CHAPTER III. HEAT AND SUNSTROKE. 310. Degree of heat consistent with life. 311. Heat exhaustion. 312. Sunstroke. 313. Post-mortem appearances. 310. Degree of heat consistent with life.-The degree of heat through which man can live depends a great deal upon the conditions to which he is exposed. Puddlers in iron foundries live at a temperature of 136° Fahrenheit, for eight to ten hours a day. Engineers and stokers live at a temperature of 150° F. In Turk ish baths the temperature of the dry rooms is frequently raised to the boiling point of water, and the bathers remain in the rooms without having their own temperature raised above normal; and instances of "human salamanders" are recorded, where men have sustained remarkable temperatures for short periods of time. Martinez,1 the French salamander, remained in an oven in the Gardens of Tivoli for fourteen minutes, at a temperature of 338° F., and repeatedly stayed in the oven when the temperature was above 250.° Chanouni,2 the Russian salamander, used to enter an oven with a leg of raw mutton, not coming out until the meat was well baked. And these temperatures seem to have been borne without detriment. On the other hand, exposure to very much lower temperatures of the sun's heat frequently cause fatal results. Such effects usually occur in those who are engaged in some laborious outdoor occupation, but the same effects may be found after exposure to artificial heat. Swift, in his "Observations on Exhaustion from the Effects of Heat," states that eleven patients were admitted to his hospital from the laundry of one of the principal hotels of New York, and several were brought from a sugar refinery, where, after working several hours in a close and overheated apartment, they fell down insensible. Upon a comparison of the symptoms and lesions of these patients Brierre de Boismont, Du Suicide et Swift, N. Y. Jour. of Med., July, de la Folie Suicide, Paris, 1865, p. 276. 2 Lancet, London, 1827-28, p. 585. 1854. and those who had become exhausted by laboring in the sun, no distinction could be found. 311. Heat exhaustion. The cases of sunstroke may be divided according to their symptoms into two classes: heat exhaustion and true sunstroke. In the first set of cases, where the symptoms appear after prolonged exposure, when combined with physical exertion there is liable to be extreme prostration, collapse, and restlessness. The temperature is often subnormal,-as low as 95° or 96° Fahrenheit. The condition may come on at night or when working in close, confined rooms. 312. Sunstroke.-The true sunstroke cases are found in persons who, while working hard, are exposed to the intense heat of the sun. It occurs frequently in soldiers on the march and to laborers in the larger cities. The patient may be stricken down and die within an hour, with symptoms of heart failure, dyspnea, and coma. Death may be almost instantaneous, the victims falling as if struck on the head. The more usual form comes on with headache, dizziness, nausea, and vomiting, followed by insensibility and coma, pulse rapid and full, temperature ranging from 107° to 110° or higher. The fatal termination may occur within twenty-four or forty-eight hours. Recovery may be complete, but often there remains a permanent inability to bear high temperatures. Such persons may become very uneasy when the thermometer reaches 80° F. in the shade. Loss of mental concentration and failure of memory are also very constant sequelæ. 313. Post-mortem appearances.-The post-mortem appearances are not characteristic. In some cases there is a congestion of the brain; but in four cases of heat exhaustion examined by Pepper "the brain exhibited no indications of congestion, and nothing, in fact, of an unusual appearance." Dr. Pepper was, however, struck with the appearance of the heart. In all four subjects it was pallid, flaccid, and softened, while the other muscles of the body were florid and firm. The lining membrane of the heart and of the large blood vessels was of a very dark, almost purple color. The cavities of the heart contained but little blood, and no coagulum. The examinations were made from six to eight hours after death. Dr. Wood found, in all the autopsies made by him, the heart firmly contracted, especially the left ventricle. Some previous observ Thermic Fever, or Sunstroke, by H. Co., 1872. And Philadelphia Medical C. Wood, Jr., M. D., Boylston Prize Times, Aug. 5, 1876. Essay. Phila., J. B. Lippincott & ers (for instance, Levick, Pennsylvania Hospital Reports, 1868, and Pepper, quoted above) had noted the heart as being soft and relaxed, while others did not report the condition of the organ. Dr. Wood accounts for the difference in the fact that in none of his cases was the autopsy made later than two hours after death. In Dr. Levick's cases the post-mortem examinations were made from thirteen to thirty hours after death; and in Prof. Pepper's cases six to eight hours after death; and, besides, all his patients had been bled before he saw them. "As the temperature of the body remains above 100° for hours, it is evident that putrefactive changes, often already entered upon before demise, must go on very rapidly, and that probably even three or four hours would afford sufficient time for the relaxation of commencing decomposition to follow the heart rigidity. Moreover, direct evidence of the truth of this is not wanting. It has been experimentally demonstrated that in animals rigidity of the heart is found directly after death from excessive heat, but that in a few hours it disappears." This rigidity of the heart and the marked rigor mortis which comes on at an early period after death from sunstroke is from coagulation of myosin. The other post-mortem appearances are mostly negative. Congestion of the brain or effusion into ventricles is not of frequent occurThe lungs, however, and the right side of the heart are found gorged with dark, fluid blood. rence. Dr. Wood has not observed any change in the blood microscopically, but the coagulability is always impaired to a greater or less degree. 'See Boston Journal of Med., Val I, p. 350. CHAPTER IV. COLD. 314. Degree of cold consistent with life. 315. Symptoms. 316. Post-mortem appearances. 317. Frostbite. 318. Causes of death from cold. 314. Degree of cold consistent with life.-The degree of cold to which a person can be exposed and live varies to a great extent. The Eskimos and the explorers in the polar regions live for long periods of time at temperatures of 40° to 60° F. below zero, without detriment. And, on the other hand, in the retreat of Bou Thaleb, January 2-4, 1845, Dr. Schrimpton reports that General Levasseur lost, from a column of 2,800 soldiers, 229 men by cold, when the temperature was but 2° F. below zero.1 Infants, old people, weaklings, and those addicted to alcohol regularly are more easily affected than people in robust health. 315. Symptoms.-In persons who have been subjected to intense cold there is a primary contraction of the blood vessels in the skin, and subsequently a congestion of the internal organs. Later, there is probably a paralysis of the cutaneous blood vessels, with a revulsion of the blood to the skin again. Hence, there is at first a paleness of the skin, and later the skin assumes a livid hue. After prolonged exposure the whole body becomes benumbed, the respiration oppressed, and the head heavy. Blood pressure is lowered, the red blood corpuscles are destroyed, and nerve activity is decreased. Perception and sensation are obtunded, the mind wanders, an invincible lethargy steals over the senses, the limbs become paralyzed, and the unfortunate person, overcome with drowsiness and exhaustion, sinks down into apparent death. Unless speedy relief is afforded, this condition soon merges into real death. According to Larray, death is preceded by a general pallor, stupor, difficulty of speech, dimness of 1 'See Ann. d'Hyg. Pub. et de Méd. de Méd. et de Chir. Militaires, 28., I., Lég., 1881, 3s., VI. Recueil de Memories p. 554. sight, and sometimes a total loss of these functions. In the retreat from Moscow, some men, he says, led by their comrades, were able to march for a considerable time in this condition. But their limbs soon refused to support them, they reeled like drunken men, and fell, benumbed and lethargic, and soon expired. Almost all the men who perished in this manner were found lying with their faces to the ground. 316. Post-mortem appearances. After death the body is found frozen and the cranial sutures are separated. The skin is reddened; not strikingly so, but distinctly so as compared with the blue of suffocation; the hairs of the skin are on end, and the penis and scrotum retracted. The blood is nearly always lightly clotted but becomes fluid as the body thaws out. It is found in large quantities in the large vessels and the heart, all the chambers of the heart being filled with blood. Wichniewski2 constantly found ecchymoses in the mucous membranes of the stomach. After the body is thawed out rigor mortis may persist, according to Blosfeld and Bruecke, though it is denied by others. Decomposition sets in early after thawing, with rapid imbibition and transudation of the blood, giving marks of the blood vessels in the skin. Serous effusion into the ventricles of the brain or under the arachnoid was observed by Kellie in two cases, and in three out of six cases by Blosfeld.* 317. Frostbite. In cases where death does not occur directly there may be signs of frostbite of the ears, nose, and extremities, or even gangrene of the lungs. Frostbite of the extremities has been classified by Parmenter as of the first, second, and third degrees, corresponding to the degrees of burns,—first degree with reddening of the skin, second degree with vesication, and third degree with destruction of the deeper tissues. The discoloration and signs of the frostbite, however, do not appear for several days after the exposure. 318. Causes of death from cold. Cases of suicide by cold are very One recent Vienna case is reported by Hofmann of a woman who went out in the winter in her bare feet. Before going out she had taken a considerable drink of cognac, and had left a note to those rare. 14. Vibert, Précis de Méd. Lég., 4 ed, 1896, p. 203. 4 2 Wichniewski (Virchow's Jahres- Stoenesco. Rev. de Méd. Lég., 1903, X., berichte, 1895, I., 460) found hemorrhagic spots in the mucous membrane of the stomach of forty out of fortyfour cases of persons where death had Beck's Med. Jour.. Vol. II., p. 68: been due solely to cold. In the oth- Henke's Zeitschrift, 1845, p. 245. One er instances of 900 autopsies that he hundred legal autopsies made in the had performed. with death from other institute for instruction in forensic causes, the spots were not found. His medicine in the Russian university at work has been corroborated by Kasan. |