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184                                             MEDICAL JURISPRUDENCE


The effects produced by exposure to excessive heat may be considered
under the following three types : —

1. Heat exhaustion. 2. Heat hyperpyrexia (heat stroke or sun
stroke). 3. Heat cramps.

Exposure to the direct rays of the sun is not necessary. An individual
may "be affected while working in a closed, hot, and badly ventilated room
or factory, especially when the high atmospheric temperature is combined
with marked humidity. Ill-nourished, over-exertion to a fatiguing point,
such as long marches, over-indulgence in alcohol, mental depression, vomit-
ing, diarrhoea, malaria and other fevers predispose to the attack.

1.    Heat Exhaustion.—The attack may come on suddenly or gradually.
In a sudden attack the patient falls down, and dies immediately or within
a short period.   When the attack is gradual, the first symptoms are giddi-
ness, nausea, headache of a throbbing character, dim vision with dilated
pupils,  insomnia  and frequency of micturition.    Collapse then supervenes
with a sub-normal temperature, rapid and feeble pulse and sighing respira-
tions.   Death occurs from heart failure, or reaction sets in after some timey
followed by recovery.   Throughout the course, consciousness is, as a rule,
not lost.

2.   Heat Hyperpyrexia (Heat Stroke or Sun Stroke).—The symptoms
supervene all of a sudden in a person exposed to very great heat in the
summer months, especially if he has been fatigued by prolonged and extreme
exertion, but in some cases prodromal symptoms, such as a feeling of heat,
headache,  giddiness, nausea and vomiting,  may be  experienced.   Insensi-
bility soon sets in, and the patient may be struck down with a temperature
of 104°F.   The  temperature rapidly rises very high,   even  upto   112°   or
115°R, and the skin is hot and dry.   The face is flushed, and the pupils are
first dilated and insensitive to light, but become contracted towards death.
The  pulse  is  full   and  bounding,   and  the  respirations  are  hurried  and
stertorous.   The urine which is usually offensive contains indican.   Death
may  occur from syncope,  but usually results  from  asphyxia  and   coma,
followed often by convulsions and delirium. ^ The shortest fatal period is five
minutes 4 ; it may be prolonged to three days.5

After-Effects.—After recovery from heat hyperpyrexia the patient
becomes very susceptible to variations of temperature and usually com-
plains of headache, loss of memory, mental confusion and nervous irritability.
Sometimes the patient may suffer from epilepsy or insanity for the rest of
Ms lif e.

3.    Heat Cramps.—These occur among workers, especially ship stokers,
who work in hot  atmospheres and perspire profusely.   The  cramps  are
caused by loss of sodium chloride in the blood due to excessive sweating.
They are very severe and painful and affect the muscles of the arms, legs
and abdomen.

Treatment.—In heat exhaustion give a hot bath, and rub the body with
hot towels or apply mustard plaster to the praecordium, and to the soles of
the feet, if the temperature is below normal. Administer enemata of hot
normal saline containing alcohol or some other stimulant. Give without
delay hypodermic injections of ether, camphor in oil, strychnine, digitalis or
ammonia. Administer chloroform inhalation or morphine hypodermically
for convulsions.

4.    Lancet, 1870, Vol. Ha p. 316.

5.   Katzebach, New York Med. Jour,, Vol. XIEL