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the greatest respect and admiration for Contributed to the JOURNAL. his devotion to study, and general scholar- THE TEMPERATURE THAT A MAN ly attainments, even as a student. I have

CAN STAND, watched him since with no little interest,

TOGETHER WITH SOME CONSIDERATIONS OF THE and he has quite achieved the distinction

SO-CALLED "SUNSTROKE.” which early life promised. One of his qualities is that he cannot be other than

Translated from the Leipziger Zeitschrift. a leader, and that he has a large follow

BY ALLISON CLOKEY, M. D., LOUISVILLE, KY. ing is but natural; and therefore we are only the more solicitous that his influences be exerted on correct lines, because The body of a grown man loses through

THE

the skin, lungs and other organs of of his great power for good or ill.

elimination about three million heat units* "Teach ye first the Kingdom of God each twenty-four hours, and in three difand His Righteousness, and all these

ferent ways, viz: by beat radiation, beat things shall be added.”

conduction and contemporaneously by If Dr. Pratt would only teach Homeo

the evaporation of moisture. pathy FIRST then these things might be

Although the skin has but a limited added.

surface compared with other organs, Without we are governed in all of our

it outdoes them all in the amount work by the Law of Similars, these other

of heat given off.

This is especthings will surely drift us upon the shoals ially so in relation to the lungs. Notof Empiricism, Eclecticism, Allopathy, and withstanding the fact that the lung surthen will be illustrated the fulfillment of

face is one hundred times that of the Hering's prophetic warning: “If our

cutaneous surface, the latter plays the school ever gives up the strict inductive

more important part in the elimination of method of Hahnemann we are lost, and de

heat; because it not only has the advanserve only to be mentioned as a caricature in

tage of radiation and conduction, but the history of medicine."

because tbe amount of air which comes in Years have passed in the hope that

contact with it is much greater than that some more able pen than mine would

which comes in contact with the lungs. take up this matter; but now, in view of

From 771 to 86 per cent. of the bodily the fact, that my criticism of "Orificial heat is lost through the skin a very good

— Surgery and Pratt's methods was a great

reason for clothing ourselves more warmly surprise” to you it is evident the time

as the weather becomes colder, for thus it should not be longer delayed, in simple is that we prevent our own temperature justice to Homeopathy.

falling below a point incompatible with Sincerely and fraternally,

*A heat unit is the quantity of heat required S. Mills FOWLER, to raise the temperature of one kilogramme of June, 1891.

Gainesville, Tex. water from 0° to 1° of the centigrade scale.

It is the radiation of the sun's rays from the Half a teaspoonful of Chloride of Ammonium in a earth after they strike it that warms our atmosgoblet of water will almost immediately restore the

phere; that this is the case we know from the

fact that as we go above the earth's surface the faculties to a man who is hopelessly intoxicated.

thermometer falls, although we are nearing the Exc.

sun.

life. When the temperature of the air remains stationary at 31° C. (88° Fahrenheit), and the air is saturated with moisture, the conduction of heat is arrested, as is also the evaporation of moisture, which latter takes place only when the air is warm and dry. This is the reason people of hydrogenoid constitution are so uncomfortable on summer days that are warm and at the same time damp. But warm air that is in motion always feels cooler than it really is; hence the use of the fan in summer, or in warm rooms.

Aside from our clothing, muscular activity and our food and drink have much to do in regulating the temperature of our bodies. The cooler the temperature the more nourishing is our food usually. Whaling vessels take on their expeditions only such sailors as have healthy stomachs and can eat a substantial quantity of food. With due regard to these factors (nourishing food, suitable clothing and accommodations and daily bodily exercise) man can go to the coldest regions of the earth. without endangering his bodily temperature. Of course few escape being frostbitten at the more exposed points of the body (nose and ears). Nordenskjoeld and his companions, while in the Behring straits during the winter of 1878-79, with stood a temperature of from 37° C. to 45° C. (34° to 49° below zero F). These explorers became so accustomed to the cold that at the close of the winter they danced about in the snow with the thermometer at 1° C. (30° F.) and without any discomfort, when we would have almost frozen.

It is more difficult for the inhabitants of central and northern Europe to accustom themselves to higher temperatures. We dress with the greatest ease when the

thermometer is at 20° C. (76° F.) but, when suitably clothed, we can bear still higher temperatures, but not for any great length of time. With the body quite naked and in the best condition for throwing off moisture, much higher temperatures can be borne. Thus Fordyce remained for ten minutes in a steam bath with a temperature of 43, 33° C. (110° F.), twenty minutes with the temperature at 48, 88° C. (120° F.) and fifteen minutes with a temperature as high as 54, 4° C. (130° F.). The thermometer which had been put under his tongue did not rise above 37.780% C. (37° C. to 37, 50° C., normal) while the surrounding temperature was undergoing such decided variations.

The above temperatures (borne in a steam bath) are much lower than those which have been borne in a dry atmosphere. Fordyce remained for ten minutes in such atmosphere with the thermometer at 92, 22° C. (198° F.), Banks for seven minutes with the thermometer at 99, 44° C. (221° F.) and Blayden eight minutes with the temperature at 127, 8° C. (262° F.). The last named felt decidedly uncomfortable till he broke out in a profuse perspiration when the uncomfortable feeling disappeared. Because of the moisture, one perspires less in a vapor bath than in a dry one; and hence the temperature of our vapor baths. is seldom above 52° C. (125° F.), while that of the dry baths is sometimes as high as 85° C (185° F.).

Our miners who work below the surface, where the thermometer stands at 22° C. (77° F.), would much prefer to work above ground when the temperature is from 36° C. to 40° C. (97° F. to 104° F.), because there the air, while warmer, is in constant motion. However,

in the tropics, during the heated terms even the acclimated can do nowork in the, open air during the daytime. This can be easily comprehended when we mention the fact that Dr. Nachtigall, during his trip through Africa, had to withstand a temperature which was 49, 40° C. (121° F.) in the shade, and that, according to Robert, the temperature in Abyssinia is often as high as 60° C. (140° F.) in the shade, and as high as 65° C. (149° F.) on the shores of the Red Sea.

very

But also in our cooler and colder climates we sometimes have high temperatures; thus, in London, on June 12, 1852, the thermometer reached 41° C. (104° F.), and in Siberia 38, 8° C. (94° F.), and even at the poles there has been noticed a difference of 103° C. (2169 F.) between summer and winter. Under certain circumstances, then, we have to protect ourselves against too great heat, as with their clothing, frequent washing, bathing, and a sparing use of those foods which produce much heat.

However, a man always requires a certain amount of food, be he in a temperate climate or in the tropics. We often hear it said of the East Indian and the Chinaman that they can accomplish as much a day "with a handfull of rice" as an Arab with a handfull of dates. But, according to the statement of the Austrian CounselGeneral Scherzer, the laborers in southern China require about nine hundred grains (about two pounds of rice) per diem. Prof. Boit claims, that, while he eats more just because he has it, this would be enough for the working man of Germany if he only added to it a little albumen. We know it to be a fact, however, that the inhabitants of the warmer climates instinctively avoid fats and depend on the

cereals, while the Esquimaux, for instance, care for nothing but blubber. One grain of fat represents nine thousand and sixtynine heat units, while one grain of the best flour represents but three thousand seven hundred and fifty-two. The less he works during the heated term the less the food he requires. The more that is required of him who works in an atmosphere of high temperature, the more liable is he to bodily disturbances, such as embarrassed and accelerated breathing, palpitation and rising of the bodily temperature, and from the saturation of the clothes with perspiration. Much concern was felt during the construction of the St. Gotthard tunnel because the men were exposed to a temperature of from 38° C. (92° F.) to 84, 7° C. (184° F.).

The result of the action of too high a temperature on the body is commonly called "sunstroke," because it is oftenest seen in summer. This name, however, is not entirely correct, or it is misapplied, because it strictly applies only to the result of the direct rays of the sun upon the body at rest. Such direct rays cause, under favorable conditions, inflammation of the skin of the first and second degree with formation of blisters; and when exhaustion results and the unfortunate one sinks to the earth and remains exposed for some time to the sun's rays, then the bodily temperature rises often as high as 42o C. (107° F.), and the heart muscle undergoes changes which often lead to death; or meningitis sets in which, though it can be recovered from, frequently results in death.

Heat stroke (warme schlag) is that which overcomes a man exposed to extreme heat, but yet protected from the direct rays of the sun, and at rest.

Sunstroke it is, or the contrary, which is so greatly feared by soldiers or long marchers, and which is due not alone to the rays of the sun, but to other causes as well, as for instance, the labor of carrying the outfit, etc. Loaded down with instruments of offense and defense and unsuitable clothes the soldier must often tramp for hours at a time. His clothing becomes so damp with perspiration that his body, which is often feverish from overexertion, cannot throw off the heat. And this condition of things is not improved should the barometer fall or the atmosphere become moist, or when the man must march shut in by other soldiers whose condition is the same as his own and where radiation has no play. If now the body is also deprived of water, in some form or other, the temperature rises, even to 42° C. (107° F.), and there is added to the already existing thirst, headache, oppression and faintness; the lips become parched, swallowing painful and the voice hoarse; then come ringing in the ears, swimming before the eyes, disturbances of the sensorium and feeling of anxiety; the heart's action becomes stormy, motion becomes uncertain and the limbs tremble and the man either drops behind or staggers until he finally falls unconscious.

It is not only during unusual heat that sunstroke is met with; for it has been known to happen when the thermometer was no higher than 19° C. (66° F.), but the atmosphere was then very heavy with moisture. The chief thing on the march is to meet the tendency of the bodily temperature to rise by the liberal use of water (drinking and bathing) and by suitable clothing, such as will relieve the perspiration to some extent and not interfere with radiation. Gerhard Rohlfs, who spent

three months in the Sybian desert, says that on the march through the desert the men had to drink twelve and a half liters (twelve and a half quarts) of water daily, so hot and dry was the air; this is perhaps overdrawn, yet the water that was used was very warm. A liter of water drunk at 10° C. (50° F.) relieves the body of five hundred and ninety-nine thousand and five hundred units of heat and a gram of water, through evaporation, relieves it of five hundred and seventy-two units of heat. These circumstances show the importance of a free use of water in summer and the sooner one resorts to its use as freely as his case demands the better can he do his work.

Ophthalmology.

Contributed by request of W. F. Thatcher, M. D., Dallas, Texas.

I

TREATMENT OF THE OCULAR MUSCLES BY THE RATIONAL METHOD.

BY WANDLESS, M. D. DALLAS, TEXAS. SAY "rational" because this treatment

is based on good reason and judgment, while that of tenotomy, graduated or complete, as practiced by some is not based on good reason. Many who have practiced this latter without have written long articles and reported great success, and so far I have failed to find any good reason for such proceedings. In non-progressive muscular atrophy or in congenital (?) insufficiency, I would think that tenotomy would be justifiable.

I have not treated a case of muscular insufficiency that could not be cured by more reasonable means than tenotomy.

216

Wandless: Treatment of the Ocular Muscles, &c.

Indeed, I think most failures are due to a lack of perseverence on the part of both patient and physician.

Most patients soon become discouraged because relief is not prompt and changes form one physician to another so rapidly that the treatment does little or no good; or he totally fails to carry out the doctor's directions, untill finally he finds himself in the hands of some ambitious operator, who advises an operation and promises prompt relief. The patient submits, because relief is promised in short order. And he got it in short order, for it usually lasts only until the weaker muscle regain its strength and the condition is reversed. The muscle then (operated on) is the weaker.

I have examined two cases lately, that had been operated upon. One, a lady, who traveled with her husband and twenty-two years of age.

Tenotomy, graduted, was done in St. Louis on both interval recte eighteen months previous. She came to me stating that the trouble had returned and desired operation interference. The case was then reversed. She stated, however, that she had prompt relief from the operation which continued ten or twelve months. She said that since that time I had read quite a good deal and that she tired quickley and was subject to headaches. I opposed operation in interference and prescribed prsimatic glasses, and corrected 150 D of Hypernutropic astigmatism.

I have one letter since and she reports would feel justified in operating on a case very much improved.

CASE No. II. An actor, aged 28 years, came to me in November, stating that he had had two operations, and wanted a third. He stated that twelve months pre

vious he had had the interval recters of his right eye operated on in New York. That two months later he had the exterval of same eye operated on and now I find that operations on interval of left eye is necessary on this line of treatment. He now has only one good muscle. I did not operate, and have not seen him since. I told him to hunt up his New York doctor and that he would accomodate him with a third operation.

He told me that he went on the stage at twenty, and soon after, that his eyes would givg out, and that for three or four years before being operated upon he suffered greatly.

On a slight examination I made out 50 D astigmatism of the right eye.

I give these two cases for two reasons. 1st, to show that the good obtained is not permanent, and 2d, to show that positive injury is done.

It is not necessary to reitirate these cases for if you have followed me, you will have observed both points.

I failed to find in these two cases any good reasons for the operation. In fact, the error of refraction shown in both cases was sufficient reason not to operate.

In most cases of muscular insufficiency there is some error of refraction. And if the doctor will take the pains to search for the cause, he will find it. And then, with the co-operation of his patient, his way is clear. A very large majority of cases are complicated with other troubles, constitutional, local or sympathetic. I

of congenital (?) insufficiency, or on a case of non-progressive muscular atropyy where permanent damage is done. I do not know that I ever saw a case of purely congenital muscular insufficiency, but I have,

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