HEAT STROKE AND HEAT SYNCOPE 



perspiration is diminished or stopped, and the bowels are constipated, 

 while the urine is copious and limpid. 



Intolerance of light and chromatopsia — red, yellow, or green 

 spots, wth suffusion of the eyes — have been noted, as well as other 

 nerve symptoms such as restlessness and insomnia. Sometimes 

 these symptoms point to disturbance of the digestive system," in 

 that the patients complain of anorexia, polydypsia, nausea, epi- 

 gastric distress, or diarrhoea. All these prodromal symptoms simply 

 indicate that the patient is not in a normal condition of health. 

 Onset. — ^The attack begins with a sudden sharp rise of temperature 

 to io4°-i07°-iio°-ii4° F., and a pulse-rate in proportion to the fever, 

 while the skin becomes dry, burning, and flushed, with occasionally 

 a macular eruption. The patient becomes unconscious, delirious, 

 or comatose, usually the latter. The pupils are often very con- 

 tracted. The respirations are noisy and quick, and rales and 

 rhonchi are heard on auscultation. The pulse is rapid, and though 

 at first of good volume, soon becom^es irregular, intermittent, and 

 thready. The urine is scanty, and may contain albumen and casts. 

 The motions are passed involuntarily. 



Course and Termination. — If the patient is going to die, convulsions 

 appear, and the skin becomes cyanosed and clammy ; the respirations 

 become slower and slower, and more and more stertorous ; the pulse 

 weaker and weaker, until the patient dies of asphyxia after an illness 

 varying from a few hours to a day or so. If recovery is to take 

 place, the temperature often falls rapidly by crisis, the respirations 

 become quieter, the pulse slows, there is a critical discharge of 

 urine, and the patient falls asleep, to awaken much better. 



Secondary Fever.- — In some cases the course of the fever is much 

 longer (see Fig. 674), lasting eight to ten days. Possibly this is due 

 to secondary infection with intestinal bacteria, and blood cultures 

 should be made. 



Convalescence.- — The patient remains very susceptible to high 

 atmospheric temperatures for a long time after recovery. There may 

 be persistent headache, photophobia and giddiness, and definite 

 cerebral and cerebellar syndromes have been noted as sequelae. 



Diagnosis, — ^The cardinal signs of heat stroke are the association 

 of a high bodily temperature, and often coma, with a high atmo- 

 spheric temperature and a high relative humidity. The differential 

 diagnosis is most important, and has to be made from malaria, 

 epidemic cerebro-spinal meningitis, alcoholism, opium poisoning, 

 renal coma, apoplexy, and epilepsy. Heat stroke must be diag- 

 nosed from pernicious malaria by the absence of parasites in the 

 blood; from cerebrospinal fever by the absence of Kernig's sign, and ) 

 absence of contracture of the muscles of the neck. The high 

 temperature should enable it to be differentiated from alcoholic or 

 renal coma, as well as from apoplexy and epilepsy (in both of which 

 the temperature may be slightly raised) and opium poisoning. 



Prognosis. — ^The death-rate varies, as a rule, between 15 per cent, 

 and 25 per cent., but it may be as high as 51 per cent, at times. The 



