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.

    145/164 (page 129)
    places his whole right hand firmly on the precordium, and should note the approximate rate of the heart beat, its regular action, the absence of excessive or extensive throb or thrill. He defines the heart’s chief impulse, and should find it, if it is to be found at all, inside the nipple line. He proceeds to percuss with a few quick strokes the left border of the heart’s dulness and should find it inside the nipple line. He listens at the maximal impulse and notes the clear sounds of the heart while the patient holds his breath in expiration. He listens at the second right cartilage and at the second left cartilage and pays particular attention to the periods of early diastole, noting clear heart sounds and no trace of diastolic murmur while the breath is again held in expiration. He requests the man to lie, preferably with the head towards the light and slightly raised. He views the neck again and notes a leisurely filling of the veins and more or less pulsation in them ; he glances again at the precordium and sees no excess of pulsation, feels it again, and listening to the heart sounds, hears them clear and unbroken. The man is next submitted to a simple exercise test and a normal reaction to this exercise is noted (see 12). The whole of these tests occupy but a few moments and if they are passed and no history of anginal pains (page 77), fainting or paroxysmal tachycardia (page 74) has been volunteered, the man may be passed provisionally as a fit man so far as the cardio-vascular system is concerned. If the tests are not passed, he is not necessarily unfit but should be subjected to further investiga¬ tion, which is guided by what has been found. 1. Pallor of the face. If the mucous membranes are of good colour the sign may be passed over ; if they are not, then the subject should be specially examined for aortic disease (page 68). 2. Blueness, with or without distension of the veins (see page 60). Men who have cyanosis, with or without