BELDING

et

al.

839

RECENTT DEVBLOPMENTS

IN TJNDBRSTAI|IDING OF EFFECTS OF EXPOSI.]RE TO HEAT*

of Occuparional Health, Graduare School of public Eeal*L University of Piruburgh, pinebugh, penncylvania

H. S. BBr-uNG, T. F. H.lrcrr, B. A. Hsnrrc, and M. L. Rrrnnspr,

Deparf,menr

at the University of Pittsburgh. \!'e shall first presenr a chart which we have developed for teaching purposes
to show the strains and overstrains o[ exposure to heat. Secondly, we shall deal with two activities rrhich are directly related to industrial heat exposures: one an analysis which relates accidents in a steel mill with the weather, the other a study of events of recoverv from exposures in which body tenperature has been ele-

This paper will be resr.ricted to a brief preliminary account of certain findings of our heat research group

Flow Chart Indicating Strains and Orerelrains of

Exposure to Heat

vated. And, finally, rve shall look at two findings which are of more fundarnental interest, including one which has hclped us better to understand the advantages of acclirnatization to hear.

Ind lon{-terrn support und.er Grant fron the National hrlittltrs of Hcalth and under Coiltract I'r'. D.,l--/q-l,tr;--\lI).q{S titrr t/rc
No. ftG
has
13-17

tThis uork

.{ chart rshich we have developed to show t}re interrclationships and interdependence of ph,vsiologic cYcnts resulting from exposure to heat appears as Figure l. \fe hare found this a useful device for describing the courscs of breakdorsn o[ the mechanisms of adjustmenr to heat and the tiistinction bet$een heat erhaustion anti hcat stroke for students anrl others not fullv acquainted with the phvsiologv of hcat regulation. I he solid lines depict the adjusr. mcnts b! rrhich adcquate thcrmal hommsrasis is maintainerl. Broken linis show the paths of phrsiologic breakdown. A surlnrarr of the events leading to these injtrries. acconpanietl the figure and appean as an
-{ppendir to this paper.
S eather and Aecidents

U.S. Arnty trIedical Ilistarch and Du,clofnttn! Coltnand.

.{ studr of accitltrrts in relation to

$'eather resulted

840
GRATER HEAT

woRK pnysror.ocy AND psycHor.ocy

HEAT STRSS
EATS 8EAT LOSSES 8Y RADIATION MO CONVECTION ARE LESS THAil P8ODUCTION OF METASOLISII

(OR LESS

LOSS GAINI 8Y
CONVECTToN

8A!j-{ICN AftD

$\l \.*,n
.*,n rr*r*orr", *'a.a ,.*.*orr", *,"..
{NeRvous nEcEPToRs FoR

I
| I

/ .,-"'.roo'n rilcREAsEc HEA' FL.H tliY otrEils7 Fnou sooY coRE F yrr:r Rrsg tN sxtil '\I 'RPERATUaE \AUGMENTE0 sKrN
PRoLoxGEo IqLoIGEO

*':-'^:."t"'
\ t:::.T3\ DE'E{'\ \

| / -/

-/

UilEVAPOAITED swEAr, SWEAT, -1:suilEvaPos^rED cooLrNG - usLrss FoR cooltilG usLtss Fd

/:.5

ilausEA EXPOSUREE-,/ ExPosuRedaa / ,f -llEArr{\q-salr,nraK-*-,3f;J,T,t", I : | \ \\* \ \ \ rilcReAsEsBLo00voLUilE:gV\\-\B\ cReAsEsBLo00voLUilEigV\\-\B\ (AGCLIHATIZAiIONI "PRIGKLY FATIGUE oF FRtghLr aattcuL uF unArN oil\ 0FAIN OrI.\ oRAtfl DRAIN oN V v Hear' swEAT cLAnDs eoov wltgn \eoov saLt \tilaDEeu4rE vENous \HEAT RETURilToHEAnT REruRilroHEAnr I / \ \ -x"o \F cRIMtS ,r' | \

/,t".i13H,itli3,},
"\
IilADEoUATE

FLO', tO VITAL AREAS

IIiA0SOUI?E

,ro' BLooO

oIRCULATIoNo\

SKIN

I DEHYuRATToN ,J".rrl'nion. P g {oFTEN Ail gltslfllSHEO

SWEATI$O
TNADEOUATE

clculltoRY sHocx (RAPlOr wEAx PULSE; Low BLooo PREssufie! eoRE TEIFERATUnE iSAY 8E XORXAL

l\:/

sTlMuLUs)

\+/
RtsE

reuesurune ] \. = \ I

tx *

800Y

'q

TNCREASED

HEAT

Erllausrlor,r

i#ii.n#k
FRFORHAIIgE

METABOLISM

FAILUR

costRoL Hcruxi3x (gwgaTrlra 9gasEsl

NAFD RISE

I OF OEilTNAt

H, s- EELOrdG

If

CORE TEHPERAIURE

UNIVRSIIY OT flTTSEUFGH r955

llg

sr8-or:

frcunE I from the observation of orrr colleague, Dr. A. G. Kammtr, tirat his medical dispensary in a large steel plant near Chicago was considerably busier in the hot summer than in the winter. He was able to obtain
temperature and humidity and that these are at a ]ower ebb in hot weather. Can this explain the results? The data are inadequate to permit any broad conclusion, but indicate directions for future investigation. These might involve a study of seasonal variations

good records of acciderits iir this plant for the four immediate post rvar years- This was a period of ful! cmployment. ,\n accident, as defned at this Plant, ws. any incident for which the plant might be liable that involved a visit io the plant dispensary, Analysis indiated, as predicted . by Dr. Kammer, that the accident rate was intleed higher i:, the sum' rner, about twice as high as in winter, and that the rates for fall antl spring were intermediate (Figure 2). The difference tretween seasons persisted despite a safety campaign which progressively reduced the over' all accident rate during the four years. l{e were interested in the thermal relationship, if any, and carried out a further analysis to re whether the hotter departments of the plant had a disproportionate share of lhe accidents in the summer. It was not possible to show any such relaiicnship" This did not rule out the possibility thal an analysis by hotness of individual jobs would rcveal a significant correlation

in accidents in other plants, where process heat is or is not a factor, and comparison of the accident experiences of plants in localities where seasonal fluctuations in weather are less severe.
Recovery from Exposure to Heal exposure

by seasons (such an analysis was not feasible), hut it suggest that some factor beyond the plant itselt might be oprrative. It has been suggestetl on the basis of studies l>y Ellsworth Huntington (i) and of comrnon expcricncc tliat the general tonus of bodily activity and alertness is related to environmen{al

did

c{fects of exposurc have largely been confined to observations of physiologic responses dzring exposure, Whcn exposures arc intermitlent the process of rcouery is of interest, for iwo reasons: (a) if recovery Irerween exposurcs is not complete, re-exposute wiil rcsrilt in cumtrlative effccts; and (b) time spent in recovery is usually iost tirne from the point of view of !ilanagemcnt, and for operating cfficiency it is desirable to minimire such Iime. Wc have had the practical objective of learning lrow hot jobs may be arranged to achieve efficiency of personnel without undue risk of injury to health. Obviously, the drlration of rccovery as well as of exposure are irnportant factors. Other factors which

of

J\Iany hot jobs in intlustry require intemittent to hrgh levels of heat. In the past studies

will affect the physiologic

responses

of the

exposure-

BELDING

' 4'.

841

U'

I c o
a

L f

Weolher ond Accident Frequency o Steel

Mc Mohon

ond Belding,

o
o
v, + c (l)

o-

o = (,
Dry Bulb

u_
u

zii\
t\\

o
a o
ts
.o
E

i\\

lii
\\ t\

li**,.,,
\\ I
t

t_\

a947
FIGUBE 2

p48
minuts only 0.3", and after 60 minutes it rvas still 0.4" C above the inidal temperaiure. Skin tempenture, sweating, and heaft nte had retumed close to pre-exposure levels within a few minutes. Ii appears that these thrft items reprffnt inadquate critedl of recovery in that bas line levels are reached before trody core tempemture has returned to pre-exposure
level. and,

some of the other variables. In these studles rve have been most impressed by the great length of time required to restore rectal temperature to pre-exposrlre levels after it has been elevated; in many cases return to base line values had effects

physiologic observations under iaboratory- and fieki conditions. Nevertheless, we have learned quite a lot about ihe subject. Dr. I-ucien Brouha (Z) ted ttre way immediatcly after the war bv demonstraring thar air conditioning of reccvery areas can reduce cumnlative fatigue from intennittent exposures. We have confirrned and extended this work and studied the

recovery cycle are intensity of environmettal heat and work during exposure and themal environment and activity drtring recovery. The numbcr of variables has made it impossible to arrive at any general form. u]a .f9r .arrangemenr of these jobs, dlspite many

after heart rate rtrovery, additional heat was added to that airead)' stored, with resulting added srrain

In fact, when men rvere rc-exposed

cases,

iromediately

in certain

circulatory collapse.

of

Body Core Temperature nnd Sweating

rate and sweating nearly to pre-exposure levels. We show one example which illustrates some of these points (Figure.3). Here rectal temperaiure rose lo C during a 30 minute period in the heat, 38.3" C. Atrer 15 minutes of rest in a thermallv neutral environment

not occurred at the end of an hour. We have also been surprised by the promptness of return of heart

rectal temperature had fallen only 0.1., after

30

None of us in this field are fully *tisfied e'irh reclal temperature as a measute of core temperature. Benzinger has recentlv reconmended use of the temperature at the external surface of the tympanic membrane as an indicator of temperature of the hypothalamus 13). and in our most rcren( studies we hat'e adopted this addirional measure. 1\-e find ear temperature to be more responsive to change in environmental condition or activitv, more labile, than rectal temperature. Results of an exposure iri which ear, rectal, and mouth temperatures were followed

84?

WORK PHYSIOLOGY AND PSYCHOLOGY

OATA FROM
OurLtBnArrON

Subiecl
5r"C Vp25m
EXPOSU R E

A TYPICAL EXPOSURE 3, Exposure C

RECOVERY

Cor

8lu
h,

B.9t:
70 r200

nr
ht

8OO

VAPORATION RAT

qoo

38

RECTAL TEMP

tor

38
37

too
99

.F

39
37

SXIN TEMP
t

35 13 4

couFoRr
2

o -2

50
Tima

50
I

70

eo

90

too

Io

t20

MrnuteS

TIGURE 3

appear in Figure 4. These are typial in that mouth and ear temperatures rise faster during exposure and fall faster afterward than rectal. This suggests that rectal temperature may not reflect the over-all thermal state of the body core. In fact, postexposure rise in rectal temperature which we have often noted (cf. Figure 3) and its slow remission suggest that during and following exposure to heat the rectal wall is essentially deprived of blood flow, and that change in its temperature is primarily dependent on the relatively slow process of conduction from or to surrounding tissues. Note that sweating, as measuted by change in body weight, falls almost to pre-exposure level within a few minutes after exposure, in coincidence with an abrupt fall in skin temperature. This occurs long before corc temperature has returned to base line ralucs. I)r. Benzinger will find this observation in ronflict with his tr,vpothesis that the level of hy-pothalamir-: tcnrpcrature dctcrmincs sweat rate.

Acclimatization

The mechanism of acclimatization remains obscure, but the dramatic results of acclimatizaaion to heat are well known. These are decrease in circulatory
strain, as evidenced by reduced heart rate: lessened elevation of body core temperature; lowered skin
temperature; and increased tolerance. Some investigators have reported a slight increase in sweat rate with acclimatization; others little change. One of us (Hatch) has recently dcmonstrated how much lower the threshold skin temperature for sweating was among a group of young Europcan men acclimatized by.living in Singapore than it was for a similar group living in Oxford, Engiand (4); actually, the threshold skin temprature for onset of sweating

was al;out 1.4' C lower for the acclimatized subiects at Singapore (ligure 5). This is indicated by the zero

intercepts
sponscs

of tlre trend lines which show sweat reof unacclimatized and acclimatized subjects,

BELDING

E' d/,

ol:l o't J

TIME-COURSE OF EOOY TEXPERATURES AI{D SYEATIX DURlilc A WARtlt{G al{D cooLtr{G cycLE ErP. (-5. t96O
SUSJECI ilUDE, SI?TflG

39r |
36
F

t.' I
L
I

.r,

]t"
J .l36 'c

F.

-....av.sKrr{

3!1.

]
J

'c 0 F-187 rr*u 8. '-26

5l

'c D.a. rrx6 -----r---

'

-28 'c 0 I. r {ttc

'}IR

Frcunr adjusted for activity level. There is considerable scatter of data on individuals, but little overlap, suggesting the validity of the difference. The regression lines drawn to show the average responses of the two groups are 500 or more grams of sweat apart for the same skin temperature, which means that if sufficiently more diffrcult conditions of exposure are set for the acclimatized.man so that he exhibits the same skin temperature as the unacclimatized, he can be expected to sweat at least 0.5 I per hour more than

to sa'eat the required amount at a lower skin lemperature.

larger iempemture gradient between core and skin,

which permits transfer of the metabolic heat with less circulatory strain. Some idea of the magnitude of the efiective change ma,v be gained from a umple situation in rvhich core temperature is assumed to be 38" C and the caloric equivalenr of the swear (S-ll) about 200 K Cal per hour- Under these circumstancs, skin temperature of the average acclimatized men.at Singapore was about 3{.4' C; at Oxford it H'as 36-7. C. In the first instance the gradient for transfer through the skin was 3.6" C; in the recond, 1.3. C. The relative demand for circulation to the skin was obviously verv much greater for the unacclimatized-at least three times as great. Experience indicates that such a demand cannot be met. The result is a rise in core temperature and/or collapse. The atrove statement is applicable only under circuurstances in uhich evaporation is free. \l'hen evap-

The gain with acclimatiation is a

substantially

the unacclimatized. Actually, he sweats at about the same rate* as the

unacclimatized man when exposure conditions are the same and when evaporation occurs freely. His skin temperature is 1.4' C lower, because he is enabled

rThe requirement lor sueat (E eq) b ntaintain heat balance in a given situalion is represented by the
lamiliar:

E..q=,trI+R+C in the
accli-

matizetl nan u,oultl increase only R anel C of this relalionship, arul undtr tlrc usrual .;t(untstencts t(, the extent ol. about )0 Calories/ltortr, refresc'ntcrl }r a 50-g per hour irrentse il su,rclirrc. T/ris rr',,uli rurrr.r,'h
eleuale

Tlte

obsened, IotL,er skin tenperature

oraiion is limitcd bv aurbient rapor pressureJ tire skin cquilibrates at a lrigher tempcrature lerel. one
rvhich nrav tre largelr intlrpt'ntlcnt

o{ state of

E"t b1'oth I or -'I,r'r.('rrl.

nrllizlrion. In this crre rre rsoultl r\pect the

accliaccli-

844

WORK PHYSIOLOGY AND PSYCHOLOGY

500

200
G
G,

/t

/!
I I

o x
= I
(n

34

36

MEAT{ SKIN TE MPERATURE

Frcunr 5--4ooling potential of sweat (with allowance for metabolism) in relation to skin te_mperature: Thirty-two uaacclimaiized men from Oxfcrd 1o-, ) and an equal number of acclimatized men_from Sin-gapore'(4 - *).Larye o and + designate data obtained under identical conditions. Small + and ' indicaiei another vaiue cn same individuai obtained with different vctiyity or environmenta-l condition.
natized man to sweat considerably more than the ihe unacclimatized, perhaps 0.5 i per hour mote, as predicted b,v the Oxford-Singapore analysis. This approach yields a better understanding of the gain to the human thermal eccrtomy resulting from rhe lowered thrshold skin temperature for without any basic shift in tire threshold for response of the receptors, we coukl account for more sweating at a given skin temperature. The gain of acclimatization rn wet heat, v/hen evaporation is limiting, may bc largely ascribed to the increased circulatory efficiency per se in bringing the metabolic heat to the surface of the skin. The lowcred threshold for sweating can
have

sweating. The shift in thresholcl appears to explain the advantage of acclimatization in dry heat, and it has focused our attention on the mechanism by which the shift is achieved. More effective circuiation of biood to the superficial layers of skin must be the fundamental change. As a result of more effective circula-

little efiect in this

instance.

Conclusions
These are a few highlights of our studies over the Iast several years. Some are no more than stlggestive.

tion, the temperature of skin receptors involved in triggering the sweating mechanisms could be higher for any given set of values Iot T''ote and I'rr", Thus,

Our goal is to continue at work, which may con' tribute to solutions of practical problems in industry.

BER.DAN

ANd PAFNOTE

845

We also wish to acquire betrer understanding of some of the more fundamental aspects of thermal response. Fulfillment of the first objective will involve construction of a better index for predicting the
stress

will requirc a more careful in the skin.

of hot jobs. Fulfillment of the second obiective

asse$ment

acclimatized,

up of skin bioori vcs:els and augmented flow of blo+,i to the skin, bringing heat from the body core, where it is produced, to ihe skin. For those who are r6t

of circulation

REFERBNCES

l. Huntington, Ellsworth: Ciuilization and Clinatc.

Yale University Press, New Haven,
H1,g.
F

1913.

2. Brouha, L. A.: Protecting the wo.ker in hot 3.

the sens of tenperature in man. Proc, Nat.
Sci., {J:645, 1959.

vironment. Trans. 20th Annual Meeting Indust.

ound.ation, 1955. Benzinger, T. H.: On physicai heal regulation and
Acad,.

en-

4. Analysis trased on supplementary data

siol., 132:559, 1956.

by Hellon, R. F.: Jones. R. NI.: Mac Pherson, R. K.; and Weiner. J. S.. auLhore of: Natural and artificial acclimatization to hor environments. J. Plty-

provided

tion, the heart may not receive adequate return of blood. This gives rise to increased heart rate and inadequate heart output, manifest by a rapid and feeble pulse and lowered blood pressure. Inadequate cardiac output first deprives the brain of needed oxygen, becuse of the unfavorable position of the head with respect ta gravity. The result is faintness, collapse, heat exhaustiorz. In heat exhaustion body temperature may be normal. Relief is obtained by assuming horizontal atdtude, by fanning, by a cool shower, or by a cooler air environment. HcAT STRoKE (on Sul Srnoxr)-The normal second line of defense against heat is sweating, which requires
water and salt. Inadequate water intake or prolonged heavy activity of the sweat glands results in diminished sweating. Diminished sweating meairs higher skin temperature and lesened removal of hat from site of.production to skin- Inadequate skin circulation may also contribute to body temperature rise. As body temperalure rises, the body tissues themselves produce heat faster and further.contribute to the ri- Sufficient rise in bra:'n temperature, to 4l' C (106" D or above, may bring complete failure of the sweating mechanism and curtailment of evaporative cooling. This is heat stroke. Drastic measures are required to break the vicious circle and promptly reduce body temperature to a level which does not rcult in tissue damage. Hrer Currrs are painful muscular spasms which

or who haye inadequate ardiac

{unc-

Appendix-Flow Chart Indicaring Strains and Overstraim of Erposure to Heat* The physiolrgic meanings of the terms "heat exhaustion- and "heat stroke" are frequently confused. The chart (Figure l) has been prepared to show rhe nature and cause of these overstrains together with the mrmal bodily responses to heat. Solid lines indicate nannal responses; brohen lines indicate the courxs of ltltysiologic breahd.own, ffu,rr Exne,usrrol-Heat
stress results

in

opening

+By Haruood S. Belding, Ph-D.

result directly from slt depletion and are remedied and may be prevented by ingestion of adequate slt,