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Cocaine use and death during heat waves.

The heavy toll in human lives claimed by heat waves is increasingly evident in the medical literature. During the heat wave of 1980 in St Louis and Kansas City, Mo, 308 persons more than the number expected to die during that period lost their lives. At the worst of the heat wave, daily mortality in St. Louis increased to 3 times the usual rate. 1 More recently, in the summer of 1995 in Chicago, Ill, severe heat-related mortality claimed more than 700 victims, and daily mortality peaked at more than 5 times the usual rate. 2 See also p 1795. Heatstroke is the only syndrome that is clearly attributable to environmental heat and that has a substantial death-to-case ratio. It might therefore seem logical to ascribe heat wave‐ related mortality largely to heatstroke. However, an accumulating body of literature strongly suggests that this is not the case. In most heat waves, only a minority of “excess deaths” (ie, those deaths that occur above the usual number for that place and season) are attributable to heatstroke. 3 Thus, any new information on the causes of nonheatstroke excess deaths increases understanding of the effects of sustained high temperatures on a population’s health. In their article published in this issue of THE JOURNAL, Marzuk and colleagues 4