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.

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    in “ effort syndrome ” cases which have arisen before enlist¬ ment are (a) an estimate of exercise tolerance immediately before enlistment ; (b) the effects of infection, shell-shock, gassing, etc., after joining, or any other event happening on active service which is known notably to aggravate. In cases of real heart disease arising before enlistment, aggravation may always be considered to have occurred where any materia] service has been given. Precisely the same points come up for consideration as in the “ effort syndrome ” group. In general, in a case of heart disease, the lowest percentage disability given for the diagnostic group to which the man belongs in the disability table may be taken as the maximal (though not necessarily the minimal figure) for the disability at enlistment. This is recommended because although a lesion, such as early and uncomplicated mitral stenosis or aortic reflux, may have passed unnoticed by the recruiting board* such lesions, in the presence of complications, could scarcely have remained undiscovered. Thus, the complications may in general be viewed as “ aggravation.” Thus in a case of mitral stenosis arising in civil life the disability on enlistment should be placed no higher, though it may be placed lower, than 30 per cent.. Where there is uncertainty the benefit of the doubt should be accorded the man, and the original disability fixed at a low percentage. If, in arriving at the full disability, 10 per cent, has been added for poor development or for rheumatic fever acquired before serving, then it must also be added to the assessment of disability on joining. * Being often in the pre-diagnosable stage.
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