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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    chest or even the sensations to which a rapidly beating heart, acting against the chest wall, gives rise. Frequently the complaint is of pain in some part of the body well removed from the heart, for example, in the shins (where there has been a history of trench fever), in the back, in the shoulders or abdomen. By most patients it is referred to the left side of the chest. In some of these the pain occurs over the lower ribs on the left side, but more frequently it is referred definitely to the precordium. Pains of gastric origin are not infrequent. Of precordial pains, an ache or a feeling of soreness is the commonest ; gnawing pain is less frequent ; stabbing pains which may synchronise with the heart beats are sometimes described ; very rarely also the pain is described as radiating into the neck, into the left arm or into the fingers. In almost all patients who experience these precordial pains the symptom is increased by exercise, in fact in most cases of genuine discomfort it is only present on or immediately after exercise. Usually there is a foundation for the complaint; very often the degree of discomfort is exaggerated. Complaint of pain should rarely be allowed to weigh in estimating the fitness of these men or in assessing their disabilities. On several occa¬ sions, inexperienced medical officers have produced an epidemic of pain complaints in their wards by paying injudicious heed to such. Very few patients have such pain that they will willingly lie in bed to avoid it ; yet, if encouraged to do so, patients will come to the examination room in some numbers, clasping their chests with their hands and complaining. While a plaint of pain is of little value, the presence of hypersesthesia of the skin or muscles of the chest is of much value. It is to be found after exercise in a goodly proportion of the men. It may be present over an area of small extent, usually the region of the maximal heart thrust, or scattered over several small precordial areas. Most frequently it is