Sir, Magnus Linklater’s fascinating account of heat illness in Afghanistan (report, July 12) brings back vivid memories of serving with the Army in Aden in 1958 when an alarming series of deaths from heat illness had occurred.

As a National Service doctor, qualified both as a physiologist and physician, I offered to go out to investigate. Troops had been flown out instead of being sent on ships, when they could acclimatise gradually, and the obvious immediate cause was expecting unacclimatised troops to train too hard, too soon.

Aden, a so-called “punishment station” for our Army in India, had temperatures at times higher than those in Afghanistan. Mr Linklater’s words, “the searing heat of an open furnace”, describe conditions perfectly.

Some conclusions in my report to the Army may still have relevance.

First, with each encounter with the Middle East the Army has to relearn some of the lessons of earlier wars. Fortunately from Mr Linklater’s description it seems that recognition and treatment skills for heat illness are now at a much higher level, and in this instance a life was just saved. Perhaps some redesign of the weight of body armour and other equipment might still reduce the workload under these conditions, particularly for women.

Secondly, the classification of “heat illness” is still confused and confusing. Heat stroke is an unscientific term. I found that an underlying infection that would be trivial in our climate could trigger hyperpyrexia. It does this by resetting the central brain thermostat by stopping sweating. Since sweating is the only method of controlling body temperature, the temperature quickly rises and coma and death can result.

This was confirmed later by experiments when my subjects and I were injected with pyrogens, the purified fever-causing component of bacteria, while doing step exercise in a hot chamber in London.

An entirely new lesson has been learnt from the recent collapse of marathon runners. They are told to drink water throughout the race to replace sweat losses. Some runners overdo this and a paradoxical consequence is a serious excess of water, which can lead to confusion and even fatal coma, sometimes mistaken for heat illness. Water intake must balance but not greatly exceed sweat losses.

In view of global warming, the understanding of these problems will take on an additional urgency.

Sir Roger Bannister
Oxford

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