August 17, 2001


Mad dogs and Englishmen go out in the midday sun.

Noel Coward (1899-1973)

It was 1943 or 4 when I took my army medical basic training. It was at Camp Pickett, Virginia in the middle of the summer. As required, we took forced marches despite the heat. We started at daybreak, but it got very hot soon after. We were issued salt tablets and instructed about "heat exhaustion" which is not directly caused by heat, but by salt depletion due to perspiration. Despite this, there were soldiers who succumbed to heat exhaustion. Whether it was because they didn't take their salt pills, or some other reason, I don't know. The salt pills made a few people sick to their stomachs.

The symptoms were characteristic. First the soldier would start stumbling or staggering and then he would collapse. He would be carried to some shade beside the trail. The medic would take his canteen cup and pour some water into it and a small handful of salt tablets and swizzle it around. Then the unconscious soldier's head would be propped up and the cup presented to his lips. This was against the first aid rule that says not to give an unconscious person anything to drink. The soldier would suck at the salt water, despite being unconscious, much like a very thirsty baby. He regained consciousness almost immediately. It was miraculous. He would then be transported back to camp. A few soldiers did not respond. They were taken by ambulance to the base hospital where they were given intravenous salt solution. Almost all recovered. There were no deaths from heat exhaustion during the time that I was there, but they had happened.

I was one of the medics who had the job of treating the heat exhaustion victims during the march. The resident physician, a captain, was a native Virginian. He was one of the few genuinely likable people in the basic training cadre. I can still hear him say "If you doan div dat man salt, he doan daa.(Translation: If you don't give that man salt, he's going to die.)

Many years later, when it was discovered that some people with hypertension(high blood pressure) could reduce or eliminate the hypertension by going on a strict salt-free diet, salt was demonized by the medical profession. People were warned about eating too much salt. This, despite the fact that the vast majority of people have no problem with salt. They simply excrete excess salt in the urine. I wouldn't be surprised if some people restricted their salt intake during hot weather because they were told that salt is bad for you, with predictable consequences. Those consequences might be heat exhaustion and sometimes death.

The first symptom of heat exhaustion is weakness. I can recognize the early symptoms of salt depletion(hyponatremia) in me and I do something about it; maybe a salt tablet and a full glass of water, a pickle or a handful of pretzels and water. The symptoms quickly disappear. Even if it might be a placebo effect, the salty food or salt tablet are innocuous enough so that I am not concerned. If I really didn't need the salt, it is of no consequence if I take some, compared to the consequences of developing severe heat exhaustion. So-called sports drinks (Gatorade etc.) contain the necessary salts and work fine, but I'm not very sporty. Besides, they contain sugar, which I don't need.

I also make it a firm policy not to exercise in hot weather. I take my walks early in the early morning, when it is cool.

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