SUNSTROKE, OR INSOLATION.
For both the mild type of this affection known as and for the grave form recognised as Thermic Fever preventive measures ate obvious. These include attention to clothing, which should he always as light and cool as possible, open-textured woollen garments next to the skin being essential. I t is always necessary that the spine and cranium should he well protected from the direct solar rays. Excesses in eating and drinking, indulgence in alcohol, violent exercises and constrictions about the throat must all be guarded against, and in the close, hot nights free ventilation is of great importance.
When an attack of heat-exhaustion has already occurred, immediate transference to the shade in the Open air, with removal of outer clothing and all constrictions about the neck, throat and chest is the first step. The patient should be placed in the horizontal position as in the treatment of syncope, with the head lowered and the vapour of Ammonia or Acetic Acid applied to the nostrils. The face should be sprinkled with cold water and the hands sponged, and if efforts at breathing do not at once appear artificial respiration should be resorted to.
A severe attack of thermic fever or typical sunstroke will necessitate similar measures, but life can only he saved in such cases by a free use of cold water. This may be dashed over the patient's naked body or the cold pack or cold affusion should be freely employed. If ice is available the entire body should be rubbed with large pieces of it, after which iced water may be allowed to trickle over a wet sheet loosely applied to the patient's body till the rectal temperature has been reduced to about Further general applications of cold water or ice should not be persisted in owing to the liability of collapse supervening, but the ice-cap may safely be kept to the head all through the attack.
If there be evidence of cardiac failure, stimulants may be required, but they should be used with great caution, and the horizontal position rigidly maintained. If removal in such cases is necessary before the urgent
symptoms have subsided, it should be accomplished upon a stretcher.
Where the symptoms continue and repeated affusion is necessary to keep the temperature from rising, the thermometer should he kept in the rectum, so as to enable the physician to keep the body heat a little above the normal. Copious enemata of iced water have been found useful, and they may be resorted to in conjunction with cold affusion or the cold bath.
Artificial respiration must be kept up when the breathing stops during the hyperpyrexia; this affords also the best aid to the enfeebled cardiac muscle. Though Strychnine may be injected in desperate cases, it is safer to rely upon artificial respiratory movements, as some authorities maintain that coagulation of the cardiac myosin occurs. Convulsions should be met by Chloroform, and this has been recommended during the early stage independent of the presence of convulsions. Though venesec tion as a routine is to be condemned, when symptoms of asphyxia show themselves there should be no hesitation in freely opening a vein. After the layperpyrexia has been combated, symptoms are to be treated as they arise. Headache may be relieved by the ice-cap, by sinapisms or blisters behind the ears or over the occipital region or neck, and constipation by smart Saline purgatives.
In the after-treatment no animal food should be given for days and absolute rest in bed must be maintained.
Meningitis and other troubles, should they follow, are to be met by appropriate remedies. As recovery is often imperfect, and followed by an irritable condition of the cerebral centres, Bromides will he indicated, and in some cases, owing to the increased susceptibility to heat, removal to a cold or temperate climate may be imperative, with avoidance of mental work and all sources of worry for a considerable period. Prolonged muscular exercise is also to be guarded against, and the use of alcohol strictly forbidden.