Disturbances of the Heart | Page 9

should be immediately increased by exercise, and
after such exercise should soon return to the normal before the exercise.
If it goes below the normal the heart is weak, or the exercise was
excessive.

3. The pulse rate should increase with exercise, but not excessively, and
should within a reasonable time return to normal.
4. The stethoscope will show whether or not the normal sounds of the
heart become relatively abnormal after exercise. If such was the fact,
though the abnormality was not permanent, heart insufficiency is more
or less in evidence.
5. The relation of pulse rate to blood pressure should always be noted,
and the working power of the heart may be estimated according to
Barach's suggestion.
6. The dumb-bell exercise tests suggested by Barringer (only, the
dumb-bells may be of lighter weight) are valuable to note the gradual
improvement in heart strength of patients under treatment.
7. The holding the breath test is very suggestive of heart efficiency or
weakness, but a series of tests must be made before its limitations are
proved.
THE EFFECT OF ATHLETICS ON THE HEART
We can no longer neglect the seriousness of the effects of competitive
athletics on the heart, especially in youth and young adults. Not only
universities and preparatory schools, but also high schools and even
grammar schools must consider the advisability of continuing
competitive sports without more control than is now the case. In the
first place, the individual is likely to be trained in one particular branch
or in one particular line, which develops one particular set of muscles.
In the second place, competition to exhaustion, to vomiting, faintness,
and even syncope is absolutely inexcusable. Furthermore, contests
which partake of brutality should certainly be seriously censored.
A committee appointed some time ago by the Medical Society of the
State of California [Footnote: California State Med. Jour., June, 1916 p.
220.] has recently reported its endorsement of Foster's "Indictment of
Intercollegiate Athletics." After five years of personal observation of no
less than 100 universities and colleges, in thirty-eight states, Foster

concludes that intercollegiate athletics have proved a failure, and that
they are costly and injurious on account of an excessive physical
training of a few students, and of such students as need training least,
while healthful and moderate exercise at a small expense for all
students is most needed.
Experts, [Footnote: Rubner and Kraus: Vrtljsehr. f. gerichtl. Med, 1914,
xlviii, 304.] appointed by the Prussian government to investigate
athletics, reported that for physical exercise to be of real value it must
be quite different from the preparation of a specially equipped
individual trained for a game. Exercise should benefit all children and
youth, while athletic prowess necessitates taxing the organism to the
limit of endurance, and hence is dangerous and should not be allowed
in schools or universities.
McKenzie [Footnote: McKenzie: Am. Jour. Med. Sc., January, 1913, p.
69.] found that exhausting tests of endurance were not adapted to the
development of children and youth, because the high blood pressure
caused by such exertion soon continued, and he found athletes to have a
prolonged increased blood pressure. As is recognized by all, boat
racing is particularly bad, especially the 4-mile row. Such severe
exertion of course increases the blood pressure, even in these athletes,
and the heart increases its speed. There is then exhilaration, later
discomfort, and soon, as McKenzie points out, a sensation of
constriction in the chest and head. This is soon followed by
breathlessness, and soon by a feeling of fulness in the head, and then
syncope. The heart, of course, becomes dilated. Heart murmurs are
often found after much less severe exertion than boat racing. They may
not last long, or they may disappear under proper treatment. He
reported that after exercise there were heart murmurs in seventy-four of
266 young men who were in normal health, and that nearly 28 per cent
of all normal young men will show a murmur after exercise. He thinks
that it is rare to find, after a week, a heart murmur in a previously
healthy heart, if the athlete has not passed the age of 30.
There can be no doubt that even one, to say nothing of more, such heart
strains is inexcusable and may leave a more or less lasting injury. Such

heart strains and exertions are not entirely seen in athletes. A man
otherwise well may cause such a heart strain by cranking his
automobile, by pumping up a tire, by strenuous lifting, by carrying a
load too far or too rapidly, or by running, and an elderly man may even
cause such a heart strain by walking, hill climbing, or even golfing, if
he does these things. More or less acute dilatation occurring in such
persons is likely to recur on the least exertion, unless the