When St. Louis temperatures dropped back to normal on Monday, city officials were jolted by grim news.  As recently at the weekend, they had assumed that only three residents had died from heat during 10 days of triple-digit temperatures.

But, on Monday, they learned that the heat had claimed a total of 10 victims, including an 8-year-old girl. In addition, one heat-related death has been reported in St. Louis County and one in Troy, Ill.

The spike in deaths was a surprise to city officials because they said they thought they were providing sufficient protection for the city's most vulnerable residents.  They had compiled a special needs registry of about 4,000 elderly and disabled people who are checked on during major emergencies, such as a heat wave.

The heat-related deaths so far have this year have exceeded the eight who died last year, eight in 2005 and seven in 2007. Mayor Francis Slay noted that this was just the beginning of the hottest part of the summer.

“We’re not out of the woods yet," he said in a statement. "We must remain vigilant, take the proper precautions, and look out for each other."

He urged people to keep watch on those who are at risk or need extra attention and to add them to the registry. He also noted that residents lacking air conditioners or needing energy assistance should call Cool Down St. Louis at 314-241-7668 or call the United Way by dialing 2-1-1. City residents can place any at-risk person on the registry, the mayor said, by calling Kelli McCurdy at 314-357-1676. They can also go to the special needs registry's website.

Those on the registry get robocalls during major emergencies. City workers then visit those who fail to respond to the robocalls. Slay was among officials and workers who visited an estimated 1,000 households last week because the residents had refused to respond to the robocalls. Other areas in the region, including St. Louis County, do not have registries.

Pamela Walker, director of the city's Department of Health, says the deaths announced Monday meant the registry had to be expanded to include people with cognitive disabilities and mental illnesses. She still insists that the registry and other changes had led to a "dramatic improvement in how we keep people safe during hot weather." But, like Slay, she said in a statement that the city had to do better. In reviewing the data of the last seven victims, she said the city had learned that many of them suffered from mental-health issues.

"Some of them resisted offers of help," she said, and added that the city had already begun to urge case workers, neighbors and family members to pay close attention to these residents during hot weather.

"Go to their homes and make sure the air conditioner is on and is working properly," Walker said. "It is important to be insistent. They must be in an air- conditioned room, even if they don’t want to be.”

Since June 28, at least 60 city residents and 162 St. Louis County residents have been treated for heat-related illnesses. Walker said anyone transported to area hospitals by EMS also would now be placed on the registry.

Some officials likened the 10 consecutive days of triple-digit temperatures to a heat wave that gripped St. Louis during the summer of 1980. During that year,  temperatures rose to 100 and above for 18 days, claiming the lives of 153 people in St. Louis and St. Louis County.

Dr. Michael Graham of the St. Louis Medical Examiner's Office said the 10 city victims this summer had body temperatures between 102 degrees and 106.4 degrees. The rooms in which they were found had temperatures ranging from 80 degrees to 110 degrees, he said.

The 10 city victims were identified as: 

• Judith Ann Reed, 74, of the 400 block of North 4h St. Authorities say her body was found June 30 in her bedroom. Her central air conditioning was working but was unused, authorities said.

• Orena Brown, 83, of the 5900 block of Mimika. She was found dead July 1 in her living room. Authorities said the residence had a window air conditioner, but that it was not cooling well.

• Willie Hall, 80, of the 2000 East College. Found dead in his second-story bedroom, Hall had a window air conditioner but wasn't using it, authorities said.

• Marvin C. Flanigan, 72, of the 3100 block of Nebraska. He was found dead on Sunday. The home had no air conditioning. His wife went to stay with family members, but Flanigan refused to leave his home, officials said. 

• Henry Lee Lomax, 72, of the 4300 block of Evans. Officials said that he lived alone in a home that had air-conditioning units, but that he refused to use them.

• Linda Allen, 62, of the 4500 Pennsylvania. She was found dead on July 4 in the second-floor living room of a two-story duplex. She lived alone and did not have air conditioning, officials said.

• Altamesa Dobson, 8, of the 3500 Franklin. She lived with her family. Officials said air conditioners were in working order in parts of the house but not in the room where she was found dead on July 6.

• Jeanne M. Marshall, 75, of the 3300 block of Arlington. She lived with her family in a home with one window air conditioner unit and was pronounced dead on July 5.

• Jeanette M Basch, 76, of the 4400 block of Wabash. She lived alone and was found dead on July 5. Officials did not say whether the home had air conditioning.

• Hedwig I. Hanus, 84, of the 3800 block of Marine. She was found dead July 5 in a home where she lived alone. Officials said an air conditioner in the home was unplugged. They said it blew hot air only when they plugged it in.

The St. Louis County victim was identified Velma Henderson, 72, of the 7100 block of Winchester in Northwoods. The county medical examiner's office said the temperature inside her home was 97.4 degrees when her body was discovered Friday. The office said that air conditioning was not working in the house, and that her body temperature was 106 degrees.

Start update: A second resident of St. Louis County died of heat-related illness. The 93-year old University City resident died in her home on July 7. The medical examiner’s office reported that the victim’s body temperature was 103 degrees and the outdoor temperature was 104 when she was discovered on Saturday.  The window air conditioner in the brick home was working properly but was set at 95 degrees, according to a report from the County.

The victim lived alone but was cared for by relatives, according to the medical examiner’s office. End of update.

The Troy, Ill., victim was identified as Dorothy D. Scott, 88. Troy police said family members found her body on Sunday. Before her death, police said the woman had left a message on a relative's answering machine, complaining of feeling ill. Police said the family had been away from home at the time and didn't get the message until later that day. The victim's air conditioner was working but was set to heat rather than cool, according to a Troy police spokeswoman.

Start update: Several news media are reporting a second heat-related death in Illinois. A 56-year-old Collinsville man was found dead in his apartment by police on July 9. The cause of death hasn't been confirmed yet by a medical examiner. End of update.