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During football practice last September 23, Harold Coxson, a 17-year-old Dallas high school player, collapsed and lost consciousness. The cause was heatstroke. Shortly afterward he was admitted to a hospital, where his temperature was found to be 109�. Prompt medical attention reduced this to 102� by the following morning, and he survived.
Harold Coxson was among the lucky ones. Since 1959 there have been nine documented cases of the deaths of high school and college football players directly attributable to heatstroke. In addition, heatstroke is believed responsible for the deaths of two other college players, one high school boy and one semipro player. This ailment, to which football players are particularly susceptible, is a breakdown of the sweating mechanism that occurs when the body is unable to throw off excessive internal heat efficiently. As a result, body temperature soars at a rapid and dangerous rate.
The deplorable fact is that in every one of the 13 cases death was preventable. This is the conclusion of Ohio State University physiologists and medical doctors who have just completed a four-month study of the effect of heat stress on players. Highly significant was their finding that the uniform and helmet—marvels of efficiency in protecting the wearer from physical damage—were major factors in causing heatstroke and heat exhaustion. Said participating physician Dr. William F. Ashe, one of the world's foremost authorities on heat stress, "Under certain conditions, the uniform can be a death trap."
The research team, under the direction of Dr. Donald K. Mathews of the OSU physical education department, began its work with a detailed examination of the player deaths in the light of certain basic medical facts: When a person's temperature reaches 106�, his central nervous system cannot cope with the heat load it must carry. His skin becomes dry and warm (sweating having ceased), and he may develop a staggering gait before falling down unconscious. Death is very likely when the temperature reaches 110�. Fully half the cases of heatstroke are fatal.
In cases where a person's life is saved—by quick, competent attention, with emphasis on reducing the victim's temperature—brain damage may still occur. Most frequently, the hypothalamus is injured. This is a tiny nucleus of nerve cells in the center of the brain that acts as a kind of thermostat for the body, regulating the throwing off of heat or the conserving of heat, depending on the body's needs. If damaged by an excessive heat load, the hypothalamus may lose its delicate temperature-regulating ability. Victims of hypothalamus damage are unable to adjust to extremes of heat or cold that would not endanger a normal person.
Heat exhaustion—another syndrome to which football players are especially susceptible—is characterized by profuse sweating, sudden weakness and perhaps headache, irritability and nausea. The number of high school and college players who, during practice or in a game, are felled by heat exhaustion is not known, but an estimate by Dr. Mathews places it annually in the high hundreds. One of the dangers of heat exhaustion is that it can turn into heatstroke. A player gets red in the face, continues to sweat, develops a high pulse rate and a slight fever. As his temperature rises still higher, he begins to feel better. This is an illusion. He suddenly stops sweating, gets goose pimples and his temperature soars. At about 106� he becomes unconscious. Heat exhaustion, asserts Dr. Mathews, is likewise preventable.
In carrying out his research, Dr. Mathews was aided by several graduate students working on Ph.D.s in physiology. Also on the investigating team were Wayne Kaufman, supervisor of athletics for Cuyahoga Falls, Ohio schools, Dr. Edwin Hiatt, a renal and cardiovascular specialist, and Dr. Ashe, who is chairman of the department of preventive medicine at OSU and has studied the effects of high temperatures on factory workers in India and miners in South Africa. Finally, several high school football players and OSU students and graduate students volunteered as guinea pigs for experiments with the football uniform.
Specifically, the research team wanted to find out how much heat the football uniform retained, how much sweat it allowed to evaporate, how much of a heat load was induced and, most important, what the physiological changes were. It is widely understood, of course, that the principal way in which a person throws off excess heat—be he football player or clerk—is by sweating. Evaporation of sweat cools the blood, which has carried internal body heat to the surface, thus lowering the body's internal temperature. The more efficiently the body sweats, the more efficiently it is cooled. When sweat is prevented from evaporating, however—by high humidity or lack of movement in the air, or when trapped by clothing that stops air from reaching it—the body's temperature rises rapidly.
It is also known that when the body sweats to an unusual degree, a fairly sizable amount of salt is lost along with water and that this salt must be replaced. The more water a person gives off, the greater his oral salt intake should be. A common symptom of excessive loss of salt through sweating is a cramp in one or both calf muscles. Sometimes the cramp can be brought on by drinking large amounts of water without taking salt at the same time. The combination of losing salt and water by sweating and replacing them with water alone will cause an imbalance affecting the behavior of certain skeletal muscles.
In their examination of the fatal heatstroke cases, the research team found that the nine players, who ranged in age from 17 to 20, were typical as to height and weight. They ranged from 5 feet 8 inches to 6 feet 1� inches, and from 165 to 244 pounds (the heaviest player was also the tallest). On the days that they were stricken, humidity was relatively high, ranging from 43% to 100%. Outside temperatures varied from 64� to 93�. (At the time of the lowest temperature, however, the humidity was 100%.) In the light of later findings, there is great significance in the fact that five of the players died on the first day of that season's practice and two died on the second day.