Automobiles represent an important source of environmental problems. It has been pointed out in the case of Nora Barnes and other patients that some individuals react to even supposedly “harmless” amounts of automotive exhaust fumes (Chaps. 3 and 7). For this reason, the consumer should think ecologically when buying an automobile. There are five basic rules to follow when purchasing a car:

1.    The car should have a valve which turns off the air intake. This is

important, since one may run into unexpected sources of fumes on

the road: a garbage dump, freshly tarred road, airport, driving through

tunnels or unusually heavy traffic.

2.    Choose the car upholstery with forethought. The best kind of upholstery

is leather, although this has become very difficult to find in American cars. The next best choice is rayon, a fabric made from cellulose, itself a wood by-product. Nylon is less objectionable than the newer synthetic fabrics such as vinyl.

3. The car should have push-button windows, to allow the driver to simultaneously raise all the windows when approaching a major source of pollution.

4. All rubber mats should be removed from the floor of the car and the trunk and should be replaced with carpeting, preferably made from natural fibers.

5. The car should be equipped with an activated carbon filter to clean up fumes which have accumulated on the inside. This is particularly important for those who are known to have a moderate-to-severe form of chemical susceptibility. Sources for such filters are given in the Colos book.

In general, one should be most careful when purchasing a car. It should be driven on the highway first, to see if unpleasant health symptoms develop when riding in it. There may be an undetected leak in the exhaust system, and any prepurchase inspection should pay careful attention to this part of the automobile. The car should preferably be tried out on a sunny, warm day, for plastic car upholstery can cause problems when heated. One should never buy a car which is a source of environmental problems or which causes or perpetuates symptoms.

Once a car is purchased, it is necessary and important to keep car fumes out of the living quarters. If there is a choice, avoid a house whose garage is located under or adjacent to the living area. The case of Sister. Francesca, who fell asleep after being exposed to fumes from a still-hot car engine, illustrates the potential for reactions.

Detached garages are best. If the car must be stored in an adjacent garage, it should be allowed to cool completely, away from the house, before it is put away.

In choosing a house site, one should make sure that it is not located too close to any major road or highway, especially one on which busses travel. The direction of the prevailing winds should be taken into account as well. Check to find out if a new highway is planned for the neighborhood. Patients sometimes choose an ideal country spot for building an ecologically sound house, only to wake one morning to the sound of highway-building equipment.

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As more and more people take up wilderness river rafting as a means of getting back to nature, the number of plant poisoning cases has been on the increase. Ingestion of the water hemlock plant (known as Cicuta douglasii), the Western Journal of Medicine (142:637) reports, has recently been responsible for the deaths of several river rafters in Oregon and Idaho.

This plant closely resembles the wild carrot or parsnip. It has large fleshy roots with a smell so strongly suggestive of carrots and celery that people are tempted to taste them.

Unfortunately, however, the water hemlock is one of our most poisonous wild plants and can bring on convulsions, collapse, and death, all within an hour or two after one has taken a small bite of its root.

About the only method of treating hemlock poisoning available in the wilderness is the induction of vomiting, but, without an emetic such as syrup of ipecac, this can be very difficult. Campers, therefore, should always be prepared for such emergencies by carrying a reliable emetic in their packs.

In emergencies, a useful trick that can save lives from poisoning, according to the Journal, is to make up an emetic by mixing a tablespoonful of liquid dish soap in eight ounces of water.

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Heatstroke is a sudden, uncontrolled rise in body temperature. Heatstroke occurs when the body is exposed to excessive heat but cannot replace the body fluids lost through perspiration. If the lost fluids are not replaced, dehydration (depletion of total body fluids) occurs and leads to a decrease in blood volume.

At this point the body has to decide whether to supply the diminished amount of blood to the internal organs or to the skin; since the internal organs take priority, they will receive the blood. At the same time, the body loses its ability to sweat. The situation now becomes critical for two reasons: the body cannot now produce enough sweat, so the evaporation of sweat on the skin cannot cool the body; and the skin is now being deprived of the blood supply that insures that excess heat can be released through the skin. The lack of blood supply to the skin and the inability to sweat together cause the body to overheat.

If it is not treated quickly and correctly, heatstroke can cause permanent brain damage or death. When there is loss of blood volume, which can mean there is not enough blood to circulate through the body, the victim goes into shock. Also, at high temperatures the blood cannot clot properly, and this can result in blood leaking from the vessels into body organs.

Heatstroke most often strikes athletes or other people who do strenuous work in hot weather. People who have had heatstroke once are more likely to suffer another attack if they return to strenuous exercise within a week. Lack of water, excessive sweating, vomiting, or diarrhea all increase the body’s susceptibility to heatstroke.

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