Help required with diagnosis

[mickey selcon]

Hi 

I wonder if anyone here can help me. I am researching a Sgt J E BOARDMAN 23rd Manchesters who on the 12th/13th of May 1917 was evacuated to Rouen on 31 Hospital Train, his diagnosis appearing to be D.a.N. He was on a train where the casualties were predominantly suffering from illness rather than wounds and he was subsequently transferred to the Labour Corps, presumably because his illness/injury rendered him  incapable of further front line service.

 

My question is, does anyone have any idea what D.a.N might mean?

 

Thanks and best regards

 

Mike

[Michelle Young]

Could it be DAH? Disordered action of the heart.

 

Michelle

[MaxD]

It is DAH disordered action of the heart.  Known Soldiers' Heart or effort syndrome.  Dicky heart.

 

Max

 

Sorry Michelle I had looked it up on his record this morning, posted simultaneously

Edited 3 April , 2019 by MaxD

[mickey selcon]

Hi Max and Michelle

 

Thank you so much for this, it answers the question as to why he was transferred to the Labour Corps!

 

Once again thanks and best regards

 

Mike 

 

[Marilyne]

great... learned something ... saw the abreviation somewhere lately but did not find out about it yet...

 

M.

[Robert Dunlop]

Disordered Action of the Heart was not a primary problem with the heart per se. The symptoms of breathlessness, palpitations, chest pain, and exhaustion were secondary to something else, typically stress and what is now known as PTSD.

 

Robert

[KernelPanic]

My GGF was discharged in 1917 because of DAH. I found this contemporary book on the topic pretty interesting. It's downloadable from archive.org 

 

The Soldier's Heart and the Effort Syndrome by Thomas Lewis (1918)

 

It's a bit technical, but it gives a good account of how the ailment was considered at the time, and how the Army dealt with afflicted soldiers.

[Dai Bach y Sowldiwr]

13 hours ago, KernelPanic said:

 I found this contemporary book on the topic pretty interesting. It's downloadable from archive.org 

 

The Soldier's Heart and the Effort Syndrome by Thomas Lewis (1918)

 

It's a bit technical, but it gives a good account of how the ailment was considered at the time, and how the Army dealt with afflicted soldiers.

Yes it is interesting for a contemporary view, and how the problem was managed.

 

Lots of it though we can say with confidence is just wrong.

His breakdown of causes of DAH is surprising, in that only 15 cases out of 370 actually get a label of an organic disease.

It's most surprising that  none of these are classified as having cardiac failure, and apart from one  labelled as arteriosclerosis, none have a specific diagnosis of coronary artery disease. But then perhaps it's not surprising considering his virtual dismissal of the ECG in the preface (p.vi), whereupon while admitting it to be of use in elucidating irregularities on on occasion, it's widespread use was "to be deplored".

We now know of course that even resting ECGs are of value in breathless patients, Left Ventricular Hypertrophy associated with high blood pressure and Heart failure can usually be demonstrated easily thus. And additionally, we have used excercise ECGs for decades to diagnose ischaemia (Angina).

Surprising also is his correlation of a higher excecise tolerance with a higher tobacco consumption.

His most outrageously dogmatically wrong statement is on p.14:

"Breathlesslessness of purely cardiac origin is always accompanied by general cyanosis, slight moderate or extreme".

No it isn't. It might, it might not.

He admits to taking the dogmatic view in the preface.

If you're going to be dogmatic, it looks better if you'reon the right side of the argument.

[PhilB]

The Labour Corps seems, at first glance, an odd place to send someone with a defective heart. Would their condition mean they were on lighter duties?

[KernelPanic]

On 12/04/2019 at 09:42, Dai Bach y Sowldiwr said:

Yes it is interesting for a contemporary view, and how the problem was managed.

 

Lots of it though we can say with confidence is just wrong.

His breakdown of causes of DAH is surprising, in that only 15 cases out of 370 actually get a label of an organic disease.

It's most surprising that  none of these are classified as having cardiac failure, and apart from one  labelled as arteriosclerosis, none have a specific diagnosis of coronary artery disease. But then perhaps it's not surprising considering his virtual dismissal of the ECG in the preface (p.vi), whereupon while admitting it to be of use in elucidating irregularities on on occasion, it's widespread use was "to be deplored".

We now know of course that even resting ECGs are of value in breathless patients, Left Ventricular Hypertrophy associated with high blood pressure and Heart failure can usually be demonstrated easily thus. And additionally, we have used excercise ECGs for decades to diagnose ischaemia (Angina).

Surprising also is his correlation of a higher excecise tolerance with a higher tobacco consumption.

His most outrageously dogmatically wrong statement is on p.14:

"Breathlesslessness of purely cardiac origin is always accompanied by general cyanosis, slight moderate or extreme".

No it isn't. It might, it might not.

He admits to taking the dogmatic view in the preface.

If you're going to be dogmatic, it looks better if you'reon the right side of the argument.

 

I was intrigued by Lewis’s dismissal of ECG, but wondered whether that was because the instrumentation at the time was not amenable for diagnoses in the field. But I suppose ECG would have been accessible once soldiers were invalided back home. Lewis’s Royal Society obituary says that he viewed particular symptom patterns as allowing diagnosis without electrocardiography (p183). From what you say, that appears to have been a mistake. His obit also gives the impression that he was pretty dogmatic with his views.

 

Was the physiological cause of DAH ever established? This 2006 paper suggests not. Is there a current scientific position about its cause? It seems that Lewis continued his researches on DAH/effort syndrome after the war, but I can’t find conclusive publications from that period. 

 

In my GGF’s case, the summaries we have from his post-war pensions boards indicate that his heart abnormalities (using the term DAH) were present at least through 1924. So his heart problem certainly didn’t clear up after he left the Army. He was also hospitalized with acute (trench?) nephritis in 1916. This, together with his heart problems, continued for many years after the war. 

[Dai Bach y Sowldiwr]

That's a good paper.

It emphasises that although physicians in those days were well versed in diagnosing fixed structural leions, they didn't really have much concept of the role of  metabolic and biochemical conditions on cardiac efficiency. In fairness, Lewis did seem to go some way in researching non structural causes although he doesn't seem to have published any work reporting any success.

Electrocardiography was in its infancy at this time. Even up to the time of the Second World War, ECG machines were large (very large - the size of wardrobes in some cases, and hardly mobile), so their use wasn't widespread. Nowadays of course we are blessed with 14 day recording ECGs that often pick up previously undiagnosable arrhythmias in patients (even young adults) who initially presented with what seem to be non specific, or( if truth be told) quite neurotic sounding symptoms.

The Great War era was a time when the absence of any demonstrable cause for symptoms was often followed by a label of 'functional' or 'neurotic' or worse.

 

 

[seaJane]

6 hours ago, KernelPanic said:

It seems that Lewis continued his researches on DAH/effort syndrome after the war, but I can’t find conclusive publications

There may be something on the medical abstracting sites - I'll try to remember to look up for you tomorrow.

 

sJ

[KernelPanic]

5 hours ago, Dai Bach y Sowldiwr said:

That's a good paper.

It emphasises that although physicians in those days were well versed in diagnosing fixed structural leions, they didn't really have much concept of the role of  metabolic and biochemical conditions on cardiac efficiency. In fairness, Lewis did seem to go some way in researching non structural causes although he doesn't seem to have published any work reporting any success.

Electrocardiography was in its infancy at this time. Even up to the time of the Second World War, ECG machines were large (very large - the size of wardrobes in some cases, and hardly mobile), so their use wasn't widespread. Nowadays of course we are blessed with 14 day recording ECGs that often pick up previously undiagnosable arrhythmias in patients (even young adults) who initially presented with what seem to be non specific, or( if truth be told) quite neurotic sounding symptoms.

The Great War era was a time when the absence of any demonstrable cause for symptoms was often followed by a label of 'functional' or 'neurotic' or worse.

Lewis seems to have had at least some interest in non-structural causes during the War. In 1916 he co-authored a BMJ paper with Joseph Barcroft (a giant of British physiology) that dealt with exercise and blood chemistry in soldiers with ‘Irritable Heart’. (Interestingly, looks like Barcroft may have been control in the study). But that paper seems to be it. I guess Lewis was more concerned with physical diagnoses and recuperation programmes than investigating causation, perhaps understandably so given the rather rudimentary state of clinical biochemistry at that time.

 

Yes, times have changed to say the least. The fact that you can now record an ECG on your iPhone and then wirelessly transmit the recording to your physician is pretty remarkable.

[KernelPanic]

4 hours ago, seaJane said:

There may be something on the medical abstracting sites - I'll try to remember to look up for you tomorrow.

 

sJ

 

Much appreciated. Thank you. 

I already searched PubMed and Google Scholar. But maybe there are other more obscure papers of his that don’t register in there. 

[seaJane]

PubMed was what I was thinking of searching but I'll try anyway, sometimes different searchers get different results.

[seaJane]

There are some PubMed references in here, not all of them cardiological, but some of them definitely relevant. It may be worth extending the later date to after 12/12/1930:

https://europepmc.org/search?query=(AUTH:"Lewis+Thomas")+AND+(FIRST_PDATE:[1914-01-01+TO+1930-12-12])&page=1

 

sJ

[Mercian]

My grandfather was also in the 23rd Manchester and then the Labour Corps, he started of in the 3rd Cheshire's, but got discharged being diagnosed with VDH, thanks to this thread I now know what it is, as on his discharge form it look like U a H. He served all the way through the war, volunteered in 1940 and went to France with the B.E.F after six months he was discharged with a bad heart.  

[Hatchetjack]

Hope this subject is still being followed..my interest..my Paternal GF joined the Royal Horse Artillery in 1898 and served in the Boer War acquiring clasps to his service medals for a number of prominent actions.

Being of reserve status he was recalled in 1914 and went to France with (I believe) AA troop (?)....according to his records that we have he was returned to the UK in 1915 and by 1917 was transferred to the Labour Corp...his discharge shows his service as "exemplary" and reason for discharge in 1919 as DAH I know what that means but it is followed. by (not permanent) HS...the HS is my question.By his passing in 1946 he was receiving a pension of just under 24 pounds a year.

Despite a lot of research we have been unable to find the reason for his return to UK in 1915 nor his hospitalization records until transfer to Labour Corp in 1917. I understand a lot of the medical records were lost inWW2. I do have a group photo of him at a hospital in the "uniform" but no other information. He obviously was an "older" man in 1914 but with his combat experience from South Africa I find it hard,especially with the time involved, to accept or rather a puzzle that his discharge seems related to a version of shell shock as was then described and a year after the cessation of hostilities. Any thoughts out there?

[Hatchetjack]

Sorry add on.... Driver in SA listed as Gunner 1914,,Charles Edwin Paul RA No,26750..Labour Corp.323396

[Dai Bach y Sowldiwr]

Can you post a picture of the relevant bit?

[Hatchetjack]

7 hours ago, Dai Bach y Sowldiwr said:

Can you post a picture of the relevant bit?

Will do my best..also the group photo. Bit of a dinosaur with this stuff so give me a little time!

[Hatchetjack]

OK...above is discharge info and group photo..my GF is top left with moustache looking across....eerily looking like me in middle ..age ..an earlier service photo from SAfrica is again eerily like me as a late teenager...I was 21/2 when he passed and I have no memory although I would have met him if a baby ever meets anyone!

[ss002d6252]

 

D.A.H - Disordered Action of the Heart.

 

Craig

[Hatchetjack]

His final pension in 1946 was 23pounds14shillings and 11pence! He worked on the LMS as a foreman and retired due to ill health in 1939 (I think)...my wife attended the Memorial Sunday parade last year as a"marcher" (we live in Colorado USA so no little effort involved)paying tribute to our four Gfathers who served in WW!

The RHA troop was close to her at the start wearing the same uniform my Gf is shown as wearing in a formal service photo we have`.

Lest We Forget as ever.

1 minute ago, ss002d6252 said:

 

D.A.H - Disordered Action of the Heart.

 

Craig

Thank you Craig appreciate very much your reply but that part I do know..it's the following initials I do not understand

[Dai Bach y Sowldiwr]

Hmm. Not quite sure what it means. I'll keep thinking...

Link