Cases of Adult General Paralysis with Congenital Syphilis

R. P. Smith
1901 BMJ (Clinical Research Edition)  
If we look in another direction to a body of men who for a part of the year give themselves over to often very great feats of endurance-the guides in Switzerland-it wil be found that some of the most active and enduring are small men, but equal to carrying their own weight and all the extras that a guide is required to carry. The standard of height, then, ought to be a low one in the army. In my opinion your short wiry man is infinitely more able to stand the wear and tear of a campaign than
more » ... r tall, finely-built man. With regard to chest measurement, I must own I am a -great sceptic. It seems to me that those who attach so rnuch importance to chest measurement overlook the fact that there are at least two very distinct types of chest-the broad chest and the long, narrow chest which cannot be measured. The lung capacity of two men of exactly the same height might be practically the same; yet their ordinary chest measurement might differ by inches. The tape only measures the horizontal diameter; it takes no cognisance of the vertical. Lastly, with reference to weight: I remember a little more than a year ago being consulted by a young man who was coaching for the army. He was hoping to get into a crack eavalry regiment. He was well built and in excellent health. I would have unhesitatingly passed him as a first-class life for assurance. His only trouble was that he was a stone too tight and he wanted to be fattened up. In other words, every effort was to be made to put a quite unnecessary stone of flesh on to a man who would be in every way healthier and more fitted for his work without it. I could not get the stone of extra flesh on him; but, as he passed well out of Sandhurst, I heard that they gave him his commission. Can anything be more absurd than this? It seems to me that if the matter of physical fitness for active service were left in the hands of competent medical men to decide each ease on its own merits, without hedging them round with all sorts of standards, it would be far better. The result would be that very probably many small useful men would get in who ate not now accepted, while others taller and finer in appearance might not. After all, in the matter of life assurance we get on very well without too many standards. Intermittent Albuminuria. To what extent I would ask does great muscular strain tend to produce or exaggerate those cases of intermittent albumiiuria which are so common among young men ? Let me take a typical case. An undergraduate, apparently in the very best -health, seeks my opinion as to his fit-aie3s for rowing. I find all the organs healthy and the muscular development good-everything satisfactory until I come to the urine, when I discover a distinct cloud of albumen with the ordinary tests. On further examination I find that after a night's rest no trace appears, that with slight exertion the amount is very small, but after a hard row the amount is very considerable. Often the effect of exercise is so marked that while the urine first passed after exercise will contain a very distinct trace, urine passed an hour or two later will contain either no albumen or only a very slight trace. I generally advise these patients to give up all competitions involving great muscular exertion, such as rowing in races and running in athletic sports, and to take to more moderate exercise in the form of golf or sculling or lawn tennis. Here again, if harm is done by muscular effort the injury will be of very gradual onset, and will not make itself felt for years. I take it that the explanation of this form of albuminuria is that there is some defect in the walls of the blood vessels which supply the kidney, that with the increase of blood pressure, which is the first result of muscular effort, the defective walls allow a certain amount of serum to escape, and the more often the muscular effort is repeated the more easy it becomes for the serum to transude. It would be very interesting by a systematic examination of the urine to asoertain the percentage of cases of this form of albuminuria in young adults at one or other of our large public schools. Certainly at Oxford I am, accidentally as it were, constantly coming across cases which probably extisted undiscovered at schoolundiscovered because the trouble gave rise to no symptom whatever. Treatment seems to do very little good. If they have albumen in their first year of residence thiey invariably have it in their fourth year, and then I lose: sight of them.
doi:10.1136/bmj.1.2094.386 fatcat:6c2tq2yanzha5meln6cajatthi