FATIGUE IN IRRITABLE HEART AND OTHER CONDITIONS
Archives of Internal Medicine
There is no more constant complaint among men suffering from the irritable heart of soldiers than that of fatigue. In civil life these men learned to adapt themselves to a low economic level by acquiring positions in which they could earn a living with the minimum of endeavor. Apparently the fatigue is of so real a nature to them that, to avoid it, they renounce most of the games and pleasures indulged in by the growing boy. In the army these men meet first their old enemy, physical exertion,
... hysical exertion, without preliminary training, and with physique usually entirely inadequate to the demands. A consider¬ able percentage do practically no duty, collapsing under the first "hike" ; it is with this group that the work at Lakewood has largely dealt. Still others with this condition struggle through the training period, only to break down under the strain of battle conditions. This work was undertaken with the purpose of finding some index to the degree or to the nature of this fatigue. Ryan1 has observed that general fatigue exerts an influence on the white vasomotor reflex which is produced by stroking the skin with a blunt edged instru¬ ment. He showed that activity or loss of sleep causes a measurable shortening of the time interval between the appearance and fading of the white line that appears on the skin after such a stroke. Ryan constructed a simple spring instrument with which a stroke can be made by a blunt edge of wood under any desired pressure. His kindness in furnishing us such an instrument made this work possible. The fatigue of which patients with the symptom complex of irri¬ table heart complain is not limited to certain muscle groups. It is a general and frequently an overwhelming sensation. They often sit abject wherever they find themselves at the end of their exercises or throw themselves on their beds as soon as they can make their way to their wards. This study is concerned with general fatigue, and this symptom is largely responsible for the military disability of men with the irritable heart.