Evening star., 1901-07-20
PATHOLOGY OF SUNSrROKE
INTENSE HEAT AND HUMIDITY PRE-
VENT EVAPORATION.
The Lungs Become Deeply Conxested
and the Ven0as System Engorged
The Heart Contracted.
From the Medical Record.

From the Medical Record
There is no argument necessary to prove
that heat In itself is the prime causative
factor OF sunstroke. Most commonly. IL Is
true. the phenomena variously grouped
under the designations of insolation. coup
de soliei and sonnenstich are due to the in
tensty Of direct solar rays; they are also
induced by artificial heat in shady quar-
ters. and even during the night. when high
temperature and extra humidity prevent
the proper cooling Of the body by natural
evaporation.
Although different grades Of heat exhaus-
tion are given with their corresponding
varieties Of pathological LESSONS. It is fair
to assume that they depend essentially
upon different degrees Of action OF the pri-
mary factor.
AutOpsfcal Lessons.
The study Of autopsical LESSONS in given
cases is not always satisfactory in recon-
CLING relations of cause and effect. When
death Is sudden no distinctive tissue
changes are manifest. Under such circum-
stances the condition appears to be either
that of syncope from simple failure of
heart action, or from direct shock to the
cerebral and respiratory centers. The lat
ter. termed the asphyxiaI form, is the most
common and most rapidly fatal. In the
hyperpyrexial variety, In which the tenn
perature may range from 1OS degrees E.
to 1l0 degrees F.. the cerebral LESSONS are
usually quite pronounced.
There are often evidences Of meningitis,
serious enuSiOnS in the yentricles and
casionally hemorrhages into the brain sub
stance. In spite of these pathological ap-
pearances, mostly focused, as they seem to
be. in the cerebral centers, the cause of
death Is asphyxia and not apoplexy. As
| evidences of this fact the lungs are deeply
congested, the entire venous system is en-
no haor RI 10 rrolHy fra Tod o,d
the blood Is dark, impaired In coagulability
and has increased fiuidity. In a general
way we may. perhaps. explain the exist
| ence of the various LESSONS by the assump-
ton that in all the cases the brain and ner-
vous centers, especially the respiratory,
are overwhelmed by the sudden elevation
OF temperature. and respiration and circu-
lation eventually fail. the latter being prob
ably due to the inhibitory influence of the
vagus. 1t is simply over-stimulation by
| heat, followed by eventual exhaustion.
Impairment of Intellect.
In the hyperpyrexial form. In which the
symptoms come on more gradually and con-
tinue proportionately longer than in the
other varieties, there appears to be more
time and more opportunities for permanent
LESSONS in brain structure. Thus in those
who recover from the Immediate attack.
there may be marked and permanent i'm
pairment Of intellect, frequent headaches.
memory, eyesight and hearing, muscular
paralysis and other evidences of permanent
absence Of nerve force. There can be no
question that these changes thus induced
are distinctly and diffusively organic in
character. although as yet, such are not
absolutely explained by any manifest de-
generation IN nerve cell structure, or in
any uniform retrograde metamorphosis Of
nerve fiber. The gross LESSONS are, however
plainly enough seen to enable us to hope
that the discovery Of the finer ones may be
only questions of time, opportunity and
study.
We only glance cursorily at the general
pathology Of coup de soleil, in order to ap-
preciate such practical matters for treat
ment as may be thereby suggested Every
thing in the way Of a promise of absolute
recovery depends upon the prompt treat
ment Of the initiatory symptoms. 1t is only
In this way that permanent LESSONS can be
anticipated or prevented. Once the organic
changes are fixed, the victim becomes
hopeless invalid. with impairment of his
most valuable faculties. The main thera-
peutical indications are in the direction Of
modifying immediate shock. and Of reduc-
ing more or less rapidly excessive tempera-
ture. In this connection, it is well to recol-
lect the numbers of important centers In
volved, and the intimate associations of
some Of these with the respiratory and
cardiac functions
Cold DOuches to the Body.
While 1t is somewhat doubtful that To-
Cal cold doucheS to head, neck and spine
can do much more than lower surface
temperature they certainly, even in this in
direct way. often accomplish wonderful re-
suits. 1t would seem almost like blowing
hot and cold with the same breath to ad-
wise heart stimulation IN connection with
the foregoing measures. but in reality by
so doing. we enectually counterbala lance
the enectS OF the ultimate exhaustion
which always follows the primary over
stimulation. In fact, we may work them
side by side as indications may demand
1t often requires the most careful watch
Ing to know when to lean more on one side
than the other, and even under most IA
vorable circumstances the game may be a
losing one. as it must be recollected that
the usual mortality is generally placed at
from 46 to 80 per cent.
The main object to be kept In view Is the
rhythmic restoration Of co-ordinatfng vital
forces. The latter must be coaxed into line
rather than forced. Hence the powerful
antipyretics are apt to be dangerous and
defeat their object well as the more
potent and pronounced cardiac stimulants
In spite OF prompt therapeutic measures
there are so many relapses In the shape
that the conviction Is almost irresistible
that In the majority Of the severe cases
some intricate and undemonstrable organic
nerve degeneration Is foregone concIu-
sion- During the present hot and sultry
season there are and will be abundant
opportunities for according theory with
practice, and for remembering that sun
stroke, in any Of it's forms, Is a very seri-
Gus calamity to the victim, requiring the
attendant in meeting the many complex
conditions likely N Dresepf