a" WS are the Lh ue ateor ee Se ees vii ing a SAN» PHYSIOLOGICAL AND PATHOLOGICAL EFFECTS OF SEVERE EXERTION (THE MARATHON RACE).* GENERAL OBSERVATIONS.; WATSON L. SAVAGE, M. D., ASSISTED BY DR. E. S. DICKEY, DR. C. B. MCABOY, DR. C. ORBIN, AND DR. A. W. WOODBURN. One of the decisive battles of the world was fought in the year 490 B. C. Mailtiades, a Greek general, commanding an army of but 11,000 men, defeated the Persians, numbering over 100,000. The conflict took place on the plain at Marathon. After the battle a soldier was dispatched to carry the news of victory to Athens, a distance of 40 kilometers (24.85 miles’). “As he reached his destination, having run without stopping, and as he emitted the words, “ ‘Victory i is ours,” he fell dead. In 1896 the Grecian government established the cotirse covered by this unknown soldier as an official event of the Olympic games. America was not especially interested in this until an American youth, in 1908, won the race. Since then it has become popular on this continent; it has, in fact, become almost a craze with the American boys to train for and compete in these races. It can easily be seen what a fertile soil for study the partici- pants in this race could furnish and that such a study should pro- duce facts of immensé Wlue: toward determining, if possible, to our own satisfaction, the ever- recurring question as to the bene- ficial or harmful effects of such a‘severe exertion as this. Not : only the visible immediate effects, but also the unseen remote *~ effects must be seriously considered. This study includes obser- vations upon youths and men from the various walks of life, already by far above the average in physical vigor, because they are the pick from large groups of men and boys scattered over our entire district. At a time such as the present, when Marathon racing is so popu- lar, and when it must be that many who are physically unfit enter into this sport, the thorough understanding of the effects of so severe a: form of exertion as this is of the utmost importance. Toward this end, the Department of Physical Research of the Pittsburg Athletic Association devoted its inaugural undertaking to the study of the participants in the Marathon race of June 26, ROOD ev *From the Department of Physical Research, Pittsburgh Athletic Association. Directed by WATSON L. SAVAGE, M. D. +Presented, by invitation, before the College Gymnasium Directors’ Society, at the Columbia University, December 31, 1909. Up to the present there have been comparatively few observa- tions upon Marathon runners. These observations, while they were made by most competent observers, in nearly all instances, were carried out upon small groups of men at irregular times and in each series they covered only a comparatively few phases of the entire subject. The reports of this work are referred to in the appended bibliography. Nothing so determines the success or failure of such a series of observations as these, as the control that the observers have over the men and the discipline of the contestants. Having this, through the liberality and interest of the Association and the con- testants themselves, we proceeded to carry out the following observations which may be classified under three headings: (1) The general observations. (2) X-Ray examinations. ° (3) Observations upon the cardio-vascular and renal systems. We compiled the following questions to be filled out by the contestants and later recorded the answers and our own observa- tions on a card so as to have nearly all our information in con- densed form. This makes such a work systematic and compara- tively easy. PITTSBURG ATHLETIC ASSOCIATION. Report of Runners in Marathon Race June 26, 1909. PHYSICAL EXAMINATION. Date. 08! Hours urs Date kee: Hour) . 2.02. Date aa Hour cee Before Race. Immediately After Subsequent Re-exams. Height’ 2. osc ce in fe SY een li SCR tm peed) eee Weight. oo ie ceva. wu. 5 Los tae epee bees cb eaten, eaeaen a Girth tAtins Rey ei te nee wav ueivs agpiesie Gy yepek Girth Thigh? R38. 99 eae ee ees Girth, Calf Reo. isa bee ween ob ois cece £5 ce eae ee IN utritions 66a hic res vote 6) stead 2 pace Co ace be. aa a Coridition © 25.2 fis wae 1 ee Eas Soe wis ae ee Temperature: Mouth \.c2es wee oe lpn do ales 6 Cae wk Oi al eer ee Ree eee glee Recta rk 20.05 pare rer er eet ar em ; L. i & a » \ ‘ Heart: . ROE tee a TU ON PN te i ee aE OP Pie vee ire) ems Neh AE pe | SES ORE IN NS Pont GA ie in! CL A a A Re eee hetero 2 cas bbe ig. ae aL Teal ta a PS We So ae MONT o te Se De maar LSpeMC PS SRE! eis 5 eas EER RU 2 Se aa Pare aE Vali Se oe eh ae kh OMS ee EE Ho OF et are tt eee ene OSs eee | aks al bee pai ym le rita OP MIET ER pt i FEA aig EEA OY slg ae Nel oem Coa ANT ak eR acl Soe CEE Sy Pr RE eS RIO ERN A AS! i im mee Mid Pi ere So hoe Beet LTTE og BER FE eee WA aden see od la steer Nae ae Ri et ee Oe ete oh ole RO Cyr ad ty Pad ea eet Sy en ee ene Oy Mai yy SN ee URINE ANALYSIS. General. (characteristics si:... ARPES Sahn at SNE gh fete, Mine ea ae Cn oes OMG) eee Re EE FP Sa SOG ogy lae SOO aa AS RS ae eR Pl pe eS ea eet CT MS Pee Gerri he eee neh ge ale Ee ey Goa sey ahah Sc. FEET Re sg RSet ie yO OR BS wok 8 eos ete Ate Sk bp aise cea NET TERE Pt ren rt age rier tera fee eS oS Be oe ed eS OE ETy 1 aA pee er ee Re on SE Rye lee Le Tee Riau | Prcutcnrem OCiCS fe fae Ss ake hs race us cee ei! nig Ut. Ne eee Oey Microscopic. Atta a eee ROD RARE NEO Obie air: igh Sn ocala Sos Mia SPs OL BNA aoth LOLS aa cal ee PARR Nt Cells DGt time eer yee eerie « ears oo ALS Ss 4, Reel, Se aA? 2 cme ee hie Gan Gb Bars eae Sat i ae eae Pans "Ste eee a ee A A ee Oi AE AR or eS SE) en 8 ee al, ne Me Ee CI Re Sear eo ut is ee acti) Aneta tere ee Oitidie Pl ada nn Ss ht Oe a Remarks. RINE SING igihl See Kaw cel ied Wathet a sake foe a ee Perea et eee ee Ree eth ee tN ag Om pe PT Se er Aon ee Pk co SG ECEY, Be oh AE oe Riga ee aelephane «Number: «02 .4st. suk au Working hours........ Cee yer pei te Reet ener A Seiat eh Bete Ge Ee 3 TIGICN TL feet eas Weight before training.......... Weight now........ Pulse rate morning before rising.......... Pulse rate evening..: soos Distance run .on\ day ofytaking evening pulse........2........ 00 «ee Diet’ sos Sealed Bale a ec ee ee ates ee ee OR ce ee er How. much coffee do you drink daily ?.... 22.5232... $222.5 ee How much milk do you drink daily?..... "oie «ale. Slang oe bs oe ke al ober een How- much water: do you drink daily?) ...5.......-. 421. 43 See How much beer. do you-drink daily-?.... 2... sc. 50s oe How much wine do you drink daily? ......0...0). 2s How much liquor do:you drink daily? .....4. 2.230 Le How many cigarettes do’ you smoke daily ?...:...1...25..2s. 2.55 oe How many stogies: do you smoke-daily?....3 5... +. iss s ss) eee How many cigars do you smoke daily?:.....2.....5.... 9. me oe How many pipes do you smoke daily ?.. :... <. 0.8 ae Write a full history of your training, giving distances and speed, as well as you can remember. ec CCC eC ewe ea tice eeiawmaeae CCK eeMe eet eat eeeerestsevsesesaees es © © 6 8.5 © dal alab Senne Ceoeonereeenwevreececene vce ese £0 60. 8 8 6 © 20.60 8 6 © 66 Sie 6 6 6 6 6 ee 6 8 0 ws & © Se) 6 ym al wie ie eee eco eoet tues eeeeecanevraetceeoCeueceecn en es Se ee eS 2 wo 6 0 0 6 0 6 0 8 6 6 6 6.6 @ SS oS 8 ele a) ei eee 4 eRe TeOleSIgiCOP © erst ocx AM binge ts Reka is Be oe keh ade whe} Do you have any impressions or sensations to report regarding the race? Deryou expect to wiun-the full distance agate is. Sikes lab ee et Meuse the Weimnt of Your running Siith <7). .6s. fos... Sonat ewe eae week Remarks. SLR Mee ese) SLO. Ve 8 6S) Sie b) © C'6e, O <0 (6 6S 8. -6\.6 8 8a. 18 0m 8 6 4 Le. oO Le Oe, @ ie 8) a ee se oo se Oe eee ee te 8 ee 8 & Cae eee ee BAe) 8 6: 8S, 6) a6 (Bie a Te 6 Ge (erieng, @ 6 4 ae ee Oo ee Oe yee 6 Gh eae Bera 6 Wee a wl Be Sw Eee 8 ee et 8 8 Se ce fe a ee oe eee NS. © se 6 658 + 6 o 61 8 S68. 6 0m ote 6 4:6 6. '6. 0.0.16, :9 6 8 6S 6.6 6 sie if eis 8 6 wee. 00 6) oe ele. 08 ee 0. @ eis, @ 2 ee #6 be Ae 6 OF HC RR ERR BOK OSS BROT HEH DK RCC MA MDH DO SDRC eae eC eee eee Cw Oe ee oe 8 GENERAL SCHEME OF THE MEDICAL EXAMINATIONS. Having entirely within our power the making of the rules of the contest and the enforcing of them, we were enabled to control the runners, as has not been possible in previous observations. The usual course, 25 miles into the country and a run back, make it necessary to find limited quarters in which to examine the run- ners in the midst of excitement, confusion and noise, and then to transfer the examiners together with their instruments, over a distance of 25 miles to the finish. It is impossible this way to undertake certain desired records. We therefore planned a course, that should start from the club house, and pass this point four times, finishing at the starting point. This proved of ex- ceeding value, as will be shown later. The first circuit of the course was 3 miles, second circuit 8 miles, the third, 12.5 miles, and the fourth 1.35 miles, making the total distance 24.85 miles, the actual distance from the battlefield at Marathon to Athens. Desiring to have some accurate heart and diaphragm measure- ' ments, arrangements were made at the West Penn Hospital where they have a very complete equipment for the making of fluoro- scopic studies. A letter was sent to all intended competitors, taking them into our confidence and telling them what we wanted to do, and ask- ing for volunteers to report on Friday before the race for pre- liminary examinations; which examinations were much more ex- tensive and complete than was possible on the morning of the race. Twenty-four men reported, and of this number 22 were taken to the hospital and placed before the X-Ray. On the morning of Hy) the race, all contestants were ordered in at 11 o’clock and with the entire staff of assisting physicians present, thirteen in all, and three sets of instruments, we were able to get a thorough examination of all the starters, but, of course, could not under- take to send all of them to the hospital for X-Ray. examinations, feeling that it was better that we should have a few thoroughly done than to undertake something that would prove a failure, because of its being more than we could accomplish. As the men finished the race, those who had on the previous day been before the X-Ray machine, were immediately exam- ined in the tents and put into an automobile and carried to the hospital for a second examination, which was usually accom- plished in from fifteen minutes to an hour after the finish. The tents that were erected, for dressing and for the examina- tions, were arranged in a group in which the dressing tents faced the large medical tent. This arrangement brought all the men together before the race, where their change of clothing, prac- tically in the presence of the physicians, compelled them to come back to the same place for their clothing whether they completed the full distance or not. Here was a valuable factor, enabling us to examine very soon after quitting the run, those who did not finish the distance, affording an opportunity to make some of the most valuable observations in comparing the effect of run- ning upon a man when in condition, and when not properly pre- pared for the run. The running of the course in circles brought them back four ‘times within easy distance of the examining tents, so that we were -able to get those who quit under observation soon after their exertion had ceased, although in one or two cases they had to be brought in by automobile attendants. The arrangement of the tents also avoided confusion and noise. The next important move was to offer prizes to all who finished within four hours, the condition being that they must pass both medical examinations, namely, before the race and after they had finished, otherwise, they could not qualify for a prize. This was the key which practically opened the door to the more com- plete series of observations that we were able to make, the conse- quence of which was as follows: Fifty-nine men entered for the run, one was disqualified before the race, 55 started; 29 com- pleted the full distance ; 20 failed to finish, but were examined by the physicians after their race and only six, most of whom did not complete, slipped by the examiners. THE COURSE. In studying the course as shown in the chart it will be seen that it is a very hilly one and different from the usual Marathon 6 asnoy qnio esnoy quio OSk! fawratwwsogt Tf} 4 AS eee ESB eee EEE rr ce) oO -_ 02 ce) -_ Oo an ~ oS — o2 oz Oll OLt 0 w eee? Og! asnoy qn) S Se) ° Lae) se) c) a SEA LEVEL FEET ABOVE 1150 Hee sem 1050 doe AGw ss PASSA vs Ea ae Pea. | | ae sea ae PaeSes eae Babee Miles Run O COURSE WITH ELEVATIONS. DIAGRAM OF THE courses which are laid out along some road leading to a city. The roads upon which many of the prominent Marathon runs have been held, are more nearly level-or slightly down grade. In this instance the hilly roads and the heavy downpour of rain, making asphalt pavements on a down grade treacherously slippery during the shower,delayed the runners, by making their task more difficult and lessening their rate of speed. The chart clearly shows that the men fell out after climbing the hills at the fourth to seventh miles, at the eleven and one half to fourteenth miles, and after the sixteenth to seventeenth miles. At the first climb, a total of 510 feet, seven of the runners seem to have become discouraged and quit when they reached the club house. 7 The second severe climb occurred at the twelfth to the four- teenth miles, a lift of 310 feet. Here six others came to grief. At the sixteenth to seventeenth mile four more gave up. The others finished, but some of them came in after the time limit, having walked some of the distance. WEATHER CONDITIONS. The weather report of June 26 was taken about three miles away and is herewith shown: The barometric pressure from 2 p.m. to 6 p.m. averaged 29.13 inches, elevation 842 feet. A thunderstorm occurred from 1.10 p.m. to 3 p.m., advancing from the west. It was accompanied by a light rain in the downtown district of Pittsburg from 2.15 p.m. to 3.40 p.m., the amount of precipitation being 0.01 inch. The shower was moderately heavy, however, over Allegheny and some parts of Pittsburg. The hourly temperatures were as follows: 2 p.m., 82; 3 pm., 70; 4 pm. 71; 5 p.m., 73; and 6 p.m., 75. The highest wind velocity during the four hours was 19 miles per hour from the north during the 5 minutes ending at 2.50 p.m. The total wind movement during the hour ending at 3 p.m. was 12 miles; for the hour ending at 4 p.m., 6 miles; for the hour ending at 5 p.m., 3 miles; and for the hour ending at 6 p.m., 3 miles. For the hour ending at 3 p.m., the prevailing. direction of the wind was from the north; at 4 p.m., northwest; at 5 p.m., west and at 6 p.m., southeast. The weather during the entire period was cloudy. We have no record of the humidity at those hours of the day, but it was probably higher than usual at those hours on account of the rain. Relative humidity at 8 a.m. was 73 per cent and at 8 p.m., 73 per cent.* Temperature 82 degrees F. at start of race; humidity 73 per cent. About an hour after the race began, there was a heavy downpour which lasted for about an hour and drenched the run- ners. This was the undoubted cause, directly or indirectly, of several quitting as a result of falls and sore feet. It may also have been a factor to be considered in the temperature findings - of those who did not finish the race. * Records from local office of the Weather Bureau, Pittsburg, Pa., submitted by Henry Pennywitt to Dr. Savage. 7 Wind varied from a velocity of 19 miles an hour to 3 miles at time of finish. | AGE. The ages of the contestants ranged from 18 to 52 years, with the major portion under 23 years of age. The under-age limit was placed at 18 years. The greatest number at any single age was 18, while more than half of the contestants were 22 or under. One man at 52, although he did not finish, still thinks he can run the distance. Success in finishing does not seem to be directly controlled by age; three at 36, one at 35, one at 31 finished, while one at 52 and three at 29 failed. Ages of the first eight men were as follows: 22, 22, 20, 18, 28, Blk ooe Lue NUMBER QUITTING AND THOSE FINISHING THE RACE. Quit Age | Finished 18 = Bm WwW %wW WwW Cl ) vo oO we ras) +1 21 Total Cases 27 Men past 40 should not try such long distance running, and the same holds true for those under 20. The most serious effects seem to have come to the man of 52 and to a boy of 18 years. HEIGHT OF RUNNERS. The general average of the entire series was 5 ft. 6.4 in., the greatest number being 5 ft. 7 in. The entire range varied from 5 ft. 2 in. to 6 ft. 2 in. The large men showed up well, both in number of cases and position at finish. The first four men averaged 5 ft. 4 in., or 2.4 in. below general average. The second four men averaged 5 ft. 9 in. or 2.6 in. above general average. ‘The third four men averaged 5 ft.5 in. or .9 in. below general average. ‘The fourth four men averaged 5 ft. 7 in., or .3 in. above general average. rinight No. of Cases at Each Height Vk dbay ont oO oO FPF WO WD Total No. of cases, 50; average height, 5 ft. 65 in.; mean, 5 ft. 6in. GiRTH MEASUREMENTS. The general run of the contestants showed better developed lower limbs than of the upper body as would be expected. Right army Ceti Sessa sake ve. dere average 10% in. Right Wali) Seto season | tee am eet average 13% in. Rightiiion «7PM: BAP: 18 %2 68 110 20 52 53 140* 19 58 58 118 21 60 ve 135 19 54 64 120 25 50 vi 150 22 60 65 125 29 60 7 162 22 vi és 125 31 48 7 138 29 64 66 115 36 5d 65 182 29 60 62 122 36 70 fe 140 29 65 71 120 52 5 68 134 * Exceptional case. PuLSE RATE BEFORE THE RACE. The pulse rate was taken in the horizontal position in all cases before the race, half of them on the preceding evening and the others in the forenoon within three hours before the race. So far as could be estimated, the psychic influence of our investiga- _tions on these contestants at this time was not a considerable factor, as we made an effort to put them at ease so as to eliminate, if possible, such influence on the pulse-rate and blood-pressure readings. Table 3 shows that, while the pulse varied from 50 to 110, in most cases it was normal. TABLE 3. Putse RATE BeEForRE RACE. No. Cases. Pulse Rate. No. Cases. Pulse Rate. pat BI Be amas 2 50-55 100%: caceackoes 80— 85t Oreo eee eres 55-60* b Cie OR eect eae 85- / RAED ig eae 60-65* Dis eee Sere 90- 95 Jigs eee ae 635-70* D Se ee eee 95-100 Qe shee hice bee 70-75* 1 eee 100-105 Sie ess hiss ee 75-80t DS eae cae eee 105-110 Total number of cases, 55. * Pulse rate 55 to 75, 27 cases. + Pulse rate 75 to 85, 18 cases. BLoop PRESSURE STUDIES. These records were made with the Erlanger and the Stanton sphygmomanometers. They were both fitted with the same width rubber cuff (10 cm.) and had been previously tested and com- pared. All the work referred to in this paper was performed with the instruments used in these observations. 30 Before the race we obtained complete records made with the Erlanger instrument in 24 cases and with the Stanton in 21. No attempt was made at reading the diastolic pressure with the Stan- ton instrument. NORMAL BLoop PRESSURE. As a basis for comparison in this series a curve was constructed based on 90 blood-pressure observations in normal males at the succeeding years. This is shown in Chart 1 and the succeeding charts of averages. Of the individuals of 60 and over, while it may be said that they should not be considered normal on account of the changes that are invariably present at that age, yet I can affirm that they were distinctly free from marked evidences of disease. It will be noted that with the advance of years the curve grad- ually tends upward. This seems in accordance with the fact that the heart enlarges as the age of the individual progresses. With this line as a normal level of the maximum blood pres- sure, in all of my observations in the past, I have found that a variation of more than 25 mm. above or below is usually asso- ciated with evidence of disease. MAXIMUM BLoop PRESSURE BEFORE RACE. - These determinations were made with the Erlanger instrument eighteen hours before the race in 24 cases, and with the Stanton two hours before the race in the other 29 of the series. The aver- age maximum blood pressure of the entire series of 53 cases was 126.5 mm. The average maximum of these cases, arranged according to the age, is shown in Table 4, which shows the constancy and regu- larity with which the blood pressure rises as age advances. TABLE 4. AVERAGE MAx1iMuM Btoop PRESSURE BEFORE RACE IN 45 CASES. No. Cases. Age. Average Maximum B.-P. 12 18-20 122.75 20 20-25 125.05 11 25-30 129.00 2 30-35 136.00 The average maximum, minimum and pulse pressures of these contestants, first in the horizontal and then in the erect position of the body, is to be seen in Table 5. These cases are arranged in the order in which the contestants finished in the race. As is well known, the change of the body posture causes certain altera- tions in the relation of the pulse and blood pressures. These are noted in the last column of the table as plus, minus and equal. The conclusions from these will be commented on later. ol TABLE 5. Brioop PRESSURES BEFORE THE RACE IN HorIZONTAL AND ERECT —_—__—_-_—__. Horizontal ——— ——_——_ -——-B. -P.—_——__ DF. &P:=P-Pulsex us. Doe Pee No. Age. Pulse. S. 4 18 5 28 v4 36 11 19 12 21 13 22 15 19 ¢ 23 19 7 22 21 24 7 7 19 30 25 32 52 38 21 39 19 40 23 41 ? 43 20 7 29 48 27 49 7 50 21 51 18 Average TABLE 6. MAxIMUM, G2 110 105 132 63 132 7 120 76 145 74 125 84 110 106 135 66 122 80 130 67 120 54 118 65 110 82 134 69 124 7 155 66 133 64 130 75 120 83 162 62 130 7 130 70 105 76 118 74.8 127.8 POSTURES. MINIMUM AND PULSE ACCORDING TO AGE. -—_———— Hrect, ——___—_ ee) AS wW io) wz o o Wy ; ' i ich Eu Tis 4 ited ac este ie ae rea florets bee DASE betel tcta iad ets 6 rs PWV -RE ) E E 444-+ I +4441 11 pac ieee pag ae en aia ae ieee | 1+ | oO he Woit wots oi+ Co Oo Woi+ w Ro PRESSURE BEFORE RACE HORIZONTAL. —Age 18 to 20— —Age 20 to 25— —Age 25 to 30— —Age 35 to 40— Max. Min. P:-P. Max. ~Min. P -P, Max. “Min> P:-P)) Max Mineo 110 90 20 145 100 45 132 98 34 132 100 32 120 85 35 125 100 25 122 90 32 ae aes oe 110 90 20 135 90 45 120 95 25 118 92 26 130 109 30 110 90 20 155 130. “25 124 95 29 162 112 50 118 95 23 133 110 23 130 100 30 Ar see ae ti 120 88 32 130 95 35 AGE 52 ee AR 105 85 20 ao: a 3 134 100 34 Average: 121.8 97. 248 12338 96. 31. 129. 98. 382. ERECT 115 80 35 145 100) P45 128 day BSE 132 100 32 ' 120 80 40 122 100 22 118 90 28 Ae vt ae 118 85 33 135 100 35 139 100 30 112 92 20 132 100 86. 22 112 98 14 igo a 120 100 =0 150 105 45 142 118 24 Kp re om ma 135 100 35 120 100 20 110 95 15 as a nae Sed =F eas oF 100 80 Palio By: 100. 32 AGE 52 ae Save 110 85 25 “ 138 100 38 Average: 11955 916 | 27:8 28.8 124.8 95.6 28. 127. + 98.2 ao oe = THae el I6 =x fal res Pa pas Le | ze] a fer | (ai =a TTT TTT TTT A TTT PORE RRRER GRRE ACE TTT TT eey BURR RES RL AURORE Ae a Be aa Sere ees ileal eS Es Ba Gage baa Ea tt at ba BS Rat A ETS Balbo Mit fa ee pee oa ai eee Pat as Le eet Bees So ia Fig. 1.—Average maximum blood pressure (before the race) of contestants Cine A-A) compared with average maximum blood pressure in 90 normal men Cine N-N). On the maximum blood pressures in all the subjects at their respective ages I have constructed the chart shown in Figure 1, and it is to be noted that this curve is at about the upper limit of the normal blood-pressure zone. RELATION OF Bopy WEIGHT To BLoop PRESSURE. Table 7 shows that half of the overweighted subjects and a little over a third of the underweighted subjects had higher than average blood pressure. Between the degree of overweight and the height of the blood pressure there was no relation whatever. TABLE 7. RELATION OF Bopy WEIGHT TO BLOoD-PRESSURE. 53 CASES. : Cases. Hypertension. Mirycl @ rerun tte perc crete oretetete etele relates c/enicec 34 10 CIVER Wel Siete eae we viasan ee ames habee 16 8 INRopoieavelilte 5 Cet cho aOR Oia Bric 3 0 RELATION OF OCCUPATION TO BLoopD PRESSURE. The occupations were subdivided according to the amount of physical strain. Only those were classified with the hypertension cases whose pressures were distinctly above the average for the age of the subjects. TABLE 8. RELATION OF OCCUPATION TO BLOoD PRESSURE. B.-P. Average, B.-P. Above Average. PTULESSIOMAY avi dats ciety dae kck Pee sce 2 1 ° REMC Ne etnies rain aes coe ae ashe Uae ve {( 1 Papeete AMON dp alec dates k eee se oe Me 6 2 Tet MrRERT ohn eet 15 4 ELS Wave EL LI Tetras ois. oui aw Fane ver connate 9 13 RELATION OF PREVIOUS MARATHON RuNS TO BLOOD PRESSURE. Some of the contestants were experienced long-distance run- ners, but most of them had partaken in long-distance races not more than one year; so that the extra strain thrown on the circu- latory system was rather sudden and in some instances was per- sistent during the entire year or less. Table 9 shows the number of races run and the time of long- distance running. The runners showing high blood pressure are in those who had trained for and run from three to five races within the first year of their experience. The experienced run- ners of nine, ten, eleven and twenty years all had average blood pressures. TABLE 9, Previous RUNS AND BLoop PRESSURE. Years Long Dis. Run, Marathon Races. Blood Pressure. Average Average Average Average Average High High High Average High High Average Average Average Average 9° TO OF OY OO OY OO HA HR OL OTOUR Co 09 OD be eh ed RD HEART CASES. Auscultation was carried out in every one of the 55 contestants, within twenty-four hours before the race, with abnormal findings in seven cases, as shown in Table 10. TABLE 10. Heart CASES. Cases. Systolicsmurmnr at APES... vc cvssek seis cee scar ote ean PEED ae eee a Systolic murmur at prlmonic\area a.k.a nee aaron stale ees A! Muted sirst. Sound atia pexs.. ioscan eicls rea visite canteen emia 1 ADED y EMA eae he Meisraters clotcteroalergrciele eheteyois ie meraiae auc efey a tate male oes 1 On inspection, a considerable number showed very prominent apex beat, and in nearly all cases the impulse was plainly visible. Percussion was not carried out, as the presence of hypertrophy was to be determined by a more accurate method. BLoop PRESSURE IN HEART-MURMUR CASES. In each of the five murmur cases there was a maximum and minimum pressure distinctly above the normal line, and four of them showed a pressure very much higher than the average height. 34 or 9 cs U ed Table 11 gives the readings in these cases, and Figure 2 shows their maximum blood pressure as compared with the other ath- letes and normal individuals. TABLE 11. HEART-MuRMUR CASES. Age. Max. Blood Pressure. Min. Blood Pressure. 18 110 90 19 155 130 21 140 100 29 162 112 36 132 110 Baie BAT Beat SScssScsa5525 SSeSSe5S=27e Fig. 2.— Average maximum blood pressure (line H-H) of five contestants with heart murmurs (before the race) compared with average maximum blood pressure of other contestants (line A-A) and of normal men (line N-N). RELATION OF HEART CASES TO Bopy WEfGHT. Having learned that in these cases there was no history of cardiac involvement from disease, I thought it might be of in- terest to search for other causative factors. We have studied the age, height and weight of these contestants and classified them as over, under and normal weight. The relation of these heart cases to the body weight is shown in Table 12. TABLE 12. Bopy Weicut In Heart CASsEs. BEFORE RACE. AFTER RACE. Heart. Weight.* Heart. Weight. FOCCHIMITCCTIL sian ses ers = Intermittent aeetece - DY SUA PO Rg cto euler rete N OY StasbaSee, wanstenhcs soe a OV She PEXieacnsiele sete — DVS Pack PO Nee date meme acer N SY SE BUA POR aes 'h wise accele _ SVSEwA Pexes evsieciess _ WYViSti A POs pss itaree oo cite ale a LTT OO ia. Wasnretaes cis esisatteeie - REY Shey ALTO IC Hie an a 4 are + JG cla gig Bin capt2h emote aoe - *In this column + means overweight; —, underweight, and N, normal. The table shows that the murmurs were entirely independent of body overweight, and that the proportion of underweight cases is about the same as in the entire series. do BLtoop PRESSURE AFTER THE RACE. The blood-pressure readings were made immediately after the finish in nearly every case. In only a few instances was it de- layed four or five minutes after entrance to the medical tent. For comparison, the readings obtained before the race are repeated in the following tables. The average of the maximum pressures before the race was 126.5 (53 cases) and 107.3 (38 cases) after the race. Table 13 gives the readings in the individual cases after the race and the average pulse rate, maximum, minimum and pulse pressures, in the horizontal and erect postures. The effects re- sulting from the change of posture are to be noted in the last column. » Tasce 13. Purse RATE AND BLoop PRESSURE IN HORIZONTAL AND ERECT PosTuRES AFTER THE RACE. ——- ————- Erect -—_—— —_—___—_—_ Horizontal ———B.-P.—_—— —___—_ 3 -- Pp. ———— Result. No. Age. Pulse. S. D2 P:=PS Pulses. Dies? eee S. Dawee--: 4 18 93 95 88 i 112 98 90 8 -- “= — -— 5 28 120 95 80 15 138 90 ? ? a — A age % 36 112 88 ? a 120 88 ? a + = F ne 11 19 112 100 vi 30 112 108 "5 33 = a= — — 12 21 100 108 80 28 108 100 80 20 a — = = 13 22 96 94 74 20 100 92 80 12 + — a = 15 18 104 105 80 25 120 110 75 35 _ + — — ft 23 106 100 80 20 116 88 7 13 — = = — 19 fi O38 110 85 25 114 100 85 15 + as = a 22 21 90 100 82 18 96 85 70 15 a — — — 24 27 80 110 fs 38 93 105 80 25 — — —— — vi 19 80 114 90 24 116 108 90 18 _ = = = 30 25 81 110 95 15 96 110 92 18 oe = = + 32 52 106 118 92 26 129 108 90 18 = — = _ 38 21 81 80 75 5 99 95 80 15 —_ a a - 39 19 108 92 vi 14 120 82 4 10 _ = — -- 40 23 114 108 88 20 135 108 88 20 + aa = = 41 ? 60 122 88 34 81 130 100 30 =~ _ _ 43 20 92 120 88 32 110 100 80 20 - _ _ — +19 +5 +6 +5 = 1. —129) = se—12 Average 95.6 108.6 82.5 22. 111.3. 100:;2' (82:4 19:1 — 330s The averages of the readings after the race (Table 13), as compared with the findings previous to the race, are shown in Table 14. Taste 14. Purse Rate, Maximum, MINIMUM AND PULSE PRESSURE, BEFORE AND AFTER THE RACE. ———_Horizontal Erect — Cases. Pulse. Max: Min: P.-P>) Pulse, 9“Max.) Mine Before sa. cers. 24 74.8 127.8 96.7 30.3 78.3 124.0 95.9 29.3 DTtCTees cen ceee 19 95.6 103.6 82.5 22.0 eS 100.2 82.4 19.1 36 -_~, , we th) oe Arranged according to age, the individual readings are to be seen in Table 15. Taste 15. Maximum, Minimum AND PuLse PRESSURE AFTER ACCORDING TO AGE OF SUBJECTS. RACE, HORIZONTAL. —Age 18 to 20— —Age20to2%5— —Age 2%to30— —Age 35 to 40— Max. Min. P:-P: Max. Min. P.-P: Max. Min. P.-P. Max. Min. P.-P. 95 88 u 108 80 28 95 80 15 88 ? ? 100 {i 30 94 i 20 110 85 25 Ac ws . 105 80 25 100 80 20 110 72 38 F 114 90 24 100 82 18 110 95 15 ; de ae Ae) 80 75 5 eas ote ws aA 92 78 14 me ar es + beh os we 108 88 20 AGE 52 S36 120 88 32 118 92 26 Average: O12 81:25 20. 101-4 Si. 20:4 106.2 838. 23.2 ERECT. 98 90 8 100 80 20 90 ? ? 88 ? ? 108 75 33 92 80 12 100 85 15 a i 110 « 35 ae i es ‘ee Ag is ne ie ahd sie ir 85 70 15 110 92 18 at 108 90 18 Bie BA a are st af an ers oa - 95 80 15 ie ae 82 70 10 ess a af Se vis sc ae 108 88 20 AGE 52 ar 100 80 20 108 90 18 Average: 101.2 80.4 20.8 95.4 79. 164 101.1 85.6 19.3 The chart shown in Figure 3 is based on the readings obtained immediately after the race. It shows the normal curve, the curve based on the average of all the cases after the race, and the blood- pressure readings in the murmur cases. It will be noted that the total average curve is now below the normal line, whereas before the race it was about 25 mm. above the line. It will also be noted that the murmur cases suffered a greater fall than the others. Fig. 3.—Average maximum blood pressure after the race in the contestants with heart murmurs (line H-H) and in all contestants (line A-A) compared with normal curve (dine N-N). 37 HEART CASES IN THE RACE. Of the 5 runners who had murmurs before the race, 4 ran the full distance and one ran nineteen miles. Three of these were among the first 12 to finish the race. These runners were all new to long-distance running. After the race the hearts were auscultated in the first 45 as they finished. Out of the 29 that finished within the time limit (four hours, fifteen minutes) 5 presented heart conditions. Table 16 shows the place in which they finished. The fourth column in Table 16 shows the proportion of the pulse pressure after the race to that before. TABLE 16. Purse PRESSURE BEFORE AND AFTER THE RACE IN RUNNERS WITH HEART SYMPTOMS. Pulse Pressure. Finished. Before Race. After Race After. Before. AAS eres Muffied apex first Intermittent and weak + Le ee ah SE O Systolic base ae 4F ACD oon << Systolic apex Systolic apex a 20 Sthisnw cen O Systolic apex 15s 34 (theses Systolic apex O re 32 Sth ceaeek Systolic pulmonic O 20: 45 29th. shes. O Irregular ci ss Sabie mare Systolic apex O 10: 29 SED oc steters Systolic apex Not examined “% ee SOC. alee Arrhythmia Not examined These “heart subjects” had more'rapid pulses and smaller pulse pressures as a result of the exertion. Their blood pressures are shown in the charts, Figures 2 and 3. BLoop PRESSURE TEN DAys SUBSEQUENT TO THE RACE. At this time we find the blood pressure about the same as before the race, or, rather, it was nearer the normal line than before. TABLE 17. AvERAGE Max1tMuM BL toop-PressurE BeEForeE, IMMEDIATELY AFTER, AND TEN Days SUBSEQUENT TO THE RACE. Cases BElOre 02. Avram ismetaee akties Wearsen aces 126.5 53 Immediately arteries 2 ih.ad. sickle cee ociea 107.3 38 ‘Petidays SUDSEQUEDL oe ones gence 124.7 19 Table 18 shows the average pulse rate, maximum and mini- mum, and pulse pressures in the horizontal and erect postures, as compared with the tables of the same data before and after. 38 ; 3/ Taste 18. AveraceE Maximum, MINIMUM AND PULSE PreEsSURES TEN Days SUBSEQUENT TO RACE. —-——-Horizontal——_-———_ -—_- Erect —- NowCasess Pulses “Max, Min; ~P:-P. ~Pulse ~Max. Min. P.-P. Sages, SARS 24. 74.8 127.8 96.7 30.3 48.3 124.0 95.9 29.3 Immediately after....... 19 95.6 103.6 82.5 22.0 111.3 100.2 82.4 19.1 feneaays subsequent... 17% 61.8. 1247 92.1 33.7 68.2 125.1 93.2 31.2 The readings in the individual cases are to be seen in Table 19, and these cases, arranged according to age of subjects, are given in Table 20. Taste 19. InpivinvAL Maximums, MINIMUMS AND PULSE PRESSURES TEN Days SUBSEQUENT TO RACE, SUBSEQUENT. —-———- Horizontal -—————_ Erect Bi ee ened Result. No. Age. Pulse. S. Di.P:-PePulse. ss: Dee P

.2"F20 Commits Gn ee 180s 1005)” BO an rece te Oc Pee ois. Gor, 159) 1007. be? 150. TOO | ob ASE) Gee? aa) Joe pod.” 63 2) 110 q 35 66 110 EMSA: Wap eae cae an) RN i foe 18252) 1120 95 25 -% 122 OF Ou are este, 8 wee 8 ie 23. ° 938.9 118 80 388 90 120 Offeee SOP a ™ oe Wl ee eeon p48 1180), 100.80: ! 58). 138 oe US cok ela oe a ae an Ba s8i.- (72. 188 909 48 90 128 Ge ie ANN SS cle Miia ate 7 VS ne: 1209) VG02= B08 120 ON iy 30") cet! |) ee pee ew 219 GB) 185 88 fr 84 F190 CES Be apayaae 2 2S Sale | nee ie ob, 5G 119 92°920' .-.BB- ° 119 Os OY “its SSN ekg kt ee See ot Shen e144 wer iD predte! 64-6 155. 110. 4B ee a es Boe 9) 56 + 110 BAe OF. 7590110 if oa emene 9 1 aenagey fF) 3% MGeeoS. 462) ©1962 100%) 25° 266") 182. 100 Bk Ciel Meare bee es ype 20) |: BG) = 5 118 S84. 90" 66. 110 OUP BOQ abe Pf | nee $1448 4° 8 +6 Bt pea An, eae Seed O- aa Olga t24 7a Oe.) micas 66.21 iie0.1, 03.2 81.2= 1, = 5) 6 = 3 TasBLeE 20. Pressure READINGS TEN Days SuBSEQUENT TO RACE, ARRANGED ACCORDING TO AGE OF SUBJECTS. HORIZONTAL. — Age 18 to 20— —Age 20 to 25— —Age 25 to 30— —Age 35 to 40— Max. Min. P.-P. Max. Min. P.-P. Max. Min. P.-P. Max. Min. P.-P. 125 88 37 152 100 52 119 90 29 124 87 37 120 85 35 110 75 35 130 100 30 ani ate Se 100 95 25 118 80 38 120 90 30 135 88 47 133 90 48 112 92 20 3 eee eee PTO Oh ak eee Wo Sx AGE BB SeMIG AR 010 eal seas h Whee bette pe 14d: 5 1101 84 Average 190. 989. 36. 1248 90 285. 120. 98 27 ERECT 130 go») yao.» *152> 5, 100 52 120 902 -°30-*., 118 100 18 4 110 ff 32 a nor ae Ary wats : 132 100 32 ah ar 50 AGE 52 : 110 90 20 lee aA 43 155 110 45 Average io Pale WO 128 90.8, 46% o 122, F-92080. Six months later we examined five of these runners and found the blood pressures lower than at the previous examination; their pressures were gradually lowering toward the normal average. The readings in these cases are seen in Table 21. TABLE 21. PressuRE READINGS IN FIvE Cases Six Montus AFTER RACE. HORIZONTAL. —-Age 18 to 20 ~——Age 20 to 25—— —Age 2 to 30—— Max.) © Min7) 2:=P a Max: Min. +P.-P.) Max. Miners 120 90 30 122 98 24 110 84 26 120 86 34 ails mate 3 An = as 106 84 22 Average: 115. 86. 28. 122. 98. 24. 110. 84. 26. ERECT. 110 86 24 130 100 30 110 82 28 110 85 25 sate “4 a ac os 112 90 22 Average: 110. 87. 23. 130. 100. 30. 110. 82. 28. The chart shown in Figure 4 is based on the findings at the examinations ten days and six months after the race. The curve at the final examination is nearer the normal level. ase Ea ea Baa faa Lesateaeed hams a ba | Ree leet | wel aay ane Sea pewste =} = Es GLa a0 SAIAIOLAL tik Fig. 4.— Average maximum blood pressures (all contestants) obtained ten days (line X-X) and six months (line Y-Y) after the race, compared with normal curve (ine N-N). Each of the four charts 5, 6, 7 and 8 represents the blood-pres- sure curve of an individual case. They all show the marked fall resulting from the exertion, the height of the blood pressure ten days after the race, and the extent to which it had fallen at the end of six months. In the case of M e it will be noted that at the end of six months his blood pressure did not recede toward the normal level as the others; the reason for this is that he had kept up his training and long-distance running to the very day of the last examination. With the high pressure he still had the mitral systolic loud blowing murmur which he presented at all of the previous examinations. 40 a) ces In the last case, that of O n, who had a murmur before and immediately after the race, it was found ten days later that the murmur could be brought out only by his pacing, and at the end of six months, even after pacing for a full half minute, it could not be heard. In this case, with the disappearance of the hyper- trophy which was accompanied by a falling of the blood pressure, there was a simultaneous disappearance of the murmur. COMPARISON OF BLoop PRESSURE OBSERVATIONS BEFORE, IMME- DIATELY AFTER AND TEN Days AND Six MONTHS SUBSEQUENT TO THE RACE. Piimtiestapies: | to x1 Ihave constructed-Charts 1.to 9. All considered, the conclusions from these evidences are that as a result of training for the Marathon race a state of increased blood pressure is developed, which is considerably above normal. In some cases when training is carried to a more severe degree or because of a preceding state of the heart, we find still higher blood pressures associated with heart murmurs. As a result of the race the maximum, minimum and pulse pres- sures in all cases are lowered, reaching a point below the normal LSAT ays | a8 3 Rae a es Pad Fa p— Rai BES EE way athe cae] iw Ba cea aS ES —y aes yt Paani aad} Ga Fig. 5.—Blood pressures, case of H—n; line A-A, maximum horizontal; line B-B, maximum erect; line C-C, minimum horizontal; line D-D minimum erect; E, before race; F, immediately after; G, ten days, and H, six months subsequent to race. average; and in the “heart’’ cases a greater fall is suffered than in the others. Ten days subsequent to the race we find the blood pressure about the same as before the race, or, rather, it is nearer the nor- mal line. Six months after the race we find the blood pressure lower than it was at the previous examination; i.e., still nearer to the normal. EFFECT OF CHANGE OF POSTURE ON BLOOD PRESSURE. The observations were made first in the horizontal and then in the erect posture. The surrounding conditions were as follows: 41 Being in June, the external temperature was warm. The con- testants were stripped; they had been weighed, measured, hearts auscultated, all of which allowed them about ten minutes in the room previous to the blood-pressure examination. They then walked over to the table and lay down, after which the armlet was applied. Within three to five minutes the reading was made. =~ 0) RE A = Ba ee OS om IE CE Re aN mez SS a ee ee Pe say hE Ee eae ol Ll TEC loch) Wee C1 OL ee oe oat Parone ey need Goes See Soe Seg Le a AS NN GS BN NL A MN ED Wad a acca eur koe Fer HE A PS EA SS Fig. 6.— Blood pressures, case of M—e; maximum and minimum, horizontal and erect, and times of examination indicated as before. Mitral systolic murmur heard at each examination. Without removing the cuff they were directed to get up and stand beside the table, not being allowed to lean against: it, while the second reading was made. After the race they were laid on the table immediately on entering the medical tent (ona run). While Fig. 7.— Blood pressures, case of H—s; maximum and minimum, horizontal and erect, and times of examination indicated as before. I was making the blood-pressure observation another man counted the pulse. When this was done, the contestant was directed to get up, in many instances having to be assisted; to stand as erect as possible without leaning against the table while the second 42 reading was being made. The technic of the subsequent exami- nations was the same as that of the first. This change from the horizontal to the erect posture caused alterations in the blood pressure which may be seen in the last columns of Table 5, 14 and 19. These effects are summarized in Table 22. EAT TPE aT TT SA Sass ins ete pee | pao bees | paren PEM ep liees | GL. Be Ad i“ A__I V4 OE er] ee Ea w Sa ad Ce TAT TT aL See a PUTA Fig. 8.—Blood pressures, case of O—n; maximum and minimum, horizontal and erect, indicated as before. Pulmonary systolic murmur heard before, after, and at the third examination, but at the time of the fourth examination it had disappeared. TABLE 22. EFFECT OF CHANGE OF POSTURE ON BLOOD PRESSURE. BEFORE RACE Increased. Diminished. Unchanged. No. Cases. No. Cases. No. Cases. PISS are oeietate te ei cremicn ee oe sree 14 4 6 Mi aorta Cl Tilneeter akieieis itata susie se 10 11 3 Miri erettereteconiet: heals ot 6 9 9 PUTSELDLESSULCG mae cartiecs ie ian 8 14 2 AA TES Catan terete Site Sie arals sleveiasteiere 19 1 AVY TA VEL TID am ety. Scere ciataras Brae. thats 5 12 3 DVUSHTSETAUITE Sit ctes © eth cies ate eteise ore 6 8 4 Paes t CSSUGE la. meme sites. ois! s 5 12 1 FUSE Mes iets tee ere acietienle ote 14 2 1 AUIS aitiealb AWN eA ar Goorttae & aee Nee 8 4 5 PLU Ey TET TID ete teiavarcielveheistavarsiaretalere 8 3 6 IMIS erOLESSUNG Ta. oe slelsiereie scree 6 8 3 CONCLUSIONS IN REGARD TO EFFECT FROM CHANGES OF POSTURE. Before Race. From these observations we may then say ‘that in individuals with sound hearts having a definite degree of hypertrophy, as a result of change in posture, from the horizontal to the erect, there 45 is a rise in pulse rate, the maximum pressure may be increased or diminished, the minimum pressure may be diminished or equal, and with this there will be a diminution of pulse pressure. This © occurs in more than half of the cases. Immediately After Race. Following severe muscular exertion, in the greater number of. cases, the change from the horizontal to the erect posture caused an increase in pulse rate, a falling of maximum and minimum pressure, and with this a lowering of pulse pressure. Ten Days and Six Months Subsequent to the Race. The changes were the same as before the race. Effect of Change of Posture in Heart Cases. So far as could be seen these cases did not show a more striking uniformity in reaction to the change of posture than the other cases. Relations of Maximum, Minimum and Pulse Pressures to Each Other. In most of these records it will be seen that the height of the minimum pressure was in proportion to the maximum, and that the pulse pressure was greatest in those cases showing the highest maximum pressures. 44 Fig. 9.— Fluoroscopic studies made by Drs. John W. Boyce and George W. Grier. Solid line indicates examination before, dotted line, immediately after, and line com- posed of dashes, examination a week after the race. A, small heart; contestant dropped out at one mile; B, heart right size; contestant finished No. 11; C, large heart, left dilatation; D, average case. RELATION OF X-RAy FINDINGS TO BLOOD PRESSURE. This work was carried out by Dr. John W. Boyce and Dr. George Grier with their assistants at the West Penn Hospi- tal. They originally classified the cases examined before the race as (a) small hearts, (b) hearts of the “right size” and (c) large hearts. The average maximum blood pressure of the small heart cases was 124 mm., while the average of the hearts of the “right size” and large heart series was 188 mm. Of six cases that had 45 “small hearts,” none finished the race. Of 17 that had hearts of the “right size” and large hearts, 10 finished. This means that with the compensatory hypertrophy there comes increased endur- ance. After the race, within three quarters of an hour in most instances, tracings of heart shadows were again made. The degree of dilatation varied. The average fall in the cases of maximum pressure as a result of the race in those cases presenting a large degree of dilatation, was 31 mm., while the average fall of maximum pressures in those outlined as showing little change in the heart shadow was 12 mm. ; RENAL SYSTEM. Before Race. The urine was examined in 24 cases. One showed less than 0.1 per cent of albumin, which was not of renal origin. There were no casts in any. On standing over night, crystals of calcium oxa- late were deposited in five specimens. Immediately After Race. Amount: We succeeded in getting 19 specimens, and in those the total quantity excreted during the time of the race, which lasted between three hours and fourteen minutes to five hours. The largest amount was 220 c.c. and the smallest was 35 c.c. Color: varied from normal to dark smoky amber; in several it was bloody. Reaction: alkaline in those containing considerable blood, and in the others it was acid. Specific Gravity: varied from 1012 to 1035. There was no ratio between the amount and the specific gravity. Total Solids: These varied from 2.2 gm. to 13.51 gm. The presence of blood makes the estimation valueless. Even on elim- inating the cases in which there was considerable blood in the urine, I could find no ratio between the solids and the loss of body weight during the race, nor to the total amount of urine. Albumin: Every specimen showed albumin from mere trace to a heavy cloud. Sugar: A positive reaction,was not obtained in any case. Acetone Bodies: Diacetic Acid: With ferric chlorid a typical reaction was obtained in 3 cases; it was distinctly present in 10, and in large amounts in 4 cases. It was absent in the case in which there was the largest amount of urine passed and present in small.amount in the next largest specimen. Acetone: The ace- tone reaction was less marked, but present. Beta-oxybutyric acid was tested and found in one of the specimens. The nature of the diacetic and acetone reactions was verified by H. L. Amos of 46 w the West Penn Hospital, to whom I am indebted for the exami- nation of a number of specimens. Microscopic Examination: Every one of the 19 cases showed casts ; five of them showed “showers of casts.’”’ All but the largest specimen showed red blood cells; three showed large amounts of blood. In one specimen I found fat globules. At Subsequent Periods. Out of the 19 specimens examined at the end of a week, 4 showed light clouds of albumin and as many had casts. Two showed casts without albumin. Three weeks after the race, 3 that did not show albumin before the race still showed traces of albumin and casts. TasBLtE 23. URINARY FINDINGS BEFoRE THE RACE, IMMEDIATELY AFTER AND AT SUBSEQUENT PERIODS. No. of cases. Albumin. Blood. Casts. Acet. Bodies. TBOLORGH are ne sates + « nc eletenve oie 24 1 0 0 0 fmmediateatyrafterier crac. 19 19 18 19 18 One week subsequent..... 19 4 0 6 0 Three weeks subsequent. .. 3 0 3 0 RELATION OF CIRCULATORY TO RENAL SySTEM (AS ESTIMATED BY URINARY FINDINGS. Table 24 gives the age, maximum and pulse pressures before and after the race in the horizontal position; the amount of urine and approximate amounts of albumin and acetone bodies. TABLE 24. RELATION BETWEEN CIRCULATORY AND RENAL SYSTEM (URINARY FINDINGS). Hor. B.-P. Before. Urine Hor. B.-P. After. Age. Max. Pee C.Cc; Albumin. | Max: P.-P. Acet. Bodies. 18 140 me 220 I 160 36 140 ve 205 I 110 25 145 re 200 yy 130 " Safe 27 122 32 195 I 110 25 I 19 122 ny 195 I 110 ar 18 122 * 190 III 96 ? 115 A 190 II 88 at ae ? 120 32 175 I 120 32 1qe 31 138 15 170 II 92 Bs sats 36 132 ?2 170 Ill &8 rlow LoL ? 132 38 170 I 122 34 O 52 134 34 150 I 118 26 i 19 118 26 130 y% 114 24 AY 25 110 20 125 if 110 15 ji 20 115 es 120 I 98 a Arie 20 1715 bs 75 Lan 130 21 135 45 35 III 108 By ate 23 135 45 ? III 100 20 I From this table it may be seen that the subjects having the highest maximum pressures before the race excreted the largest 47 amounts of urine during the race. The pulse pressures were ob- tained in only part of this series, and their relation to the amount of urine seems variable. Albumin was present in small amounts in the cases in which the larger quantities after the race were passed. * Albumin was present in largest amounts in those cases which showed the greatest fall in the maximum blood pressures; and in those which showed the most marked falls in the pulse pressures. From these observations on the renal functions, it seems that the more serious the disturbance of the general circulatory system, the more marked are the evidences of this disturbance in the renal circulation, and this is evidenced by the amount of blood, degree of albuminuria and cylindruria. As to diacetic acid, all considered, it seems that it was found in larger amounts in the urine from those who ran most success- fully—i.e., those who ran hardest in the shortest time. Undoubt- edly, many other factors play a part in this. The amount of ace- tone seemed small in proportion to the diacetic acid; one way to account for this is perhaps that it was largely eliminated by the respiratory effort. CONCLUSIONS. In the conclusion of this study, it may be said that the most marked changes which occur in the contestants who train for and compete in this race are as follows: Before the Race. The average individual who has trained for this race will, about the time he is in good training condition, have a pulse that is~ moderately slower than normal, with a normal diurnal variation. His blood pressure is higher than that of the average individual, and with this he has developed a compensatory hypertrophy. If in his case it is found that he has a greater than normal diurnal pulse variation, that will be associated with a higher than average | blood pressure. Or we may say that from these observations we are led to be- lieve that the individual who has this more than average compen- satory hypertrophy and higher blood pressure, will have a greater number of heart beats in the twenty-four hours. The average heart shadow as seen with the X-ray is larger than normal in nearly all cases, and some will show comparatively very large hearts. The subjects showing the larger hearts are the ones that have the higher blood pressures. In the contestant who as a result of hard training, or because of some unknown preceding state of his heart, has developed a heart murmur, there will be found the very large heart and higher blood 48 ‘2 a ae + .. as + 2 whe 9 eis RLS Sere? cA ey th ay * - + ae ys SUMMARY OF WRINE TESTS SECOND SUBSEQUENT BEFORE | IMMEDIATELY AFTER SUBSEQUENT i) Oo . . a a a re Q Pa a oO oO , 9 Pe = Py af u u : ; = E 2 5 % S 5) Microscopic a6 8 Seika = Ss g, 5 3 Microscopic aa) = g Se es iS Sn = Microscopic 2 3 oA s Bp Microscopic A i | one 4 a 4 & 43 3) alal| o < a 4 A of S| a | a < a} a O | m | a se vtec neces LT SES RSE ge Fe ie ee ey |e ieee a en or act os |: Mili Ue Mees 4 ALICE ets Sera oles ate wl Ae Cid SOO 0 0 |6-26 r. 1. ep. spermat. Rn PN PT ee eg ie cp osc es SSS © 02 30 tgs) 25 So AS See ioe Singers (a Cees eae a erase Crt ne i ee eS a Se. RN oa ele en Aca wey ees |) Bommel LOR 0 0 |7- 6 neg. Oe Bg ee ov sie the Bibi 0 a's = 0 alantahenet mame eee as eae a ere a eee ea ett) eS asctsea sss esaees- |) TO, v. d.a ac, {1030} 7.2 Ill Omura Seto ate ciree LLL quite m. gr. c. & hy. c. few ich ee | Pee on Parte ERE teed ri Aorist adeaa ao rs Bee Pe ree Pe - Soc Saree Se Re Ca ee ae ee eee 0 cylind eg rol og ete sake oss oR Sa ck on? Pew eee ee toe e Sel Aabae, [LOGE 0 0 |7- 4 neg. | ooa%e wets einlf « «'fie mse Seachem epee ae ele aaa pee eee eee eee 3.25/| a. | ac. 1016 0 0 leuk. es teks an ls eet ope cet es ehaly nine oops aces eo} Deer peeeOlD 0 0 | 9d. 1 narrow gr. c.; uric ac settee oS hoets. Slit!" stowers a by @ few oriesinabs¢, “w» byen cam alka 1014 0) 0 |21d. neg oA ea Eva den ltocuin OPCS wre aie ott ee ele SSeS en Paar ere re ef eS ei! yk ersidisle's one's areal) 220 te 3. alk. |1022| 11.27 I 0 enter | ed UI er. c. qu. num. Cap. a wee a Ree Sreeto ns whe ad LIE SAO a ee oe LVL VES a Rta ee eee eee ae aes sea ise ee ee Ny Naa sobre d| avec karan ae ee s(t 190 a ac. |1020} 8.85 Ill 0 say Sees rae BS 8| eae gr. & blood c. ti D.fC. Wea Da Calle ‘ fb ies, (ecm ene: oOo ee eals 4 ES eer a ed ne rr ee Se es oe PRIS Ss xtc ens re See gecesi kN. Payzec's foc. ages caxeeseee|| 200 toca, alk.|1016| 7.64 I 0 estan ane, ea aA gr., hy., cellular c. t.-b. ©. | We Des. ees Fee ee ae er cre cee te ore eae RN Es I eR | ie SPY GI TS EAS EES > a ie bee leuk. Melee ie She occ. “ES ica eae Ue ea PR AND PE SLs Wr Ro ee. 0a eee and nan te ci four Mu AM MM RIT EY Al eegclierncs cu 08 KIA leuk. only Aeckce So cebs Ces oes eee ee = Soe ae ers AC. oa. ah aiewe 2. | > 0 0) leuk. ca. ox. tet eee Pee ey | 5A ea Cl es ies Bennet | Ae ee Serge Sc en ee Fee | os Nope ae bara Ue L ) 0 | 9d. leuk. eee Ee ee eee See cia Dean ACS | OSS we Fay kes os 0 0 0 42) | nr ae wi lea cate RRS OE eae a eg ea er lea ke eres SE EE cree, 3 a ira Perera een ep re hicy oes a. | ac. [1021 0 0 \24d.).. 00. 0c be ce be ee a win we are ee TS SSS a ea a Se eee eee et ee ee laces ove oes eeesl| 200 a. ac. |1029) 18.51) dof I 0 -1see.2..2+.|/$0£ 1] Showers hy., gr., cellular 0 0 See ee te res (tee eee tr rr ye ee retary ||aroxn oo eee ep ep oon vost ch <(4hs eee e Bee ties ft» - ace a. | ac. {1022 0 WI Sy Sie ea ee |< Rees aeeeRr | PRG rece ee te eee eg Ne eee Melle Sp en Samu NS a velit, L Pt ac horet uc «of Peace e ere a. | ac, 1020] cloudy 0 | 9d. |no casts; few w. b. c.; t. a.| ac. [1026] f. trace | 0 Juric acid (19 days after race 1 eee ee OE a TES ee | od eel freee eee | ee a x aa Ag ome Re 5 car ie ae a Da oy a ra pC ee ae rh a SRR TEMA een | Reel Sap TE Noes een eee Nee Ree Re Ie oe ee arts ni cd pease tc wo ce Dale's ote sy one Se are Seg OSE, Ee RRA elie aaa ar (ie ica-ox. standing): d. a, Alka LO20| sees." III Oe teleemercatents’. se ] broad & n. hy. ec. © bec: swabs €.|| a, | ac. )l000 0 0 | 9d. one hy. c POM Pe rs Peri ce | 2 ae ee ces RSET ORS Rare fe ee a 9A) SS 05 ales Ree ee eee BD d.a, ac. |1027) 2.2 TT Poe parton tee wea. a Lileyehowers muh yer cots. DlOOdiiny... -crnmr 4.". ers er eS (ee ae Bec i alec cele cccaee dela selecche tesco aleacu Saves ef) Daves [tetera [Ss traHle qtuco temteted a kite ttt sista i . le ee OPC samaCn sens Sos ss «|. O 0 ca. Ox 195|smoky v.d.a| alk.|1024| 12.26 I 0 eee he inone*seen > lateeramt. blood: ae ween 1D: dae L006 0 O |LOG.) .. 2. ec ca cabs s cele e wea che cele e|[ee sc Peccee [ae © elle cree otal) cpeme a eine eles eletae ita ) ee seat re a oie Al... ocelot. sae. eveees|| 120 daca: ac. {1085} 9.78 I 0 red ring II showers, hyere tailedycm | TUNG: mews D-cC.||Ei: ere ees cea cea evra aacahiigy elite ec c'e eu acids cle [ects [pecs oilletetelni satel eapelet th irateieti te iti os SSS = See rapes ac. |1024less than ;,%| 0 | part ox cylind. Ree hE os a este iis ei | Sa ee a ete ee eer oa Deen | een meetin cn eccilis mah AC. OO) dace u Oy Nese Onan cylind.; ca. ox. AUN ae eee wee eta oy eee eee Se ee eae eerie ae Ne ee ee ee is ans |c a ealemsclac vee sie cee see eee cece cslecnccaacese cid cece seme este eee eS aa seeedenee ee eleaee ce sete ane ess HAS AER a tee have eee cecleeeelececceec ue dateeh sels swe cere cue e ull fcr ofl araueeceecills cms eteisil lh ® lt tattle eet tose eee EAC) An Pic ig ae es ee cc] se 0 =O ne ERR eh Se Sees (etic re ORI Khon etc |r Moe |e ak He oie Ine et ae ORs on hd once ales ma etveaehr ont atall Gy eeu) Lee 0) 0 | 8d. few cylind. Rs Ps Ws “eee 2 St ee ont DES) rye Al BG Beier ee See ean Presi lieecrogis deans aeot tend aan eee De soitea ele pai oh Seen Re a ge 5 oe ge AS a Mia eg Lee Rc Re Gn I: PRN Seater ie ci ace ac lovcsacccculeccelescalecaescideteceeecke cass sceeeeee calls ane efe ace} s7eia nt) Cesietgtene =] te re titestettst Eg 8 GO ed oe raed (eS (eee SO a ae ee ae een re Pee ole Wey era. 2s ela ipa Ie mremeuee s aye ee apolar ie rae all>. © ears cesqeratatetel hts SL saree he reek earl Sere A aula cccelees evel nue serch pcuelee cele ested ules s ¢fecctecoi| duet siel ie: saiea aise lfeseeiets (Met siete Peet eo i OO) a. | ae. |....5.:....2.-2- 0 shreds leuk. 130 a. AC TOO oie.) CAtoress et Osean ed eyed aps IV none found féw r. b. c. a. | alk.|1021 0 Ub COs (en ee 7, Me nn ee | Many ey rR RE eae hel Geko cc ee eC er ee Nac, so |. Seen einiane meee oilman Sensi alah SP se slhctat tial ae eee tena eee a ar reer GN oe ey nt iy abl cl ilies [eee 11 POM et Paw. ns ae os os SS 0) CasOx | caer a ep ee I Deena aM ce el ney ee ems Some ae EN evn ams aR Cec hot ce a MRMera® «ps oop gate apraearal tay one Gua logtte eps Gta .a.| alk.|1014 0 0 10d 1 mucous cast a. |ac. 11010|- 0. 1-0 lo “dchwe meatier TeMeni oe che PAC Wl oe ee eee} 0 Cees ssid axe Scans 170 a alk.|1012) 4.75 I UNM Ee Bee ears oa 0 many blood.& gran. ¢.— \r..b..c.. “Sw. b: ¢ e wag Tied oo 07d [erates cafe’ gtr eo Dios ed Reem gene eee ee ee a Plea : aa le OS Rie sas URS 6 ones Or a SoG hee areas er et a ee ET cn Re BE Se hgh AEH ee Ae Pa OS er eee ee end eee a eRe Sh Oke Tih earl Pain amet he eo saline Diedesac © een eee wwalecesdeceeseucuce aah acgleccvnce vous tiles colette Rey ys: 20st CO ATR eas ee Re 0 0 i) 09 | pean ree alk.|1021) 8.56 il OZFe Laer esa ee II qu. num. gr. & hy. rb.c. w.b.c||p.a.| ac. 1010 () Mahe et. Re cee = Mee A | ser ete Pei Perr Pee INSU SUORORD! [ene [een ODIO nt cbcenen (NOODOESORISE a aca ee ne SG | BO ere Re ne ee (eee eee eee Bene Corea at pas 4 ake Ma hea ce Niemen NEN eh ede eye resis s/o ces ene 16 | So Pa Seek Seema Oe peeves cee ecesed [aoe s[eves[eans lees cigpeeliote sewed eles suntan gale eas econ CS aes Ge a. | ac. |1020 trace 0) i) MT Atel Oa coer Ree oe cer ilar cee ss SZ Ae) SIG Shea Stell ote a: Sole l/s a, w alayeestarciah w WfbMiw 2 aie ¥e eho, wha, Ruell loud o-e.9e; 6 wa girevahe ace 7s See ee ore Ws wnietete OSG ea. Soe een aes ; ree 12 rae a4 ace |10 0 0) 0 Ae Se eae Nees tee ena Eo ava re arc ails Sere Fan |famsten bee guess cai). “caw cbactatu one: Gyare lelars | Sade Ney acu apaieve ta yeial sara ee MOA Re psig Src. ORL Ea og ere eee ee: ie er eee ae eee ee ee. |= 0 0 0 Re olan Oe mec alee ch este Blea 2d a a ae SUN DORE aie ane Faber Acree ie perl Lear ven Pt aan cased. exe ena eR ee Rene MEMS etayaeistacs'> «2 MAE N tie eerie ss 2 | U 0: 0 | Cea EICE RENE | eae pe a 2 = iam (eins acc Re a Ran eee area AEE’ 7) OMMMPMREE Ate nasil ice gral lr geirh. coca wer reer Rickk ceases Gita, 00 0G pete eke ad a eee | on Sa Ee = 5 ee 13 RN ee ga esc Pamela TL Se a Pe cae See re Oe eA eee ote lleses 2s Dros[ecccevaevess[ecsees[sececeeeetduastiersetesecccelscsesecetesvereslfactalecwslerseleesctaaecc/es clea tee oe lye te amitenctGiasgietnss ait inset ec. 24 a. | ac. |1021 0 Te 4 On erate Bl. ks eee ac, |1026|...... I Neat ee Ree 0 few n, hy. c. oie he ah ree Seavseeueceuaubueacucesueun swell cs selee eatin: ales alike glasses 2 eee pee Ae eee | ee oe IIIS I a Sa arm Vira ni FO rns nena Penn PIO DORE ES res MEI ESSERE rasa: Ereerareearacen linen irre tere Perens) rns te Sls ns =| (7 cell Sebrlsphneit Fennens Revere REE )SDTEN IssStesebecoreabepesbs see DOD SSO SsEESTEs ee Snenmneenl benbebeenneial EI ff pressure. Body overweight, laborious occupation, short and severe training are productive of higher than average blood pres- sures and associated hypertrophy. After the Race. As a result of this inordinate exertion, if he is of the average class, he will have a fall of about 20 per cent in his blood pres- sure; if he is of the “heart-murmur cases,” he will have a still greater fall in his blood pressure. If his heart shadow with the X-ray shows a marked increase in size (much dilatation), his blood pressure will have a greater fall than if his heart shadow remains about the same size(slight dilatation). At the end of six months the blood pressure is still nearer the normal level than at the previous examination. Most of these contestants had been running during the preced- ing six or nine months, and it is natural to expect a gradual dis- appearance of the established hypertrophy, as our findings bear out. The change of posture from the horizontal to the erect is fol- lowed by certain accommodative changes in the blood pressures, these depending largely on the reserve energy of the circulatory system, and the promptness with which it reacts to the force of gravity. The effect of this severe bodily exertion on the kidneys is defi- nitely proportionate to the degree of general circulatory disturb- ance, of which the renal circulation is part. In these studies we have had the rare opportunity of observing the transition stage from health to disease. Beginning as physio- logic changes many of these cases have transgressed the dividing zone entering into that of the pathological. The exciting factors once removed, a recession into the normal followed, in some cases reaching the physiological quickly, others slowly, while some, it may be, will never return to normal. BIBLIOGRAPHY; SELECTED FROM HIRSCHFELDER’S DISEASES OF THE HEART AND Aorta. 1910, McCurdy, J. H. Effect of Maximal Muscular Effort on Blood Pressure, Am. J. Physiol., Bost., 1901, v., 95. Masing, E. Ueber das Verhalten des Blutdrucks des jungen und des bejahrten Menschen bei Muskelarbeit. Deutsch, Arch. f. klin. Med. Leipz., 1901, Ixxiv., 253. Gordon, G. A. Observations on the Effect of Prolonged and Severe Exertion on the Blood Pressure in Healthy Athletes. Edinb. M. J., BOW eC II: Gel, On: Dds Tangl, py and Zuntz, N. Ueber die Einwirkung der Muskelarbeit auf den Blutdruck. Arch. f. d. ges. Physiol. Bonn., 1898, Ixx., 544. Kaufmann, M. Rechgrches experimentales sur la circulation dans les eae en activité physiologique, Arch. de Physiol. Par., 1892, 5 ser., iv 49 Bowen, W. P. The Pulse Rate as Modified by Muscular Work. Contrib., Sc. Med., dedicated to V. C. Vaughan, Ann Arbor, 1904. Hough, Th. On the Physiological Effects of Moderate Muscular Actyite and of Strain. Science, Lancaster, 1909, N. S., xxix., . Blake, J. B., and Larrabee, R. tas; Scannell, D. tbe Tileston, W., Emerson, W.R. P., Strong, L. W., and Conolly, J. M. Observations upon Long- Distance Runners. Bost. M and S. J., 1903, cxlviii., 195. Dietlen, H., and Moritz, F. Ueber das Verhalten des Herzens nach lang- dauernden und anstrengenden Radfahren. Mtinchen. med. Wehnschr, 1908, lv., 489. Bruck, E. Ueber den Blutdruck bei plotzlichen starken Anstrengungen und beim Valsalva’schen Versuch nebst Bemerkungen tiber die hierbei eintretenden V ea ue der Herzgrosse. Deutsch, Arch. f. klin. Med., Leipz., 1907, xc., : Williams and Arnold. Effect of iclent and Prolonged Muscular Exer- cise on the Heart. Philadelphia Med. Jour., 1809, il eaes Potter, N. B., and Harrington, J. T. Medical Supervision of Athletics ee Boys at Boarding Schools. Jour. Am. Med. Assn., 1909, l1ii., 1957. rw [a7 THE LIBRARY OF THE UNIVERSITY OF ILLINOIS GENERAL SUMMARY b on : pee Wt. , Training | Day Prev. Blood Pressure Baore During Race After Race Subsequent Examinations é LAST EXAMINATION X RAY : Occupation | Work Hours Habits es |. S Lost PANO Heart Pulse Weight Gained 1 On 1 - ’ 4 sm | 3 |Z uns Pulse | Temp. Horizontal Erect | Eatand| Eat and : Loss i : 4 5 izontal Erect poo woe, ; ; 7 4 7 Zs | 3 = Lbs.| Marathons |Dist. aM. p.M.| MO. REC. 3S . oP s. oe P. Drink penis Cramps Het hao. ee! Weight gue nee ey See ass OS Pie fe Home myect bee toe sf D. PP.|| Se Betote Goes = AMO: ee ie ; Poy Good Byrs.| 2 0 o | 4 3 he- se . 25,992 1008) Negative | 77 .. |105 .. ..|.... .....| Light 0 0 0 | 99% 1022] 3% |114 133] 182 112 20 | 105 90 15 |Sitting 84 115 85 30]... ... .. ]2 Ibs.im Tday ]].......... gee Re eel (a es 0 cI ot RET eS Uieer cac| kv See th a tht NSS SSI z i ~ 9) Good |l0yrs.| 4] 0 | 0 | 8 1 oT SM SSR oO sere re o160. 4. 120 Re) oc. oe. Light 0 | Stomach” | ,Weak and | 973 1002] 4% |100 120) 115... .. SS oy |5B* 66 1128 95'., -|| 188 100 88/4 IbsJaMelS daySadlt oPrcccselt te cos csc lle «ae gael | ier ee xc ce te | cau ane ee MN ce Pac Sate er 1 wk. later showed most extreme dilat. of any 104" Good Tyr. |}2 | 0 | 0 | 0 fimar.s15-mile|.. .- .. | 99$ 1003 0 2) LL) eee sree |B. Light 0 th Mi | Syst. Base | 974 1004) 43 |108 ...| 180... .. Hes MG Sel Tod ee eten Ea este See MI) rr | reel Meee eters NER ennai | Raed ieinn cor’ Sraatisd or,ca2 ly doccacoaddaonen hooks MM oonadnoneass Tae hese Good lyr. | 2 3 OF} 12 3 12 72 68] 993 ....| S. Apex | 72 72 |110 90 20/115 80 35] Meat Both For 8 Mi, | Syst. Apex| 992 1012} 4% | 98 112] 95 88 7] 98 90 8] 50 52 [125 88 37] 130 95 35 |311bs.in Qdays || 66 74 |120 86 34 /110 85 25 ||110 right 95 dilat. 1 wk., recov. to less than Ist shadow. Night 5) Alcohol lyr. | 1 0 0 | ? 2 ie “cia t SELE ane 105 97 |182 98 34/128 95 33] Light 0 Syst. Apex|.... 104] 4 [120 138] 95 8015] 90 ?.. | 76 80 119 90 29] 120 90 30 [2)1bs.in 9days |/ 72 82 |110 84 26 |110 82 28 left dilat. 1 wk. later, outline narrower, slightly to its original size. D. and N 8 y Pp t y Laborer [aiternate 9 Good lyr. | 0 0 0 | 15 1 DAC MO MED SommLOUA I Ne xativey sil W. eiOS) Mame: ontseen ale||-v sang sto|sisvicicne «e/eiee corns emcees Haremie mere NCEE HF VE MY Carl) MEA ccense || Bab eano collec Sel bron oerd |peopnoeranel Raseeacc. o00e000|||baoscasedn opsetcccsocra ocorssermedc ||enounc lossenonoocosotoopd Von Gn\lan sobdsoneccotoctcach SaocongQoooo whee Puddler |N. &D. 10 |Tooynucn Mest! 1yr. | 3 mie 0-| ¢ 1 3 55 65)... 994] S. Apex | 63 76 /132 100 32/182 100 32| Light | V- Light} (Sig. 0 ie se] GP oeP MS) To, NCE) than INGE PIN I eI | GIR TOE ooh... coosacacelllppnooedoonlleaeo°dcoed|snpeesanccns much larger Waborern ici tno! - Wegtarien [2 ¥t-|0 | fey 08) 6 1 - 1002 1012 0 Biers 140) eee ieee cel Light sp Onene 0 0 g7§ 1008] 17 | 84 .../ 100... .. see Deter || chee Mets | Ee aceers cin teehee |aanenecthebrteteewel oe ak oe allie ocx gan padlloee Seater lh pease eaten ale er ne cs cleo Sea a Wend JS ek Se ean Meatt id. |ayr | 3 |Cigars) 0 |... J1mar. vothers|-- -- -- | 99? 100! 0 GE ny /108! rer al deer ..|V. Light|s Raw Bees 0 O) (OG LORI AR |. OO a) eee Pe Gag hies coe ac] aah wat les |b conew pigeamea ancl eee Nemes Sauie es ser lack Se uae aw a]| abet acts avec tear eee eee a Bae reese eae eco Good Pye. | t ae o~ |. 8 4 3 70 78 | 98? 100 0 C6 Simeae 1 (40) Meera) Rece Seelll: waen oe to e Soh ae el 0 ee AGL] EM TG ee ill cea ao ee Ill oe Red rR ee ae me ne Se yt ell Oe all aoe cbt manan ipaoeasacead PS eee een SE ee Se tt ats ; 1 ae Se 14 Good lyr. 0 ee) 3 ee |e. 1002 0 78 90 /120 85 35120 80 40) Light | V. Light Leg 0 100) 1004) 0% 172 112) 100) 70180 |) 108) 75889162) 80) /120) 85 401/130)100) 80/8) Ibs, amid Ol days ying, oss) eeiecrtie sls sseeeee excessive dilat. 1 wk., recov. ; pul., art, & left auricle smaller than Ist ex. - - Murmur After Pacing . 34) Coachman TI) SR 0 0 | 8} 5 .. .. .. | 99% ....) S. Pulm. | 76 80 [145 100 45/140 105 35/F. Light 0 0 0 97 991] 6 {100 108] 108 80 28] 106 8020] 68 74 |152 100 52| 152 100 52 |6}1bs. in 10 days || 72 78 |122 98 24 |122 90 32 left sided dilat. in 1 wk,, original size ..| Merchant 8 Good lyr. | 1 0 Ocje8 3 pee 608 65°/1008 G2. 0 74 76 |125 100 25122 100 22) Light | Water | Abdomen 0 98 993] 8 | 96 100] 94 7420] 92 8012/63 66 |110 75 35| 110 80 30 piace SIR ee lee A vate scallelehtacceseee|U45.° 9)” “erighit RSet a ae ee a .. 83) Laborer ee DCR ese | alseu ie Only OP 5.4 3 eee |100 6 1012 0 80 .. 145 .. ..|... .. ..| Heavy | Heavy 0 0 99" 1021) 28 }100 ...) 180... .. Seetpiobers Al eee err ere RP A cineca | eo Ee ened Ronn cnpanaee |Meadne lds condctnddnadcoco|(> ical Scaanaaosaeehoagveraaconusdccosn ak o% Hite see ee Clerk : 8 Good Lyr. | 2 0 (9s 2 Here || 9925... 0 84 84 110 90 20118 85 33/\V. Light 0 0 0 1003 1013] 4% |104 120] 105 80 25] 110 75 35] 52 70/120 95 25] 122 92 80 /44 Ibs. in 10 days ||..........|.--...---ses/eee-cseeesee dilat. both sides 64...| Teamster 104 Good dlyrs.| 1 3 0 | 12 3 eee ee 00% 100% 0 (So ea BH Gs 5 gal iat oor an) fAYAglbpteatant 1) 0 0 972 983] 4 BS NLL oe at peerage coenie allies Poe (eeeeniear meen mn conerias (Per! 8 crs) | I ee ta nent] Moree aston eter latarrineseiconms Sse: ccd Awe cceerhenormnery: Coca ron l 8 scone 74...|Light Labor} - 8 Good lyr. | 2 0 O |....|1moainedmar |. 2. 1. |... 1008 0 106 106 |185 90 45185 100 35/V. Light] V. Light lonce, Rt. Side| 0 981° 100a|44 108) 116) 400, 80020) 88. 7bi18)| "89" 190) 118 = 80) 38) 120" 8080) 11a Ibs sane Oidays | eee auleeonecer eee saneneeee dilated 5%...| Electrician 10 Good Tyr. | 1 0 |Ale1} 10 0 5 60 74 |100 1004 0 Cla wag WUBIN Aline one rll WEA Noaisteaate 0 | 0 GOL OUST SOO Deh LOB eee ech |i aefencctsicn eerie A |aeeooe goal eae soll aja ate ehepersteta/ebrietnr=t ll ud ufayatayey seyel|(sravetsiei=?e1e¥=\ eta | {et rey eiaye oy xtctarara||lo's/efonnyal velotVale tayo leioxaliatete}efo|| eta fopfoll orate tenet sfetstayete et state ts alate late atest eaten 81...) Bank Clerk 83 Good 9 yrs. a 2 0-8 0 wae Ba Rat MN aga 0 66 76 122 90 82/118 90 28) Light 0 0 0 CH ai) fet Ce Tore) ia lelin Esai ZEy GRAB SU eI iby Ce tien TIGERS |/G4 98 5c! beanonoccon|lossnnoddeosa |jeisacd ydcaronsnadsqsones fossas RS Te te is ermal Ce ara |edit (C(O UU, (CR Sg (|e td ind i a eee dah | een |lemem ne come Go |g [oii SoS eee ... 8 | Teamster 10 Good lyr. | 2 7a 0} 8 Bi5-mile|.. .. .. [100 1004 0 94 .. |115 «.. ..|... .. ..| Heavy 0 0 0 982. GOI ea] 94 ATO)! OB ccc cag srer gies we cdlhan 9 Gel liane Melt dine: caress Me-csoa dele emer eectsrege cs levee ae betel Svcvarscese-one acres Paveve eyavcs desetote| | ers vee etetersteretettte Slee eaten nes ae | an CE Soll ae eee 12 Good lyr. = 0 0 3 1 pe ee ere me) 994 0 OG) (150 Gea cee eee 0 V. Light 0 0 99 102] 2 OB Perr | BO epee wal | rauesteente oe le te wid) leigh soa] ies wields we. |la's boule. GeQletatateetsiote eM lP cae a heleceualte'y abeels overs ie aval|(Goendsa’e“evesetetate;cilfia%e ares slfts., otctala o(ufapcsxtetavmtONets tall leh=T tae | Stat ae cane ne cee Dae: Pelee. 12 Good lyr. | 1 0 0 | 38 1 eee race 101 0 80 83 |130 100 30182 110 22] Light | V. Light 0 0 100 1004] 12 | 90 96/100 8218] 85 7015/72 90 |188 90 48] 128 9838 |721bs.in Odays ||.........|......-.--..|..---200eee- 130 |right (dilat. to lefty) 100 more dilat. to left .. 64 H. Laborer 8 Not Good lyr. | 3 0 0 | 10 | Short Dist. |.. .. .. | 983 992 0 O2re. [L807 Meee te ei|| Lamht 0 | Right Ribs 0 Ste SOB eee || OO) 0.) dO moe, wal tetera ae || cee a) | Spar nn | Pease | PPE M0 | (nen pm een een en ee etna | Penne eR SAN! 6 lA 14-9200 sano an Soasecobore hase sos mag ee ... 52| H. Laborer 8 Good Qyrs. | 2 0 (i all Eee 4 Sart ye hones ae 0 67 72 |120 95 25/180 100 30)V. Light 0 0 0 985 994] 2 SO) (Bi 110) 27288" OS SONS 85 se 76) 120" OO 80120) 290. S00 | Sits amine ial yi) a leer] ere re erennrearion leer paneer 120(a) right + 110 no change; diaph. higher EOE a Cc eee 5 Good 20yrs.| 1 4 0 6 8 iceetreln Ad PR aba See 0 CP i |G cline Se colNGabir gat: 0 0 0 OO eeLOOP ema a OG. adel a) cit, aeerpereied| | meen eter aeons alms sta [is ete eels cali cer Fel termie vo. eve eco :a 0/4 olptatapurenete lateral ucrzje/eroreserarall etajaletere sim.e a = el|farnuctecelcte.etttetes lll five: ofevalfietosrks ato steteratatalet tie tetel fa ciate fad ie abel tetae = ee sate ake a eae 124. M. Labor 5 Good tye. | 1 0 0 5 1 8 54 64/99 101 0 92) ee) 120) eee serene = (Velen oht!| Ve ilipiht 0 0 9SF= s1OQM eS ate TAO) Seis) £O0Si% ci ent ice eevee eee Sie cceee ep ats oral -aterae avatar, moat lle aserssayeselaeetayoletaretetee ll apere peceis eaves lleversie cinem cam ltarsi(tecaser syopetaccrat eco elf arzarelats || exeiay atelier tet rete eeene re | REP tet es okis ate teeta eee Te - 54/V. L. Labor 103 Good lyr. | 2 0 0 4 3 Pe DS b8 |... 99 0 54 74/118 92 26/112 92 20) Heavy 0 Abdomen 0 972 1009/41 80 116) 114 90 24] 108 9018] 66 54 /185 88 106 84 22/112 90 22 |/118 right 114, dilat. + w. 1 wk., outline less than Ist; diaph. rev. serio (Ci = Se aoa Good lyr. | 0 OU a. 0' a) 42, 1 = //982 1008 0 oe LO Me a 2 Sco eS OA Ae = tae 0 09). 03H heme | 045 0 73] = GS iene my leew ereerse ||| Laren ||le eter sessions) abivste gull ava bdchois arecaleal | oteronsee all eaves gate) Sk eee eae eee eee eee se eae Bis Clerk 64 Good 2yrs.| 1 0 0 2 5 65 70} 99 1002 0 72 ,. 120 .. ..)... .. ..| Light IMuch Water 0 Irreouilam, "952" O08 Se 62). LO We 2. |) vente ete il cu way We wteo aimee wal) 2 e0) cece, ST [eveve mie a ocauaematacterelewel [Mos chs ote cyetrslherwievesecenw’s suave fletchatararaueiaie aun alfficrcte eles Rcapco te ei ehal ce oven ney et eats 30 11 ...| H. Laborer | D. & N. 10} Good Tyr. | 0 0 Gas 2 eee 100 0 65 70 1110 90 20/112 98 14)V. Light 0 0 | 0 953 1002) 4 | 81 96 110 95 15 | 110 9218/56 658 |112 92 20] 118 92 20 [8$lbs,in Qdays |]... . 1.1.) |... eee ccc eeclecsceeeesee. 110 small 110, bigger 1 wk. later, outline bigger 31 14 ...| H. Laborer TOM eos Oh tyr. | 8 Ope 0 |, “7 2 .. .. | 992 1004 0 64 (i115) See, 22: -|| Heavy |Onenee ancl + 0 OStpe Ree POG: ee lic $n ri fea ntalenme vel! canted ye ea len Se oe) QROEMPaee oar lah eather Pose ie r/erescice mie oerart amet Seen fe eee eee en | ee ike ecu serenity eee eS ames Sere : e sacar te Pat cal ye : : ; ; 36 [128 98 ¢ 3) 92/5 s. in 20 days | a : 32 PG \ Meahanic oe Good tyr. | 1 0 0 7 2 3 56 68/994 .... 0 82 78 134 100 34/138 100 38) Light 0 0 0 981 1003] 18 |106 129] 118 92 26 | 108 90 18 - a ee ae Pa nn Ai a re in " ae Bae Sead Sones GERI |e beiea ies a 134 good size 118 excessive dilat. 1 hr. later 1 wk. later, not restored to former size 33 13 ...| M. Laborer 10 Good lyr. | 1 0 Oe eb 0 , Gece 0 80 tre | Seaham noms! Teht yecawte << 4s 0 pee eel OD 190 Rielle wn ell Ween eNO 6 Rule Otoko ell 4 Meese: 7 aie t || eeine | Ce eee pen nnn Re res or Yn os Nader onlcwaoaunddeeardne 34 ... 2.|M. Laborer 9 Good 1yr. | 2 0 (yey laa, 5 5 652 58|.... 1002 0 60) | 140 Mechs Sal eau 0 0 0 TIT pees | apr: NRG ieee ee et land Ieee mira eieat|| RAN oN ee 4 mi sicsas ni: vein fase as5-:stoPeibeiatanrsctobetcei lo cca caee cece [ ostaccvasnschcctacl out ovchawel Cases Peek nrc legs Sch esele ets Bc Nee en Sa 35 34...| Clerk 9 Good lyr. | 1 Se yend.) 84 1 3 60 621992 1002 0 Hie, (120) Geel Peewee, ell Tietit 0 |si-PaininSiae 0 Gh apeclh cel Mee on cortse |onowats conn 9 coe Hand ae wal cas. wgn se Pesan oe Meiethuarounisel[lceascc ccc [nites uc ye |oigcicesats hace omeecd| iad a ROMs ele metepnens| eeelien Lessee een ee ne 36 | 25 | 6- 168 | 64...| H. Laborer 9 pepeeaD lyr.| 0 0 0 8 0 13 50 70 | 992 100 i) ie A Ge os Gulloaas vec = 0 0 i) 0 97 OSS pour | 80h cac lense nme ee (Ut tet aero t al [or sa (|ereiet cejee fecell) einje. Giggs sped {|iniw aie cr ow dateolaveletesavere:allllavcrsis oteGcetera||/evsva sao alaresece s]{lerecy a ouaiersye ce sc] [lalave cheval ova vistere re ecatats tetera fe [eo gene fae Male eit Sant ta tlle Ee 37 | 18 | 5-6 | 140]... 6 Laborer 104 Good Lyre) 1 0 0 10 3 oe 974 100 0 68s 120) aarti ore | ight 0 0) 0 97 ten’ coe OGr yer aaa sieeere Go more’ 40 we loge odie wall ere: eels (a |'o 10 cue vielayefecololnie tee /slll © yasare-oi aie a \|lsietevers «sits erevel]ls e(eie mv vee.) 500\||ince'e,«-s ll a/eranara:Bietalales poate 6) sim tetei| (eo lahatental (alae inet iad etls Settee le fe alleen eee Lee 7 Sy oa ea be ie ae eee 8 Fair 1yr.|2 | 10 |Beere| 8 2 is 1O02N Se. 0) 69 76 |124 95 29/120 100 20} Light |..........]..........0- 0 98: 992] 64 | 81° 99] 80 75 5| 95 8015 | 56 521110 88 22] 110 78 82 |bRlbs.in Odays ||... ||............1.......0..., 124 | tight BOI. 5. sec Aan ee eae eee ce TON) TEN Se I, Be Re ee Fair ty) S| Weer. < 2 S (in GO) Vso Apex Basell| 87 84°55 180) 25/140 118 24), ok Note eecsac[ecenencee: 1 OO RoSenOMl 1108) 120i) 02) 79/1490 82 eae TON meee. A PS are Oi os occinnal sec ia deals tee eral ae Eo 155 small 92 dilat. more than ! former size (11 miles) 1 wk., smaller 40 | 23° 5-5 |130)... 5 | H. Laborer 12 | Only Fair Ayres} Br -|. females a 5 3 So deepal RPS ao 0 66 66 |138 110 23/135 100 35/V. Light 0 0 0 993 1018) 13, /114 135] 108 88 20} 108 8820] 66 62 |125 100 25] 182 100 82 /2} Ibs. in Odays ||...) 1 1|............|......... 0. 133 (a) right + 108 no change ‘ Si 2 SS al a ae he es ae lati Ame he REE Ses es-998 0 BLO Ae (SOMOS REE IG OMIDU MAILE CNA ene alle Bees Cull, aie Sanehe, | 95+ 9721 4 | 60 81] 122 8834] 18010030]... .. |... ite A. SOR Beds ast Can ierek aaa ytae lly Nice ae 130 pay 122 : 42 |. Pe Se yh | PT a eg er |e cl. Seeman les voc pec ee clee 994 101 0 £000 ee t4b een te eee Ca Weioht 0 (0 0 Oi ooh a 63, Sele See ee ee re . Be a a ie is zo SE eats sae eas Pence ake Panay aaa ie g 5 Gee "Fe AAAS aaa pepe 2 Seale : cle. a: ery ie eae Eeversevevallecseceetaslunsesacsuese|indeceeceed- [fic conalish ass oes ausd sues) ah Aiile] sane? scsi iees= iaeen an tea mana 43 Sie 1 1 mies (LOO! erect. 0 15 76 |120 88 32/100 80 20) Light 0 0 9 99° 98. ter BD INO) TAO BB Sail) RODS BOve0i" Tauegular (M18 85°90 ETO 0. oO (a1 Ie: tm Vidar sans a nly eee eel ene, eee 120 [small (dilat. right) 120) no change 1 wk., slight change ee ee ear ee Neate as vats els edn ewocts's v[iwicine ec cceeecclesces > SP eet ee coos Peete er ee a-26 wie-0. - eee 99° 100° 0 RG Ses t120" geeecrcll erties Sl Rane acl naa rao Mo oe Space onc PSS or er oar 98: 994 34 90) oe alle) Scere cee | ecerreoie aie il! mot Soe aiecee meas, mace || sete a tiacars: Mets ratell ane alocerow memento leeate Ye ne ae Ae | en PRESS try Morne rity, a gasneiboncl a tyooe see ecu 45 | 29 | 5-7 |146| 7 Mechanic 104 Good 11yrs.| 1 0 0 2 1 2 64 66 | 992 1003 0 Bee oo NOT Galles en nel ee eaat: 0 0 0 Vey eece Me lint 4108 Sal Sia ge aeee kate tone eae ee | eee A) ed Dea Seo an ern OU (RUSSO | | ee Bodh vuSacdeaneona, 46 | 23 5-4 |114/10}...| Farmer 14 Good 6yrs.| 2 0 0 1 ene. | 995 1002 0 GS e190) eer eee ..| Light 0 Stomach 0 eee NA Tee ‘Weck oatlode ek sell eee Ta! We Heretics cel aaa erctey- epee sla cahc ape aeons tl gerard Gl aie a |e canalleancceccn’ca ene-cet > RRS Ree Rat Recetas cnet Gy | S| Mo? Sa 2 8 | Eating Bad | 1 yr.| 2 0 0 2 1 5 60 74]|.... 994] S. Apex | 83 85 |162 112 50/150 105 45] Light 0 OD aieallveers tere erate el lt ate ner Actes into eater taal |i ty ete a ic ar Chee eran lee Patieeton | ecinncr oh aqt.c hotell nea Pendle eee eg elle Jake 8 162 Tight: ||reeea eetercscre stein nteterstee wie ee sre eer eee 48 | 27 5-53 |140|... 5 | Milkman 12 |(pts. Beer) Fair] 1 yr.| 1 |P-€%| Beers] 0 4 12 LINC at al Ge aie ere eee 62 72 |130 100 30/120 100 20] Light 0 Wn LA extn eee Poe el oc Eel ee ee seen se an {tae pene ees I ee A Pee et ERG seo oc ase | RN el ee eee eae wee 130 Tight Bi» 2 |g ; ema eee eeeicrtics er er nee eae 49} 27 | 5-7 [128/18 ...)....05... fhe 9 Pair deyr.| 2: ) WO 3 el ee a Bae Uby 1A) ARBRE BITE A SATONBOL, oe wet dll ceed Peek Wada lone ol eae Ee pena es Se ageemiel es Ue absRadh ha ane Bee [ee ke Re ee AME yee ene 130 small |. DY eee CD LLE, )a2 od ana niof acne siieerns- Fair eyes} 0) || fOmglest0 4 Mate Seryth NO-<10 (10h: veo e00', 8686) Taphtahcscccsics|sebeeesdoatleurt s-seb. Fane eo ear Mem cere ear alline cone ates ie Besa heen: EGR es Geen ak. 62) tc act | abe Ma lee te al hei See Lh small ae Aen Sed Bees ROBE op BL [18 ese d48 |. .2 | He Laborer 12 Fair 1yr.| 2 #/ 0 | 2 1 ue Ep’ “in eee S$ erpeee Peegereccn oe toh ebu|lnkey by, NGI) WISE ane bo caoeocedbseaea opnca|beonmenouace Ese db callbcd yal lboor yall sath raat aN maApinae ate ence tou! Eom || Git Saat os) [hacer eeeeees G6. 84 [120 90. 80 [110 80 24 Jl svc lesesnanosaaeceee]Cewenm Maman ce atten ee ete ese 52 | 21 | 5-5 (145)... 8 cn 9 Fair 1yr.| 1 4 1 9 3 peer | 008 LOOM ae aes ne WG 2A od Fimeea eae es ..| Light 0 0 0 De rim | oes Blige. Seria Pee ane ee (Unies Peres Sa arr ROA Perens Gao atoce CO dlubomoerccs. 55 0d0c | bdacee gone meena onOAEWionee sanded Heec Dna lonen podroscceincd oc. < 53 | 24 | 5-8+/121/ 5 ...] Machinist 13 Fair Lyr.| 2 #| 0 | 0 8 . .. ., | 991 1003] Negative | 68 .. 120 .. ..|.... ....| Ham 0 Cramps |....e.ce00s- Shree ita Cem ee ete a Ee eee (ee eat ne ener em Ge icc pee Mame BL P26 15-10+-| 164). 9B Jose. eee 9 Fair 2yrs.| 3 0 Seles 4 PPE (C008 O08 so arca cee te G4 een Same aie) oemiae | Walioht 0 8 ara eR Rae SEB ah Be Seal Roan Bee es 2 ib oon Renal Mee ator ne Roe eee a Rae eT ncn. ‘ Doioet Yiteo | ds. We Student! lait. ace so Tobacco |1yr.| 2 !Manyl 0 6 7 98 9921 Hyper. 72... 120 Gen.lcond_poor'P. Light! 0 mes Rononnaaue ig! foe : Sr PHO SP ALOn Menino Wee lntao asec are Ye Ra nrmcpne ac PEcectcauriy re P : 4 z Small See small 7 E 7 : (a) = largest hearts. ai, el St is Te yt)