The soldier's heart and the effort syndrome / by Thomas Lewis.

  • Lewis, Thomas, Sir, 1881-1945.
Date:
[1918]
Catalogue details

Licence: In copyright

Credit: The soldier's heart and the effort syndrome / by Thomas Lewis. Source: Wellcome Collection.

    29/164 (page 13)
    (a) In a few patients the vital capacity of the lungs is sufficiently reduced to account for breathlessness. The full expansion of the lungs is not used by men resting and in health ; there is a large reserve. In some few men, poorly built and with flat or narrow chests, this reserve is small, and being small is soon exhausted as inspiration deepens. Nevertheless, the vital capacity in the “ effort syndrome ,5 group is in the average only a little below normal (Wilson and Levine) and the chest measurements are only a little below those of peace time recruits of the same weight and height. (b) In not a few patients the breathlessness is attributable to the nervous system or is aggravated by the condition of this system. To this last class belong patients who become breathless during medical examination or in response to sharp orders on drill, loud noises, etc. (c) In many patients of the “ effort syndrome ” group, there is probably an alteration in the character of the blood. The blood reaction in health is alkaline ; it is equally or almost equally alkaline in these patients ; but, owing to a deficiency of certain blood constituents, it is said to approach more nearly towards an acid reaction than is normal, when small quantities of C02 or lactic acid (such as are produced by exercise) are added to it (Barcroft). This approach to an acid reaction is at once signalled by breathlessness, the respiratory centre being extraordinarily sensitive to the blood reaction. Genuine breathlessness is difficult to simulate ; it is accompanied by tightening of the accessory muscles of respiration, the face expresses anxiety, and the speech of the patient is disturbed by inspiratory movements. The breath cannot be held for any length of time, and if held the distress is afterwards exaggerated. In “ effort syndrome ” cases of a moderately severe type who are up and about the breath cannot be held as a rule