The temperature, at first subnormal, generally rises, especially in mild cases, to below 102° or 103° F. Recovery usually takes place in a couple of days under proper treatment. Mild cases may recover in a few hours.
The sequelm most frequently observed in cases of heat-exhaustion are undue sensitiveness to even moderate tempera tures; acceleration of the pulse and res piration; disorders of digestion; head ache and vertigo; tenderness of the spine. Chromatopsia; irritability of disposition, particularly recurring with the onset of warm weather. Epilepsy and disorders of locomotion and sensa tion have also been observed. Impair ment of memory and of the general aptitude are often observed.
The reflexes were, as a rule, exagger ated in a series of cases observed among soldiers. In 4 cases, epilepsy appeared after the insolation; in 2, partial hemi plegia; in 0, cutaneous anmsthesia; in 3, hyperresthesia. The mental faculties were impaired. In the majority, mem ory was enfeebled. One case presented marked inucular tremors; in 27 there was deafness. Twenty-six presented im pairment of vision. Sighing respiration was a not infrequent manifestation. In 14 cases the heart was irritable; in each of 15 a cardiac murmur was heard. in many of the eases the murmur was dependent upon the anaemia; in some it was organic. In some cases the heart was irregular or intermittent. Barlow (Cincinnati Lancet-Clinic, June 6, '01).
Case of a laborer, 31 years old, who, while at work, in midsummer, lost con sciousness. For some five weeks he was delirious. During convalescence there was difficulty of speech and impaired mo tility and sensibility in the extremities. The man could not whistle; there was slight drooping of the lower lip on the left side; there was wasting of the mus cles of the shoulder, and fibrillar tremor of these and of the biceps and triceps; if the arms were grasped below the elbow a coarse, purring thrill was felt; the muscles of the buttocks, of the thighs, and of the calves also presented fibrillar tremor; there was slight tremor of the lips and marked tremor of the tongue; there was persistent, dull, aching pain in the dorsal and lumbar regions; the knee-jerks were, perhaps, slightly sub normal; the muscles presented slight quantitative electric changes; the sphinc ters were competent; the hands and feet were cold and livid. Two applications
of the white-hot cautery to the back were followed by a disappearance of the pain and by decided improvement in the symptoms. Dercum (Univ. Med. Mag., June, '91).
Case of insolation accompanied by hemiplegia in a boy aged four years. Arthur F. Messiter (Lancet, June 26, '97).
HEAT-APOPLEXY.—This form is much less frequently observed. It resembles to a great degree the variety of heat exhaustion occurring in people suffering from malarial poisoning. Dizziness, in tense local headache, the appearance of muscm volitantes, marked throbbing at the temples, dryness of the skin, and dyspncea are the most usual premonitory symptoms. Suddenly the sufferer falls, convulsions occur, followed, occasionally, by all the symptoms of cerebral haemor rhage, barring the hemiplegia, but end ing with cardiac failure.
In the majority of cases, however, this stage is not soon reached. Besides the first symptoms outlined, there is marked flushing of the face, which may extend to cyanosis; the breathing is stertorous; there is marked delirium; nausea and vomiting or, rather, retching, and the tongue is coated. In these cases the temperature may also be subnormal at first, but it usually rises until it some times reaches 115°, 116°, and even higher.
In moderate cases the temperature gradually falls and in three or four days the patient is able to go about. lie is, however, very apt to suffer from either or many of the sequehe already enumer ated.