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Problems of prickly heat in India

It takes one cramped journey in a non-airconditioned car or time spent outdoors and the red blisters burst across our skin, sharply painful when touched and annoyingly scratchy.

, ET Bureau|
Jun 22, 2019, 07.47 AM IST
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When prickly heat happens, you deal with it, not by scratching or slathering on medicines, but with traditional remedies.
The British exploited India in endless ways, committed colonial crimes in abundance and provided little in terms of apology or reparations (or the Kohinoor). But India did inflict one type of revenge that was, literally, very small, yet deeply felt at that time: our climate gave them prickly heat.

Many of us have forgotten the pain of prickly heat. We live in dry, airconditioned surroundings and the light clothes and regular showers we take in summer mostly keep it away. Yet it takes just one cramped journey in a non-a/c car or train or time spent unavoidably working outdoors and the small red blisters burst across our skin, sharply painful when touched and almost impossible not to scratch painfully.

For the British it was hell, and never more so than now, in that period just at the onset of the rains. Pre-monsoon showers have brought moistness to even dry interior areas, but not yet the cooling onslaught of the full rains. And since it’s still so hot everyone sweats and stifles and ends up with prickly heat. “In ten years of Calcutta hot weather I have never before seen such an epidemic of prickly heat,” wrote a Times of India (ToI) correspondent in June 1915. The afflicted complained they “might as well have measles as far as looks go.” A group of theatrical performers “looked quite pathetic on their opening night with scarlet necks and arms, and the poor Territorials (soldiers) stationed at the Fort and at Barrackpore, without punkahs, mosquito nets, or any other comforts are a greatly mottled crew.”

The sufferings of the soldiers are a reminder of the callousness of British hierarchies, but prickly heat affected the powerful too. Hobson-Jobson, the compendium of British-Indian slang, notes that it was nicknamed ‘red dog’ and describes Sir Charles Napier, the conqueror of the Sind “standing, when giving an interview during the hot weather, with his back against the edge of an open door, for the convenience of occasional friction against it.”

An even more vivid image is provided by Lord Minto from 1807 who describes how “Lord William (Bentinck) has been found sprawling on a table on his back; and Sir Henry Gwillin, one of the Madras Judges… was discovered by a visitor rolling on his own floor, roaring like a baited bull.” Anyone who has suffered a bad attack knows how maddening the sensation of being pricked with burning needles can be, pushing you to scratch, even when you know that makes it worse.

Prickly heat isn’t special to India. It occurs in all warm, moist climates and ET Renbourn in his essay ‘The History of Sweat and the Sweat Rash from Earliest Times to the End of the 18th Century’, traces an early mention in Western texts to a treatise on sweat by the Greek botanist Theophrastus (c.371-c.287 BCE): “it breaks out in travellers especially on the limbs, and sometimes on other places… exertion makes it worse as shown by an inflammation.”

The multiple small blisters resembled the many small grains of millets, and this led to the formal name for prickly heat: Milaria, which meant “presumably any rash of papules or vesicles the size of millet seeds,” writes Renbourn, noting its using in the early medical Hippocratic texts. The term ‘prickly heat’ he traces to the British colonies, who might have been translating the Spanish term “calor picante”, or burning heat.

Renbourn explores how prickly heat helped early scientists understand how sweat is produced in the body and the role it plays. Theophrastus identified early on that prickly heat, for all the pain it caused, was essentially harmless – and that it was the scratching that made it worse: “Scratching produces a bad quality of sweat and is followed by a profuse rash.” And he noted that rubbing on liquids, for ostensibly medical purposes, just irritated the rash.

This is close to what doctors still advise today. Dr. Nina Madnani, a Mumbai based dermatologist explains that, for all the agony it causes, prickly heat is not seen as a serious issue by doctors: “It is usually ignored as it is a self-resolving condition and does not cause long term complications.” Anything that brings down body temperature will help, she says, and powders have some value simply because “they work by providing a soothing feel.”

The problem is this sensible advice is of little comfort to people suffering the full agonies of prickly heat. The British, in particular, had an overwhelming desire for immediate solutions, and came up with many over their decades in India. The pre-monsoon season regularly saw articles and letters in ToI discussing prickly heat solutions.

“Borax dissolved in hot water,” advised one reader in 1879, confidently adding that the price of borax would rise as people realised its value. Substitute soap with coconut oil advised a reader in 1901, noting that “since then I have been able to keep free from prickly heat, though I live in the steamy climate of Lower Bengal.” But other writers countered that this was terrible advice, since sticky oil would clog up the skin pores and, moreover, attract insects.

Some ToI writers gave detailed directions for anti-prickly heat recipes. “two teaspoonfuls of Eau de Cologne in ten ounces of a one in two thousand solution of perchloride of mercury,” directed one writer in 1922. More alarming was a suggestion from 1913 to use a very dilute solution of hydrochloric acid. Branded versions of Listerine and Milk of Magnesia got in on the action, touting their cleansing power. But perhaps the best answer came from a correspondent in 1923 who recommended rubbing with plain gin: “It’s a great waste of gin, but it gets rid of the pickles.”

An alternative approach suggested that the treatment should be internal. Prickly heat couldn’t be seen as a neutral, natural reaction to heat and moisture, but a consequence of personal weakness. Prickly heat was not a skin disease, asserted a ToI writer in 1876, but the result of “excesses either in eating or drinking, which produce derangement of the liver. The rash is an effort on the part of overburdened organs to relieve themselves.” If the victim suffered it was because they deserved it; if they tried to stop the suffering the body couldn’t cleanse itself and the problems would become worse. A particularly cruel variant of this approach links the summer pain of prickly heat to one of the benefits of an Indian summer, the abundant joy of mangoes. An article in ToI in 1952 warned ominously that the luscious fruit “are one of the chief sources of boils and prickly heat. Their content of sugar is very high. They must be eaten sparingly.” It is good sense, of course, to eat lightly in summer, but depriving oneself of mangoes for a non-proven link with prickly heat is just tragic.

With so many cures, mostly unlikely to work, its little surprise that one contributor of verses to ToI moaned: “But each day I’m getting worse, which explains this scratchy verse/ So my own advice I’ll sell you for a song/ Every nincompoop you meet, has a cure for prickly heat/ And every single one of them is wrong!” Yet the answer to containing prickly heat, if not quite curing it, was always in plain sight in India, and it was an American who understood this.

Dr. Jack M. Planalp’s report ‘Heat Stress and Culture in North India’ was produced in 1971 for the US Army Research Institute of Environmental Medicine. Planalp was an anthropologist who had done extensive field work in villages in North India, and he realised in 1962 that his fieldwork could be converted into a study on how people coped with the intense heat of Indian summers, which would be of value to the emerging field of environmental medicine.

Planalp’s work came at a time of transition, when electrical cooling methods were becoming available, but were still far from replacing traditional techniques. Much of what he describes may seem simple common sense, yet there is a real value in describing the traditional means he details – the houses with open windows and cool deep courtyards, the ways in which work life changed in summers, so people slept during afternoons, and so on. As an anthropologist he is also open-minded, describing ayurvedic and homeopathic solutions without the judgments a medical doctor might give.

Prickly heat is an acknowledged summer risk in the report, and some of the solutions used in villages might sound unusual. Villagers, he notes, treated it with a powdered clay called kothvar “derived by pulverising the wall material of an old grain storage bin.” These bins were built from clay mixed with dried straw and rice husks, and when powdered this material was absorbent but non-sticky – a homely equivalent of the medicated powders of today.

But Planalp didn’t just look at village practices. He was also interested how others, like the British, had dealt with the heat, and as an American approached them in the same anthropological style he had looked at Indian villagers (though since the Raj was over his main sources were old British reports, journals and memoirs). And the picture he creates is of almost comical incompatibility with the climate – and as a consequence, almost assured ailments like prickly heat.

The British in India. Planalp notes, “were seemingly often torn between the impulse for comfort and the sometimes rigid prescriptions of their own traditions, suitable to a much colder climate.” Early British colonists quickly realised the value of light Indian clothing, but as the Raj took control of India it was felt that an image of authority, and of superior difference had to be projected. And this meant dressing formally, with no concessions to Indian climate.

This meant that judges had to sit in Indian court rooms for long hot hours in full gowns and with wigs, officials needed similarly formal outfits and, worst of all, soldiers had to wear fulldress uniforms while out in the heat of the Indian sun. It was little surprise then that the Bitish were tortured by heat related ailments, including prickly heat.

Planalp noted that new arrivals in India were strongest in sticking to heavy clothing. This neatly explained one common myth about prickly heat – the idea that it was like measles, a disease that everyone had to get at least once, to get a kind of inoculation. In fact, the inoculation worked by getting used to India, so after a few summers the heavy clothing was put inside for lighter garments.

Prickly heat, in Planalp’s telling, seems less like an ailment than a metaphor for the heat of an Indian summer. You can try to fight it, as the British did, and it will drive you made with its insidious, inescapable irritations. You can avoid it, as we do today, ducking into a/c rooms and cars, but it will catch you in the moments when you let down your guard.

Or you can accept the heat and moisture by embracing and adapting to it – living in houses designed for it, wearing clothes appropriate for the season and seasonal foods that deliver the light, liquid heavy nourishment that is needed.

When prickly heat happens, you deal with it, not by scratching or slathering on medicines, but with traditional remedies, like sandalwood powder or multani mithi (for those who don’t have grain stores to scrape clay from). And the prickly heat will pass, just like these last, steamy weeks of summer, and the monsoon will begin.
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