February 23, 1918


JAMA. 1918;70(8):540-541. doi:10.1001/jama.1918.02600080042012

Among the many problems presented to the physician examining prospective candidates for the Army, none is more perplexing than that of the heart. What constitutes proof of disqualifying cardiac conditions? Of course in most instances the answer is clear; even on closest scrutiny, the heart is free from any sign or symptom of disease, or, on the other hand, the history and examination reveal unmistakable evidence of organic mischief in valve or muscle. The more questionable cases are those in which the rate, rhythm or size are not according to the generally accepted standards, or those in which an endocardial murmur arrests attention. What, under these circumstances, constitutes fitness, and what unfitness? And particularly how is one to decide when, as in the case of the man trying to break into the Army, the symptoms of heart inefficiency are minimized or glossed over, or, in the case of the young

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