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.

    79/986 (page 55)
    The microscopical studies of various tissues and organs have shown that the cells of the liver and kidneys and of the nervous system all undergo parenchymatous degeneration. The nervous system suffers particularly, and there the changes are similar to those found in cases of intoxica- tion with poisons, as lead or alcohol; namely, marked chromatolysis of the celts. The condition of the blood deserves special attention. Leukocy- tosis and in some cases destruction of erythrocytes with diminution of the alkalinity of the blood are the changes which occur. As to the pathogenesis of the disease, there is a great divergence in the theories which have been advanced to explain the symptoms and deatli in insolation. Vallin at first believed that death is due to heat coagula- tion of the cardiac muscle. Hirsh believes that the cause of death lies in alteration of the blood—diminution of oxygen and retention of a toxic principle. Vincent^ arrived at the conclusion that there is a poisoning of the organism by toxic products accumulated in the blood. According to * Laveran and R6gnard,^ who made an extensive experimental study of the question, death in insolation is due to a direct effect of sun-rays, prin- cipally upon the nervous system; this effect is first excitant and then par- alyzing. The investigations of more recent writers tend to the conception of a paralyzing action on the nervous system of some toxic elements, with the probable result of metabolic changes in the neurons; and according to the degree of auto-intoxication the effect of the sunstroke will be either an attack of ordinary heat-prostration or syncope with unconsciousness or death. Diagnosis.—It is only in exceptional cases that the diagnosis will be difficult. Usually the history of exposure, with the high temperature and the condition of the skin, render the diagnosis easy. In some cases, however, especially when there is a history of alcoholism or cardiac lesion, the diagnosis will be difficult; apoplexy should then be thought of. In the latter case the temperature is usually normal, the breathing is stertor- ous, the pulse is slow; but the most important symptom is the local paraly- sis, hemiplegia, or monoplegia. In malarial districts, a pernicious malarial paroxysm may give difficulty but a blood examination will make the diagnosis clear. Prognosis.—The outlook in cases of sunstroke will naturally depend upon the degree of prostration, and, according to some authors, upon the temperature. The latter condition is not absolute, as the writer has ob- served a patient with 110° who recovered. However, on general principles a very high temperature renders the prognosis unfavorable. The previous general health, and especially whether the patient uses or does not use alcohol, is of utmost imj)ortancc in forecasting the outcome of his sun- stroke. The promptness of rendered assistance ami the character of the treatment are also factors which ]ilay an important role in determining the prognosis of a given case. In mild cases of heat-prostration the prognosis is favorable. As to the complications following sunstroke, they are all as a rule temporary, excej)t the grave forms of insanities. As in the latter, sun.stroke similar to trauma plays only the role of exciting factor, the prognosis will be not dependent upon the insolation. In some cases the sequelse of sunstroke are very rebellious to treatment, and may ' Rech. exper. sur Vhyperthermie, 1887. ’ Bull. d. VAcad de Mid., 1894.