HEAT SYNCOPE AND HEAT STROKE 393 



It appears to be a form of meningitis. 



The temperature rises suddenly as a rule, 104°, 107°, 110° F. 



There may be frequent desires to micturate. 



PATHOLOGY. 



Post mortem, there may be little found. 



There may be a post-mortem rise of temperature, or a raised tem- 

 perature maintained for some time after death. When the temperature 

 has been known to fall after death it has never been known to rise 

 again after any disease. 



The lungs are congested. The vessels in the meninges are con- 

 gested. There may be minute hemorrhages in the brain substance. 

 There is a coagulative necrosis of the nerve cells. 



(B) Indirect. 



This is much the same as the direct but exposure to the sun is not 

 necessary. It may come on at night. 



There may be prodromata. 



Sambon savs that it has a distinct geographical distribution, and is 

 caused by some microbic agency. 



Newcomers are more liable to it. 



Long residence produces a relative immunity. 



The predisposing causes are as before mentioned. 



It is most prevalent in the hottest season. 



It may become epidemic at times. 



It has a definitive course, peculiar lesions, tends to terminate by 

 crisis and thus behaves like a specific fever. 



Some authorities affirm that this is the same as the direct form. 



THE MORTALITY OF HEAT STROKE. 



Early judicious treatment is very effective. 



The mortality is 15 per cent, to 20 per cent. 



It is stated that among the English troops in India one in four die. 



During the Great War, 1,026 men were passing some hours in a 

 train in India. There were 136 cases of heat stroke with 15 deaths. 



Overcrowding was blamed chiefly. 



Sir Victor Horsley died from heat stroke while on active service 

 in Mesopotamia. 



DIAGNOSIS. 



Diagnose from A, E, I, O, U, and sometimes D and T. 

 A Icoholic poisoning. 

 E pileptic conditions. 



/ ntracranial causes such as meningitis, cerebral haemorrhage, 

 thrombosis, embolism, gummata, and all tumours. 



