Cause of Death - Heart Problems

[Neil Clark]

14% of ALL War Disability Pensions awarded after the Great War (1918-1929) were awarded to former servicemen suffering from HEART PROBLEMS. It was generally accepted by the War Office/Ministry of Pensions that these heart problems were caused or aggravated by war service.

Serviceman in the field would often work in filthy environmental conditions. Men would also be recovered through the medical evacuation chain to Casualty Clearing Stations where rudimentary surgical procedures would be performed in order to save life. It's entirely reasonable to suggest that some men picked up infections from these procedures and went on to suffer from heart problems in later years after discharge. This is most probably the reason why so many men were awarded a war pension for a heart problem.

Obviously we know more about these medical conditions now than in the early 1900's. Decisions should now be made based upon modern science and medicine. It is generally accepted that Valvular Heart Disease and closely linked Endocarditis can be caused by infection (exposure to dangerous bacteria - streptococci bacteria. Subacute endocarditis).

The service authorites carrying out non-com adjudications should NOT be throwing out cases like this without getting proper medical advice. My experience is as follows -

ARMY

The MoD (Army) are now making sensible and timely adjudications and are clearly giving the man the benefit of any doubt (which is only fair). They appear to make their decisions using the civil test "On the balance of Probability" which is the correct test used in civil matters. The situation has greatly improved since 2005. Before this time they were almost as bad as their naval counterparts in Portsmouth. Well done to the Army!

ROYAL NAVY / Merchantile Marine

The Naval Historical Branch in Portsmouth are STILL making some very odd adjudications of late including throwing out all cases where a man died of HEART PROBLEMS. Many of their adjudications appear harsh and unfair to the man being considered. Naval caualties are NEVER given the benefit of any doubt (which is an utter disgrace). The NHB appears to be incorrectly using the criminal legal test "Beyond Reasonable Doubt" which results in cases being unfairly rejected. They go by the book every time and never seem to use common sense when determining cases. It's obvious to me that none of them have the slightest interest in doing the job properly which isn't entirely surprising given the fact that they never wanted this job in the first place.

If you identify a non-com who died of heart problems please don't just bin it and let these idiots dictate to you like this! If you really can't be bothered then please send it too me and I will try to make a good case on your behalf. It pains me that men like this are being forgotten and that the authorities are getting away with this disgraceful behaviour.

Whenever I find a naval or RAF casualty I know instantly that I have an uphill fight on my hands and that I will be dealing with a bunch of uninterested jobsworth morons. Oh how I wish that the government would set up a tri-service task force lead by the Army who seem to be the only service making a good job of the situation. But it aint going to happen soon....

________________________________________________________________________________

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Endocarditis

Endocarditis is a rare condition which causes inflammation of the heart lining, heart muscles and heart valves.

The heart is made up of four chambers and four valves which are lined with a membrane (thin layer of cells) called the endocardium. Endocarditis is caused by an infection of the endocardium, usually with bacteria. In most cases, these organisms are streptococci or staphylococci bacteria. However, in rare cases fungi or other infectious micro-organisms can cause the condition.

Endocarditis causes vegetations (clumps of bacteria and cells) to form on the heart valves, making it more difficult for the heart to function properly. It can also cause infection to spread to other parts of the body, such as the kidneys, lungs and brain. In some cases, endocarditis also causes abscesses (collections of infected fluid) to develop in the heart muscle.

The bacteria and fungi that cause endocarditis usually enter the body through everyday activities, such as brushing your teeth or eating food. However, in some cases the infection is the result of a dental or medical procedure.

Endocarditis is uncommon in people with a healthy heart. You are more at risk of developing endocarditis if you have a heart defect, such an abnormal heart valve or damaged heart tissue. Men are twice as likely to be affected by endocarditis as women. Endocarditis can occur at any age, but is more common in people aged 50 years and over.

Although relatively uncommon, endocarditis is a serious and potentially fatal condition. However, with the appropriate treatment and care, most people with endocarditis recover.

Symptoms

In most cases, endocarditis develops slowly. Symptoms tend to appear gradually, usually over a period of several weeks or months. This is known as sub-acute endocarditis. However, in some cases, the infection can develop very quickly. This is known as acute endocarditis. The symptoms of acute endocarditis tend to be more severe and can develop after just a few days.

Many of the symptoms of endocarditis are not specific to the condition, and it can therefore be difficult to diagnose.

The symptoms of endocarditis may include:

• fever,

• chills,

• a new, or changed, heart murmur,

• sweating, including night sweats,

• muscular aches and pains,

• chest pain,

• coughs,

• weakness and fatigue,

• headache,

• shortness of breath,

• unexplained weight loss,

• small areas of bleeding under fingernails or toenails,

• broken blood vessels on the whites of the eyes and in the skin,

• swelling of feet, legs, abdomen,

• blood in the urine, and

• tender nodules (small lumps) on finger and toes.

The severity of the symptoms will depend on how harmful the bacteria or fungus causing the infection is. Symptoms also tend to be more severe in those who already have heart problems.

Causes

When someone has endocarditis it means that a part of the lining of their heart, which may include one of their heart valves, has become infected. It is more likely to occur if the lining of your heart, called the endocardium, has a damaged surface which makes it easier for bacteria to collect there. It is extremely rare to see endocarditis in someone who doesn’t already have structural heart disease.

It’s a rare condition; there are only about 1,500 people out of 60 million that get endocarditis a year, in the UK. But it is a serious one, and it can be life-threatening. Today most people who have endocarditis have antibiotics and recover well, although some long-term damage may occur to the valves as a result of the infection.

As the heart valves within the inner chambers of the cardiac muscle do not have a blood supply of their own, they have no defence against infection, as it the white blood cells that cause these defence mechanisms, they can develop bacterial infections very quickly. These organisms can enter the body through various means, but sometimes something as simple as brushing your teeth, especially when the oral cavity tissues are damaged, can introduce them to your system. This process is made particularly easy if there are already defects of the valves themselves, or if an infection is already present elsewhere in the body. Once the bacteria have made their way to, and established themselves on the valves and surrounding anatomy, these tissues can become inflamed causing endocarditis.

Very rarely a fungal infection can be to blame, as can the introduction of foreign bodies or devices to the system such as the needles used in intravenous drug abuse, surgical implants and instruments or even from a urinary catheter that can introduce infection to the internal tissues of the body.

Endocarditis is most commonly caused by bacteria that enters the blood stream and attaches itself to heart valves and tissues. The most common types of bacteria that cause endocarditis are streptococci or staphylococci bacteria. In rare cases, the infection can also be caused by fungi or other micro-organisms. The infection causes inflammation of the endocardium (the thin layer of cells that covers the four heart valves). It can also cause vegetations (clumps of bacteria and cells) and abscesses (collections of infected fluid) to develop on the heart valves and muscles.

Sometimes the bacteria that cause endocarditis are those that live in your mouth, upper respiratory tract or other parts of your body. These bacteria are normally harmless. However, if these organisms make their way into the endocardium, they can attack the heart tissue, causing endocarditis to develop.

Bacteria can also enter the blood stream through:

Everyday activities

Common activities like brushing your teeth or chewing your food can sometimes allow bacteria to enter the bloodstream. This is especially true if your teeth and gums are in bad condition, as this makes it easier for bacteria to enter.

Infection

Bacteria can occasionally spread from areas of your body that are already infected. For example, you may have an infected sore on your skin, or have bleeding gums as a result of gum disease.

Bacteria could also have entered your body as a result of a sexually transmitted infection, such as chlamydia or gonorrhoea. Inestinal disorders such as inflammatory bowel disease may also give bacteria the opportunity to enter your bloodstream.

Dental and medical procedures

In rare cases, certain medical and dental procedures provide an opportunity for bacteria to enter the bloodstream. For example, professional teeth cleaning and scaling can allow bacteria in through the gums.

Some diagnostic tests also pose a risk, including gastrointestinal procedures used to examine the organs which take in and digest food, such as the mouth, stomach and intestines. One of the most common gastrointestinal procedures is a colonoscopy. A colonoscopy involves a specialist nurse or doctor looking into your colon (large intestine) using a thin flexible telescope. The telescope is passed through the anus and into the colon. Your doctor will then look at your colon and take samples of tissue if necessary Very occasionally the colon can become damaged during the procedure, which can sometimes lead to infection. Some procedures on the genitourinary tract (the kidneys, bladder and urethra) can also lead to infection. For example, a urethral dilation (a procedure where the urethra is expanded using a dilator to improve the flow of urine) has, in rare cases, led to people developing endocarditis. If a catheter is necessary there is also a small risk of infection. A catheter is a thin, hollow tube which is inserted into the bladder to either inject or remove fluid. Catheters are usually used to drain urine from the bladder when you are unable to control or pass urine. Sometimes bacteria may enter through the tube. As a result, approximately one in ten people who have a catheter will develop an infection

Contaminated needles and syringes also pose a threat for intravenous (IV) drug users. Although the bacteria and fungi that lead to endocarditis can enter the body in a number of ways, there are certain people that are more susceptible to developing endocarditis.

You are much more likely to develop endocarditis if:

• You have an existing disease of the heart,

• you have had heart valve replacement surgery,

• one or more of your heart valves have been damaged by an illness such as rheumatic fever,

• you have been fitted with a heart pacemaker,

• you have a history of intravenous drug use,

• you have a long term condition that suppresses the immune system, such as HIV, cancer, chemotherapy, diabetes, or,

• you are recovering from a serious illness such as pneumonia or meningitis.

Subacute endocarditis is the most common form of endocarditis and is usually caused by streptococci bacteria. Subacute endocarditis tends to affect those with heart valves that are already damaged.

Acute endocarditis occurs when an aggressive form of bacteria, especially staphylococcus, enters the bloodstream. Intravenous drug users are at high risk of this type of infection.

How do you get endocarditis?

It is caused when a particular type of bacteria enters your blood stream, and settles down on a defect in the inside lining of the heart (endocardium). Bacteria may settle on the lining of the heart or the valves. Although it is not possible to stop all bacteria getting into the bloodstream there are some things that you can do to lessen the risk of getting endocarditis:

1. Keep your teeth and mouth clean every day, and go to the dentist for regular check ups.

2. Avoid having body piercings and tattoos.

3. Don’t inject recreational drugs, such as heroin, speed or crack cocaine.

Diagnosis

In order to make a diagnosis your GP will look closely at your medical history, paying particular attention to any problems you may have with your heart. Taking a medical history will also allow your GP to identify whether you have undergone any recent medical tests or procedures that may have put you at risk of developing endocarditis. For example, if you have recently had surgery to the valves of your heart, you will be more susceptible to developing endocarditis. Your GP will also examine your physical symptoms, looking for signs such as fever or nodules (small lumps) on your fingers and toes.

Your GP will also listen to your heart using a stethoscope to see if you have developed a heart murmur. A heart murmur is when you heartbeat has an extra or unusual sound. It is caused by a disturbed blood flow through the heart. If you already have a heart murmur, your doctor will listen to your heart to check that the murmur has not changed in any way.

Your GP may also refer you for a series of tests to help confirm that you have endocarditis. Because the symptoms of endocarditis are very similar to that of other conditions, it is important that your GP rules out any other possible causes. The tests your GP may refer you for include:

Blood tests

A blood culture test is usually taken to check for any bacteria or fungi that may be present in your blood stream. It can be used to isolate the specific organism responsible for the infection. If bacteria or fungi are identified then they can be tested against a variety of antibiotics to see which type of treatment will be most effective.

Another blood test is known as erythrocyte sedimentation rate (ESR). In an ESR test a sample of your red blood cells are placed into a test tube of liquid. They are then timed to see how fast they fall to the bottom of the tube in millimetres per hour. If they are sinking faster than usual, this could mean that you have an inflammatory condition such as endocarditis. 90% of endocarditis patients have an elevated ESR.

Echocardiogram

An echocardiogram uses sound waves to scan your heart. These waves can then produce accurate images of the heart muscle, chambers and valves. This will allow your doctor to examine the structure and function of your heart more closely. It is often used to check for any vegetations (clumps of bacteria and cells) that may have formed and can detect infected or damaged heart tissue.

Computerised tomography (CT) scan

This type of scan uses x-rays to take pictures of your body. A computer is used to then piece the images together. A CT scan can be useful for identifying any abscesses in the heart tissue.

Prevention

Endocarditis is much more likely to result from frequent exposure to random bacteremias associated with daily activities than from bacteremia caused by a dental, gastrointestinal (GI) tract, or genitourinary (GU) tract procedure. Prophylaxis may prevent an exceedingly small number of cases of endocarditis, if any, in individuals who undergo a dental, GI tract, or GU tract procedure.

The risk of antibiotic-associated adverse events exceeds the benefit, if any, from prophylactic antibiotic therapy. Maintenance of optimal oral health and hygiene may reduce the incidence of bacteremia from daily activities and is more important than prophylactic antibiotics for a dental procedure to reduce the risk of endocarditis.

Not all cases of endocarditis can be prevented, because we don't always know when a bacteremia occurs. In past years, the American Heart Association has recommended that patients at increased risk for endocarditis take prophylactic antibiotics before certain dental, GI and GU procedures. Recently, the American Heart Association’s Endocarditis Committee, together with national and international experts on endocarditis, extensively reviewed published studies in order to determine whether dental, GI or GU tract procedures are possible causes of endocarditis. These experts concluded that there is no conclusive evidence linking dental, GI or GU tract procedures with the development of endocarditis. They also concluded that endocarditis is much more likely to result from frequent exposure to random bacteremias associated with daily activities than from bacteremia caused by a dental, GI or GU tract procedure.

Treatment

Antibiotics

Most cases of endocarditis will be treated with a course of antibiotics. You will normally have to be admitted to hospital so that the antibiotics can be administered intravenously (through a drip in your arm) Whilst in hospital, blood samples will be taken regularly to measure the effectiveness of the treatment. Once fever and any severe symptoms subside you will usually be allowed to leave hospital and continue taking your antibiotics at home.

If you are taking antibiotics at home you should have regular appointments with your GP to check that the treatment is working and that you are not experiencing any side effects.

The antibiotics you will usually be prescribed are penicillin and gentamicin. However, if you are allergic to penicillin, you may be prescribed vancomycin instead. You will usually have to take these antibiotics for a total of two to six weeks, depending on the severity of your condition.

Your doctor will normally have to take a blood sample prior to prescribing antibiotics. This is because the antibiotics must be specific to the bacteria causing the infection. If your blood sample shows that fungi are causing your infection then you will be prescribed an anti-fungal medicine.

Surgery

Endocarditis can cause serious damage to your heart. You may have to be referred to a cardiologist (someone who specialises in disease of the heart and blood vessels) so that the condition of your heart can be assessed more thoroughly.

One in four cases of acute endocarditis require some form of surgery. This is usually to repair damage to the heart. Surgery may be required when:

• damage to the heart valve is so severe that it causes regurgitation (where the valve does not close tightly enough, allowing blood to flow backward into the heart),

• persistent infection does not respond to antibiotic therapy,

• fungal endocarditis does not respond to antifungal medicines, and

• large vegetations (clumps of bacteria and cells) attach themselves to a heart valve.

The three main surgical procedures you may require if you have endocarditis are

• the repair of the damaged heart valve,

• the replacement of the damaged heart valves with artificial ones,

• the draining of abscesses (collections of infected fluid) that may develop in the heart muscle.

Complications

If endocarditis is left untreated, or if treatment is delayed, then you are more likely to develop complications.

Complications of endocarditis include:

Heart Failure

Endocarditis can cause permanent damage to the heart. It most commonly affects the heart valves. In severe cases this can lead to heart failure. If you develop heart failure, your heart will no longer be pumping blood around your body efficiently. This means your body's tissues may not get enough oxygen and nutrients to keep them working properly. Your body will also struggle to get waste materials to the lungs and kidneys where they would normally be excreted.

Arrhythmias

Endocarditis can also affect the heart's rhythm, causing heartbeats to become erratic. These abnormal heart rhythms are known as arrhythmias. If you develop an arrhythmia you may be left feeling dizzy, faint and short of breath. You may also experience palpitations (an abnormal awareness of your heat beat).

Infection

Endocarditis can cause infection in both the heart and in other parts of the body. In the heart, endocarditis can cause abscess (collections of infected fluid) in the heart muscle. It is important that abscesses are treated, as if they burst, they can cause infection to spread to other parts of your body. Infection can also develop in other tissues and organs, such as the kidneys, lungs or brain.

Vegetations

Occasionally, the vegetations (clumps of bacteria and cells) that form on the heart valves can break off. These can then be carried by the bloodstream and can cause infections and abscesses anywhere in your body. Larger vegetations can sometimes block the blood flow in an artery. If the vegetation becomes lodged in an artery in the brain, it can cause severe problems such as a stroke, or loss of vision.

With appropriate medical treatment, approximately 90% of people with bacterial endocarditis recover. However, endocarditis is a potentially fatal condition. In severe cases, where the bacteria or fungus is particularly harmful or if the condition is left untreated, then endocarditis can result in death.

Prevention

If you have a high risk of developing endocarditis because of a damaged heart valve or other medical problem, you should inform your dentist and doctor.

Endocarditis is most likely to develop as a result of frequent exposure to bacteria that enter your bloodstream through everyday activities, such as brushing your teeth or chewing food. Fewer cases of endocarditis are the result of medical tests and procedures.

Practice good oral hygiene

If you are more at risk of endocarditis, then it is important that you practice good oral and dental hygiene. Do not let abscesses and gum disease go untreated. It is important to visit your dentist on a regular basis to ensure you maintain good oral health, and to minimise the risk of bacteria entering your blood stream through your mouth.

However, if you are at risk of developing endocarditis, then some preventative steps can be taken.

Antibiotics

In the past, people who were thought to be at risk of developing endocarditis were offered antibiotics if they were undergoing an invasive medical procedure, such as dental treatment, childbirth, or a bronchoscopy (where a flexible camera is used to examine the inside of your throat). However, antibiotics are no longer recommended when undergoing these types of procedures because they carry little risk of developing endocarditis.

Antibiotics should only be used when absolutely necessary because each time that they are used, there is a risk that bacteria will become resistant to them.Therefore, if you take antibiotics when there is little risk of an infection developing, they may not be as effective in fighting serious infections in the future.

Antibiotics are usually only used if you are having a medical procedure at a site where there is a suspected infection in your gullet, stomach, or intestines, or in your reproductive, or urinary, system.

[chrisharley9]

Neil

you should have been a paramedic

Chris

[Neil Clark]

ME in a caring profession

[chrisharley9]

One of my cases - cause of death acute valvular heart disease - not caused but aggravated by military service - result accepted by MOD Army - he had never left the UK

[pier]

Really interesting, thanks for posting

Carol

[Ice Tiger]

ME in a caring profession

Neil

Having done such wonderful resarch in endocarditis; do you have further research to back up your claim that Paramedics are caring

Andy

(seniour ambulance officer)

P.S. James Goulter in my signature suffered the effects of being gassed, on partial recovery joined the Labour Corp but developed "valvular heart disease" (I have his death cert) & was buried in Brookwood Military Cemetery.

[Doc2]

Neil, that's good and pretty accurate information. The issue still is showing some kind of connection to service. First, endocarditis is relatively rare. Second, most acute cases make the patient sick enough that they should be hospitalised (not all, certainly, but most). Third, the vast majority of people with this type of heart disease have never served in the military. Fourth, there is nothing inherent in service (even in the WWI trenches) which really predisposed people to having this disease at a higher rate than did civilians. Epidemiologically, it is hard to prove a connection to service unless the individual had documented health problems while serving or soon after discharge.

Even using the "balance of probability" standard, the mere fact that a person served, and later in life was found to have valvular heart disease, is not really grounds for determining that there was a service connection. I want to get these guys commemorated as well, but we really should avoid the "he served and later had a health problem, so the service caused or aggravated it" type of argument. There needs to be some evidence of a problem which occurred during service, or some evidence that the individual suffered from a condition clearly related to service in the trenches. "Post hoc, ergo prompter hoc" is a basic logical fallacy which we have to avoid. Doc

[chrisharley9]

Doc

can we avoid the latin as there are some of us ere who speak only Norfolk

Chris

[Doc2]

Doc

can we avoid the latin as there are some of us ere who speak only Norfolk

Chris

Sorry, "post hoc, ergo prompter hoc" translates freely as "If B follows A, then obviously A caused B". Any book on logic points out how non-sensical this concept is--- Doc

[Sue Light]

Sorry if this has been covered somewhere above - I got lost half way through.

But to the best of my knowledge, most valvular heart disease in the general population during the Great War period was caused in childhood or early adulthood by Rheumatic Fever - the past's great destroyer of heart valves. It also increased dramatically suspectibility to endocarditis. Many of these men would already be suffering damage when they joined the Army, which may well have gone undiagnosed at that time. Although it might have become evident during their service, it would have cause problems whether they were employed as a soldier, clerk or candle-stick maker.

Rheumatic fever, fortunately, declined rapidly and (almost) completely in the UK following the introduction of antibiotics.

Sue

[Neil Clark]

Andy, It's a pre-requisite to be caring to be an Ambulance Technician / Paramedic The casualty you refer to was a serving soldier and therefore he was entitled to commemoration regardless of the circumstances. By the way Andy, I copied all that medical bumff from the web (but don't tell anyone, they might think I'm clever)

The Rheumatic fever thing deserves more investigation. I feel another thread is on it's way this time devoted to yes you guessed it - Rheumatic fever and it's relationship to VALVULAR HEART DISEASE.

Chris, I take it that the casualty you refer to here was not in service when he died? If he was still serving then he will be entitled to get a commemoration regardless of the circumstances? Obviously most non-coms died after being discharged and this is where we have to prove causation or degree of aggravation.

I'm glad this thread has been well recieved by you all. I often worry I'm going off on a tangent and that it will upset a few people (as though that's caused me a problem in the past ). I appreciate what you say regarding linking a death to service without establishing a good and reliable cause. I think that in the majority of cases (like Chris's example) the disease was merely AGGRAVATED by the service and the CAUSE was NOT The Service itself. I presume this is why his chap got approved.

DOC2 is always very welcome to get involved in the discussions as he alone (on the forum anyway) is supremely qualified to speak on these subjects and pass an opinion. It's always nice to hear a qualified doctor commenting on all my mistakes

So it's clear that we need to prove (on the balance of probability) that the disease was AGGRAVATED by the war service. This is clearly sufficient to get a casualty commemorated. Although in the case of sailors it would seem that this is a totally lost cause at the present time! I'm going to open my new book and try to destroy their groundless argument next time I find a non-com who died of heart related problems...

[Neil Clark]

Very rarely a fungal infection can be to blame, as can the introduction of foreign bodies or devices to the system such as the needles used in intravenous drug abuse, surgical implants and instruments or even from a urinary catheter that can introduce infection to the internal tissues of the body.

Could a filthy piece of shrapnel be sufficient to cause an infection?

Could surgery on an open wound in a dirty Casualty Clearing Station or Regimental Aid Post be sufficient to cause infection?

Many men must have had catheters put in under extremely dirty conditions (Sort of reminds me of the modern day NHS) .

[Greyhound]

But to the best of my knowledge, most valvular heart disease in the general population during the Great War period was caused in childhood or early adulthood by Rheumatic Fever - the past's great destroyer of heart valves. It also increased dramatically suspectibility to endocarditis. Many of these men would already be suffering damage when they joined the Army, which may well have gone undiagnosed at that time. Although it might have become evident during their service, it would have cause problems whether they were employed as a soldier, clerk or candle-stick maker.

Rheumatic fever, fortunately, declined rapidly and (almost) completely following the introduction of antibiotics.

This is borne out by the case of a man I've been researching who enlisted in 1914. He was discharged in 1915 as "permanently unfit" with rheumatism and valvular heart disease. The rheumatism was a pre-existing condition following rheumatic fever seven years earlier, which was noted on his attestation.

However, he was recalled in 1916 and was KIA in 1917 at Cambrai.

It's this chap if anyone wants to look up his records - there are two on Ancestry, the first set of papers is in the pensions section.

[chrisharley9]

Chris, I take it that the casualty you refer to here was not in service when he died? If he was still serving then he will be entitled to get a commemoration regardless of the circumstances? Obviously most non-coms died after being discharged and this is where we have to prove causation or degree of aggravation.

Neil

he was a post discharge case

Chris

[hillgorilla]

This is borne out by the case of a man I've been researching who enlisted in 1914. He was discharged in 1915 as "permanently unfit" with rheumatism and valvular heart disease. The rheumatism was a pre-existing condition following rheumatic fever seven years earlier, which was noted on his attestation.

However, he was recalled in 1916 and was KIA in 1917 at Cambrai.

It's this chap if anyone wants to look up his records - there are two on Ancestry, the first set of papers is in the pensions section.

Makes you wonder actually how bad his rheumatism and valvular heart disease where, or did a doctors ears tell them something that wasn't there. I.E did the doctor hear a murmur that wasn't actually there. Or did the presenting symptoms in 1915 actually relate to somthing else. One would have though that possibly that if the valvular heart disease was so severe then it would have progressed to a level where being recalled would not been feasible. It would be interesting to know what valves where involved and also what type of valvular problem. Did the valvular heart disease relate to the tricuspid, mitral or aortic valves and then was it stenosis or regurgitation of the valve, If the problem was such a problem, one would then think that their activities would be limited by shortness of breath and heart failure, not health problems which a soldier needs.

With regards to the subject of endocarditis, what about poor dental hygiene, I am sure that the dental hygiene of the early 20th century was not as good as it should have been.

[Greyhound]

It would be interesting to know what valves where involved and also what type of valvular problem. Did the valvular heart disease relate to the tricuspid, mitral or aortic valves and then was it stenosis or regurgitation of the valve

Part of it says "sys??ic murmur heard in mitral area, indicating mitral incompetence". Why not take a look at his record, you'll find it in the pensions collection in Ancestry (free at the moment). He was 5070 in the Royal West Kent Regt at that time.

[Neil Clark]

I should now like to quote T.J Mitchell and G.M Smith in their 1931 publication “Casualties and Medical Statistics of the Great War” (page 349) –

You will note that nearly 9% of war pensions were awarded to men for HEART PROBLEMS. This table represents all Ministry of Pension awards from 1914 until 1929.

CAUSES OF DISABILITY AMONG BRITISH FIRST WORLD WAR PENSIONERS

Wounds and Amputations 324,722 (38%)

Tubercolosis (TB) 65,370 (7.6%)

Respiritory Diseases 55,383 (6.5%)

Organic Diseases of the heart 31,502 (3.7%)

Functional Diseases of the heart 44,855 (5.2%)

Neurasthenia 58,402 (6.8%)

Malaria 44,749 (5.2%)

Rheumatism 33,908 (4%)

Ear Diseases 23,722 (2.7%)

Phychosis 13,030 (1.5%)

Dysentery 8,025 (0.9%)

Nephritis 15,837 (1.8%)

Other accepted causes 135,933 (15.9%)

TOTAL ALL DISABILITIES: 855,488

It is clear that the service authorities and the Ministry of Pensions both clearly accepted the argument that war service could cause or aggravate Heart problems.

I rest my case!

[caroline@linkagecomputing.co.uk]

Neil since you are turning in to this forums War health expert I thought you and others maybe interested in a new exhibition which I heard mentioned on the radio yesterday.

I do not think it is advertising as it is on the British legion site and is a free exhibition.

War and Medicine Exhibition held currently at Welcome collection ,183 Exhibition Rd, London.

www.garanc.co.uk/war_medicine_exhibition.php

Traces the course of medicine via war from the Crimea to current day.

Caroline

[Neil Clark]

Caroline,

Thanks for that information I shall certainly look at this exhibition although I'm not a fan of the RBL at the best of times! (ask Chris H) ha ha.

I would NEVER call myself an "expert" in anything I do however I am proud of the fact that along with a very few others (John Morecombe etc..) I was one of the first (circa 1999) to recognise the extent of the non-com problem. I am so relieved that the "cat is out the bag" now and that so many more kind and thoughtful researchers are getting involved. There are plenty of cases to go round - I estimate about 45,000 but no one knows for certain. I found 13 on my local civic memorial alone! As far as I know this is still a record? It was this shocking find which started my work in this area all those years ago.

The GWF has been instrumental in all this and I pay tribute to all the pals who have done their bit. The "In From the Cold Project" (T.D,J.H & Co) also deserves special recognition too. We are truly a "Band of Brothers" fighting for these brave and gallant men's right to an official comemmoration. They did afterall give their lives for this country didn't they? There are probably a few isolated researchers working outside the framework of the GWF but from what I can see, by far the majority are connected to this forum in one way or tuther. I would ask that my own non-com total is added to the forums totals as much of the evidence has been obtained by using this excellent forum. It's a team effort.

I'm a plain taking chap who sometimes "rubs people up the wrong way" with my harsh opinions but I (nearly always) mean well and I'm always loyal to those I respect. I'm not one to keep a grudge long term either.

The purpose of these kinds of medical threads is to draw people's attention to the fact that many war pensions were awarded by the authorities to men suffering from a huge range of ailments some of which on the face of things you wouldn't normally connect with a mans war service.

The Ministry of Pensions was often extremely harsh and mizerly with it's war pension awards. In order to properly understand this I think all of us should read these two books which can still be obtained -

1. T.J Mitchell and G.M Smith in their 1931 publication “Casualties and Medical Statistics of the Great War”

2. Forgotten Lunitics of the Great War by Peter Barham.

Both these books will enable non-com researchers to make an informed judgement with regard to submiting a case or not. In my personal opinon why not just let the service authorities do what we pay them to do and adjudicate ALL cases. This way you avoid making a mistake.

If cost is a (Genuine) issue (together it comes to about £60), I'm prepared to lend my copy's out. Pensioners don't get much nor does anyone on benefits or those earning a low wage!

Whenever I submit a borderline case I always try to provide a covering letter which sets out the reason(s) why I think the man deserves to be commemorated. I think this is very important as without this the person making the call is often likely to make a ill informed and rushed decision. If they know that you're not an easy push over, they are inclined to take more time and care determining a case.

The comments above are not in this case aimed at the MoD (Army Department) who at the present time are now (at last) making timely and sensible decisions. Whoever is doing this work obviously has a REAL interest in the work and is giving the man the benefit of any doubt which is the decent thing to do. I just wish their naval and RAF counter-parts would do the same...

Keep your eyes peeled - I intend to do some more work this time with Mental Cases (servicemen who commited suicide in asylums). I'm also thinking of discussing Nethritis (Brights Disease) on another thread.

[PhilB]

As the electrocardiograph was invented in 1924, wouldn`t diagnosis of heart complaints be a bit hit and miss in WW1? And perhaps a handy diagnosis for those doctors who weren`t sure?

[Neil Clark]

Phil,

I agree. Thats why I have a BIG problem with early Death Certificates! The MoD seems to treat this piece of paper with reverance which is not right in my opinion. Doctors in the 1900's would often be making an educated guess as to what killed a man. An example which I have used in the past -

A man was discharged after being severely gassed in the trenches, he returned home and moved away from his family. His lungs eventually packed in and he died alone in poverty (in the most appalling circumstances)! The certifying doctor knew nothing of his previous service or family history etc... so certifies he died of - (yes you guessed it) T.B or todays favourite Pnuemonia! (tens of thousands of pensioners had this incorrect cause of death on their DC's last year)!

It even goes on these days too - doctors trying to hide a real cause of death like MRSA, C Diff etc...

These D.C's are NOT to be totally trusted. I agree they represent reasonable evidence but other things should be given the same level of priority such as a name on a civic war memorial etc... At the present time the CWGC has given guidance to the service authorities that they should completely ignore the war memorial thing which is utterly daft!

I can testify that at least 99% of names on war memorials we have transcribed (422 odd) contain ONLY the names of men entitled to be commemorated. Thats pretty good odds in my book. The war memorial trustees in the 1920's would normally only put a name forward if it was felt the man died as a consequence of his war service. There are the odd errors but these probably represent less than 1% of mens names.

Nearly all my cases come from civic war memorial transcriptions - often all we start with is a surname and initial.

The service authority carrying out adjudications need to use some common sense and take ALL factors into consideration including the fact a mans name appears on a CIVIC WAR MEMORIAL. The test used should be "on the balance of probability".

[hillgorilla]

QUOTE (Phil_B @ Nov 20 2008, 05:50 PM) <{POST_SNAPBACK}>

As the electrocardiograph was invented in 1924, wouldn`t diagnosis of heart complaints be a bit hit and miss in WW1? And perhaps a handy diagnosis for those doctors who weren`t sure?

There was still the ability to listen to heart sounds, and also careful use of signs and symptoms to make a diagnosis. Fair enough maybe the ECG may have been in its infancy, but there is more to cardiology than just the ecg.

[Doc2]

Part of it says "sys??ic murmur heard in mitral area, indicating mitral incompetence". Why not take a look at his record, you'll find it in the pensions collection in Ancestry (free at the moment). He was 5070 in the Royal West Kent Regt at that time.

That is probably "SYSTOLIC".... Doc

[chrisharley9]

"Band of Brothers" fighting for these brave and gallant men's right to an official comemmoration.

Neil

dont forget that I have also submitted women for recognition

Chris

[Neil Clark]

Whooops - AND Gallant and Brave Ladies