1458 HEAT STROKE AND HEAT SYNCOPE 



are severe, inhalations of chloroform and oxygen mixed may be 

 administered. 



When the temperature is reduced, and the patient is conscious 

 and can swallow, a dose of calomel (gr. iii. to v.), followed by saline 

 purgatives, is advantageous. As soon as urine can be collected, 

 it must be carefully examined for signs of renal trouble, which, 

 if present, must be treated. Recurrent temperatures may be 

 bacterial in origin and will not be easily reduced, but blood cultures 

 should be made and the causal organism determined with a view 

 to vaccine therapy if prolonged. 



Bromides may be required to soothe the irritated nervous system, 

 and do more good than hypnotics or morphine. 



Food must at first consist of only milk with barley-water or 

 toast -water, and be given in small quantities and often; but as con- 

 valescence proceeds, broths, soups, eggs, milk-puddings, etc., can 

 be added. No alcohol on any account must be given, except on the 

 advent of collapse. 



The room in which the patient is lying must be kept as cool 

 as possible by punkahs and large blocks of ice placed in baths, and 

 it must also be kept dark — i.e., well protected from the sun's rays, 

 and also from the glare of electric light. There is apt to be great 

 intolerance of light and heat, and therefore, after thermic fever, the 

 patient should, if possible, go on leave to a cool climate. 



An alkaline treatment (ammonium carbonate, sodium bicarbonate) has been 

 recommended with the object of combating acidosis. 



Prophylaxis. — Prophylaxis consists in protecting the head and 

 eyes from the sun, in wearing proper clothing, in living in dwellings 

 and offices protected against the sun and kept as cool as possible, 

 as described in the preceding chapter. 



Muscular exertion should not be taken in the heat of a tropical 

 day if it can be avoided, and during these hours alcohol should not 

 be touched. 



If any of the prodromata are noticed, the person should be put 

 on the sick-list, and treated as though he were ill. He should be 

 kept in a cool shaded room ; the bowels should be freely opened, and 

 cool applications applied to the head. The diet should be light 

 without alcohol, and, when better, the patient should be extremely 

 careful not to expose himself in any way. 



In regard to railway travelling, Nicholson advises the avoidance 

 of coupe and corridor compartments and the use of carriages running 

 the length and breadth of the coach. This probably refers to second 

 and third class carriages, as the small compartment for one person 

 in the first-class carriages of Sudan trains is most excellent. He 

 advises the use of fans, which are constantly employed on Sudan 

 trains, and the running at the highest speeds possible. Double 

 roofs and windows well protected by coloured glass and jalousies 

 should also be noted, as they have been used for years in the Sudan. 



