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.

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    effect of intense sunlight. Cases of insolation in children are also rare. As we see, the subject is of sufficient importance to warrant a more de- tailed description. Sunstroke (Insolation) — Symptoms.—In the majority of cases a sun- stroke is preceded by a few premonitory symptoms before complete prostration sets in. They are headache, dizziness with generalized tingling sensations, and nausea. Pain in the epigastrium, vomiting, and excessive thirst soon make their appearance. Consciousness is retained in mild cases. The patient enters into a state of exhaustion, which may. go to complete prostration and end in death quite rapidly. If he survives, a slight fever may be present, which gradually goes down to normal. The above-mentioned symptoms then gradually subside and complete recov- ery takes place. Before recovery occurs the patient will complain for a long time of headache; this is practically the only symptom which per- sists after others have disappeared. In severe cases of insolation there is always a loss of consciousness, which may be followed by death; the latter is rather exceptional. In a great majority of cases the patient re- gains consciousness; but there is extreme pallor, rapid respiration, rapid pulse, which is soon succeeded by a slow pulse; temperature is raised to 104° or 105° and in very severe cases to 108°. In some cases the tem- perature reached 112°-113°, which, according to certain observers, is not uncommon in severe forms of insolation. The skin is usually dry or covered with a clammy perspiration. Convulsions, epileptiform in char- acter, may occur, while general muscular twitching is exceedingly com- mon. Delirium is not an infrequent occurrence. The entire body is either in a state of rigidity or absolute flaccidity. Ecchymosis, or a petechial rash, was observed in a certain number of cases. The severity of certain cases is not dependent upon, the degree of the temperature or upon the state of the pulse, and it is therefore difficult to foretell exactly the issue of a given severe case. Despite the unusually pronounced symptoms, recovery may follow, although not without a per- sistent headache and various parsesthetic disturbances, as tingling, numb- ness, pins and needles, etc., or some physical and intellectual weakness. Generally speaking, patients who remain unconscious for twenty-four or forty-eight hours usually die. Sunstroke is one of the causes of chronic meningitis, and the cephalea which so frequently follows recovery from insolation finds its explanation in the meningeal involvement. Far more important and frequent sequelae of sunstroke consist of distinct mental disturbances, as impairment of memory or of sustained attention. Some writers ])retend that delusional insanity, paresis and mania may be caused by insolation. The writer’s view is that if insolation is sometimes followed by these mental derange- ments, it is only as an exciting cause similar to trauma; patients of this character undoubtedly were predisposed to insanity or were already in- sane, and exposure to intense sun radiation only intensified the condi- tion. Among other possible consequences of sunstroke we may mention polyuria and glycosuria. Pathology and Pathogenesis.—The gross pathological changes found in cases of sunstroke may be expressed in one ])hrase: general congestion of the organs. The lungs, liver, spleen, and particularly the meninges of the brain and cord, are in a state of congestion. The blood is very fluid.