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War Surgery and Medicine

First World War Cases (Carbery Series)

First World War Cases (Carbery Series)

Any detailed investigation into the incidence of hypertension amongst servicemen of the 1914–18 War is impossible, because indexed records to files were not kept and, as already pointed out, the sphygmomanometer was not in general use before 1930.

However, in 1932 the late Dr Carbery of War Pensions Branch became interested in the subject of hypertension, and for several years he indexed the files of ex-servicemen routinely seen by him which recorded an abnormally high blood pressure. These files have been available and, after excluding cases of nephritis and toxic goitre, these being the only two conditions in the series likely to affect the blood pressure, some 499 cases remained for this survey.

In making this survey, and as a basis for comparison, a case is described as one of hypertension only when on two or more page 660 successive occasions the diastolic pressure has risen to over 100 mm. of mercury, with the systolic at 160, or when the diastolic has reached 90, with the systolic above 160.

Having checked the cases on the Carbery list by the above standard, all cases were then checked by the suggested figures of Master, Dublin, and Marks, the results of whose exhaustive survey appeared in the Journal of the American Medical Association. They consider there are so many variations of the normal that hitherto abnormalities have probably been accepted at too low a figure.

These observers suggest the following as the minimum figures for hypertension in the several age groups:

Age Group Systolic Diastolic
40–44 165 100
45–49 170 104
50–54 175 106
55–59 180 108
60–64 190 110

Using these figures as a gauge only some six cases accepted on the Carbery list would have been excluded. These six cases include two who died of a cardiac condition when aged seventy-five and seventy-seven years, with blood pressures of 190/90 and 175/110 respectively. Considering the ages of the patients, these blood pressures are not abnormal. Also one case aged sixty-three with B.P. 172/106 and the other three cases with systolic pressures of 170 and diastolic varying from 90 to 105 could all be considered not unduly high for their age groups.

Investigation of the 499 cases on the Carbery list reveals that in the year 1952, 211 are still living and 288 are dead. All 499 cannot be accepted as cases of hypertension because the readings recorded are too low according to the present-day conception of this condition. Also, as the pressure finding may have been recorded on the occasion of an examination not for pensions purposes or for a pensioned disability, a second recording has never been entered on the medical file. Measured either by our own or the American standards, only 143 of the 211 living can be accepted as hypertension cases.