Ice-baths and the ice-cap resorted to, but antipyrine employed to keep down temperature. Smyth (Brit. Med. Jour., Jan. 9, '97).
The ice-pack and ice-cap recommended, and ice-water dashed with force from dippers at distances of from eight to ten feet for thirty or forty minutes if neces sary. The most efficacious stimulant, though it can be applied only one or two minutes at a time, is a fine stream of ice-water poured from an elevation upon the forehead. Finally, most pa dents are given subcutaneously 40 min ims of digitalis at a dose, unless the sufferer is very plethoric, in which case venesection is practiced, and the fox glove given later on in smaller doses. O'Dwyer (N. Y. Med. Jour., June 5, '97).
Great relief is obtained in cases of heat-exhaustion from the application of cold over the spine. In sun-stroke the cold bath, rubbing with ice, blistering, shaving the head, and the use of anti pyrine is advocated; although these measures cannot compare, in the writer's estimation, with the effects of heat ap plied over the last four cervical and first four dorsal sympathetic ganglia. The application of heat to this region and of cold to the head, and also the inhalation of oxygen have been followed in his practice by the best results. Kinnear (Med. Record, Aug. 21, '97).
In thermic fever in infants the ice bath condemned. In the milder form sponging the body with hydrant-water and the administration of more water internally is all that is required. In the severe forms a bath, the temperature of which is not below 60° F., may be used; at the same time friction should be vig orously applied to keep the peripheral arterioles dilated. Stimulants may be given as required. In the hyperpyrexial forms it is well to make the skin in tensely red, as by nitroglycerin, friction with towel or hand, or a mustard bath; then even sponging with hydrant-water will rapidly produce the desired result. Spraying cold water on the patient has been found to be the most effective treat ment. The water should not be too cold. For convulsions and tonic spasms chlo roform is important. Free perspiration should be induced as soon as possible. Diuretics act well by assisting the elimi nation of waste-products. Nux vomica should not be administered, as it may only be synergist to the toxin. Water should be given as soon as possible and freely administered until convalescence. John Zahorsky (Pediatrics, No. 4, '98).
A watery solution of antipyrine (1 to 2) should be carried in the pocket for instant use when there is danger of en countering cases of sun-stroke, and as soon as the patient is seen 20 minims should be administered hypodermically. Lewis (Phila. Med. and Surg. Reporter, July, '98).
In the Indian territorial service, when sun-stroke occurs in the open, the sub ject is at once removed to a cool and shady place, placed in a recumbent posi tion, with the head slightly eleva.ted, to
which cold applications are made. The chest and shoulders are stripped and cold-douched. Then hypodermic injec tions of the following are made in dif ferent places about the shoulders:— H Quin. sulph., 5 grains.
Acid. sulph. dilut., 5 minims. Aquae, 50 minims.
M. et ft. liquor.
Should the heart's action be weak, the following is used, hypodermically: 1 Strychninm sulph., I grain.
Aquae, 200 minims.
M. et ft. liquor.
Sig.: Inject 5 minims (equal to grain) p. r. n. C. Fitz-Henry Campbell (Med. World, Aug., '98).
Case of a stoker on a transatlantic liner who suddenly collapsed owing to the extreme heat, and was brought on deck unconscious and in a state of most vio lent convulsions. The patient being ap parently about to succumb to respiratory and cardiac paralysis, venesection was tried as a last resort. After eight ounces of blood were allowed to flow, instantane ous relief was obtained. Klein (11iiineb ener med. Woch., July 3, I900).
Heat-exhaustion requires rest and stimulation, head low, and body recum bent. If able to swallow, an ounce of brandy and 20 drops of tincture opii should be given at once. If unable to swallow, a large dose is to be given per rectum, or whisky and tincture of digitalis hypodermically. No ice or bleeding is to be used. Heat fever is treated in different ways: ice cold pack, cold douche. In India the pa tient is removed to the shade, and cold water is thrown on him after removing all Cold water is to be thrown into the rectum. If depression comes on, stimulation should be resorted to. If convulsions appear, hypodermic injection of morphine is of value. Ice should be put to the head, hot bottles to the feet. and ice-bags to the spine. Bleeding may be of use. C. C. Herman (Penna. Med. Jour., Dec., 1900).
Studies of 92 cases of thermic fever. The best method of applying cold was apparently rubbing with ice. In those cases in which there was no decrease in the symptoms corresponding to the fall of temperature bleeding was found to be of benefit. It was employed in S cases, with 4 deaths. The quantity withdrawn varied from 6 to 20 ounces. Hypodermoclysis was employed in 28 cases of the severest type, and only 1 died. As, the normal saline solution entered the circulation too slowly, intravenous saline injections were used in 10 eases, with 4 deaths. No infection occurred. In certain cases not improved by the hypodermic method venous section and transfusion may be employed. Lewis and Packard (Amer. Jour. Med. Sciences, Sept.. 1902).