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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    ease of Graves’ disease or is suffering from excessive activity of the thyroid gland (“ hyperthyroidism ”). Certain writers, imbued with recent endocrinological doctrines, are but too ready to regard every enlarged thyroid as an over-acting gland ; these writers seem unaware how frequent a palpable thyroid is present in soldiers and civilians who suffer from no symptoms. The hypothesis of “ hyperthyroidism ” is not only premature, but careless in its application. It is not even proved that Graves’ disease is the result of excessive thyroid secretion. To adopt “hyperthyroidism” as the primary cause of his complaints in a patient who presents the “ effort syndrome ” and a palpable or obviously enlarged thyroid, without further investigation, is to succumb to a line of reasoning fraught with elementary fallacies. Tachycardia, tremor and loss of flesh are common manifestations of many prevalent forms of ill-health ; in dealing with the class of patients whom we have under consideration the presence of these symptoms is practically valueless in diagnosing exophthalmic goitre. The actual prevalence of clinical enlargement of the thyroid in those of our patients who present the signs of heart disease is, I believe, little or no greater than in soldiers returned for medical ailments to other hospitals. Amongst 517 cases of the “ effort syndrome,” the clinical condition of the thyroid was as follows :— Table VIII. Thyroid enlargement. No enlargement Generally enlarged Slightly enlarged One lobe enlarged One lobe slightly enlarged Isthmus enlarged Isthmus slightly enlarged Enlargement doubtful 483 cases * 99 1 „ 3 „ 1 „ 3 „ 15 „ Thus palpable enlargement (uniform or local) was i ascertained in 19 out of 502 soldiers examined, or in 4 percent..