442 THE RESPIRATION 



toxins, and that evidence of preexisting infectious disease is very common 

 in those suffering from effort syndrome (Lewis). It is also interesting, 

 as Bainbridge points out, that "as regards their response to exercise a 

 man suffering from effort syndrome bears almost the same relation to 

 a healthy untrained man that the latter does to a trained man. ' ' Since 

 training affects the cardiac function, primarily, the above analogy 

 would lend support to the view that the cause for effort syndrome is a 

 great depression in cardiac function. Under suitable treatment, rest 

 followed by exercises that are graded to the capacity of the individual, 

 the condition of effort syndrome often disappears (remedial dilatation), 

 but sometimes this is not the case, and the heart remains permanently 

 dilated (irremedial dilatation) ("over stress" of the heart). It has 

 been assumed by clinical investigators that in the latter group of cases 

 the cardiac muscle fibers have become mechanically stretched beyond 

 their limits of elasticity by the exertion which was responsible for the 

 establishment of the effort syndrome. 



It has been shown by Wearn and Sturgis 76 that intramuscular injec- 

 tions of 0.5 c.c. 1-1000 epinephrin in normal men cause only a slight rise 

 in blood pressure and 'pulse rate, and only transient and trivial subjec- 

 tive symptoms. In those suffering from the condition known as irrita- 

 ble heart or effort syndrome, however, the blood pressure rises decidedly 

 (by more than 25 mm.), the pulse accelerates (by about 26 beats per 

 minute) and marked objective symptoms of tremor, pallor or flushing, 

 sweating, etc., are noted soon after the injection is made (in about 12 

 minutes,). The patient also complains of great discomfort. It has also 

 been found by Tompkins, Sturgis and Wearn* that these injections in- 

 crease the basal metabolism, the pulmonary ventilation and the respiratory 

 quotient in patients with irritable heart to a greater extent than in normal 

 persons. 



*Tompkins, E. H., Sturgis, C. C., and Wearn, J. T.: Ibid., 1919, xxiv, 269. 



