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HEAT                                                            185

In heat hyperpyrexia measures should be taken to reduce the tempera-
ture as rapidly as possible. The patient should be unclothed and placed
immediately in a bath containing water having a temperature of 70" to 80-R
He should be kept in the bath until his temperature has fallen to 101 :F
After removal from the bath, if the temperature is found rising, an ice bag
should be applied to the head, and ice should be rubbed ever the body or
the patient should be again immersed in the cold bath. Ice-water eneniata
may also be employed with benefit Venesection may be necessary, when
the symptoms of intense asphyxia are evident.

In heat cramps sodium chloride should be given daily in doses of 10 to
20 grammes well diluted with water. Sedatives should be administered to
relieve the pain of the cramps.

Post-mortem Appearances—External-Rigor mortis is well marked
but comes on early and passes off rapidly, putrefaction Mowing immediately
after. Petechial and livid patches are found on the skin.

Internal.—The brain and its meninges are congested, and the ventricles
contain serum. There may be actual haemorrhages in the brain. The nerve
cells in the grey matter show degenerative changes. The lungs are con-
gested and oedematous. The right side of the heart and pulmonary arteries
are dilated, and gorged with dark fluid blood, and the left side is empty and
contracted. The spleen is congested and is sometimes enlarged. The liver
and kidneys may show a cloudy swelling.

Medico-Legal Importance.—There is no medico-legal importance attached
to deaths occurring from heat stroke, as they are all accidental, but the
medical man may have to hold a post-mortem exanunation on such a body
if found lying dead on the roadside or in a railway carriage, as it sometimes
happens on hot summer days, and the police are bound to send such cases
for autopsy.

In the case of K. E. v. Lieut Clark, I.M.D., Mrs. Fulham and others
charged under section 302, I.P.C., with having murdered Mr. Fulham and
Mrs. Clark, it was proved from the letters produced that under instructions
from Lieut. Clark Mrs. Fulham so simulated heat apoplexy in her husband
by the judicious administration of poison (a mixture of belladonna or
atropine and possibly cocaine) that the medical officers of the military
hospital at Meerut were completely deceived and they treated him as a case
of sun stroke. It may be mentioned that at the time some fatal cases of sun
stroke had already occurred in the military hospital, and the knowledge of
these cases led Mrs. Pulham to write to Clark at Agra to send her some
poison which, when administered to her husband, would produce symptoms
simulating sun stroke. A book of medical jurisprudence found in the
possession of Ckrk at the time of his arrest was brought to me during the
course of the trial at Agra. The symptoms described under certain poisons,
such as arsenic, belladonna, cocaine, gelsemium, etc. had all been underlined
with red pencil suggesting that he had made a special study of these poisons,
most of which were alleged to have been administered to Mr. Fulham on
different occasions.