ON INSOLATION. - pdfs. ?· in the main, it is absolutely necessary that we should separata these causes…

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  • ON INSOLATION.

    In our April number we published the commencement of a

    paper, (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

    Calcutta.

    The profession is under considerable obligation to Mr. Barnard for drawing attention to a mode of treatment, in heat

    asphyxia, which, we believe, has not, in that disorder, been adopt- ed to the extent that it, perhaps, might have been : although we venture to think that the amount of success which the author

    predicts for it is hardly to be anticipated, viz., recovery in nine cases out of ten. Mr. Barnard speaks of the condition, which he would treat in this way, under the synonymous terms

    " coup-

    de-soleil" or *' insolatio but we take leave to designate it

    under, what we conceive to be, the more appropriate head of heat 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 these causes clearly in our minds, as a due consideration of each

    may lead to more correct notions of their individual patho-

    logy. 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 influ-

    ence of heat alone ; or of heat plus drink or a vitiated atmos-

    phere, &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

    upon artificial respiration, per se. Were it not that we satisfied

    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 character-

    istic feature?the pathognomic sign of the disease?viz.,

    pungent lieat of the skin, once mentioned. We are to understand,

    then, that artificial respiration would be the remedy on which

    Mr. Barnard would most rely in ardent fever, as much as he

    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

    * We have reviewed Mr. Barnard's paper, without waiting for his final

    communication, which, we understood, doea not affect the text.

  • joq THE INDIAN MEDICAL G-AZETTE. [June 1, 1868.

    have always been led to believe that it was sun, or heat stroke ; and something more.

    It so happened that, at the meeting referred to, a medica^

    officer, who ha3 recently gone through the course at Netley, stated that he had never, when there, heard any other

    cause 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 concen- trated form ; with various others.

    It will be seen, on reference to these authorities, that the

    idea of malaria being the remote cause of insolation, or ardent

    fever, rests upon very insufficient grounds. Or, rather* it is by no means established that this is the origin. Still, there is ample evidence to lead to the belief that there is something more than

    mere heat in the fons et origo mali. To quote from Mr. Barnard's

    own favorite 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 perspira- tion. 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

    instances quoted by Mr. Barnard from Sir T. Watson's

    book, this case of the rabbit does not invalidate the proposition that something more than mere heat is required to produce a

    * The term " ardent fever" should not, it is urged by some authorities, bo used 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 use in this way, would lead to incorrect notions of its pathology.?Ed., I. IT. G. t This invitation is hardly applicable now. The article was written for the

    last number of the Gazette, but postponed to give place to more pressing matter.?Ed., I. 21. G,

    fatal result. Doubtless, in debilitated constitutions, 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 whatever being in operation, and the more readily where the skin is 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 do not occur at what is considered the malarious seaon of the

    year, viz., the autumn. This, as a rule, is true, though there are exceptions. But cholera and insolation often go together, and the former is undoubtedly associated with a poisoned state of the atmosphere. When Sir Thomas Watson wrote his lectures, insolation was less understood than it is now. Sir

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

    synonymously with mere sunstroke. For its deeper meaning we are indebted to Dr. Scriven, whose classification of Indian fevers is simple, yet thoroughly practical, whilst it is eminently, we believe, true.

    Whilst then we thank Mr. Barnard for laying stress upon a

    remedy, (in cases of heat asphyxia, however 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 shock to the system from excessive heat, cases of mere ictus

    solis, in short*): at the same time, (our author must pardon us if

    we are in error,) it would appear that this remedy, upon which, in 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

    appear to have used the cold douche at all.

    We commend the study of insolation, or ardent fever, to the careful consideration of the junior members of the profession. We are