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.

    81/986 (page 57)
    can be controlled by placing the patient in a lukewarm bath and by admin- istration of morphine aided by atropine. Restlessness and insomnia are best treated by the bromides. High temperature can be controlled pai’ticularly by cold spongiugs frequently repeated, or by cold baths, the tempera- ture of which is gradually reduced while the patient is in the tub. The patient should be vigorously rubbed. The same ])rocedure can be em- ployed in cases of unconsciousness. These hydrotherapeutic measures can be modified according to the conditions in each individual case. If baths are not convenient, cold packs may take their place. Sometimes a shower-bath, or a douche over the spine, of short duration and followed by a dry rubbing, reduces the temperature admirably besides having a stimulating effect. It should be borne in mind that while the patient is treated with cold water, stimulation with the above-mentioned means be kept up. Among the stimulants the writer lays special emphasis on saline infusions, which in many cases prove to be an excellent adjuvant. If the patient is a full-blooded individual, venesection followed by saline infusions will be of better service than infusion alone. When death is imminent, repeated stimulation with the usual remedies and artificial respiration must be used. After the pronounced symptoms have disappeared, the treatment will be s}Tnptomatic. Headache, insomnia, nervousness, parsesthetic disturb- ances, should be treated accordingly. When the hyperpyrexia is great, as, for example, in siriasis or in ex- treme cases of insolation, all the efforts must be directed toward reducing the temperature by rapidly acting measures. Chandler’s' directions are of great value in such cases. He advises to put the patient, undressed, on a stretcher the head of which is raised slightly so as to facilitate the escape of involuntary evacuations and to provide for drainage. A ther- mometer is kept in the rectum. The body is covered with a sheet upon which is laid numerous small pieces of ice, larger pieces being closely packed about the head. Ice-water is then allowed to drip for thirty or forty minutes on the patient, from drippers hung at an elevation of from five to ten feet. A fine stream of iced water poured on the forehead from an elevation will act as a stimulant; this jjowerful measure must not be kept up for longer than one or two minutes. A hypodermic injection of forty minims of tincture digitalis is given as soon as possible, its administration being preceded in the case of plethoric ]>atients by a small bleeding. As soon as the rectal temperature has sunk to 104° the application of cold should be at once discontinued. On discontinuing the iced sheet, the patient should be wrapped in a blanket and hot bottles applied to limbs and trunk. In this .stage strychnia as a stimulant should be avoided. In case of failure of respiration, artificial res])iration should be resorted to; Chandler urges to keep it up for half an hour. 'There is a very important warning given by Man.son. Antipyretics (antifebrine, antipyrine, etc.) should by all means be avoided, as they are dangerous in view of their depressing action on the heart. If the treatment of sunstroke as outlined here will .save some patients, the prophylactic measures are of greater importance. The above-men- tioned investigations of Laveran and R^gnard, also those of Hiller, show ^Medical Record, New York, lSt)7.