Treatment.—Hydrotherapy and skilled and careful nursing seem to be the chief factor, in treatment of insolation; fre quent recording of the temperature en abling the baths to be given at the earli est and, therefore, most effectual time; the use of the ice tub-bath, with constant and general friction of the entire sur face, this reducing the temperature in the shortest possible time, and being stimulating rather than depressing; the use of the same bath for all severe sec ondary elevations of temperature, and for the minor elevations sponge-baths of ice-water or of water at from 70° to S0° F., depending upon the individual case; and the repetition of these baths when ever the temperature is high enough to make them seem advisable. All other means have seemed entirely inadequate to N. R. Norton.
At St. Vincent's Hospital, New York City, the following method of treatment of insolation has given good results. It is given here as detailed by G. F. Chand ler, because it seems most in accord with modern views as to the pathogenesis of insolation. The ambulances are well supplied with ice, which is kept about the patient's head from the moment he is picked up until he enters the hbspital.
Upon admission the patient is im mediately stripped. His temperature, per rectum, is taken as he is being placed upon a raised stretcher or table.
The body of the patient is covered with a sheet, upon which are placed small pieces of ice. Large quantities are laid closely about the head. Ice-water from dippers, at a distance of from five to ten feet, are dashed with force upon the patient. This is continued about thirty or forty minutes.
The most efficacious stimulant, and one which has served to arouse when everything else has failed, was the pour ing, from an elevation, of a fine stream of ice-water upon the forehead. As this treatment is very radical, it is continued for only one or two minutes at a time.
In severe cases it is repeated several times, unless consciousness returns.
While this is going on, each patient, with very few exceptions, is given hypo dermically 40 minims of the tincture of digitalis at one dose. Exception is in the case of the plethoric patients with great arterial tension. Upon such patients venesection is practiced, and later tinc ture of digitalis is given in smaller doses.
The temperature is carefully watched, and when, after hyperpyrexia it reaches 104° F., the patient is laid in a bed, covered with blankets, and hot bottles are placed about him.
When the temperature is reduced to 99° or 100° F. by bath, as is usually
practiced, clinical history shows that it nearly always becomes subnormal—even falling at times as low as 91° F.—and leaves the patient in collapse. When the temperature is only reduced to 104° F. it will, in most cases, continue downward of its own accord.
Strychnine is never given. It has proved upon trial to cause convulsions or make them more violent. Convul sions are treated by chloroform.
When the secondary rise of tempera ture occurs, a sheet, wrung from ice water, is spread over the patient, and kept wet until the temperature becomes normal. In some of the cases, where the secondary rise is very rapid, the entire ice-and-water treatment is repeated sev eral times, or until the temperature re mains normal. An ice-cap is kept upon the head from the time the temperature becomes normal until the patient is dis missed. This has been found of the utmost value.
In cases of prolonged unconsciousness patients are nourished and stimulated by means of the stomach-tube.
In extreme cases hypodermics of whisky are used.
As death seems the result of respira tory paralysis, artificial respiration is kept up for long periods of time—often half an hour or more. Surprising re sults are sometimes obtained.
The after-treatment consists of light diet, stimulants, fresh air, the ice-cap, and sudorifics, such as ammonia—prefer ably the spirit of Mindererus—in large doses.
Preference expressed for the wet pack over the cold bath in the treatment of heat-stroke. The wet pack does not pro duce so rapid a depression of the tem perature; but, on the other hand, it is not followed by a secondary elevation. A large muslin sheet is wrung out of cold water; the patient wrapped in the sheet, placed in bed, and covered with a blanket. As soon as tne sheet becomes warm it is removed and replaced by an other that had meanwhile been cooling in the water. This procedure is con tinued until the temperature reaches the normal. Illoway (Med. News, Aug. S, '91).
During convalescence, if pulse bound ing, veratrum viride and bromide of sodium useful; if pulse weak, ergot. Counter-irritation to the nape of the neck where evidences of meningeal irri tability exist. If surface of the body is very cold, high injections of cold water into the colon, reducing heat and driving congested excess of blood to the surface. If heat-exhaustion occurs in which there is an unusual fall in bodily temperature, hot injections or baths. E. C. M. Page (St. Louis Clinique, June, '95).