Volume 1

A system of medicine by eminent authorities in Great Britain, the United States and the Continent / edited by William Osler, assisted by Thomas McCrae.

Date:
1907-10
Catalogue details

Licence: In copyright

Credit: A system of medicine by eminent authorities in Great Britain, the United States and the Continent / edited by William Osler, assisted by Thomas McCrae. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

    77/986 (page 53)
    The skin is not the only organ wliicli may sufl’er from tlic immediate effeet of intense sunlight. The eye may beeome affeeted. Ophthalmia and conjunctivitis are not infrequent occurrences in the ])olar regions and in the mountains. A few cases were reported in which cataract was aj)- parently produced in workmen whose eyes were e.vposed to prolonged action of intense light.' All these changes, and particularly those of the skin, are the result of the effect of light-rays in a comparatively mild degree. The produced lesions are usually limited to the tissue exposed to the light. When the effect of intense sunlight is manifested in general disturbances, the condition may become alarming, as it may terminate by death. We speak then of sun- stroke. The term “sunstroke” has been considerably abused. Ileat-exhaus- tion, heatstroke, sunstroke, insolation, coup de soleil, heat-asphyxia, and thermic-fever, have been described as one condition. Manson, in his book on tropical diseases, brings some order in the terminolo_gy, and his classifi- cation is, in my judgment, the most satisfactory. He considers separately a condition produced by the elevated temperature, to which he gives the name “heat-exhaustion;” another condition produced apparently and only by the direct rays of the sun, to which he gives the name “sun- traumatism;” and, finally, a third morbid state, to which Sambon gave the name “siriasis.” The latter is in all probability due to a microorgan- ism which develops only in a high atmospheric temperature. 1. Heat-exhaustion.—This condition is characterized by a sudden tendency to syncope in an atmosphere with a high temperature. It can be brought on indoors or outdoors. The main etiological factor is heat from any source. It is observed in industrial plants where work is carried on at temperatures above 120°F. Individuals suffering from various diseases, those whose physiological activities are knvered by alcoholic or other ex- cesses, or by exhaustion, present very little resistance to the effect of heat. With the syncope occurring from heat-exhaustion are also ob- served the following symptoms: shallow res])iration, small and soft pulse, dilated pupils, cold skin, and subnormal temperature. Recovery usually follows, but very occasionally death may ensue. Heat-exhau.stion brought on by exposure to the sun is called sunstroke, insolation, or coup'de .soleil. This condition is of great interest, especially to military surgeons; insolation in the army during summer months is of frequent occurrence. In warm climates those who are compelled to work outside of dwellings are apt to be stricken. Those who use alcohol are particularly predisposed to the effect of intense heat, and they constitute the majority of the victims of sunstroke. Some individuals are peculiarly predisposed to repeated attacks. Four cases came under the writer’s personal observation, when the patients, free from alcoholism, had three attacks during three successive summers. Among other predisposing causes we may mentibn excesses of all kinds, constitutional diseases, or low vitality following protracted diseases. Finally, any cause which pre- vents the evaporation of the perspiration, as, for example, clothing fit only for cold weather and worn on hot days, predisposes to sunstroke. It is interesting to note that the black race is remarkably resistant to the ‘Win. Robinson, British Medical Journal, January 24, 1903