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.

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    minutes. A heavy sweat broke out over the forehead and spread over the chest and body ; the pallor remained extreme ; respiration was slow and sighing. The pulse was imperceptible for several minutes ; as it returned the systolic blood pressure was registered (palpatory and auscultatory) at 60 mm. Hg.. A little later the pressure fell to 55 and then to 50, the pulse varying in rate between 50 and 60. Five minutes after the onset some recovery was noted, the pulse had risen to 64 and the blood pressure to 80. Nine minutes after the onset he was able to respond to questions (pulse rate 88, blood pressure 105). The blood pressure gradually rose to 110 mm. half an hour after the onset, and the man was able to leave the chair and walk supported across the room. The average blood pressure of this man in ordinary circumstances was 118, the pulse rate 80 to 90. He was shaky and exhausted for 36 hours subsequently. It was his second attack, the first having been experienced while saluting on guard duty. This example is one of similar attacks witnessed in a number of patients ; in some they have followed the drawing of samples of blood, in some they have come without warning in patients standing and waiting routine examination. The simultaneous falls of pulse rate and blood pressure stamp the attacks as vagal in origin, a view fully confirmed by the occurrence of simultaneous gastric disturbances and by the observation that atropine at once raises the pulse rate. Such attacks, when witnessed, can scarcely be mistaken for epilepsy. If the medical officer has to rely upon the patient’s statements, then the onset with gastro-intestinal symptoms, the extreme pallor witnessed to by his friends, the presence of profuse sweating, the absence of tongue- biting and urination are important points. The fact that these attacks occur rarely if ever while the patient is in