Tour de France racer Tom Simpson’s death on Mont Ventoux is chronicled in William Fotheringham’s book “Put Me Back On My Bike: In Search of Tom Simpson.” In his weekly newsletter, Dr. Gabe Mirkins wrote about the British great’s death and the dangers of drugs and heat while racing. Below is an edited version of the article.

On July 13, 1967, 29-year-old cyclist Tom Simpson died from heat stroke during that year’s Tour de France. At the time he was the best British bicycle racer and leader of the British team in the Tour. At the bottom of Mont Ventoux he drank Coca Cola with brandy. His bloodstream was already full of amphetamines. He was climbing up a 14 percent mountain grade.

He fell off his bike, got back on it, rode 500 yards more and started to wobble from side to side. Three spectators grabbed his bike and lowered him to the ground, but he was already unconscious. He was given mouth-to-mouth resuscitation and oxygen. He was air lifted to a hospital in Avignon, but he was dead before he arrived.  Two empty vials of methamphetamine were found in the rear pocket of his racing jersey.

Earlier in 1967, Simpson won the week-long Paris-Nice race, with his young protege on the Peugeot team, Eddy Merckx, perhaps the most dominant bicycle racer ever, close behind. In the Vuelta Tour of Spain, he won two stages and then had to be forcibly dragged from his bike by his Peugeot manager, Gaston Plaud, after he lost control of his bike on the ascent of Port d’Envalira in the Pyrenees while leading by 10 minutes. Three days before his death, he was advised to drop out of the Tour de France because he was vomiting and had diarrhea. He refused, probably because he always wanted to ride as hard as he could and he had dropped out of the two previous Tour de France races.

Nobody Should Die from Heat Stroke

The most common cause of death during hot weather sports is heat stroke, in which the body temperature rises so high that it cooks the brain like an egg in a frying pan (Medicine and Science in Sports and Exercise, July 2008). Most cases of heat stroke occur during a sudden increase in the intensity of exercise, such as the finishing sprint of a long-distance cycling or running race, a sprint up a hill or an intense run down the playing field.

Nobody should ever die of heat stroke because your body sends you plenty of warning signals as your temperature rises. Still, hundreds of athletes and exercisers have died of heat stroke since Simpson’s death, most notably Korey Damont Stringer, an All-American college football player and pro-league offensive tackle who died from a heat stroke during a Minnesota-Vikings’ training-camp workout in 2001. More than 30 players have died during NCAA college football workouts in the last 20 years. 

Warning Signs of Heat Stroke

As your temperature starts to rise, your muscles feel like a hot poker is pressing against them.  It is normal for intense exercise to make your muscles burn, but hard exercise does not cause pain that feels like a hot flame is burning your muscles. Furthermore, the burning of hard exercise is relieved by slowing down, while the burning of impending heat stroke does not go away when you slow down.

When you feel that the air is so hot that it burns your lungs, stop exercising. This sign means that your heart cannot pump enough blood from your exercising muscles to your skin so heat is accumulating rapidly and your temperature is rising rapidly. Your temperature is now over 104 and continuing to exercise will raise your body temperature even further and it will start to cook your brain.

Your head will start to hurt, you’ll hear a ringing in your ears, you may feel dizzy, you may have difficulty seeing and then you will end up unconscious. Your temperature is now over 106 and your brain is being cooked.

Why Amphetamines Increase Risk of Heat Stroke

Amphetamines and other stimulants may increase risk for heat stroke by preventing your brain from recognizing that you are exhausted (Temperature (Austin), 2014;1(3):242-247).  These researchers showed that in rats, amphetamines increased the maximum amount of oxygen taken in, time to exhaustion, and body temperature.

How to Treat a Heat Stroke Victim

When someone passes out during hot weather exercise, get medical help immediately. The most effective treatment is to place the victim in a cooling bath (J Athl Train, 2009;44(1):84-93), but a heart attack can also cause a person to pass out and a heart attack victim should not be cooled with cold water.

If the cause is heat stroke, any delay in cooling can kill the person. If possible, carry the victim into the shade and place them on their back with the head down and feet up so blood can circulate to the brain. Cool the person by pouring on any liquids you can find or by spraying them with a hose. As the body temperature goes down, the person may wake up and talk to you and act as if nothing has happened, but their temperature can rise again.  They may go into convulsions or pass out again, so the victim must be watched for several hours afterward.