, but we would invite those who are willing to pursue the enquiry during thef coming hot season, when, unhappily, such cases maybe expected, to consult the following authorities in the pages of the Indian Annals:?fa) October, 1855, No. V, Marcus G. Hill, on Insolation or Heat Apoplexy, fbj July 1859, No. XII, Deputy Inspector-General T. Longmore, on some Tabulated Cases of Ileat Apoplexy, (c) Report on the Outbreak of Insolation in the 3rd Cavalry, by Surgeon T. II. Butler, (d) October, 1856, No. VII, on Indian Fevers, by J. B. Scriven, Exq (ej No. XX, August, 1866, an Enquiry into the truth of the Opinions generally entertained regarding Malaria, by W. J.Moore, Surgeon, Marivar Political Agency. This author quotes Dr. N. Chevers as having remarked on the probability of sudden attacks of heat apoplexy being caused by malaria in a concencause

trated form ; with various others. It will be seen, idea of malaria

on

being

reference to these

authorities,

the remote cause of insolation,

that the or

ardent

Or, rather* it is by origin. Still, there is ample there is something more than

fever, rests upon very insufficient grounds. no means

established that this is the

evidence to lead to the belief that

origo mali. To quote from Mr. Barnard's authority?Sir Thomas Watson. Sir Thomas does indeed give one instance, that of the rabbit in Sir Benjamin Brodie's experiment, where death took place apparently as the result of mere heat. But in this case there was no portal open for the relief of the heated blood ; there was no perspiration. The animal died, therefore, from the prostrating effect of the accumulated heat. So that, free perspiration being essential to enable human beings to remain in ovens heated to a temperature sufficient to boil or roast an egg, as in the Sir T. Watson's instances quoted by Mr. Barnard from not invalidate the proposition does rabbit the this case of book, that something more than mere heat is required to produce a mere

*

heat in the fons et

favorite

own

fatal result.

Doubtless,

[June 1, in debilitated

constitutions,

1868.

where there

is great loss of nervous energy?the effect of excesses or disease?? heat alone will strike down and kill, without any other cause

being in operation, and the more readily where the dry, and there are no means of relief open. But it is to insolation or ardent fever that we would especially apply our remarks. It is remarked by-those who maintain that heat alone will produce it, and who ignore malaria, that cases of insolation

whatever skin is

do not

occur

at what is considered the malarious seaon of the

year, viz., the autumn. This, as a rule, is true, though there But cholera and insolation often go together, are exceptions. and the former is

associated with

of the

Sir Thomas Watson wrote his

undoubtedly atmosphere. When

lectures, insolation

was

a

poisoned

less understood than it is now.

state

Sir

Thomas Watson himself uses the term, and after him Mr. Barnard

synonymously

with mere sunstroke.

For its

indebted to Dr.

Scriven, whose fevers is simple, yet thoroughly practical, we believe, true. we

are

Whilst then

deeper meaning

classification of Indian whilst it is

eminently,

thank Mr. Barnard for

laying stress upon a produced,) which may not have had hitherto a sufficient trial, we would wish to urge the younger members of the profession, of those who are practically unacquainted with tropical disease, not to draw too hasty an inference from his paper, that insolation (the ardent fever of Dr. Scriven) is mere sunstroke, and that artificial respiration is tlie one remedy upon which reliance is chiefly to be placed. Mr. Barnard advocates, it is true, the cold douche for reducing the temperature, which, he believes, is the cause of the temporary paralysis of the cerebro-spinal ganglia connected with respiration (though in his paper, singularly enough, pungency of skin is omitted ;?indeed, from the description of his cases, one would think that they were the result of simple remedy, (in

we

cases

of heat

asphyxia,

however

shock to the system from excessive heat, cases of mere ictus in short*): at the same time, (our author must pardon us if

solis,

are in error,) it would appear that this remedy, upon which, conjunction with stimulants, we have been most accustomed to rely, is put somewhat in the background. In the single case which came under Mr. Barnard's observation, he does not

we

in

appear to have used the cold douche at all. We commend the

of insolation, or ardent fever, to the junior members of the profession. We are not yet sufficiently enlightened on the action of malarious, any more than of other, poisons, to be able to say, with precision, that malaria has nothing to do with the production of certain diseases. Our chief object, in penning these remarks, is to invite further enquiry, as to whether malaria or a poisoned atmosphere, plus heat, has any share in causing insolation, or ardent fever ; and we shall be only too glad to chronicle recorded cases in of the Gazette. the columns carefully

study

careful consideration of the

" ardent fever" should not, it is urged by some authorities, bo synonymously with insolation. But, as in consequence of heat, which is caused directly or indirectly by the sun, there is fever, and as this is of a very ardent description, the application of the term appears to us to be very appropriate. We should fear that a discontinuance of its

The term

used

use

in this way, would lead to incorrect notions of its

IT. G. t This invitation is hardly applicable

pathology.?Ed.,

I.

last number of the

Gazette,

matter.?Ed., I. 21. G,

but

now.

postponed

The to

article was written for the

give place

to

more

pressing

*

Though the author heat," he does gives us.

without

says, "you never get any form of insolation not mention its existence in the cases which lie