THE QUESTION OK FATIGUE FROM THE ECONOMIC STANDPOINT. 255 



to the field hospital or even to the base, where apparently complete 

 recuperation takes place, and he may once more take his place in the 

 fighting line. 



This is the case usually which, through insufficient rest at the base, 

 may return again suffering in the same way but more severely, and he 

 may be eventually considered unfit to return. 



These are the cases that provoke attention ; but the cases which are 

 more important to consider from the point of view of military values 

 is the great class of combatants which do not collapse in the field but 

 yet betray to some extent the symptoms of these graver cases. They 

 manage to come through without collapse, but they too display extreme 

 pallor, their blood pressure is extremely low, their heart feeble, and 

 they also exhibit an extreme and incessant restlessness of the hands 

 and feet — faiblesse irritable. In this condition they are practically 

 useless as a fighting unit, and are in fact a genuine encumbrance. 

 Fatigue here again has gone shghtly beyond the possibility of sound 

 physiological recuperation, and the tissues show depreciation by the 

 celerity with which fatigue is induced on the next occasion for great 

 physical strain. It becomes then a matter of the greatest urgency to 

 see these soldiers are replaced before this excessive fatigue is established ; 

 that of course can only be done empirically by a knowledge of the 

 endurance of the soldier in the present type of warfare. It is essential 

 that these soldiers return to the fighting line with their capacity for 

 work undiminished, and it is with this object in view that the hom's 

 in the fighting line have lately been limited and the period of rest 

 increased. 



Finally the result we have to expect if the demand for adequate rest 

 and recuperation is not satisfied is that a permanent lesion is 

 established. 



From this last type of case we perhaps ought to exclude those cases 

 which after great exposure and great strain betray or develop on the 

 one hand tubercular trouble, on the other those cases which, through 

 inherent heart- weakness, develop dilated hearts and incompetent heart- 

 values. The cases which are especially instructive are those cases 

 which show no other lesion than the arterial. 



It was extraordinary to observe how many Serbian soldiers, who 

 have lived through the Balkan wars culminating in this present war, 

 revealed arterio sclerosis. Their temporal vessels were always markedly 

 tortuous, and, on examination, almost all palpable vessels were found 

 to be thickened and tortuous. 



There seems no better illustration of the result of hard work on 

 arteries than this continued war strain. Hard work has long been stated 

 to be an alternative to the acute specific toxins in the productions of 

 fibrosis in arteries, but has never received much attention. 



It was in almost all the above cases possible to exclude the mineral 

 poisons, alcohol, and specific toxins, and by exclusion the only con- 

 clusion which could be arrived at was that accumulative fatigue bodies 

 themselves act as an arterial toxin. Moreover, it is necessary to 

 remember the great demands made upon the vasomotor system, which 

 is constantly in requisition in hard work, and therefore constantly 



