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

  • Thomas Lewis
Date:
[1918]
Catalogue details

Licence: In copyright

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

    142/164 page 126
    so complicated, paroxysmal tachycardia may be assessed on the same lines as fibrillation. Mitral regurgitation.—This condition has been deliberately omitted from the table of disabilities. The diagnosis of regurgitation is uncertain ; its cause when diagnosed is not easy to ascertain (see page 61). In itself it does not lower exercise tolerance or in any way disable. The assessment of the disability when regurgitation is thought to be present should be based exclusively on associated factors, such as exercise tolerance, enlargement of the heart, a history of rheumatic fever, recent or repeated, fibrillation, aortic disease, etc.. Where exercise tolerance is normal and there is no history of rheumatic fever no assessment is required. In cases which give a history of rheumatic fever and show a good exercise tolerance it may be wise to assess at 20 per cent, or less. Cases uncomplicated by enlargement, but showing only fair exercise tolerance, fall in the “ effort syndrome 75 group and start with an assessed disability of 20 per cent.; if a history of rheumatic fever is present they obtain an extra 10 per cent., thus rising to the level of early mitral stenosis with good exercise tolerance. If slight enlargement is added to regurgitation, the assessment is from 20-50 per cent, (see “ enlargementgroup in Table XXI) according to the exercise tolerance and the presence or absence of a history of rheumatic fever. Consideration of the murmur itself is not only unnecessary in assessing, but would lead to endless difficulty in fair assessment. Question 24 (b).* “ In cases of aggravation or where there is any evidence that there was a disability on entry, what in your opinion was the degree of disablement which existed at the time of joining the Army ? ” The answer to this question should be expressed as a percentage. The chief points for consideration * Question ] 2b of Array form Z22 is answered similarly.
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