his bare head and naked body with indifference, almost pleasure, that would rapidly prostrate a European. But when the temperature rises above a certain standard all succumb, and natives of India suffer and die like others in numbers every year from loo marna (hot-wind stroke).
The extent and duration of the toleration of heat depend much on the vigor of constitution and actual state of health. The refrigerating powers of the body, when in health, enable it to support a very high temperature, considerably above that of the blood. Thus, in the hot winds little inconvenience is felt so long as perspiration is free, but, when that fails, suffering soon ensues, and the danger is great.
In the fourteenth annual report of the Sanitary Commissioner with the Government of India, 1877, it is stated that two hundred and thirty-five cases of heat-apoplexy and sunstroke occurred in the army in India, of which seventy were fatal. Of those who recover, or rather do not die, many are permanently injured, and remain invalids for the rest of life, which is frequently shortened by the changes induced.
No remarkable morbid change is observed in cases where death has occurred suddenly. The heart may be firmly contracted, and the lungs and brain and its membranes congested, but not invariably, for sometimes the reverse conditions exist; and the blood is dark and clotted, its coagulability is impaired, and it is deficient in oxygen. In death from ordinary cases of thermic fever or insolation, the pulmonary system is often deeply congested; the heart is firmly contracted with coagulation of myosin; the venous system is engorged; the body may be marked with livid patches; the blood shows a tendency to a separation of its fluid and solid constituents, and may be acid in reaction; and the body retains a high temperature for some time after death. The brain and membranes may be congested, but the disease is essentially asphyxia, not apoplexy.
In cases of simple exhaustion, remove the person to a cooler place, if possible. Give a douche, but not too prolonged, or it may over-depress. A stimulant may be useful; rouse, and gently stimulate; remove tight and oppressive clothing. Treat as in ordinary fainting—apply ammonia to nostrils, etc. Let the patient rest, and avoid exposure to over-fatigue or to great heat. In the form of sunstroke where the person is struck down suddenly by a hot sun, remove him into the shade, and allow a douche of cold water to fall from a height on his head and body. This should be freely resorted to, the object being twofold—to reduce the temperature of the over-heated centers, and to rouse by reflex action. During the assault on the "White-House picket," at the capture of Rangoon in 1853, numbers of men were struck down by the fierce April sun. They were brought to me, and laid out in rows, perfectly unconscious, in their red coats and black leather stocks. They nearly all recovered—for the time, at all events—under the influence of the douche, freely applied over the head and
