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RESPIRATORY EFFICIENCY TEST
813
be obtained from any efficiency
commence to absorb. (5) Under artificial pneumothorax treatment these shadows appear to form areas which do not readily collapse, indicating that at that point the pleura is adherent. It would be idle to deny the possibility of more than one cause for such a radiographic appearance, but to me a pleural origin seems most in accord with the observed facts.-I am, Sir, yours faithfully, ERNEST WARD. Paignton, Oct. 4th, 1932.
tests without whole-
cooperation of the subject concerned, especially in those requiring concentrated maximal For this reason I agree that the effort to perform. results obtained from out-patients cannot be satisfactorily compared with those obtained from Royal Air Force personnel. The essential purpose of the Royal Air Force efficiency tests is not directed so much towards gauging disordered function as towards the estimation of the relative degrees of efficiency among normal, healthy young adults. The average hearted
RESPIRATORY EFFICIENCY TEST To the Editor of THE LANCET
age of Dr. Moncrieff’s cases was about 40-the limits 17 to 70. Respiratory efficiency tests in general, such as those mentioned, are not applicable to elderly persons. The vital capacity may be quoted as a case in point. Calculated vital capacity from height, weight, and chest measurement as laid down in Air Publication 130, can only be applied up to the age of about 30, as increased weight and chest measurement occurring with increasing years would require a higher standard of vital capacity in an individual at 50 than at 20-which is absurd. The tests employed by Dr. Moncrieff have never been considered applicable to severe cases of disordered respiratory function and might be dangerous if applied in this connexion ; it is probable that in such cases a careful clinical examination in experienced hands is likely to prove of greater value than any of the existing tests of respiratory efficiency. I am, Sir, yours faithfully,
being
SIR,—The considerable interest aroused by the recent observations of Dr. R. A. Young on the need for the measurement of respiratory efficiency and by the report of Dr. Alan Moncrieff who, in your issue of Sept. 24th, describes the results of a series of such tests on " the hospital population," requires, in view of this interest, a more strictly accurate representation of the views of Flack than has been given and generally assumed in Dr. Moncrieff’s account. Flack, in the Milroy Lectures referred to, did not intend that the standards of efficiency as adopted by the Royal Air Force should be applied to the general civilian community. Instead, from a series of researches which included the study of a group of pilots who were stressed, unfit, and suffering from " breakdown in the bodily system " from various causes, he merely observed that " a similar condition of bodily inefficiency may be found among individuals who are deemed more or less normal members of the community." Surely this is not, as Dr. Moncrieff suggests, an " unjustifiable generalisation." The fact that evidence of similar inefficiency is discovered among the more or less normal patients attending Middlesex Hospital should come not as a surprise in terms of Air Force standards, but as a clear proof of Flack’s contention. Nevertheless, to those who have been long conversant with the work of Flack and more partic. ularly concerned with the application of his tests, the report of Dr. Moncrieff’s investigation has a refreshing appeal; but it must be remembered that these tests are too subjective in nature to give comparable results unless conducted under strictly standard conditions. Apart from a discussion of relative unfitness, one might offer this suggestion, that by retaining the principles, and by a modification of methods, Dr. Moncrieff might still find in these tests a solution to the clinical problems he had in I am, Sir, yours faithfully, view. H. W. CORNER, M.D.
H. A. TREADGOLD, Consultant in Medicine, R.A.F. Central Medical Establishment. Royal Air Force, Clement’s Inn, W.C., Oct. 3rd, 1932.
GASTRIC ACIDITY To the Editor of THE LANCET
SIR,—In a series of articles on gastric acidity this year you have repeatedly drawn attention to recent
an intimate relation between the acid-base balance in the blood and the secretion of acid in the gastric juice ; but you appear to be using these observations to support some new conception of gastric pathology. I admit I do not know what this new doctrine is ; I do not always understand what you mean by "gastric acidity," and at times I am left with a haunting doubt as to whether you are clearly distinguishing between gastric juice and gastric contents ; in one place in your first article (THE LANCET, 1932, i., 29) by a slip of the pen you definitely write gastric juice when you mean gastric contents. In the last article (August 13th, p. 352), however, you clearly invite us to believe that the Wimpole-street, W., Oct. 1st, 1932. acidity of the gastric contents is of little, if any, in the production of gastric symptoms. importance To the Editor of THE LANCET I cannot myself accept this invitation, but what SIR,—Dr. Moncrieff conveys the impression that puzzles me is where you find any connexion between the expiratory force and 40 mm. Hg tests are the these remarks in the opening paragraph and the very main, if not the only, methods employed by the Royalinteresting experiments of Browne and Vineberg, Air Force to estimate respiratory efficiency. This is which you discuss in the rest of your article. These far from being the case. The vital capacity, calculated experiments are entirely concerned with the control from height, weight, and chest measurements, and the of the gastric secretion by alterations in the acid-base breath-holding test, are at least of equal, if not greater, balance in the blood ; but variations in gastric secrevalue as a gauge of respiratory efficiency than the tion have nothing whatever to do with the quite test he quotes. Of the four tests connected with thedistinct problem of the effects produced in the stomach estimation of respiratory efficiency, the expiratory by variations in the acidity of the gastric contents. force is probably of the least value, while the 40 mm..Although this point is really very obvious, it is test is of more value in demonstrating the coordina-frequently missed by those who write on gastric tion between the cardiovascular and respiratory pathology. I do agree with your conclusion that wee systems under stress than it has as a purely respiratoryneed a wide outlook, but I do not get on very fast if, test. ] my eyes on the horizon, I stumble over the keeping It is unreasonable to expect that good results couldobstacles that lie at my feet. Will you help me by
investigations showing
J
be obtained from any efficiency
commence to absorb. (5) Under artificial pneumothorax treatment these shadows appear to form areas which do not readily collapse, indicating that at that point the pleura is adherent. It would be idle to deny the possibility of more than one cause for such a radiographic appearance, but to me a pleural origin seems most in accord with the observed facts.-I am, Sir, yours faithfully, ERNEST WARD. Paignton, Oct. 4th, 1932.
tests without whole-
cooperation of the subject concerned, especially in those requiring concentrated maximal For this reason I agree that the effort to perform. results obtained from out-patients cannot be satisfactorily compared with those obtained from Royal Air Force personnel. The essential purpose of the Royal Air Force efficiency tests is not directed so much towards gauging disordered function as towards the estimation of the relative degrees of efficiency among normal, healthy young adults. The average hearted
RESPIRATORY EFFICIENCY TEST To the Editor of THE LANCET
age of Dr. Moncrieff’s cases was about 40-the limits 17 to 70. Respiratory efficiency tests in general, such as those mentioned, are not applicable to elderly persons. The vital capacity may be quoted as a case in point. Calculated vital capacity from height, weight, and chest measurement as laid down in Air Publication 130, can only be applied up to the age of about 30, as increased weight and chest measurement occurring with increasing years would require a higher standard of vital capacity in an individual at 50 than at 20-which is absurd. The tests employed by Dr. Moncrieff have never been considered applicable to severe cases of disordered respiratory function and might be dangerous if applied in this connexion ; it is probable that in such cases a careful clinical examination in experienced hands is likely to prove of greater value than any of the existing tests of respiratory efficiency. I am, Sir, yours faithfully,
being
SIR,—The considerable interest aroused by the recent observations of Dr. R. A. Young on the need for the measurement of respiratory efficiency and by the report of Dr. Alan Moncrieff who, in your issue of Sept. 24th, describes the results of a series of such tests on " the hospital population," requires, in view of this interest, a more strictly accurate representation of the views of Flack than has been given and generally assumed in Dr. Moncrieff’s account. Flack, in the Milroy Lectures referred to, did not intend that the standards of efficiency as adopted by the Royal Air Force should be applied to the general civilian community. Instead, from a series of researches which included the study of a group of pilots who were stressed, unfit, and suffering from " breakdown in the bodily system " from various causes, he merely observed that " a similar condition of bodily inefficiency may be found among individuals who are deemed more or less normal members of the community." Surely this is not, as Dr. Moncrieff suggests, an " unjustifiable generalisation." The fact that evidence of similar inefficiency is discovered among the more or less normal patients attending Middlesex Hospital should come not as a surprise in terms of Air Force standards, but as a clear proof of Flack’s contention. Nevertheless, to those who have been long conversant with the work of Flack and more partic. ularly concerned with the application of his tests, the report of Dr. Moncrieff’s investigation has a refreshing appeal; but it must be remembered that these tests are too subjective in nature to give comparable results unless conducted under strictly standard conditions. Apart from a discussion of relative unfitness, one might offer this suggestion, that by retaining the principles, and by a modification of methods, Dr. Moncrieff might still find in these tests a solution to the clinical problems he had in I am, Sir, yours faithfully, view. H. W. CORNER, M.D.
H. A. TREADGOLD, Consultant in Medicine, R.A.F. Central Medical Establishment. Royal Air Force, Clement’s Inn, W.C., Oct. 3rd, 1932.
GASTRIC ACIDITY To the Editor of THE LANCET
SIR,—In a series of articles on gastric acidity this year you have repeatedly drawn attention to recent
an intimate relation between the acid-base balance in the blood and the secretion of acid in the gastric juice ; but you appear to be using these observations to support some new conception of gastric pathology. I admit I do not know what this new doctrine is ; I do not always understand what you mean by "gastric acidity," and at times I am left with a haunting doubt as to whether you are clearly distinguishing between gastric juice and gastric contents ; in one place in your first article (THE LANCET, 1932, i., 29) by a slip of the pen you definitely write gastric juice when you mean gastric contents. In the last article (August 13th, p. 352), however, you clearly invite us to believe that the Wimpole-street, W., Oct. 1st, 1932. acidity of the gastric contents is of little, if any, in the production of gastric symptoms. importance To the Editor of THE LANCET I cannot myself accept this invitation, but what SIR,—Dr. Moncrieff conveys the impression that puzzles me is where you find any connexion between the expiratory force and 40 mm. Hg tests are the these remarks in the opening paragraph and the very main, if not the only, methods employed by the Royalinteresting experiments of Browne and Vineberg, Air Force to estimate respiratory efficiency. This is which you discuss in the rest of your article. These far from being the case. The vital capacity, calculated experiments are entirely concerned with the control from height, weight, and chest measurements, and the of the gastric secretion by alterations in the acid-base breath-holding test, are at least of equal, if not greater, balance in the blood ; but variations in gastric secrevalue as a gauge of respiratory efficiency than the tion have nothing whatever to do with the quite test he quotes. Of the four tests connected with thedistinct problem of the effects produced in the stomach estimation of respiratory efficiency, the expiratory by variations in the acidity of the gastric contents. force is probably of the least value, while the 40 mm..Although this point is really very obvious, it is test is of more value in demonstrating the coordina-frequently missed by those who write on gastric tion between the cardiovascular and respiratory pathology. I do agree with your conclusion that wee systems under stress than it has as a purely respiratoryneed a wide outlook, but I do not get on very fast if, test. ] my eyes on the horizon, I stumble over the keeping It is unreasonable to expect that good results couldobstacles that lie at my feet. Will you help me by
investigations showing
J