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81
acceleration of the pulse rate due to fear is in this way to some extent eliminated.
The system of marks shown in the attached schedule is used.
"The fallacies of this method are realised. It is in part a measure of exercise
tolerance. Some children—'the effort syndrome' type—have rapid pulses. Conditions
other than heart disease—e.g., tuberculous glands—may quicken the pulse.
On the other hand, if all the factors are taken into consideration, these scales are of
great help in determining efficiency. The figures are based on a large number of
cases, and it is appreciated there is a fallacy inseparable from numerical methods;
in general they will be found to err on the side of safety. Work, however, is still
in progress and modifications in the scale are possible.
"The last point is that lectures to parents on elementary hygiene have been
given in schools. The attendances have been good, and the many questions asked
after the lecture showed that the parents took interest in the subject. Head
teachers have said that they find this work very useful in their health propaganda."
These figures are adapted from Schneider and Blumer and afford a simple
means of estimating cardiac efficiency. The following 6 factors are taken:—
1. Reclining pulse rate.
2. Standing pulse rate.
3. Increase of pulse rate on standing.
4. Increase in pulse rate after exercise.
5. Time for pulse to return to normal.
6. Difference in blood pressure in lying and standing.
Cardiac
efficiency
tables.
Marks are given as in the following table. The maximum score obtainable is 18 marks.
8 marks or better can be passed; 7 is doubtful, and scores below 7 indicate myocardial
inefficiency.
Reclining pulse rate— 0—10 beats. 11—18 19—26 27—34 35—42
50—60 3 3 3 2 1 0
61—70 3 3 3 1 0 —1
71—80 3 3 2 1 —1 —2
81—90 2 2 2 0 —2 —3
91—100 1 2 1 —1 —3 —3
101—110 0 1 0 -2 -4 -3
Standing pulse rate—
Increase after exercise— 0-10 11-20 21—30 31—40 41-50
60—70 3 3 3 2 1 0
71—80 3 3 2 1 0 0
81—90 3 3 2 1 0 —1
91—100 2 2 1 0 —1 -2
101—110 1 2 1 -1 -2 -3
111—120 0 1 -1 -2 —3 -3
121—130 0 0 -2 -3 -3 -3
131—140 1- 0 -3 -3 -3 -3
Return of pulse to normal—
0—60 seconds 3
61—90 2
91—120 1
Above 120 sec. 2—10 above resting rate 0
11—30 -1
Blood pressure—
A rise of 8 or more mm. between reclining and standing blood pressure 3
rise of 2—7 2
no rise 1
fall 2—5 0
fall of 6 or more —1
The exercise used consists in touching the toes with the outstretched hands
20 times where this is practicable.