It hit a seasonable 100° F. or higher in Abilene and Phoenix, Jackson (Miss.) and Kansas City last week. The Dakotas had it in the 903, and so did normally more temperate New England and the Pacific Northwest—Hartford 90, Boston 92, Spokane 98. The cliche, “It isn’t the heat, it’s the humidity,” was only locally and partially true. Heat, both wet and dry. sent scores of patients to hospitals and some to their graves. The heat was a burning question for laymen and military surgeons. But two doctors write in GP (published by the American Academy of General Practice) that civilian physicians pay too little attention to its dangers, and unwittingly contribute to the heat’s toll of illness and death.
The viewers with alarm were Sister Michael Marie* and Dr. Matthew Ferguson, who saw most of their cases of heat illness at St. Vincent’s Hospital, among Manhattan’s bakeoven brick and brownstone pueblos. Doctors have long since dropped the lay term “sunstroke” because, they note, heat can strike down a man in the shade almost as readily. Actually, say the St. Vincent’s physicians, there may be a dozen forms of heat illness. Some of them “are true medical emergencies, and any hesitation or indecisiveness in their diagnosis and treatment may result in death or in a permanently incapacitated patient.” The major forms:
¶Heat Stroke. The body temperature soars to 106° or higher; sweating stops and leaves the skin hot, dry and flushed. Warning signs include fever, headache, restlessness, thirst, and absence of sweating. Treatment is drastic, and the physician must not leave it to the nurses. Most effective is to put the patient in an ice bath until the rectal temperature drops to 101°. If shock sets in, the patient will need intravenous fluids, plasma and drugs to boost the blood pressure. Mortality ranges from 20% to 80%.
¶ Heat Cramps. The acute form of salt depletion, marked by fatigue, dizziness, headache and muscle pain, leading to cramps from contraction of the belly muscles. The remedy: salt (given intravenously if the patient cannot swallow enough). The milder and more insidious chronic salt depletion shows the same signs, but sometimes in such vague form as to be mistaken for malingering or hypochondria. Salt tablets (but only for those who really sweat excessively) will prevent or cure it.
¶Prickly Heat. Usually trivial, but may be incapacitating if it affects large areas or becomes infected. Prevention: wear loose, well-ventilated clothes, bathe often with little soap. Remedy: keep in a cool, dry place. (Creams, ointments and powders may do more harm than good.)
¶Heat Exhaustion. One severe form results from spending several months in hot, moist climates. Marked by fatigue, headaches, dizziness, blurred vision, palpitations and—paradoxically—inability to sweat, except on the face, palms and soles. Moving back to a temperate climate (or into air-conditioned quarters) is the answer, but the sweating mechanism may be knocked out for months, leaving continued danger of heat stroke.
*Born Sarah Louise O’Brien in the Frog Hollow section of Hartford, Conn, in 1922, she took vows in the Order of the Sisters of Mercy, got her M.D. (’58) from Woman’s Medical College in Philadelphia, is now at Mercyknoll, West Hartford, caring mainly for oldsters.
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