88 REVIEW — TKOriGAL MEDICINE, ETC. 



Heat Stroke being in vogue in tlie Sudan. Proper forms of helmet, tinted glasses, loose clothing of a 

 — continued proper colour, and the spinal pad are all considered. 



As regards treatment, douching the head and neck with cold water, the application of 

 annnonia to the nostrils, turpentine cneniata and mustard poultices to tlic chest are 

 mentioned. The use of ice to the head is contra-indicated where the skin is cold and the 

 pulse feeble. Convulsions indicate a few whifl's of chloroform. In cases of direct heat 

 stroke in Italy, trinitrin has been found useful, a solution of 1 in 1000 being given in doses 

 of 20 minims to 4500 minims of water every quarter of an hour. Venesection is dangerous. 



Manson quotes Chandler's treatment for hyperpyrexial cases. It consists principally 

 in the use of ice and iced water externally, with the patient on a stretcher, digitalis being 

 given to ward off heart-failure. Strychnine is contra-indicated. Artificial respiration has 

 saved cases iu desperate straits. 



Gardini,' describing cases in Florence in 1905, notes that the attacks frequently came on 

 after a full meal when the production of CO., was increased, and that the coma of sunstroke 

 resembles that of urismia, but, unlike the latter, is usually associated with hyperpyrexia. 

 The types he gives in order of frequency are : 1. Mixed forms, 2. Asphyxial, 3. Syncopal, 

 4. Cerebro-spinal. In every case, he states, the prognosis should be reserved, as cases 

 beginning very slightly may rapidly get worse. 



Rogers believes that under the terms Heat Exhaustion, Sunstroke and Heat Stroke or 

 Siriasis, two broadly different conditions are included. First, — syncopal attacks due to 

 exposure to the direct rays of the sun or to hard labour during great heat {i.e. in stokeholds 

 of Red Sea and Persian Gulf steamers). In these cases there may be no marked elevation 

 of body temperature, and, if properly treated, recovery is the rule, with or without some 

 permanent mental injury. 



Second, — true heat stroke with hyperpyrexia and acute pulmonary congestion, coming 

 on very suddenly, usually without any actual exposure to the sun's rays. Such cases only 

 occur under very trying atmospheric conditions, either excessive dry heat or lesser 

 degrees of moist heat. This is true heat stroke. 



In the first class, it is faintness due to heart-failure under special stress which takes 

 place. In the second, it is essentially loss of consciousness due to hyperpyrexia, the cause 

 of which is attributed either to exposure, to excessive heat, producing in some way not yet 

 fully understood, failure of the heat-regulating mechanism of the body, or to the toxins 

 produced by a hypothetical microbe. It may be said at once that Rogers has no faith 

 whatever in Sambon's microbic theory, and adduces arguments against it. He dwells upon 

 the important part the presence of atmospheric moisture plays by checking surface 

 evaporation. Alcohol seems both to predispose markedly to heat stroke and to greatly 

 increase the gravity of the cases. Rogers also contradicts the statement that the disease is 

 never found at an altitude above 600 feet, and shows that 71 per cent, of 424 Indian cases 

 occurred at over this elevation above sea level. 



As regards premonitory symptoms, the desire to micturate freely receives special mention. 

 It appears to be a valuable warning sign. The author thinks that quinine, guarded by 

 cardiac tonics, should always be used, as, apart from the question of malaria, it is likely to 

 help in restoring the control of the heat-regulating mechanism. He suggests careful 

 intravenous administration, and the rubbing of 10 to 15 minims of creosote into the axilla, as 

 a method of producing diaphoresis. The occurrence of mild forms of fever due to heat stroke 

 is considered, and it is stated that they quite possibly exist but are not common, in Calcutta 

 at least. 



Hydrophobia. This disease is happily not common in the Sudan, but a case did 

 occur in Khartoum, and, as in most tropical countries, it may assume importance, some of the 

 recent work upon it — mostly foreign — may be cited. 



Williams and Lowden- carried out original work with two ends in view. 



1. To determine the value of the " Negri bodies" in diagnosis and methods for their 

 rapid identification. 



2. To determine their precise nature. 



' Qardinj, O., Clin. Modern, No. 22-24, au XII. Quoted in Epit., British Medical Journal, October 6th, 1906. 



" Williams, A. W., and Lowden, M. M. (May 18th, 1906), "The Etiology and Diagnosis of Hydrophobia.'' 

 Journal of Infectious Diseases, p. 4o"i. 



