37
Of the 22 cases in Lahore District 14 were at Amritsar from one Company
of Infantry chiefly in July when there were maximum temperatures up to
112°F. The one fatal case here was a stout, constipated alcoholic.
In the Peshawar District the hot weather in Nowshera was exceptionally
severe with high temperatures, at 107° to 111°F. together with a high relative
humidity in July and August. All troops were placed upon Epsoms salts
twice weekly with very beneficial effects, the cases of heat stroke and heat
exhaustion being 4 each.
In Waziristan there were only 2 cases amongst British troops, a point well
worthy of note considering the extremely hard physical work and exposure
undertaken by all troops on frequent columns in the worst of the hot weather.
The importance of occupation, even if it be occupation out of doors in the
sun all through the middle of the day, is well shown by this contrast between
2 cases in Waziristan and 14 cases from one Company in Amritsar.
Fortunately the shibboleth of " exposure to the sun means sunstroke " is
rapidly dying out. It is now beginning to be recognised that the best way of
keeping men healthy in. the hot weather and preventing heat stroke is not to
shut them up in barracks from 9 A.M. to 5 P.M., nor need a large, heavy topi be
worn from dawn to dusk, but that men should be fully occupied, outside if
need be, throughout the day provided reasonable common sense precautions
are taken and immediate notice is taken of any one who appears to be off colour
or looks ill. The Waziristan figures of this year, the results during the 1937
operations, the July civil disturbances in Lahore in 1936, the recent experience
of training in the hot weather months in certain stations all indicate that heat
stroke and heat exhaustion are not inevitable because men are engaged on hard
physical duties out in the open throughout the day ; but rather the reverse,
provided ample drinking water is available, that clothing and feeding are
adjusted suitably, that common sense precautions are observed and that any
men who appear to be off colour receive immediate attention.
There is now one other factor which appears to be of considerable import-
ance and that is the maintenance of the total salt content of the body at a
proper level. In paragraph 16 the issue of an extra salt ration for the reduction
of minor septic conditions and boils was noted. Bat views are now being
expressed that an extra salt ration may be of definite benefit in the maintenance
of general health in the hot weather and the prevention or reduction of heat
stroke and the effects of heat. A daily excess loss of salt in the perspiration
which is not made good in the daily food must after 2-3 months produce a dele-
terious effect on the general tone of the body and particularly of the central
nervous system. In a short article published in the Royal Army Medical.
Corps Journal on work done at Peshawar, during the year, a medical officer
noted that the salt loss was 6.8 grammes or almost oz. of salt for a normal
route march. of 9 miles in the hot weather of Peshawar. He found that the
water requirements of a man marching 8 to 9 miles on a day when the tempera-
ture is 104.3°F. in the, shade and relative humidity 47 per cent, was approxi-
mately 6 pints of water in order to maintain real fighting efficiency, to which
must be added the amount of common salt which has been lost during the day,
which is estimated at practically half an ounce. Stokers at hard work in hot
climates utilise weak solutions of salt water as their drink. In mines, with
high temperature and humidity, the effect of salt drinks are dramatic in effect-
ing recovery from incipient heat stroke or exhaustion. The use of increased
salt for this purpose is therefore well worthy of consideration in the prevention
of heat stroke and more particularly of heat exhaustion.