Climate and Health in Hot Countries and the Outlines of Tropical Climatology / A Popular Treatise on Personal Hygiene in the Hotter Parts of the World, and on the Climates That Will Be Met Within Them.

by George Michael James Giles

It is never prudent for anyone who has survived a warning of this sort to remain in a climate the severity of which he has proved himself unable to resist; and it should be the rule for those who have suffered to take refuge in a cooler climate as soon as they are sufficiently recovered to travel.

If stationed far inland, it is best to seek refuge in a mountain sanatorium, and not to attempt to reach Europe, as the long journey in the train and subsequent passage of the Red Sea would, in all probability, finish the record of a person so situated before the desired relief could be gained. On the coast the quickest relief can be generally obtained by sending the patient to sea, but if the route necessarily involves passing through the Red Sea, such a course is too hazardous at the bad time of the year, and the change to Europe should be postponed till the dreaded stretch of water can be passed in safety, or a visit to Australia substituted. It must not be imagined that in practice cases of “stroke” can be as sharply divided into classes as it is easy to do upon paper. Naturally a large number are of mixed origin, but the extent to which heat, pure and simple, is concerned, may be generally judged by the temperature of the body, and whatever may appear to be the causation of the disease, whenever this is high, no efforts should be spared to bring it down as soon as possible.

Prickly Heat and Dhobi’s Itch.

Among the minor ills which European flesh inherits in the Tropics there is none that is more distressing than this troublesome malady. The symptoms and appearance are too well known to require description, and the disease is, as a rule, rather irritating and distressing than involving any danger. The process of regulating the temperature of the body depends, however, almost entirely on the action of the skin, and where prickly heat is so extensive and severe as to partially incapacitate it from its functions, it is obvious this usually trifling disease may be a predisposing cause of more serious maladies. Then, again, the loss of sleep and nervous irritation kept up by the constant itching, pricking, and soreness, are powerful helps in pulling down the already severely tried powers of resistance to the climate, and often have a great deal to say in determining an ultimate breakdown.

There is a common popular notion that prickly heat is “healthy,” people saying that “it is a sign of health,” and that it is a mistake to check it. This, however, except in so far that healthy, full-blooded persons usually suffer worse than those in an anæmic condition because they usually perspire more freely, is an entire fallacy; as though good health may predispose to prickly heat, it cannot but have an influence in rapidly reducing that factor in its causation. Then, too, the numerous small abrasions that result from the bursting of the minute vesicles, and from scratching, are extremely liable to become infected with the germs of suppuration, and give origin to crops of boils.

Boils are extremely common, and are most painful and debilitating when present in large numbers, as they often are in hot climates, and I believe they should be really regarded merely as sequelæ of neglected prickly heat and not as a distinct condition. For these reasons the writer is strongly of opinion that prickly heat should always be treated, especially as it is usually quite possible to keep it within moderate bounds, by the use of appropriate remedies. At sea the use of salt water for bathing should be avoided, but frequent bathing in fresh, and especially in rain water, is not only a great alleviation, but tends towards cure by removing the irritating accumulation of saline matter that results from the constant evaporation of the perspiration. Almost any metallic astringent, such as sulphate of copper or sulphate of zinc, 4 grains to the ounce, will be found to be extremely useful in reducing the extent of the irritation, but none of these are nearly as effectual as a lotion of perchloride of mercury of a strength of one per thousand.

This agent can be obtained ready measured out into tabloids, which are always coloured blue to prevent mistakes in handling the solution; which is a most useful one, not only for this purpose, but as a general antiseptic. Care should, of course, be taken in the custody of these tabloids, and also in the handling of the solution; but the latter is not really more poisonous than the copper solution, or than many other antiseptics which, like carbolic acid, are nowadays in constant domestic use. This mercurial solution is undoubtedly by far the best remedy we have for prickly heat, and I have never seen any harm or signs of absorption of the mercury result, even from its copious use. The tabloids should be got of such a size as to make about a quarter of a pint of the solution, and after the bath and before retiring to bed, all affected parts of the skin should be dabbed with a bit of lint dipped in the solution, which should be allowed to dry on to a certain extent before putting on one’s clothes. A further great advantage over the other metallic astringents is that, owing to the weakness of the solution, it does not injure the clothes, and the slight blue aniline colouration easily washes out. It will be found, too, an almost complete preventive against boils, if resorted to from the commencement of the hot season. Powdering with violet powder is also useful in subduing the irritation, which by the adoption of the above-described plan, may almost always be kept within moderate bounds.

“Dhobi’s itch” is a troublesome irritation of the skin often met with in hot climates, which is due to the growth of a minute fungus within the structure of the scarf-skin. It commonly attacks those parts of the body where the surfaces of the skin come in contact with each other, as, for example, between the legs, and in the armpits. The general appearance is very much that of a “ringworm,” the patches spreading by their edges, where they are red and irritable and tending to fade in the middle. There can be little doubt that the disease is generally caught by the infection of clothing that has been washed in dirty pools along with that of previous sufferers from the disease, which is very common among the native races. If neglected, it is apt to spread so as to cover a large area, under which circumstances it is apt to be troublesome, but if taken early, there is generally no difficulty in dealing with it. All that is necessary is to destroy the fungus by means of strong antiseptics, but in doing so it must be remembered that any solution strong enough to kill the fungus must necessarily also cause more or less inflammation and, for the time, increased irritation of the skin.

On this account, if any considerable area be involved, it is a mistake to attempt to treat the whole of it at once, as such a course may easily result in producing an amount of soreness and inflammation which may involve confinement to bed. The patches should be attacked piecemeal, a couple of separate patches the size of a shilling being quite as much as is prudent to attack on any one occasion.

Equal parts of tincture of iodine, carbolic acid and glycerine painted over each patch, to the extent above described, is a safe and efficient remedy, as also is Goa powder; but the essential point is to be on the look-out for the contingency, and to at once treat any patch that may appear before it has time to spread.