HOW IS YOUR HEART? HOW IS YOUR HEART?7 Intimate Talks on the Prevention of Heart Disease and on the Care of an Already Damaged Heart BY S. CALVIN SMITH, m.sm m.d. AUTHOR OF "HEART AFFECTIONS: THEIR RECOGNITION AND treatment"; "heart records: their interpretation and PREPARATION," ETC. BONI AND LIVERIGHT Publishers :: 1924 :: New York Copyright, 1924, by Boni and Liveright, Inc. Printed in the United States of America WHO STIMULATED MY FIRST AND ABIDING INTEREST IN HEARTS, THIS BOOK IS INSCRIBED BY HER HUSBAND TO LOUISE NOR LOVE, NOR HONOUR, WEALTH NOR POW'R, CAN GIVE THE HEART A CHEERFUL HOUR WHEN HEALTH IS LOST. BE TIMELY WISE; WITH HEALTH ALL TASTE OF PLEASURE FLIES. -Gay. CONTENTS PAGE CHAPTER I Present-Day Conceptions of Heart Disease A day of prevention-Present-day conceptions of the heart contrasted with older views-Reasons for former attitude of fatalism-How the change in views was brought about-Lessons learned in the World War-Heart disease no longer a term of terror 15 CHAPTER II The Heart in Action Reasons for knowing something about the heart-Emo- tions reflected in the heart action-The heart con- sidered from a mechanical and engineering point of view-A surpassing mechanism-Driving the mechanism at high speed 22 CHAPTER III How Hearts Are Hurt Simple beginning and gradual onset of heart disease- Importance of opportunity for heart rest at this stage-How the heart rests-Tremendous work force of the heart-Reserve force held in store for emergencies-Accumulating reserve force and work force 28 9 10 CONTENTS CHAPTER IV PAGE Faulty Habits: Over-Eating Circumstances which the individual can control- Faulty habits-Over-eating-the heart tax im- posed by excess food-Fatty hearts 37 CHAPTER V The Abuse and Disuse of Physical Exercise Over-indulgence in exercise-The athlete's heart- Modern life and the lack of sufficient exercise- Routine, systematic daily exercise keeps the heart in trim-Lazy heart muscle-Educating the heart to withstand the demands of acute illness 45 CHAPTER VI Perilous Stuff Which Weighs Upon the Heart Worry, emotional disturbances and kindred disorders of thought-Dreads and fears-Loneliness-The heart load of intense and unremitting devotion to duty-Domestic incompatibility-The strain of sustained posture-Unsound sleep 52 CHAPTER VII Heart Loads Imposed by Disease, Past and Present Circumstances beyond control of the individual-Heart trouble existing from birth-Former diseases that may later affect the heart-Muscular "rheuma- CONTENTS 11 tism" in childhood-St. Vitus' dance-The "inno- cent" diseases of childhood-Diphtheria-Scarlet fever-Pneumonia-Typhoid fever-Acute rheu- matic fever-Influenza-"Goiter heart"-Tuber- culosis-Diabetes-Blood deficiencies-Venereal diseases-Operations-Focal infections 59 PAGS CHAPTER VIII The Teeth vs. the Heart Difficulty of convincing the average person that tooth defects may derange the heart-Other bodily structures protesting against dental infections- The causes of abscessed teeth-How they affect the heart-Cooperation of doctor and dentist absolutely necessary 78 CHAPTER IX The Tonsil Question The tonsils may be useful-Their useful purposes- Diseased tonsils and their relation to heart affections-How to recognize suspicious tonsils- Reasons for the doctor deciding the question of the tonsils 93 CHAPTER X Early Heart Signs That Should Take You to Your Doctor Early signs of heart trouble, including continued weariness after an illness-"Rheumatic" twinges 12 CONTENTS PAGE and "neuralgias"-Shortness of breath-Dizzi- ness-Rapid heart action-Irregular heart action -Sense of chest constriction-Chest pain 104 CHAPTER XI Advancing Signs Suggestive of Actual Heart Involvement Later signs of heart involvement including an anemic appearance-Congested appearance-Limitation of effort-Vision defects-Fainting-Labored breathing-Profound chest pain-Utterly dis- ordered heart action-Swelling of ankles-The value of knowing that a heart defect is present. . 114 CHAPTER XII Heart Findings Which May Indicate Heart Trouble Medical words that often cause panic because they are not understood-Murmurs and "leaky hearts" -The muscle is of more importance than the murmur-Enlargement of the heart is natural at either end of existence-Heart enlargement may be a life-saving process-High blood pres- sure and how to avoid it-Hardening of the arteries-The advance of years-Apoplexy .... 125 CHAPTER XIII How to Live When Damage is Already Done A philosopher's wise remark-Treating the patient rather than treating the heart-Nature's abundant CONTENTS 13 PAGE provision-The margin of safety in damaged hearts-Heart capacity expressed in percentages -Do not advertise your malady-Maintain en- thusiasm-Optimism a precious asset-Beware of entrance to a quarrel-Avoid contact with crowds during epidemics-Periodic dental sur- veys-Living conditions-The patient's daily life -Bathing-Diet-Alcohol-Tobacco-Learn to Relax-Considerations of marriage-Motherhood -Drugs in heart affections-An annual physical inventory as a birthday celebration 136 CHAPTER XIV Appropriate Exercise for Heart Patients Exercise necessary to keep heart muscle in trim- Heart reeducation after an illness-Gradual exercise-The heart exercise creed-Avoid bursts of speed-The urge to exercise-The undesirable element of contest-The old exercise the best exercise-No swimming-Why some swimmers sink-Walking-Dancing-Golfing-Fishing- Hunting-Horseback riding-Polo playing-Mo- toring not always desirable-Canoeing 174 CHAPTER XV Appropriate Occupations for Heart Patients Recovered heart patients should work-General prin- ciples governing occupations-Heart patients are desirable employees-The old job-Summary .. 195 Index 203 HOW IS YOUR HEART? CHAPTER I PRESENT-DAY CONCEPTIONS OF HEART DISEASE This is a day when the prevention of dis- ease and the conservation of health command the attention of thinking people. The most recent subject to attract public interest is the prevention of heart disease; and well it might, for heart disease is at the head of the list among the causes of death. Modern Medicine declares that heart disease is preventable! We can better appreciate the advances which have been made in our knowledge of the heart if we contrast the views of the present with those which were current in generations past. A day of pre- vention is worth an age of cure. Some people may recall an occasion when grandmother, frail and delicate at best, pre- pared for days in advance of a dinner party and then scattered consternation among her guests by collapsing at dinner from a heart Heart disease in grand- mother's day. 15 16 HOW IS YOUR HEART? attack. Her grave, white-whiskered doctor felt the pulse of the prostrated woman, listened to her heart, shook his head regretfully and uttered the solemn pronouncement "heart dis- ease." It required the dramatic procedure of blood-letting, bottle after bottle of squills, any amount of licorice powder and many weeks of time to nurse the patient back to a measure of health. But grandmother's health stood upon very slippery ground. She scarcely dared venture from home for fear of another heart attack. There was no way of telling what she might undertake with safety and what she could not do, and so she did nothing. She had heart dis- ease, and there was no difference of degree in the ominous pronouncement, nor were there any methods of gauging its severity. She was a prisoner of fear. All was shrouded in doubt -except the outcome. A prisoner of fear. House bound at last, then bedridden,-pale, wan and worn, grandmother's heart spells came oftener, her neuralgia, which she had for years, grew worse, her rheumatism was more crip- pling than ever. Finally the end came. "What troubles she had!" the neighbors said; "never really well, but she lived with it all until that Might not the heart have been more sinned against than sinning? PAST AND PRESENT VIEWS 17 sudden heart disease killed her." And the faithful old doctor gravely shook his head as he left the house, solacing himself with the thought, "Once a heart sufferer, always a heart sufferer; little or nothing can be done for heart disease." Understand-grandmother was not to blame, for she availed herself of the best medi- cal talent of her day; such popular medical books as were available for her to read dealt with the treatment of disease rather than with its cause and prevention. The doctor was not to blame-peace to his spirit!-for who in his time ever thought of searching through the body-teeth, tonsils, gall bladder, intestines, kidneys-even to examining the bodily fluids, to locate the hiding place of germs or to dis- cover the perverted bodily chemistry that had prostrated the heart! Peace to their spirits! Nor could the old-time doctors be blamed for their fatalistic attitude toward heart dis- ease. They saw their patients only when the heart trouble was so far advanced that invalid- ism was permanently established. Medical men had no opportunity to study the cause and the beginning of heart affections; their observations were made on heart wrecks. As Heart disease formerly a term of terror. 18 HOW IS YOUR HEART? far as the doctor was concerned, heart disease was a bandit, lurking in dark places, ready to pounce upon the innocent passer-by and strike him down. Little wonder that "heart disease" became a term of terror to doctor and patient alike! No one knew what the cause, duration or effect of heart trouble might be. Other diseases behaved in an orderly manner. The beginning of pneumonia, for example, could be recog- nized, for it started with exposure to cold and a chill; it had early signs, such as chest pain and cough; it ran a rather definite course of so many days, and gave signs of its termina- tion by a sudden drop in fever. Furthermore, pneumonia was not likely to recur if the patient exercised ordinary care. Not so with heart disease! It followed no rules, obeyed no laws, had no regard for the conventional behavior of maladies. It was the outlaw of medicine. Heart disease once the out- law of medi- cine. Then came the days of the modern medical laboratory, where disease and its causes were intensively studied. One discovery in medi- cine led to others and the physician began to apply the new opinions acquired in one field to a study of causes in another. The advent of the X-ray'supplemented the studies made in the Detectives on the trail. PAST AND PRESENT VIEWS 19 laboratory. Special instruments were devised for the intimate study of the heart's action in health and disease. Eventually there devel- oped a feeling among physicians that the heart could be affected by disease in other parts of the body, however remote. Hence heart affec- tions must surely have their beginning in causes other than "nervousness" and certainly tuberculosis, cancer and syphilis-the hoary scapegoats of medicine-could no longer be regarded as the only causes of heart defect, for the vast majority of heart sufferers never had such diseases! Thus the intensive study of heart affections had its beginning. It required only sufficient time to apply such observations and opinions to patients themselves in order to prove the value of the novel conceptions. The new era in heart affections was upon us. An undreamed of opportunity to apply the new conceptions concerning the heart soon pre- sented itself. The World War burst upon civilization. For the first time in history enor- mous numbers of men were amassed under medical inspection and supervision,-and best of all, they were under military control and so could be studied exhaustivelv. The soldier The outlaw captured by the armies of the world. 20 HOW IS YOUR HEART? could not be capricious as civilian patients can be; in the army a man did as he was told and reported promptly for observation at the hour appointed. Thus the physicians of all nations conducted intensive studies of heart disease under the happiest auspices. From the examination of unprecedented numbers of men, the effect of previous disease upon the heart was shown in the physical unfit- ness of the recruit. The influence which hidden infections could exert upon the heart was proven by the recovery of heart invalids when such infections were removed. The effects of overwork and of insufficient nourishment in the production of heart disturbances were ascer- tained. The heart derangements attendant upon anxiety and emotional stress were proven by the records of incapacitated soldiers who recovered from heart affections when ordered home. Much of what would have been called "heart disease" a generation before was not heart disease at all,-it was simply due to the heart protesting against an unaccustomed manner of living; protests against a change from those circumstances to which a given heart had adapted itself in civil life! The outlaw not such a ter* ror after all. PAST AND PRESENT VIEWS 21 And now new views prevail concerning the heart. While some points are not yet settled, this much is definitely proven: Heart disease is preventable and in many early cases curable. All over the United States associations are being formed to do for the once doomed heart sufferer what has been done for the once doomed tuberculous patient,-namely, to edu- cate the people to the recognition of early signs of heart protest. Then the doctor may begin an early search for the provocative circum- stance, condition or infection that is affecting the heart before the derangement eventuates in prostrating heart disease. Thus future gen- erations will be spared the heart wrecks of Grandmother's Time. The old order changeth, yielding place to new. CHAPTER II THE HEART IN ACTION Have you ever thought of what a wonderful organ your heart really is? Many persons give very serious consideration to their heart when it suddenly protests against some load which they consciously or unconsciously throw upon it; but there are very few people in the full enjoyment of health who ever actually contemplate this marvelous structure that sup- plies every part of the body with the nourish- ing blood which means health, happiness and physical well-being. CONTEM- PLATE your heart! Just because so few give any thought to their hearts when they are in health, the ma- jority of us are thrown into a panic when this most faithful of all our organs protests against abuses. Perhaps if we know something of the duties and purposes of the heart, of its regular habits, of its faithfulness and of its whole-souled devotion to duty we could better understand the heart when it takes a queer little spell; and instead of becoming panicky we could search the immediate past for that Destructive anxiety vs. constructive thinking. 22 THE HEART IN ACTION 23 cause which made the heart depart from its customary well-ordered manner of acting and greet the doctor, when he calls, with a state- ment of probable causes rather than with ap- prehension and alarm. Alarm doesn't help him a bit in the understanding of the trouble. The Ancients thought the heart to be the Seat of the Soul, and even today a soulful man is spoken of as big-hearted. The Ancients also considered the heart to be the Seat of Love; and indeed this belief is handed down to us in the marriage ceremony of today, in the ring with which lovers of the present plight their troth, when it is placed upon the third finger of the left hand. The Ancients believed that this finger had the largest pulsations in it of any, and that therefore it was in closest connection with that Seat of Love, the heart. There is much reason for the heart having been considered the Seat of the Soul, for soulful persons are usually those of deep and intense feeling, and such emotional disturbances as arise in sensitive natures are often reflected in the action of the heart. Consider, for example, the unhappy Prince Hamlet, whose soul was torn by noble emotions and of whom it was said at his death, "Thus cracks a noble heart." Shakespeare Ancient views brought down to date. 24 HOW IS YOUR HEART? seems to have recognized the effect which long- continued emotional disturbances can have upon the heart. There is also good reason for considering the heart as the Seat of Love, for the tender passion can produce either an over- action of the heart that brightens the eyes and gladdens the cheeks, or produce depressing emotions which bring actual heartaches and cause the color to flee from the face, making the sufferer the picture of dejection, "Like Patience on a monument, smiling at grief." The heart, however, is much more than a Barometer of the Emotions. Mechanically considered, it surpasses any mechanism which the ingenuity of man has ever contrived. It can be likened to the most modern pumping outfit, to the governor of a steam engine and to that last word in mechanism, the automobile. The heart is indeed the main central pump of a distributing system which supplies the brain, the skin, the muscles and every structure of the body with the circulating fluid that is neces- sary for life. It is to the body what a central pumping station is to the water supply of a city. Failure of the central pump deprives the outlying districts of their supply, and misery and suffering result. The heart is more than a Barometer of the Emotions. THE HEART IN ACTION 25 The heart is also a governor of our activities. When increased physical energy is demanded of us the heart responds with an increased out- put-otherwise we would soon be prostrated by a burst of physical effort, for effort makes such a demand upon our muscles that if the blood supply to the muscle is not sufficient to replenish the demand and to promptly remove the waste products of activity, early muscular fatigue must inevitably follow. As the gover- nor of a steam engine responds with increased speed to increased demand, so does the heart respond to the demand of physical effort. But there is a point in speed beyond which the gov- ernor cannot maintain an efficient circulation; crowding too much steam on or forcing the engine at high speed for too long a time mate- rially disturbs the distribution and results in a failure of function and purpose. Your heart a surpassing mechanism. Those who drive motor cars realize that the efficiency of the automobile depends upon the integrity of the engine. A quiet engine that works so smoothly that we are unconscious of its action as we glide along the highway, can be so injured by bursts of speed over rough places or by long sustained forcing of the motor on high gear that the engine finally be- The motor of the human frame. 26 HOW IS YOUR HEART? comes noisy. A knock develops in the motor; the efficiency of the car is decreased; it no longer glides along smoothly and uncomplain- ingly; instead, it protests against abuse and the car begins to grow old. With such an insensible thing as an abused automobile engine, the cylinders can be rebored, new pis- ton rings can be fitted, loose connections can be tightened and the engine can be made quite as good as new. But the effects of too much abuse may still be shown in body noises and in jerky running gears! Even the heart, which may be called the motor of our body, can very often be made to act efficiently again when abused, if we heed the warnings of begin- ning motor damage. When the warnings are allowed to pass unheeded because we are vain- glorious enough to consider ourselves iron men or superwomen, the body shortly becomes an unfit place in which to live and the Joy of Life is gone. There are many ways in which the heart can be hurt. There are many circumstances of living which will lead one to anticipate heart hurt, when one is acquainted with such circum- stances. And later on there are signs by which one can recognize the beginning of heart hurt. There is not much mystery about heart hurt nowa- days. THE HEART IN ACTION 27 It does not require a medical education to perceive these things. It only requires a little information, a little discernment and a little checking up occasionally, if one would hope to pass into the Sear and Yellow Leaf in the full enjoyment of Heart Health and Happiness. CHAPTER III HOW HEARTS ARE HURT Generally speaking, any circumstance of life which throws a repeated or long-continued load upon the heart may damage it. Let us read that rather heavy sentence again, and then examine it a bit, before setting forth the various items of living which can be called heart loads. A heavy sen- tence. First of all, let us completely disabuse our minds of the idea that we can suddenly plunge from heart health one day into heart disease the next. It is nonsense to assume that such a sudden transformation can take place. No one ever heard of a healthy arm or leg muscle becoming diseased over night-and it is equally absurd to imagine that such a complete change can take place in that powerful muscle called the heart. Hearts usu- ally stumble before they fall. The trouble is that when a leg is fatigued we give it sufficient rest upon the first appear- ance of discomfort and it is thereafter a good leg. But when the heart muscle is fatigued we Hearts stumble under excess load. 28 HOW HEARTS ARE HURT 29 keep on driving it just the same by the de- mands of tomorrow, and perhaps lash it to still further effort by anxiety over its tempo- rary disablement; thus Pelion is piled upon Ossa, and the protesting heart enlarges in order to meet the demands which continued effort and anxiety impose. Let these loads continue unabated-and of course the heart tissue finally becomes stretched, inelastic, thick- ened and perhaps hardened, so that the heart has no more punch than has the arm of an overtrained or flabby pugilist, beefy though he is. But if we give the heart as much of a chance to rest proportionately (note that word proportionately) as we gave the wearied leg, it finally becomes a good, efficient heart again, for rest has relieved the load and permitted the heart to accumulate force. We have side- stepped eventual heart disease! "How is it possible to actually rest the heart?" The question is often asked by per- sons who seem to have a rather vague idea that the heart must pound on from minute to min- ute, hour to hour, all day long and all through the night, like the incessant pounding of the riveting machine in the steel-ribbed building that is being erected across the street, which cour8e the heart rests,- plentifully. 30 HOW IS YOUR HEART? never pauses between blows. If the heart worked like that it could not last very long! As a matter of fact, a well heart pauses after each beat, and it is this pause which affords the opportunity for rest, while blood is flowing from the vessels into the heart. Then it con- tracts again. The rest period between beats is almost twice as long as the beat itself. For example, in a heart that beats seventy-five times a minute, each squeezing-and-filling period is eight-tenths of a second in duration. Of this brief time, three-tenths of a second is required for the squeeze, and five-tenths of a second is taken by heart rest while the filling of the heart chambers with blood for the next squeeze takes place. Thus the ratio of work to rest is as three is to five. Do a little arithmetic. Apply this ratio to a day of twenty-four hours-and we find that the heart is actually at its work of squeezing for only nine hours and that it rests fifteen hours out of the twenty- four. Interesting-isn't it?-to know that a healthy heart believes in a nine-hour working day! However, it cannot take that amount of rest all at one time,-as a weary leg can do. The heart must seek and find its rest through- The heart be- lieves in a nine-hour working day. HOW HEARTS ARE HURT 31 out the day, for just a brief interval between beats. Lengthen that interval and heart rest is increased; speed up the heart with incessant physical or emotional demands and heart rest is decreased. Suppose a tired heart is kept intensively on the job despite its weariness; it then tries to make up with speed what it lacks in force. You would not dare lash a horse to such extremes in an uphill pull if the S. P. C. A. caught you! On the other hand, suppose that when your heart complains you rest, physically and emotionally; such rest saves the averaged harassed heart at least ten beats a minute-prove it yourself: have some- one count your pulse when you are asleep. Ten beats a minute means six hundred beats an hour-over fourteen thousand beats saved in twenty-four hours! And now do you begin to see what your doctor means by heart rest? The average person has no idea of the tre- mendous power which the heart puts forth, taken in the aggregate. There is so much force expended by the naturally acting heart that this work force is sufficient to lift seventy-eight pounds to the height of one foot every minute. Multiply the minutes by hours workendO1IS accomPlisi1ed- 32 HOW IS YOUR HEART? and see how many tons the heart is capable of lifting in a day. So do not think of a well heart as a frail, delicate piece of mechanism that must be eter- nally guarded to prevent it from collapsing suddenly,-simply do not abuse it. As a power- chamber, it is magnificently constructed to produce force and to direct that force. Only one other muscular structure in the human body is as architecturally strong-only one other organ is so capable of withstanding sur- passing temporary strain and momentarily supreme effort-as the heart: that other mus- cular structure is the womb. They are both made up of layers of muscle which cross each other, the interlacing sinews running in differ- ent directions,-something after the manner of the cross-layers of wood in the light but strong laminated lap-board that is used by the dressmaker. In legs the muscle fibers run in only one direction-and yet we think of legs as strong! Nothing frail about the heart. Force re- served by the heart for emergencies. Work Force is not the only force which resides in heart muscle. It also has reserve force. It is this reserve force which enables us to meet the emergencies of life such as sud- HOW HEARTS ARE HURT 33 den physical strain, bereavements, domestic tragedies or terrible nerve shocks; and it makes us win our battles with exhausting diseases, fevers, etc., even keeping the body going for weeks when food is unobtainable. Indeed, the reserve force of the well heart is so great that you could, in an emergency, put forth thirteen times as much exertion as is required for your normal life today, and yet the heart would emerge undamaged from the momentary strain. The heart's reserve force is one of the greatest assets of the human body. Reserve of any kind should be regarded as an almost sacred thing. If any little shopkeeper on the street were to spend all of his working capi- tal, he would next have to begin spending his reserve capital to keep in business. Soon he would not have any reserve left. In an emer- gency he would be a bankrupt, and the court would appoint a receiver for the business. Isn't it foolish, then, for a man to spend all of his heart's work force, so that the heart's reserve force must next be frittered away? In an emergency, such a man is a heart bankrupt -and the doctor becomes the receiver for the Spendthrifts and bankrupts. 34 HOW IS YOUR HEART? heart's business. Often it's lucky if society does not appoint the undertaker as receiver. Do you now understand why your doctor insists on your staying in bed a long time- proportionately-when he wants to lessen the demands on the strained business of your heart ? That is the only way he can be sure of replenishing heart reserve; by lessening expen- ditures and increasing the period of heart rest. It takes weeks, rather than days. And yet men of the dynamic, dominant, governing type, who have made a success of every phase of life-men who are accustomed to giving orders, not to obeying them-are sometimes ungracious enough to remark that about all the stupid doctor can do for their heart trouble is to preach rest, rest, rest. Meanwhile, they lie in bed, unwilling prisoners, and fume, fuss and fret away the benefit of rest by assuring everyone within earshot that they cannot afford the time-they have to work for a living, and besides the business is going to h 1 For all the help that such persons give him, it's a wonder that the faithful doctor keeps on caring which goes first-the patient or the business. The reactions of patient and doctor. HOW HEARTS ARE HURT 35 And seek compromise-ye gods! Put a man like that on the shelf for a while in order to replenish his exhausted storage batteries and after the first real night's rest he will start negotiations to reduce the usual six weeks bed- period to three weeks. He will out-junk the Junkers in wrecking the value of his own cur- rency rather than pay the full reparations. Should he need a month's vacation in a quiet health resort, the spirit that brooks no denial will try to crowd the thirty days into a week- end trip at a gay seaside playground. There are mighty good reasons for so many gray- haired doctors. The devil was sick, the devil a saint would be; the devil felt well, the devil a saint was he. So much for an understanding of the heart's dynamic forces. By this time we certainly agree that physical strain and emotional stress can throw a load upon the heart and pave the way for an eventual heart breakdown. But these are only two of the many possible circum- stances in the journey of life that throw a repeated or long-continued load upon the heart to damage it,-and remember, the load must be repeated or long-continued if it is going to damage a well heart, for the heart is not so tender a proposition, physically, as the wails of the love-lorn would lead us to believe. Yes,-Yes; strain and stress: -what else? 36 HOW IS YOUR HEART? Other causes of heart load are faulty habits, over-eating, the abuse and disuse of exercise, previous diseases and hidden infections. They all tend to deplete the work force and draw upon the reserve power of the heart. CHAPTER IV FAULTY HABITS: OVER-EATING Nearly everyone considers his habits as most exemplary as long as he does not indulge in cheating, swearing, drinking and gambling in public. But these are vices, not habits; if one has them to excess he should visit the con- fessional, not the doctor's office. You might be surprised, should you become a heart patient, to find that the doctor classifies under per- nicious habits such apparently innocent pas- times as fumbling with Mah Jongg past mid- night, playing at auction bridge until the eyes swim, going to the theater several times a week and dancing into the morning hours. Such habits certainly are pernicious, for they serve to expend the reserve force of hearts that can the least afford such extravagant expendi- tures. You may be good and still have bad habits. Eating habits may also be harmful,-and in this respect many Americans are dissipated sinners. First among the results of faulty eating habits, doctors place overloading of the Excess bag- gage carried at excess rates of toll. 37 38 HOW IS YOUR HEART? stomach, for it throws a tax on the digestive organs, besides storing up food within the tis- sues for which there is no use,-excess bag- gage, consisting of layers of fat, to be carted around, for which heavy toll is often paid by the heart. Dieting is about as popular a pas- time as filling out an income tax blank; any- thing that makes us get down to brass tacks in our indulgences or extravagances we resent as an intrusion. Therefore but few people are interested in learning how small a quantity of food is actually necessary to support the body; and so most of us choose to live on in contented ignorance of where appetite can lead us, until perhaps permanent damage threatens. There is probably no sentence in the English language which has done more to produce sickness and to perpetuate invalidism than the misguided advice, "You must eat plenty of rich, nourishing food." Surely he was a lineal descendant of Solomon who first observed that The Platter Kills more than The Sword. What you don't eat won't hurt you. Over-eating taxes the eliminating organs of the body. A moment's thought will convince one that digestion and elimination both make a demand on the heart, for digestive juice can be manufactured only when the digestive Paying both an income tax and an outgo tax. FAULTY HABITS: OVER-EATING 39 organs are supplied with a proper amount of blood; hence increased digestive requirements mean additional heart effort. Consider also the demands which elimination can make on the heart; the kidney secretion, for example, is composed of solids and fluids. If we increase our food intake we increase the work thrown on the kidneys to eliminate the products of food combustion; the kidneys must therefore require an excess blood supply of the heart in order to take care of their excess work. More demand on the heart's reserve force! It is little wonder that kidney disease and heart disease so often travel hand in hand and lead the procession in those ills which incapacitate the White Race. Imagine a heart thus depleted of reserve force. Imagine a stomach, once sweet-tem- pered, now sullen and rebellious at the repeated insults of excess provender. Imagine kidneys, struggling to free themselves from an accumu- lation of waste material that clogs the millions of little waste pipes in each kidney. Then the dinner hour arrives; and for no other reason under heaven than that it is seven o'clock- not for the reason that he actually requires nourishment-the gang-boss of these three Acute indigestion anything but cute. 40 HOW IS YOUR HEART? protesting workers sits at dinner and gives stomach, heart and kidneys still more work to do. Shortly the laborers throw up their hands and go on active strike. The face blanches for a moment, the features are drawn, the eyes are set, the limp framework drops to the floor -slow, noisy breathing, flapping cheeks and twitchings of the muscles all bear testimony to the convulsion of Nature that racks the body. "Acute indigestion," the newspapers say. "Uremia," quotes the family doctor. "Paraly- sis of that nerve which supplies the heart, lungs and stomach," says the consulting physician. Take your choice of these diagnoses-you have seen how it all came about, and it little matters what name is given to such consum- mate abuse. Of course such a catastrophe to the house we live in does not fall from a clear sky with- out giving warning signals in advance. Hearts usually stumble before they fall. The signs of approaching danger often consist of a feeling of fulness after eating, together with a sense of oppression about the heart, amounting per- haps to stitches of pain in the left chest. As the oppression is often relieved by belching, vomiting or physics, some people reassure "Gas pressing on the heart'' is usually a myth. FAULTY HABITS: OVER-EATING 41 themselves that the discomfort was occasioned by "a little gas pressing on the heart." That is a risky assumption, and a person who has oppression or pain around the heart should see his physician at once and allow the doctor to make the diagnosis of "gas pressure"-and be assured, he would make it only after thor- oughly excluding a possible heart cause. For doctors, as a rule, realize that when the heart is so easily upset by digestive disturbances there is likely something wrong with the heart. "Gas pressure" is usually a fat man's opinion, -not a doctor's diagnosis. Speaking of fat, there are those who eat "scarcely anything" and still grow fatter and fatter. Scarcely anything at the table, they mean. They do not count the cake of milk chocolate in the morning, said to contain the equivalent in food value of an ordinary meal, nor the bag of peanuts in the afternoon-the ice cream soda on the way home-the bonbons they nibbled last evening-no wonder they eat so little at the table that the family is actually worried about their poor appetites! Maybe there's an after-the-theater supper scheduled -and as digestion takes from three to five Some people beguile themselves. 42 HOW IS YOUR HEART? hours, the stomach that has been working all day must keep working virtually all night, while other bodily structures are resting for the next day's labors. Look at the soda fountains and candy shops on every street. Then look at the over-weight folks who grasp such frequent opportunities to feed, trudging heavily along under the bur- den of only their bodies. In the Arab villages of Northern Africa, where there are no con- fectionery stores and pastry shops to tempt susceptible people to excessive food indul- gence, one sees a different type of humanity. There the slender, graceful natives with baskets poised on their heads walk with the elasticity of youth in their step, despite the dignity of years and flowing beards that are whitened by Time. At noon a nap instead of a midday meal, sitting with legs crossed under them, backs against a palm tree in the village street-and they arise, these old men of an Arab village, as easily and gracefully as they sit down-by employing the muscles of their trunks and legs, not by using their hands and arms as levers to lower or to pry up excess weight. The contrast of the Orient. A lean horse for a long race. FAULTY HABITS: OVER-EATING 43 Think of another result of eating to excess -think of the eventual overhanging cheeks, the double or treble chin, of the folds of fat at the back of the neck, of the festoons of adipose tissue that sag the arms, of the abdomen that makes the lap extend to the knees, of the thighs so thick that it has been years since the feet could be drawn under a chair,-and think of ankles lost to form and charm in plump rotundity! The weigh of the trans- gressor. If the fat would only stay in these super- ficial structures of the body we would not hear of "big, stout and healthy" people suddenly dropping dead from fatty heart. Not only does the heart muscle become infiltrated with fat cells, but an amount of bodily tissue in excess of that which is proportionate to the age and years of a person throws a tax on the fat-damaged heart. This tax simply complies with a law of physics that it requires a given amount of energy to propel each pound of weight; the muscular energy required to move excess bodily tissue from one place to another can be furnished only by the heart supplying the locomotive apparatus with blood for fuel. "Fatty heart." 44 HOW IS YOUR HEART? Fat is sometimes due to an abnormal condi- tion of the thyroid or other glands,-and per- sons so afflicted keep on gaining in weight in spite of reducing their food intake to a point scarcely sufficient to keep body and soul to- gether. So it is mighty good sense to let your doctor direct any reduction treatment before going off on some food fad which is likely so to alter the chemistry of the body, depriving it of certain elements obtained from foods which are necessary for the harmonious work- ing of the system, that the last condition of such a person is worse than the first. Fat may be a sign of dis- ease. Bear in mind, too, that there is such a thing as the body conforming to a family type; you may grow large as you approach maturity, because you come of physically large people. You can be naturally big and robust and even plump-but it is seldom if ever natural for a person to be actually fat. When one finds that he is gaining in weight and that the gain is disproportionate to height and age and family tendency, a consultation with the family doctor is in order. By the correction of faulty habits in diet careful people can often ward off eventual heart dis- ease. Like father like son. CHAPTER V THE ABUSE AND DISUSE OF PHYSICAL EXERCISE Exercise and rest are so interwoven in a rational manner of existence that they are the warp and woof of our physical fabric. While it is scarcely possible to discuss one without discussing the other, let us now consider the habitual perversion of exercise in its relation to affairs of the heart. Harmful habits in exercise. There are extremes in exercise,-athletes especially are quite likely to overdo in this re- gard. The danger in athletic games lies in the element of contest which requires an athlete to push his effort beyond that point where he would otherwise desist. Recalling the formula that excess physical demand means increased heart output, it is easy to see why the heart enlarges and eventually does its most efficient work only under the stimulus of superdemand. A toy balloon can be kept inflated far beyond its normal capacity, and soon the rubber loses its quality of tonicity; when deflated it will not Athlete's heart. 45 46 HOW IS YOUR HEART? shrink to its customary size, for it has been overstretched to the point where it loses resili- ency. When the once youthful athlete reaches a later period in life where athletic contests are no longer inviting or desirable, the flabby heart muscle cannot adapt itself to the simpler physical demands, and thus is produced that inefficient heart muscle within an apparently robust body which we call "athlete's heart." Naturally, a heart of such lowered tone is read- ily depressed by minor ailments and easily upset by infections or intercurrent diseases, and the unhappy possessor is therefore seldom up to the standard of health enjoyed by those about him. A great many more hearts are hurt by insuf- ficient exercise, however, than are hurt by excessive exercise. Many men pen themselves in their business cages for months at a time and neglect to take systematic, daily rou- tine exercise. You never saw a lion neglect- ing his daily exercise, despite the narrow con- fines of a circus cage. And you never heard of a man who did not like to be called a lion, with all that the word implies of dominant strength, agile grace and exquisite poise. Harmful habits in business. FAULTY HABITS IN EXERCISE 47 To be rolled down to the office, comfortably lounging in the deep upholstery of a glass en- closed limousine, without even the exercise of steering the car or changing the gears, is cer- tainly not the way in which primitive Nature intended primitive mankind to collect his food supply for the day. And Dame Nature is always primitive-she hasn't changed her man- ner of doing things for us since the Dawn of Creation, when the Master Mind first ordered her habits, so that she might order ours. Get back to Nature's primitive laws: EXERCISE. When the modern business man arrives at the office building, a bank of elevators saves him the physical exertion of climbing the stairs. Once seated at the desk, office girls and mes- senger boys furnish the feet for the Brains of the Business. An inter-department telephone may further save steps for the Modern Prome- theus-chained to the rocks of business, while the vultures of physical inactivity tear at his entrails. Perhaps the office boy's legs will even be requisitioned to fetch a sandwich and a bottle of milk to the desk for luncheon, saving the executive still further exertion and minutes -minutes for business. "Exercise?" ask him. Of course he exercises; he plays tennis and golf. What part of this exagger- ated picture applies to you? 48 HOW IS YOUR HEART? Last summer's tennis does not furnish to- day's necessary exercise, nor does next Sun- day's golf supply today's physical needs. What we require, if we propose to have our mind sound because it is nourished by a sound body, is daily systematic routine exercise. The head of a match is of very little practical use unless the stick is firm and sound enough to withstand pressure. One can attend to the schedule of daily business and attend to the schedule of daily exercise just the same, and thus keep fresh, invigorating blood circulating in the brain. Of course there are some men who seem to require very little exercise in order to keep fit and for whom diligence in business seems to furnish sufficient exertion. Such men may attribute their physical well-being to occa- sional excursions into the field of sports. But it is probable that they continue to be physi- cally fit regardless of the sporadic exercise, rather than as a consequence of it. Unless experience has proved that you belong to the fortunate minority just mentioned, ask your doctor to help you with this problem of adapt- ing simple, regular, daily exercise to your business. It is TODAY'S exercise that counts. FAULTY HABITS IN EXERCISE 49 What penalties may the heart pay for the lack of exercise? When we do not exercise we do not eliminate properly. Poisons accu- mulate in our bodies and these poisons may throw the heart out of kelter. But even more than this, when we fail to systematically exer- cise our muscles, they become soft and incapa- ble of withstanding any sudden demands thrown upon them. The heart is a muscular structure,-and it can become so accustomed to putting forth only a minimum amount of exertion that it is eventually too lazy to re- spond to unusual or sustained physical or mental demands. Result: languor, lassitude, weakness, lowered resistance, and the body is therefore an easy prey for those germs that happen to be hanging around in clusters at some particular moment. When you were a boy your vigorous, robust grandfather used to catch a cold and then set out to "work it off"; and he succeeded in working off the cold, for his body was made of stern physical stuff by the muscle-building efforts of the nation- building men in the pre-limousine age. The life of to-day is not conducive to such body building-Heaven help the average grandson who tries to work off a cold nowadays I Lazy heart muscle. 50 HOW IS YOUR HEART? The lack of physical preparedness of the present generation was well illustrated during the influenza epidemic which swept through America during the World War. There was a tremendous demand on the man-power of the country, and thousands of people had to emerge from the accustomed, easy routine of their business life and suddenly tackle larger problems. Perhaps it was long hours, over- time, increased production, taking on in addi- tion to one's own work the job of the lad who went to the front-added responsibility, added care, anxiety, emotional stress-these were the factors that depleted an already slender stock of physical reserve, and influenza spread like wildfire amongst such physical tinderwood. In time of peace prepare for war. The heart must bear the brunt of any germ invasions. That is why you have often heard the doctor say of a sick friend, "He will recover if the heart holds out." It is a mighty good reason why the heart of the modern business man should be educated by systematic, daily, routine physical exercise to withstand more than the accustomed demands of daily business. Long-term Insurance. CHAPTER VI PERILOUS STUFF WHICH WEIGHS UPON THE HEART Worry, emotional disturbances and kindred Disorders of Thought have a definitely estab- lished and long-recognized relation to the production of heart affections. That the rela- tion is definitely established is attested by the care with which physicians universally guard seriously ill patients from the possible intru- sion of depressing thoughts by excluding even best friends from sick rooms. That the rela- tion has been long recognized,-even back in the days when hellish brews and witchcraft were considered remedial agents,-is shown in literature by the fervor with which Macbeth entreats the physician for an antidote to "Pluck from the memory a rooted sorrow, raze out the written troubles of the brain, cleanse the stuff'd bosom of that perilous stuff which weighs upon the heart" The brain, too finely wrought, preys on it- self and is destroyed by thought. 51 52 HOW IS YOUR HEART? There is always abundant solicitude in ad- vanced cases for the mind distracted, the heart bowed down or the body wrecked by sorrows, anxieties, fears or sustained emotional tension; yet, strangely enough, there is little general appreciation of the fact that these mental loads have a simple beginning. Hence there is often scant sympathy shown for the one who is dis- trait, introspective, uncommunicative, queru- lous, cranky, cross or in other ways unlike his former self. Recognized in that early period, acute mental suffering can often be cured; but indifference or neglect on the part of those who can minister to the one afflicted may dam- age the heart irreparably. The heart has been reported to have actually burst open-as a paper bag full of water might do-when a person was driven almost frantic with distress- ing emotions from which there was neither escape nor relief. ''Broken Heart not always a figure of speech. Macbeth's physician acknowledged the in- ability of the medical profession to cope with Disorders of Thought when he said "Therein the patient must minister to himself." Nor have things changed much, as far as medical aid is concerned, since the days when Shake- Sympathetic understand- ing the best remedy. HARMFUL HABITS OF THOUGHT 53 speare wrote. True, the physician of today can recognize the beginning of malign mental states and can enlist the aid of the patient and arouse the sympathy of unobserving relatives, towards removing the cause of the obsession ere it becomes a permanently fixed habit of thought. Perhaps this little volume may be able to point the way to relief by drawing attention to a few of the more common anxi- eties and emotional strains that derange the heart. There is one pet dread which is so easily remedied that it can be mentioned first in order to dispose of it. A surprising number of people harbor the conviction that they have some mortal malady that blights their present and shrouds tomorrow in dread uncertainty. And they studiously avoid the doctor for fear that he may find something wrong which they would sooner not know of absolutely. From this class is recruited many of the cases of cancer that are too late for operation, as well as many cases of "weak heart" that are but a reflection of the influence of worry and concealment. All on account of an unreasoning dread of going to the doctor! Concealment feeds on damask cheeks. 54 HOW IS YOUR HEART? People who whirl along in the accustomed affairs of their routine days have little appre- ciation of the heart and circulatory derange- ments that often attend the homesickness and distressing loneliness which ensues from a com- plete upheaval in an accustomed manner of living. Physicians of boarding schools recog- nize the physical unfitness of pupils so afflicted; where the interest of sympathetic principals is unavailing, a brief return to the longed-for scenes is often the only effective remedy in restoring heart balance. Such relief was not possible for the unschooled boys of the Ameri- can Expeditionary Force, many of whom, de- pressed in mind and body by the ever-increas- ing miles that separated them from all that they cherished, succumbed to illnesses which otherwise would in all probability have left them unscathed. Homesickness and heart* aches. Sacrifices of self on the altar of Duty and Circumstance are all too frequent, even in this pleasure-seeking age. The man who has de- voted himself so closely to business that he has gone stale on the job can find relief in a vaca- tion which is free from responsibilities. The woman whose household cares pall on her to such a degree that it is irksome even to plan Ties that bind and chains that fetter. HARMFUL HABITS OF THOUGHT 55 the day's meals, can relieve the dread monot- ony by getting away from home for a few weeks. Artistic natures that attempt hum- drum occupations as a means of livelihood can be on the lookout for positions more suited to their temperaments. The friction which arises between married couples who are eternally together can be relieved by one taking a vaca- tion elsewhere while the other enjoys the same vacation period amid familiar home scenes. Less fortunate are those married people who are utterly out of harmony with each other and who are bound by considerations of church, society or family to endure in silence the heart- aches and bitterness of domestic incompata- bility. For them must be only such relief as is offered by intense concentration along fresh mental lines; yet always an undercurrent of unhappiness threatens, ready in an unwary moment to engulf them again in the depths of feeling. Emotional stress does not affect alone the heart of those unaccustomed to the battles of life-it is related that the sturdy warrior Grant admitted to a stopping of his heart and a feel- ing of faintness when the news of Lee's It's a man's job. 56 HOW IS YOUR HEART? surrender was handed to him. It takes the courage of a soldier to overcome the emotional strains that may play upon the heart strings and it requires the studied cultivation of a bright and sunny optimism to repel fresh dis- cords that eternally threaten the harmony of life. So far we have spoken of mental rest and emotional rest as measures with which to repel the insidious onset of heart disturbances. Rest for the Mind and Rest for the Spirit are two members of a triad which is completed by Bodily Rest. Too few of us take the time for complete physical relaxation during the day. A midday nap of an hour in a quiet rest room is unknown to the modern man of affairs or to the housekeeper; at the other end of the social scale the laborer is on his feet all day, the scrub woman is on her knees, and so the strain of posture is thrown on blood vessels from morning to night, with never a respite while the heart puts forth increasing effort to maintain the column of blood in elastic vessels at a level sufficient for supply to equal demand. The Arab, with his noonday siesta, is far more clever than the astute American business man The strain of sustained posture. HARMFUL HABITS OF THOUGHT 57 when it comes to knowing how to save his cir- culatory apparatus for a mellow old age! Mental Rest, Emotional Rest and Bodily Rest each bring their greatest degree of re- freshment when all three meet in sleep. And yet very few of us make any actual preparation for sleep. Slumber does not come at will to minds that are kept alert until bedtime by exciting games or stimulating pleasures. Ac- customed forms of thought are also repelling to repose and often steal an hour or two from the eight to which we are entitled out of the twenty-four-eight for work, eight for play and eight for sleep. The pernicious habit of reviewing the day's work and planning to- morrow's routine at bedtime is responsible for much of the wakefulness of which people com- plain. Most of us cannot take our responsibili- ties to bed with us. To do so is simply to burn a hole into the comforting blanket of night; and through that hole the cares of today creep insidiously into tomorrow. Slumber is best wooed by physical quiet and by a complete change of thought for half an hour before retiring. That is why Bible reading is such a splendid bedtime diversion in this grinding modern world; it leads us into quite unaccus- The Gideons placed those hotel Bibles ■wisely. 58 HOW IS YOUR HEART? tomed fields of thought that lack excitement; and by restoring our Faith in the things of life that are really Worth While, such reading helps us to forget the perilous stuff which weighs upon the heart. CHAPTER VII HEART LOADS IMPOSED BY DISEASE, PAST OR PRESENT So far, we have spoken of habits, emotional strain and faulty ways of living as having a direct influence on heart health. They are circumstances which for the most part are within control of the individual. When one feels that one's heart health is not quite as it should be, certainly the most logical first step in investigation is to inquire into one's habits, daily life and other circumstances within the individual's control. Correction of individual faults may relieve the symptoms of heart pro- test. Circum- stances within control of the individual. It may happen, however, that one has been leading an ideal life from the standpoint of personal health care (health care is so much more expressive than the word hygiene) and has still not succeeded in correcting disquieting heart sensations. Every once in a while and often without sufficient cause, there arises a feeling of heart consciousness-not heart pain, You should not know you have a heart. 59 60 HOW IS YOUR HEART? not heart hurry, not heart oppression-simply heart consciousness. In such a case, the next logical step is to search for circumstances be- yond control of the individual,-conditions which are known to have both an immediate and a remote effect upon the heart. Circumstances which are beyond control and which can at present be affecting the heart include: Circum- stances be- yond control of the individual. 1. The diseases of childhood; 2. Acute diseases, either recent or remote; 3. Chronic diseases, mild or unsuspected; 4. Focal infections. Let us put that term "focal infection" in our vocabularies right now-no one can speak of present-day medicine without using it. The word "focus" means "concentrating point." Hence focal infection means that infection is concentrated at a point, as distinguished from an infection that is diffused throughout the body. An abscess at the root of a tooth is a focal infection; the infection is localized. Syphilis is a generalized infection; it is dis- tributed by the blood to any or every structure in the body. EFFECTS OF PREVIOUS ILLNESS 61 Continuing with our search for a cause of heart protests, we logically begin with infancy and come up through the intervening years. Heart trouble may exist from birth. At birth one might have been a "blue baby." Nature provides an opening between the red blood side and the blue blood side of the heart in order that blood may be propelled through the body of the unborn child; and Nature sees to it that this opening closes shortly after birth. That is why even old grannies lay a new-born baby on its right side,-to facilitate the closing of this no-longer-necessary open- ing. But when the opening fails to close-it may persist for days or for years-the red and the blue blood mixes and the baby has a decidedly bluish hue, strikingly noticeable when it cries. Of course the child is delicate -its bodily tissues are under the necessity of trying to extract sufficient nourishment from blood, some of which has been used before, none of which carries that full quota of nour- ishment of which each droplet is normally capable. Yet many such children live to grow up and prosper during adult life in clerking or other positions which require but little physical effort and no physical strain. 62 HOW IS YOUR HEART? There are other birth defects of the heart, but they are too rare for general discussion. The "patulous foramen ovale" (the persis- tently open oval window in the partition of the heart) which has just been described is the most frequent birth defect. Convulsions in childhood are important in the history of a person, and the doctor who is searching for earlier evidence of heart load will want the patient to be accompanied to the office by an older relative who can describe such attacks and thus enable him to distinguish be- tween really significant seizures and the all- inclusive term "infant colic." Soothing syrups and paregoric have lulled more than one mother into a false sense of security about her child and have permitted the undermining of health to go on until it is later reflected in heart disturbances. Plaintive cries are not for paregoric. "Growing pains" have nothing whatever to do with growing-except to retard it. Sup- posed for generations to be one of the preroga- tives of childhood and therefore smiled on indulgently by parents, the words "growing pains" should be stamped out of the vocabulary of mothers henceforth and forever. Modern medicine has investigated "growing pains." "Growing pains'' have grown perilous. EFFECTS OF PREVIOUS ILLNESS 63 It is a blanket term that is thrown as a cover over the vague muscular aches and indefinite nerve pains of mild rheumatic fever or other infection. Being of only moderate severity, the doctor's advice is usually not sought; a neighbor calls them "growing pains"-as the child grows of course they will be outgrown!- and so the youngster is allowed to pass, often for months, from one mild attack of rheumatic fever into another until sooner or later the heart is affected by the poisons of that arch enemy of childhood, rheumatic fever, which seems to have a special affinity for heart tissue. St. Vitus' dance should come in for promi- nent mention when speaking of the "rheumatic group" of diseases in childhood. Any child that has it should be carefully watched for heart involvement not only during the active stage of the disease but also at stated intervals thereafter. St. Vitus' dance is capable of pro- ducing heart defects long after the child has, to all appearances, fully recovered from the invasion. The infection so often remains hid- ing in the tonsils that the only future safety lies in removal of the tonsils during a quiet period, when they are not actively inflamed. This statement concerning tonsil-removal ap- Baby robbers. 64 HOW IS YOUR HEART? plies with almost equal force to "growing pains" and frank rheumatic fever; so much so, indeed, that some heart hospitals for chil- dren insist that the recurrence of invalidism be guarded against by the removal of tonsils before the admission of a patient who has had St. Vitus' dance, "growing pains" or attacks of rheumatic fever. These three diseases are now regarded as cowardly robbers, lurking in ambush to steal the heart health of children. Have you ever heard it said "The children might just as well get all the diseases of child- hood now and have them over with"? The person who generations ago first uttered that gem of colossal ignorance must be having a painfully hot time of it now-if just retribu- tion exists in the hereafter. By the same logic, why not stand the unprotected child outdoors in the driving storms and biting winds of early winter, so as to harden it to withstand ex- posure ! Some old Herod coined it. Today we know better than to give voice to such thoughts. Mumps, chickenpox, whoop- ing cough and measles are quite generally regarded as innocent little companions of childhood. This in a general way may be true of mumps and chickenpox. It is perhaps true The • 'inno- cent" dis- eases of childhood. EFFECTS OF PREVIOUS ILLNESS 65 of whooping cough, although one who, with scientific apparatus, watches the heart cham- bers enlarge during the violent paroxysms of strangulating cough, must fear for the future efficiency of a heart thus repeatedly strained. But those who saw the prostrating effects of measles among adults in war-time hospitals conceived a deep respect for this "innocent" disease and marveled at the inherent natural strength of childhood that can so often pass through measles with so little immediate incon- venience. When the ears discharge or when "pneumonia" develops either during or as a consequence of measles, the heart is likely to give evidence of struggle with the new in- vasions, and if they are severe the heart may be damaged in after life. Old-fashioned folks used to give children hot tea in order that the measles would not "strike in." Now that the disease is believed to be an infection that probably travels by way of the blood stream to any part of the body as well as the skin, the idea of measles "striking in" is not so archaic as it sounds. Furthermore, the possibility of the blood-pump sharing in the blood-infection should result in more attention being paid to 66 HOW IS YOUR HEART? the heart during measles and during recovery therefrom. Diphtheria is a notorious heart wrecker in childhood. Twenty-two per cent of the chil- dren affected with this disease develop heart conditions. Of the twenty-two per cent, many recover from the immediate heart involvement, only to show an aftermath later in life, in hearts that are less efficient than they should be. The immediate peril in diphtheria is heart paralysis-striking as suddenly as a bolt of lightning from the clearing skies of approach- ing recovery-after the heart has borne the brunt of the blackened storm, after the young- ster has recovered sufficiently to smile from the pillow and take an interest in toys again. In dozens of communities the story is told of a child almost recovered from diphtheria who sat up in bed and asked for a drink of water and who, without a sign of warning, dropped in death. The untimely suddenness of the disaster is appalling. The bolt from the brighten- ing skies. But there is a preventive for such a catas- trophe-a remedy as certain as any preven- tive or cure in all of medicine. It lies in the early use of diphtheria antitoxin in sufficient^ dose. Antitoxin that is used after the child The lightning arrester. EFFECTS OF PREVIOUS ILLNESS 67 is stuporous with poisons is of little avail- antitoxin that is used in timid dose only creates a false sense of security. When the remedy is put in a vein on the first suspicion of diph- theria-within the first thirty-six hours of invasion, even before a report can be hur- ried back from a laboratory-the heart is al- most invariably saved from catastrophe. It is impossible for antitoxin to harm a diphtheria patient. Careful study has proven that any ill-effects from which the child may later suffer are due to the poisons of diphtheria, which either got a start in advance of the anti- toxin or which smoldered along because the remedy was not used in sufficient dose. No harm can come from antitoxin. Nowadays medical progress has gone fur- ther than the cure of diphtheria. It is possible, by the simple "Schick" skin test, to deter- mine in advance whether a child is predis- posed to the disease and even to so immunize that child (with a substance called toxin- antitoxin) that it cannot acquire diphtheria if an epidemic should break out. Think of the hearts and lives, heretofore needlessly sacri- ficed, which will be saved by this precautionary measure on the part of parents! The crowning triumph of modern medicine. 68 HOW IS YOUR HEART? Scarlet fever affects the kidneys of a child as notoriously as diphtheria affects the heart, although not with such frequency nor to such a lethal extent. The kidneys may not give evi- dence of damage until years after; but when the kidneys are involved to any degree, heart symptoms are likely to arise. One of the most necessary things to know about scarlet fever is that the depth of color and the degree of illness and the amount of scaling bear no re- lation whatever to the degree of kidney in- volvement. A child who is desperately ill with scarlet fever may totally escape kidney involve- ment,-while a child with a neighbor-made diagnosis of "scarlet rash" which lasts for only a few days may develop a profound kidney affection. Inefficient kidneys throw a load on the heart, regardless of what disease or circum- stance is primarily responsible for kidney de- ficiency. "Scarlatina" and "scarlet rash" mean scarlet fever. Passing from the diseases of childhood to what we can for convenience call the acute diseases of young adult life, there are three- pneumonia, typhoid fever and acute rheumatic fever-which are likely to have an effect on the heart. The poisons of pneumonia are so likely to overwhelm that heart failure is the Acute diseases of adult life. EFFECTS OF PREVIOUS ILLNESS 69 critical feature in the treatment of the lung disease. Typhoid fever, once the community scourge of spring and fall, is becoming a rare disease, thanks to antitoxin. In a person who has just recovered from typhoid fever the pulse is usually very slow and lacking in force, bear- ing testimony to the battle of weeks which was waged between the heart and the infection. One should not confuse the much used term "rheumatism" and its vague, indefinite mus- cular aches, with acute rheumatic fever, which prostrates its victims for weeks with joints so swollen and painful that often the weight of bed coverings is unbearable. Acute rheumatic fever occurs frequently in young adult life and is so prone to produce heart involvement that the assertion has been made that the heart is always affected; certainly a very much exag- gerated statement, and yet of value in showing how often the heart-more particularly the valves-participate in the distribution of poi- sons. Infective tonsils are responsible for a great many cases of acute rheumatic fever. Acute rheu- matic fever is not soon forgotten. Influenza epidemics usually leave an after- math of heart affections. In exceptional cases the infection may persist in the body and con- tinue to weaken the heart; but as a usual thing A stitch in time. 70 HOW IS YOUR HEART? the heart weakness is due to the fact that the victim did not go to bed and take prompt care of himself during the period of invasion, and further failed to stay in bed for sufficient time in which to complete the recovery. "Goiter heart" refers to the rapid rate, chest pounding, general physical weakness and nerv- ousness which is sometimes associated with an enlargement at the base of the throat. It is no longer necessary for patients who do not find relief from the usual methods of treatment to go through life with a "goiter heart," for the X-ray specialists and the surgeons are of- ten able to distinctly benefit the condition. "Goiter heart.'' Tuberculosis and diabetes are at times ac- companied by periods of heart disturbance which, for the most part, takes the form of unusually rapid heart action. Later in the course of these protracted, exhausting diseases the heart rapidity becomes an established fea- ture of the illness, as the heart is driven not only by the poisons or altered chemistry of the body but also by the demand of starving tissues for blood nourishment sufficient to carry on their duties. What is true of exhausting dis- eases is also true in principle as concerns under-nourishment or lack of sufficient nour- Tuberculosis, diabetes and under- nourishment. EFFECTS OF PREVIOUS ILLNESS 71 ishment from any cause,-be it the inability of the stomach to digest food, the disgust for food which drug addicts feel, the unbalanced rations of armies in action, or individual in- stances of improper diet such as self-willed children are often permitted to exhibit. The attempt of the heart to supply the tissue de- mand for a full quota of nourishment speeds up the rate and weakens the heart. In this connection may be mentioned the influence which blood deficiencies frequently exert on the heart. When certain constituents of the blood are less than their usual quantity, the blood is of course less nourishing than it should be. The heart itself requires a great deal of blood. When it does not get enough, the heart is likely to show the lack of nourish- ment before any other organ in the body; and it is likely to be the last organ to respond to blood-building treatment. The reason is plain; the heart continues at work while other organs dare enjoy brief holidays in which to build up. Blood deficiencies. If there were only one source of venereal disease, discussion of the subject might be without point to the readers of this volume. However, such infections can be acquired in many ways and without any moral obliquity Infections may be innocent or accidental without pollution. 72 HOW IS YOUR HEART? whatever,-as the inherited taint of a child; the innocent and unintentional contamination of a wife by a husband once pronounced cured but in whom infection smoldered; the acci- dental contacts with infected drinking cups, filthy public places, etc. Hence it is necessary to know what effect these diseases may have upon the health of the heart. During the active infection, the gonococcus germs may attack and deform the heart valves and heart muscle, and the person so infected can hope to escape these complications only by strict obedience to instructions concerning rest. While such com- plications are fortunately rare, there is no telling in what sort of case they might arise, and the heart involvement is nearly always of such profound severity that the battle wages for weeks and often months. In syphilis heart involvement is not rare. It is to be expected, but not during those earlier stages of the disease which are so vividly described in the thirty-eighth Psalm. A con- siderable length of time elapses before the heart gives signs of being involved in syphilis -indeed, many doctors believe that the aver- age lapse of time is fifteen years. Probably the heart invasion has been quietly going on for The treachery of King David's dis- EFFECTS OF PREVIOUS ILLNESS 73 some time; at any rate, when the earlier stages are so far past that they are all but forgotten, the heart signs put in vigorous appearance and advance rapidly in severity. One who has thought himself cured of syphilis may be dis- mayed to find, at a late date, that the "cure" has broken down, unannounced and unknown to him. Physicians who specialize in this dis- ease make repeated and periodic examinations of patients who have once been infected, and by such vigilance prevent syphilitic heart wreckage or at least greatly minimize the dam- age. The blood-vessels suffer with the heart. A man of thirty-five with syphilis of the heart and blood-vessels may have arteries as hard as the average man of seventy-five,-and one will be as old physically as the other. The heart panteth, the strength faileth. The most important point to remember con- cerning syphilis is that no degree of perma- nency can be attached to its cure; the patient must receive medical observation at stated periods to insure freedom from taint. Another important point is that syphilitic involvement of the heart, no matter when it appears, usually advances from one degree to another with such rapidity that there is little time to lose in seek- ing medical advice. The third point to remem- Eternal vigi- lance is the price of-a free circulation. 74 HOW IS YOUR HEART? her is that modern medicine can hold the dis- ease in check and often in complete subjection -but modern medicine must not be hampered by the patient's neglect or disregard of instruc- tions. The youth who is secretly contemplating a future day when he can scatter a handful or two of wild oats should turn to the seventh chapter of Proverbs. There he will find the wisest man of all the Ages looking at him with eyes as keen and penetrating as though he were appraising a street scene of today. It is a pity that King Solomon, in relating this tale of a youth void of understanding, did not wind up his graphic picture of the shameless, dis- reputable affair by using the word syphilis rather than its poetic equivalent, "A dart . . . through his liver . . . for life." As an ox goeth to the slaughter. Previous operations may have a direct bear- ing on the heart. The manner in which the patient bore the anesthetic, the time duration of the operation, the extent of surgery per- formed and the time required for healing-all enter into the appraisal of a heart. Repeated operations suggest that the same cause which required surgical interference may also have Cutting re- marks. EFFECTS OF PREVIOUS ILLNESS 75 affected the heart. Operations on different organs may mean that a common cause of all is still present in the body and possibly influ- encing the heart,-as when joint abscesses, gastric ulcer and carbuncles have been caused by the distribution of pus that is hidden at the end of a tooth. Having examined the above long list of pre- vious diseases which, however remote, might be the cause of present day "heart conscious- ness," many seekers after heart health will exclaim, "But I never had a day's illness from any such diseases, and yet I am conscious of something not quite right with my heart." Scores of heart patients never were ill before. This is the type of person of whom some- times it is said: "She has complained of her heart for months, and has been told repeatedly that nothing whatever is wrong with it. I wonder if she does not just imagine that she has heart trouble?" Thus is the stigma of such terms as neurotic, highly imaginative, hysteri- cal, etc.,-together with their implied meaning of sham, pretense and counterfeiting-un- justly fastened on a seeker after health. If one is deterred in the search for relief by such superficial comments, the heart eventually may Counsel as profitless as water in a sieve. 76 HOW IS YOUR HEART? be damaged beyond relief. There are further sources of heart protest which require investi- gation before a person supinely accepts the reassuring counsel of a too-candid friend that "only imagination" underlies the heart con- sciousness. So when there is nothing in the past history sufficient to have once thrown a load on the heart; and when there are no present faulty habits or emotional strain to correct, then there certainly exists some present condition which is responsible for the sensations of heart con- sciousness. An inquiry should therefore be instituted to locate a hidden focus of infection somewhere in the body. Search the past, then search the present. Focal infections which are affecting the heart may be attributed to such unusual sources as discharging ears, nasal sinus infections, gall bladder disease, ovarian infections, etc. But it is rare indeed for these conditions to affect the heart, for the reason that there is in each instance a natural channel through which the infection can be discharged. However, when infective material is pent up or under pressure, it is then most likely to be driven into the sys- tem and carried to the heart. By far the more The hidden causes of many a heart affection. EFFECTS OF PREVIOUS ILLNESS 77 common and more serious focal infections are found in the teeth and in the tonsils. Indeed, they are of sufficient importance and of such frequent occurrence as to warrant separate and detailed consideration. CHAPTER VIII THE TEETH VERSUS THE HEART Just as soon as a medical man of modem training begins to make an examination of a patient's teeth, the patient goes on the defen- sive. Very few people can grasp the idea that there is a direct connection between tooth de- fects and heart conditions. Furthermore, most persons are so scrupulous in the care of and daily attention to their teeth that they rather resent dental inspection by a physician. Throw up your guard! Such a patient may feel that she goes to the doctor to find out about her heart, not to have her teeth criticized. The idea! To insinu- ate that she does not keep her mouth clean- and the doctor must mean that if he searches for tooth trouble, for all the magazine adver- tisements say, a clean tooth never decays. Medical inquiry, too, might mean the extrac- tion of a questionable tooth that dentist and patient have been fighting hard to save. So it is likely that one or all of these mental proc- The insinuat- ing doctor. 78 THE TEETH VERSUS THE HEART 79 esses put the patient on her guard to defend her teeth. The doctor, however, is used to such resist- ance. He next inquires, "May I ask how many of your teeth have been X-rayed?" "Yes, the dentist took pictures of this one after he filled it and said my teeth were all right." One out of thirty-two-an X-ray of one tooth guarantees the integrity of all the others-isn't that ab- surd! What can such a superficial assurance of tooth health as this possibly amount to, when even a first-year dental student knows that there is no way under heaven of excluding the teeth as among the possible causes of heart and other troubles until each and every tooth has first been properly studied by properly taken X-rays. Of course there are several sci- entific tests to be made of the teeth after the X-rays are taken; but from a medical stand- point, the X-ray is the first step in tooth inves- tigation. Public health is going to be better served when the last of the guessing dentists retire and give place entirely to Dentists of the Modern School who have such superb training in the relation of tooth affections to bodily disease that, truly has it been said, the Tooth car- penters vs. dental surgeons. 80 HOW IS YOUR HEART? future hope of preventive medicine lies in the hands of the Modern Dentist. How can tooth defects disturb the heart? Principally in three ways: first, by an insuffi- cient or tender chewing surface, resulting in the food not being properly masticated before being swallowed, thus producing digestive dis- turbances that in turn affect the heart. Second, by the infectious material that so often exudes from soft, tender and swollen gums which may also bleed easily-that is pyorrhoea. The word means flow of pus, although it is seldom so bad that it actually flows. It is no criticism of your personal habits to have pyorrhoea-it does not necessarily mean that you neglect the daily hygiene of your mouth. Pyorrhoea is often due to the presence of germs which have worked down between the teeth and the gums, -and it can be acquired through no fault of your own, just as can any other germ invasion. Why all this hullabaloo about teeth? Pyorrhoea,- in a heart book! Pyorrhoea, possibly, can affect the heart directly by the absorption of infection from pockets of pus,-that, however, is certainly rare, for all pockets have openings. It more often affects the heart indirectly, by the diges- tive disturbances that arise from each mouthful of food being squeezed between teeth that Watch your bite at forty! THE TEETH VERSUS THE HEART 81 exude infection with every bite, sending the stomach an otherwise dainty morsel, germ- saturated, to dispose of as best it can. The stomach disturbance in turn affects the heart. In many persons at the fortieth year of life the gums naturally begin to recede and loosen- that is the time when germs are most likely to gain ingress between the teeth and gums. However, neither an insufficient masticating surface nor pyorrhoea can be compared in their heart effects with the third and most common dental condition of all, which is abscessed teeth. The root of a tooth,-that end which is buried from sight in the jaw bone,-may be resting in a long-standing abscess, and infec- tive material from this source may be seeping into the near-by vessels, contaminating body- streams and you never know it. Any part of the body may be affected by the constant, steady source of poison. Abscessed teeth a menace. For example, when a muscle is the part most affected, people call it "rheumatism"; if a nerve is irritated, it is called "neuritis"; if the side of the face aches, if the temples throb and if the eardrum has sharp little twinges of pain, these signs of pus-absorption are labeled Heart PRO- TESTS are not heart DISEASE. 82 HOW IS YOUR HEART? "neuralgia." Stomach, kidneys or liver may each be the point of attack, and when any of these structures are affected their disturbances make extra demands on the heart, cut down its period of rest and the heart sooner or later protests. Under such circumstances people say, "I had a pain in my heart last night, a feel- ing of tightness in my chest; my heart dropped a beat and then it palpitated furiously; I must suddenly have acquired heart disease!" and off they rush to the doctor, panic-stricken. This is the usual course of events in the vast ma- jority of cases; these are heart protests, not heart disease. But in rare instances the poisons attack the heart valves or the heart muscle itself, and then that faithful organ seems to be driven fairly mad; the patient cannot go to the doctor,-the doctor in such instances visits the patient, who is feverish, bed-fast and distinctly acutely ill; a long uphill pull is in sight for patient and doctor alike, recovering from severe heart prostration. What causes abscessed teeth? Broadly speaking, any circumstance that injures the central nerve, which originally is in every tooth, may result in an infection and death of Some things that we ought not to have done. THE TEETH VERSUS THE HEART 83 the nerve; an abscess may then form at the root. The nerve may be injured, among other causes, by defects in development; by straight- ening of the tooth, sometimes; by the teeth being naturally soft; by accidents; by a break in the enamel of a tooth, perhaps through bit- ing threads or using unsuitable toothpicks, thus permitting germs to gain access to the soft parts of the tooth; by the repeated shocks of extremely hot or cold drinks, which constrict the tiny blood-vessels that supply the nerve, thus reducing the nerve's vitality; by systemic or blood diseases, which also reduce the vitality of the nerve or actually carry infection to it; by the inordinate eating of sweets (including chocolate), some say, claiming that sweets change the character of the saliva in which the teeth are bathed, thus permitting tooth decay; by external decay, no matter how vigorously the teeth are brushed; and last, but by no means least, countless abscessed teeth have been caused by the dentistry of other days (which many mouths still carry!), such as nerve killing for bridge work, grinding down of adjacent live teeth for bridge abutments, crowning of hopeless tooth stumps, etc. 84 HOW IS YOUR HEART? So you see that a clean tooth does decay, despite the blare of the advertising pages to the contrary. - A grower of fancy apples might just as well broadcast the slogan, "A polished apple never decays"-were it not for the fact that most of us know something about apples. Ananias a mere beginner. No matter what causes an abscessed tooth, you may have one or a dozen in your mouth and actually not know it. The long-standing infection may be there, sealed in and shut off from free escape (unlike an ordinary skin abscess, which ruptures and escapes freely on the surface); meanwhile the pus from it is being slowly absorbed and thus affecting the heart, mind or body. Trouble may find us 'way down in the mouth. Can you imagine what happens to that pent-up abscess at the end of a tooth when your 280-pounds-pressure bite grinds down on it? Where else can some of the infective mat- ter be driven under such compression, except into adjacent vessels that carry it anywhere and everywhere in the body? Regular cave- man force. Occasionally an acute abscess will open on the surface and, as the pus then has free escape, this variety is not so likely to affect the heart as is the infinitely more frequent chronic Detecting the abscessed tooth. THE TEETH VERSUS THE HEART 85 variety, which gives no sign of its presence. X-rays that are properly taken not only reveal shadows that on further tooth study prove to be abscesses, but also often detect those that are in process of forming, by showing an un- natural thickening of the membrane which is between the tooth root and bone. Even the X-ray cannot always detect abscesses, espe- cially if they are on posterior roots,-so the pictures should invariably be taken from the X-ray specialist to a modern dentist who will supplement the film-studies with a thorough clinical testing of each tooth. There was a time, not long ago, when teeth were required to prove their innocence, and such an attitude resulted in the extraction of many teeth on suspicion. Today teeth are required to prove their guilt, and the distressing wholesale ex- tractions practiced in the recent past no longer shame the medical and dental professions. Abscessed teeth are a most prolific source of bodily disease-both from an experimental and mathematical point of view. From an experimental standpoint, let it be said that a modern laboratory investigator had patients who were operated on for ulcer of the stomach Remarkable recent experi- ments incrimi- nating the teeth. 86 HOW IS YOUR HEART? and also for diseased kidneys. He had the teeth of these patients X-rayed, and found ab- scesses at the ends of some teeth in the jaw bone. This scientist secured some of the tooth pus when the abscesses were removed and injected it at the ends of the teeth of two dogs, by drilling a hole in the teeth of the canines and "killing the nerve," just as many dentists used to do. Lo and behold! A little later the dogs were etherized, operated upon and it was found that one had developed an ulcer of the stomach, while the other dog had a diseased kidney, just like each of the human patients from whom the tooth-pus was taken. What is meant by the statement that abscessed teeth are 'mathematically a prolific source of heart and other bodily disease? Let us state the proposition this way: you have in your abdomen only one appendix. If there were a drop of pus in that appendix the chances are it would give pain,-a cramplike, colicky pain that would upset the household in the dead of night, rout the doctor out of bed and land you in a hospital by daybreak. Cause of all this commotion, one drop of pus. Now, in your mouth you have thirty-two teeth. If there Only a tooth- ache. THE TEETH VERSUS THE HEART 87 were a drop of pus at the end of any tooth, you might be awakened with a throbbing, jumping, roaring pain in the jaw and about all the sympathy you would get would consist of a bottle of cloves and a hot-water bag, shoved at you with rather scant ceremony and perhaps with lack of sympathy, because you had "only a toothache." By morning the pain would be gone-by noon perhaps forgotten. Another protest, more feeble than the first, might be registered a few days later and this danger signal-this sign of nerve death-you would likely greet by ejaculating "There goes that d tooth again," and then promptly forget it, or the only reminder you ever have might be a sharp pain for a moment or two when drinking hot liquids,-the heat causing gas in the abscess to expand, producing pressure on adjacent nerve ends. Or you might have no sensation whatever. Meanwhile the absorption of pus goes quietly on, probably for years. Somehow you don't feel quite up to snuff; you blame the weather, or that piece of pie, or the brand of cigars you smoke, or any other inconsequential trifle in your daily life. 88 HOW IS YOUR HEART? Thirty-two teeth,-some with two roots, others with three; forty-six roots in all. Each root a possible area of abscess formation. Likelihood of poisonous pus in the jaws to poisonous pus in the appendix, forty-six to one! There is certainly a mathematical basis for saying that the teeth are a most prolific source of heart and other bodily disease. And yet the ultra-conservatives say, "This tooth business is being overdone nowadays!" As a fisherman, would you cast your line in the riffles of a brook where you had seen one trout disporting, or would you cast in the pool where you knew forty-six were agitating the deeper waters ? Is there really too much atten- tion paid to teeth nowa- days? If only dll teeth would die painfully, disfig- ure the jaw by swelling and continue to throb and jump until frenzy drove us to the dentist! Then the doctors would not hear so many heart patients advance the argument, "But, doctor, my teeth never hurt me a particle,- they are not tender nor even sensitive to hot or cold drinks." Isn't that a lot to expect of dead teeth,-to expect them to give such mani- festations of life! In defense of the dead. THE TEETH VERSUS THE HEART 89 Gold crowns and crowns with porcelain facings have so often in the past been put on improperly prepared roots that such teeth later develop abscesses beneath their shining exte- rior. Hence crowned teeth are notorious culprits in the production of heart affections. Present-day dentists are sometimes successful in removing abscesses from the roots of such teeth by performing an extensive surgical operation through the jaw bone, removing every particle of the diseased tissue as well as the tip of the root after thoroughly filling the canal. Uneasy lies the tooth that wears the crown. The above-mentioned operation of "root resection" is usually a compromise. On the one hand are the wishes of the patient, who naturally desires to retain a pivotal tooth as long as possible before adopting the artificial denture which its removal would necessitate. On the other hand is medical experience, which insists that an abscess must be removed. Therefore, if the physician sanctions the opera- tion in a selected case, the patient should remember that it is probably a temporary expedient. Root resection can be performed only on a dead tooth. Nature will sooner or Store teeth are never sore teeth. 90 HOW IS YOUR HEART? later reject non-vital tissue and the tooth will likely come out eventually. It is the inexora- ble operating of a natural law that separates the quick from the dead. It is not uncommon to hear of persons who sought relief from crippling "rheumatism" or heart troubles by sacrificing all their teeth,- and who, in the end, were just as miserable as before. In such instances subsequent X-rays may show that an abscess or two did not come away at the time of extraction, but remained in the jaw bone; or perhaps all of the diseased tissue did not drain from the tooth socket be- fore the wound healed over, and more pus formed from the little that was left in place. Of course, under such circumstances tooth ex- traction is futile as far as much improvement is concerned. Again, the germs at the end of the tooth might have gone from that original location to the liver, to a muscle, perhaps to the marrow of the bones, and in these structures have found an abiding place. Think of these possibilities when next you hear of someone who had all the teeth pulled and did not get one bit better. All pulled and no better. THE TEETH VERSUS THE HEART 91 Do not let another person's unfortunate, crippling experience of wholesale extractions dissuade you from at least having your teeth searched if your doctor so advises you. There are many causes of heart trouble, and if the evidence points to your teeth, listen to the doctor. He is the captain of your ship,-if you try to steer your own course, there are two siren voices that may lure your health to wreckage on the rocks of dental defects. One is the deep bass reverberations of the whole- sale extractionist. The other is the sweet- pitched voice of the commercial flatterer, who never saw such white, perfectly shaped teeth and who advises you that it would be a dental crime ever to permit one of them to be ex- tracted,-as long as they can be gouged, drilled, pounded, pasted, plugged, polished and set about with expensive dental jewelry. How firm a foundation is laid for your faith? Doctors and Dental Surgeons nowadays work hand in hand,-just as do doctors and other surgeons. Even though you decided to take your teeth in your own hands, you would encounter difficulty in ordering a modern den- tal surgeon to do your extracting, for such men, before they administer an anesthetic, want to know the general physical condition of Your doctor at the helm. 92 HOW IS YOUR HEART? a person,-just as do other surgeons. Fur- thermore, a bodily reaction not infrequently follows the stirring up of an infection; the ab- sorption of pus from the freshly torn tissues may be so profound that an occasional patient is made severely ill and then there may be the deuce to pay. When the doctor is at the helm he sometimes decides to prepare a heart pa- tient for dental extraction by several days' rest in bed before permitting even one tooth to be extracted,-and after the operation he may wish to guard that affected heart from further insult by additional days of rest in bed. Doctors and Dental Surgeons are not taking any chances with health nowadays, even though an occasional Iron Man does break into merry laughter at such precautions for the simple (?) pulling of a tooth. CHAPTER IX THE TONSIL QUESTION A great many people associate tonsils with building blocks, dolls and toy engines. Tonsil trouble is so bound up with the memories of childhood that adults will often say, almost coyly, that they still have their tonsils-they have lost the golden tresses of earlier days, but the tonsils remain as a heritage of youth. And when the doctor tries to trace a connection between tonsillar troubles of long ago and heart protests of today, the idea seems so far fetched that the average patient loses no time in trying to bring the wandering doctor back to the subject. Many people have solemnly resolved that their particular tonsils shall not be mo- lested by the present-day medical fad of tonsil removal. Why did the Creator give us tonsils if we were not intended to use them? Tonsils are not play- things. That's just the point-exactly. As long as you can use your tonsils, by all means keep them. It is believed that they elaborate an internal secretion which benefits the body to More than a trap for fishbones. 93 94 HOW IS YOUR HEART? some degree,-but more than that, useful ton- sils stand in the throat as sentinels on guard at the principal portal of entry to the body, ready to arrest and repel intruders. Let the breath of a sweet spring morning be laden with germs, and as the breath passes the tonsils many of those germs are caught and held prisoners; what might have been a pneumonia is only a simple cold perhaps, thanks to our useful ton- sils. Or let a glass of milk, a drink of water or a bite of food contain germs that are en route for a frolic in our bowels and many of these, too, are held under arrest in the cells of the spongy tonsils; what might have been typhoid fever may be only a little stomach- ache, thanks to our useful tonsils. This is get- ting too agree- able; there's a trick some- where. Having made such captures, the sentinels in our throats next have to dispose of their prisoners. An officer cannot make any fur- ther arrests when he has culprits in each hand. So a riot call is sent out and answered by myriads of policemen who arrive by way of the tonsils' tremendous blood supply,-and these white-cell policemen tackle the germs and literally eat them alive. In the battle they have learned just how to combat those particular invaders most successfully, and then Acquiring immunity. THE TONSIL QUESTION 95 away the white cells scamper through the body, looking for some more of that tribe who are now so easily whipped that the bodily tissue, which is the battle ground, scarcely needs to inflame or enlarge in order to accommodate the combating forces. For weeks, months or maybe even for years thereafter, when any germs of that once-defeated crowd try to shuffle through a gateway into the body, they are promptly nabbed by trained police- men who are constantly on the lookout for that particular tribe. The body is immune to diseases caused by that germ. And the im- munity process is repeated time and again for the many different germs of many different diseases. Not all germs are good fighters, but many of them are. That explains why you had those attacks of sore throat when you were a young- ster. The tonsils were the scene of combat for ever so many struggles, and they enlarged as a result of the scuffle which was taking place within them; the enlargement stretched the surrounding tissue and this stretching tugged on nerve ends and your throat felt sore. A red flannel bandage around your neck, goose grease or mutton tallow rubbed on the throat, They were the silver and gold days. 96 HOW IS YOUR HEART? hot senna tea or sassafras, sulphur blown in your mouth between sobs,-and to compensate for these indignities three days home from school,-then the battle ground was ready for still another fracas by which your body could acquire immunity for future resistance to each new variety of germs that assails the human family. If that resistance had on any occasion completely failed, instead of reading these Hints on Heart Health you would probably by this time be taking lessons on the harp. So if you have useful tonsils, for health's sake hold fast to them and do not let some doctor cash them in for a new Ford. The trouble is that thousands of tonsils are no longer useful. From repeated conflicts or especially desperate single engagements, the battlefield becomes scarred and jagged, and in the scars the purifying streams of blood are so squeezed together that they are almost col- lapsed and can no longer cleanse away the debris of conflict. The tonsils themselves are at last infected. Ah! there's the trick,- that word USEFUL. Germs can hold high carnival in such soil without a protest from the battle-scarred tonsil. It no longer has the blood supply necessary to react. The days of sore throat are over; them just be- small. they 16 THE TONSIL QUESTION 97 the years of local reaction are gone. The ton- sils are fibrous now and no longer give local symptoms. So the germs multiply and make little lakes of pus in the tonsil; then the tonsil very often shrinks in size as the years go by, for the tendency of scar tissue is to shrink and shrink, ever and anon. The next time you gaze in your throat and find small, innocent looking tonsils, just remember that you may be looking at a shell that encases poison in its center. Lay not the flattering unction to your soul that enormous tonsils are the only offending tonsils! Now, there are more vessels draining a tonsil than there are supplying it. No matter how reduced the incoming blood channels might be, the outgoing lymph channels are always sufficient to carry infection to other structures of the body,-particularly when pus is under pressure, as in the act of swallowing. Do you see now why some of those little lymph glands along the sides of your neck, which are trying to check the spread of infection, are sometimes swollen to the size of a pea or soup bean? Does not one word-absorption-ex- plain the stiff back of the morning, the "rheu- matic twinges" of the afternoon, the "neuritis" Call it absorption not "rheuma- tism." 98 HOW IS YOUR HEART? on the way home, the unwonted sense of ex- haustion in the early evening and the antici- pated heart pains, palpitation, sense of oppres- sion and heart fright of the night ? And now the light dawns on an incident connected with your visit to the doctor's office. He was searching for the cause of your heart protests and had asked to see your tonsils. "But doctor," you said with deep conviction, "my tonsils have not given me any bother for years and years; and besides they are so small that you can scarcely see them." Is it any wonder that the man gave his head an im- patient toss and then looked at you with an oh- what's-the-use expression! Doctors are not all crabbed; some are just logi- cal. Doctors have many ways of judging whether a tonsil is infectious. One of the re- cent ways is to put a small wire loop into one of the crypts of the tonsil and compare the deep-seated germs with those that are grown from the surface of the tonsil, etc. But let the doctor have his methods of examination. Are there any signs hy which ordinary mortals may reasonably suspect the tonsils of being the likely source of infection that is throwing a load on the heart ? Do your own suspecting. THE TONSIL QUESTION 99 Yes, there are many reasons for suspecting the tonsils of being centers of infection. A history of repeated attacks of tonsillitis earlier in life is most suggestive-albeit you haven't had a sore throat for years. Even one single tonsillar inflammation long, long ago may have burned the life out of the tonsils, especially if the sore throat was associated with St. Vitus' dance, acute rheumatic fever or "rheumatism." As soon as the doctor hears you mention any one of these three words he pricks up his ears, -for twenty per cent of the persons so af- flicted who retain their tonsils develop heart affections sooner or later. The terrible tonsillar trio. On looking at the tonsils one may see red streaks-the blush of guilt-shooting up each side of the throat and meeting at the soft pal- ate. Infective tonsils may be red and large or pale and small; they may be ragged and full of openings, or they may be smooth and bound down. When touched they are usually hard and resistant,-not moderately firm and yielding, as glandular tissue should be. This may dis- quiet you mentally. Often people notice yellow or white spots on their tonsils, and if such a cheesy particle becomes dislodged and is crushed between the fingers it has an offensive odor. Some persons Bett€r mentally dis- rather than heart sick' 100 HOW IS YOUR HEART? have the queer idea that these little cheesy particles, which are about the size of a grain of wheat, are crumbs of food that have in some mysterious way defied the laws of gravity and wandered uphill from the stomach. So the stomach gets blamed for the bad breath that ensues when one of these particles finds its way into the mouth, bringing with it, perhaps, a little creamy pus from a tonsillar canal from whence it was dislodged, reeking with germs and polluting the breath for the time being. Therefore if you have a bad breath at times, and particularly if it is bad in the morning, do not jump at the conclusion that it is due to the stomach or to the teeth; blame the ton- sils, and make them prove their innocence by an acquittal from your doctor. Of course one may have a bad stomach at the same time- stomachs resent tonsillar infection as much as do hearts. But for goodness' sake do not rush off to the drug store and begin treating the stomach because the breath is bad-that par- ticular form of self-medication went out of style with the passing of the horse and buggy. Breath does not come from the stomach. If you have some of the signs of tonsillar infection enumerated above, talk them over with your doctor. When he weighs the his- Tie doctor works like a judge. THE TONSIL QUESTION 101 tory, sifts the evidence, and considers the testi- mony of such additional witnesses as may be called, he will be able to deduce an opinion on your tonsils. Perhaps he will keep them under observation for a while-perhaps acquit them altogether. But when the ultimate decision is that a noose shall be placed around those ton- sils and the wire snare tightened until the culprits no longer menace the heart, the doctor-judge will rather expect you imme- diately to present your motion for a new trial. These are the customary pleas for such disreputable clients as infective tonsils, so ad- vance your arguments along some such lines: ARGUMENTS FOR THE DEFENSE REBUTTAL BY THE PROSECUTION 1. I am sure that you can treat them, doctor, and make them better. 2. I thought they only did a tonsil operation on children. 3. My tonsils have not giv- en me any real trouble for years. Do not attempt flattery with the Court. This is poor bait with which to try to catch a trout. It might, however, land a sunfish. Why pick especially on children? A child wants the operation postponed until it grows up. Probably for the reason that all the fight was knocked out of them in the all-but-forgotten battles of years ago. 102 HOW IS YOUR HEART? 4. But, doctor, if there is any cutting done in my throat it will simply ruin my singing voice. 5. I could not stand having tonsils taken out at my age,-I am too old for that operation. 6. The tonsils will cer- tainly bleed terribly in a person like me. 7. Both tonsils were nearly all removed sev- eral years ago; only small fragments remain; This singing-voice argu- ment is not the poser which its sponsors believe it to be. Two hundred college stu- dents had their voices reg- istered by a singing teacher before and after removal of the tonsils. One hundred and ninety-four of them- 97 per cent-gained three major tones following the operation. What does the age of the patient have to do with any indicated surgical procedure? The operation is proposed as a method of relief, not as a mode of amusement or form of self- indulgence. One is never too old even to have a leg cut off, as when it is gangrenous, poisoning the body and threatening life. Yes, if one selects a ten- second performer instead of a cautious operator to take out the tonsils or to take off a leg, some blood vessel will most likely be left open. Those small fragments may prove to be worse of- fenders than the original tonsil. The unmolested THE TONSIL QUESTION 103 surely these fragments cannot jeopardize my heart. 8. A friend of mine had his tonsils taken out and got worse instead of bet- ter, etc., etc. tonsil might openly drain a little from its front sur- face. The fragment is probably sealed shut by scars and can only drain back into the body. Yes, and one has other friends who kept their tonsils in and they, also, got worse instead of bet- ter. The doctor might be wrong; but his judgment, either for or against a ton- sil operation, will be right more often than will the opinion of an untrained person. And so the doctor-judge answers each count with the saintly patience born of repeated ex- perience in replying to such futile pleading. Before court adjourns your motion for a new trial will likely be denied, should the weight of evidence remain against your clients. Sentence will next be passed, the date for exe- cution will be set and a little later the worse- than-useless tonsils will dangle from the end of a wire snare. . . . The Clerk of Court will now call the next case on the calendar. All the saints are not yet in heaven. CHAPTER X EARLY HEART SIGNS THAT SHOULD TAKE YOU TO YOUR DOCTOR Heart disease must have its beginning. A forest cannot suddenly burst into flame with- out the first kindling spark that ignites it. Some forest fires are self-limited and do no more damage than the burning of the under- brush. Others are discovered in time for the flames to be checked before the tall timber is consumed and the woodland laid in ruins. The progress of a heart defect is very much like the progress of a forest fire-with all the advantages in favor of the incipient heart trouble, for when conflagration threatens, the heart has its owner constantly on guard and expert aid can easily be summoned by calling the doctor, provided the owner has received instruction in recognizing certain early danger signs. A woodsman does not wait for the smell of smoke and the crackling of twigs before investigating his timber land; such simple yet unusual circumstances as the flight Prevent forest fires: it pays. 104 EARLY HEART SIGNS 105 of birds and the appearance of distracted forest-animals in the open fields are sufficient reasons for investigating the possibility of an incipient conflagration. There may be simple yet unusual circumstances in your body which require investigation if future extensive dam- age is to be prevented. Potential heart disease-that is, heart dis- ease that does not yet exist, but which may eventually come-yields many signs which should take one to the doctor.* But before enumerating the signs, let it be understood that one or all of them can be caused by conditions altogether outside of the heart. That is why you should go to your doctor,-to get his ex- pert interpretation of the signs and to guide you in understanding and correcting them. Early signs of possible future heart disease. (1) After any illness consult your doctor if you tire unnaturally when you are up and around. Perhaps your convalescent period (the word means "to grow strong") has been too short and, by trying to drive the weakened body to its accustomed tasks, you are throwing a load upon the heart and permanent damage may result. It may be all of the poisons are not Assuming pep when one has it not. * Physicians who read this volume will appreciate that the word "sign" is more readily understood by lay readers than is the word "symptom." 106 HOW IS YOUR HEART? yet out of your body-as in the "relapse" of influenza or typhoid fever-and such residual poisons seem to take a fiendish delight in at- tacking the weary heart that you are driving to the limit by keeping up and being around. (2) "Rheumatic" Twinges and "Neu- ralgias" are notorious forerunners of heart affections, even though the heart may not have protested as yet. Once and for all, get it out of your head that you are entitled to have a little "rheumatism" because you sat near an open window or forgot to put on a light-weight overcoat on a mild evening. If such effects followed such causes, think of the thousands of youngsters who would be hobbling around on crutches! And while abandoning this ab- surd "exposure" excuse for septic absorption, also abandon the family legend that you have "neuralgia" because grandmother had it. It may be that you are very susceptible to expo- sure and cold; but what circumstance within the body renders you susceptible? The same observations apply to muscular soreness or joint stiffness that is not brought about by un- usual physical effort. If you are the uncom- fortable possessor of these potential heart risks, go see your doctor before the heart com- Pet family legends are comforting but unsound. EARLY HEART SIGNS 107 plains, and let him take the responsibility of confirming your pet family opinions, if he will. (3) Shortness of Breath that is con- stantly attendant upon certain moderate effort is an early sign of heart protest. But to be of significance the shortness of breath should attend some simple exercise to which one has been long accustomed, such as mounting one or two flights of stairs. It is quite natural to pant a little on climbing stairs after a full meal, and it is natural to drag one's self up- stairs, wearily sighing, at the close of a tire- some day. But if you habitually have short- ness of breath and early limitation of effort on accustomed exercise without provocative cause, go see your doctor, whether or not your heart beats rapidly at the top of each flight. Normal peo- ple are usually unconscious of their breathing. (4) Dizziness (giddiness, vertigo and "swimming of the head") may be a sign of heart instability or of blood vessel fault, al- though it is more often indicative of digestive derangements. When of heart significance the dizziness often follows sudden change of pos- ture, as when getting up or lying down. If one is habitually dizzy when bending over, as in the act of tying shoes, or if he cannot stoop without a blinding rush of blood to the head, Disturbance of the sense of balance. 108 HOW IS YOUR HEART? he should have a search conducted for possible heart or blood vessel disturbance. (5) Palpitation describes a rapid beating of the heart of which the patient is uncom- fortably conscious. Relay runners, hurdle jumpers and other athletes quite frequently have palpitation at the conclusion of a contest, and under such circumstances it is not an evi- dence of disease. When palpitation occurs habitually on slight emotional disturbances, trivial effort or in the dead of the night, it should be regarded as a warning of possible future heart disease. Heart hurry. (6) Irregular Heart Action is never normal,-even though some ancestor's pulse did "drop beats" for years. The one thing that an ancestor simply cannot pass on to an adult is irregular heart action. You have to acquire it absolutely on your own hook. A heart that protests against a load by throw- ing an irregular beat occasionally is a lucky heart to have, for the first time an intermittent pulse occurs it hurls such a scare into a person that he loses no time in seeking medical advice. If only all sinned-against hearts would kick up such a scare, instead of suffering in silence as some of them do! You cannot inherit an intermittent pulse. EARLY HEART SIGNS 109 The most common type of an irregular pulse may first happen this way; when a person is quietly smoking an after-dinner cigar, or rest- ing between games of tennis or golf, the heart "thumps" or "turns over in the chest." More often a similar thump occurs for the first time as one is falling asleep. Then the person is alarmed because a long pause follows the ir- regularity and he fears that the heart will never start up again. It always does start beating again,-usually very rapidly, for apprehension increases the heart rate, and on account of the increased heart rate the irregu- larity does not repeat itself-until the agitated person finally becomes reassured and dozes off once more when-there it goes again! After the second occurs there is usually very little sleep for one who is just making an acquaintance with "dropped beats"-simply because the mental tranquillity is upset. And so, with morale by this time completely shattered, one keeps a vigil through the night, looking for other signs of heart trouble, and attaches much significance to the unimportant fact that the heart was heard beating when the ear was on the pillow. A doctor, of course, knows that this phenomenon is caused by the First night performance, and the audience un- appreciative. 110 HOW IS YOUR HEART? compression of some superficial artery and that the sound therefrom is conducted by bone to the nerve of hearing-but the apprehensive person is not a doctor, and naturally thinks that something of great importance has been discovered. Persons so annoyed-we cannot yet call them afflicted-constitute many of the early morning callers at the doctor's office. And often the doctor cannot find the irregularity in early cases, for the flurry incident to getting to the office drives the irregularity away. Emotional strain, mental concentration and physical effort nearly always drive away the ''dropped beats" in early cases. At this stage they are not dangerous. Later on, they may so multiply that nothing drives them away,- and then the real heart trouble is on in earnest. Polish'd per- turbation, golden care, that keep'st the ports of slumber open wide. There are, of course, some people who are so accustomed to their heart cutting up capers that they don't mind at all when the heart jazzes things up a bit. Such nonchalant per- sons, if they happened to sit on a keg of dyna- mite, would probably continue to sit there despite repeated warnings, on the theory that what is to be will be. The fatalistic attitude. EARLY HEART SIGNS 111 Just what does a "'dropped beat" signify? Considered by itself, there is no immediate danger in it,-so thus far, the old-time doctor was right when he told his patients not to be worried over this single sign. But the later generation of doctors have been studying heart irregularities with modern instruments very closely, and the more they study the more they realize that the instinctive fears of the patient have an actual physical foundation, sooner or later. So put this in your pipe-even if you are sitting on a keg of dynamite-an inter- mittent PULSE IS INDICATIVE OF HEART muscle protest and may eventuate in actual heart muscle disease. Eventually,- why not now? (7) Chest Constriction may be an early sign of heart fault although this, too, may be due to other organs within the chest. If the heart is enlarged, either temporarily or per- manently, the enlargement makes pressure on other organs; for the chest wall is only expan- sile, not elastic, and therefore it cannot extend sufficiently to accommodate much of an in- crease in heart size. Hence an enlarged heart presses on other organs, producing the feel- ing of chest constriction. Persons so affected often say that if they could only unbutton their A little tight across the chest. 112 HOW IS YOUR HEART? chest, as they can unbutton a tight waistcoat, they would feel all right. It is the doctor's business to tell you whether the sense of tight- ness is due to lung congestion, heart enlarge- ment, liver troubles or what not. (8) Chest Pain is so often due to the heart that one should never commit the folly of as- suming that chest pain is due to "intercostal neuralgia," "muscle strain," or to "gas press- ing on the heart." Doctors are so exceedingly careful of making such easy disposal of chest pain that they use these reassuring words only after a thorough, repeated and long-continued search that finally releases the heart from sus- picion. Never neglect chest pain. So much for the signs of heart protest,- "functional" heart trouble as it was formerly called. We have seen that these early signs embrace an insufficient period of convalescence, "rheumatic" twinges, shortness of breath, diz- ziness, palpitation, irregularity of heart action, chest constriction and chest pain. Not one of the group is ever actually prostrating. Nor are any of them continuous and unremitting. If they were, people whom they annoy would seek medical advice earlier than they do. Many of us are so mentally engrossed with our Here are those cryptic words "functional" and "organic." EARLY HEART SIGNS 113 daily affairs that we pay scant attention to occasional bodily discomforts, until perhaps a friend insists that we give our health a frac- tion of the consideration which we devote to our business, our ideals or our hobbies. There is poor judgment shown in allowing these early signs of heart protest to pass, as they might readily do through neglect, into the more advanced signs of actual heart involve- ment-"organic" heart trouble, as it was for- merly called. CHAPTER XI ADVANCING SIGNS SUGGESTIVE OF ACTUAL HEART INVOLVEMENT There are other heart signs more advanced than those enumerated in the preceding chap- ter, which may follow progressively in the steps of the simpler symptoms. This second and more serious group may also arise inde- pendently, without any of the earlier signs, as after an illness from which one has recently recovered,-or, indeed, it is possible that they may even follow long-continued emotional or physical strain. Such later signs include an anemic appearance, a congested appearance, marked limitations on effort, vision defects, choking cough, fainting, labored breathing, profound chest pain, utterly disordered heart action and swelling of the abdomen or ankles and legs. A heavy heart bears not a humble tongue. An Anemic Appearance-the word mean- ing "absence of blood"-is of value as a sign of heart trouble when it occurs with other signs. The condition should not be confused Good morn- ing! Have you had your iron today? 114 ADVANCING HEART SIGNS 115 with the pallor of fright or with the pallid features of persons who lead confined or seden- tary lives. A persistent absence of color from those areas where Nature distributes a pinkish blush irrespective of age, as the lips, the lobes of the ears and under the finger nails, may mean that some hidden disease is affecting the blood and also affecting the heart at the same time. Or it may mean that the blood is im- poverished and therefore does not carry suf- ficient nourishment to the heart to maintain heart strength. Your doctor makes a diag- nosis of anemia only after he has examined the blood under a microscope; depending on what he finds in the blood picture depends the treatment. Some people make the diagnosis of anemia just because their color is poor-a thing the doctor would not dream of doing- and off these people rush to the drug store in response to the urge of newspaper advertise- ments to buy bottles of Hoax-ated Iron,- and throughout the day they disorder perfectly good digestions by loading their stomachs with fermenting masses of raisins; for do not the billboards say that raisins contain iron? Iron isn't the only constituent of blood! 116 HOW IS YOUR HEART? A Congested Appearance is so associated with heart trouble in the minds of many per- sons that the distinction is sometimes not made between the florid complexions that are natural to people of certain nationalities and the red, congested appearance verging on bluish dis- coloration which bespeaks heart or blood-vessel fault. When the congestion deepens to a purplish hue of lips, cheeks or under the eyes, -often first noticed shortly after arising in the morning,-a heart defect is probably present. Florid com- plexions and congested faces. ' Limitation of Effort that comes on grad- ually and that progressively increases is often a sign of heart defect. It is not to be confused with the fatigue which attends sustained physi- cal or mental demands, nor with the utter prostration by which many acute diseases are ushered in. Heart significance especially attaches to the inability to perform accustomed tasks without being distressed, as in the simple acts of bending over to lace shoes, climbing staircases with which one has long been familiar, etc. While these signs are of less importance in persons who are under sixty- five, their occurrence at any age is a signal that the heart significance of beginning physi- Accustomed tasks should not bring distress. ADVANCING HEART SIGNS 117 cal limitations should be evaluated. It is not enough to content one's self with the melan- choly self-made diagnosis "I guess I am grow- ing old" and let it go at that. The sad part of such "guessing" is the prob- ability of error, inasmuch as it takes no account of Nature's Love of Balance. As the heart ages, so does the desire for activity age. Re- duced physical capacity is naturally distributed throughout the entire body,-legs, lungs, liver share in the limitations as well as does the heart, and there is between all the organs the natural balance of declining years. When the heart alone protests at exertion, there is either something wrong with the heart or else it is being driven beyond its capacity. And protest it will in the person who refuses to recognize that there is a sharp dividing line between a life of activity and the life of partial retirement from business. The man who forces his heart to undertake at sixty-five what it was capable of doing at fifty,-or who drives it past the natural balance of seventy-five to attempt the duties of sixty,-will likely find that the dividing line has suddenly become a stone wall, and that his continued effort to Vaulting am- bition o'er- leaps itself and falls. 118 HOW IS YOUR HEART? overleap the restraining barrier throws him into the heart-patient class for a while. Vision Defects frequently herald the ap- proach of heart and blood-vessel trouble. The eye is such an exquisitely sensitive organ, with its subtle appreciation of lights and shades, with its delicate interpretation of color and form, with its adaptability to distances and ready focusing on near-by objects, that dis- turbances of the blood supply may be expected to also disturb the delicate mechanism by which we see. Of course, not all eye defects are due to disturbances in blood supply; but disturb- ances in blood supply often produce defects in vision. Progressive oculists-men who have been educated in medicine and trained as phy- sicians-recognize the interdependence of eyes, blood vessels and heart and, by advising the patient in time, frequently prevent circulatory calamities. Heaven knows what becomes of people who intrust their vision defects to mere spectacle peddlers of various cults who cannot see farther down the anatomy than the bridge of the nose. Oculists see more than the eyes. The flashing of the red semaphore. Fainting or swooning, when occasional, is often due to digestive disturbances, to the effect of deep impressions on emotional tern- ADVANCING HEART SIGNS 119 peraments or to extreme physical fatigue. When such a cause is demonstrable, it is not likely that heart trouble exists. That type of fainting-and it is rare-which is associated with heart or blood-vessel defect is usually of frequent occurrence and arises independently of a cause ordinarily sufficient to bring on a fainting attack. With it a slow pulse rate, as well as other associated signs, will be found when this type of fainting is of profound heart significance. Labored Breathing, in which the breaths are short, shallow and more frequent than the usual sixteen or eighteen breaths a minute, may be due to the heart muscle being weak and therefore unable to drive the blood through the lungs with customary vigor. As a result, some residual fluid from the blood may accumulate in the lungs, cutting down the total air capac- ity. Persons so afflicted often have a choking cough upon trivial exertion, such as going up stairs, turning in bed, or following spells of laughter. Home-made diagnoses of "asthma," "bronchitis," "chronic cough," etc., should not be accepted as explanations for labored breath- ing or choking coughs until the possibility that The heart cough. 120 HOW IS YOUR HEART? heart muscle fault underlies their production has been ruled from consideration. Profound Chest Pain is so alarming, espe- pecially when it occurs in the left chest over the heart, that persons who have it usually lose no time in consulting their physicians. The pain, however, may be referred to the breast bone, to a shoulder or arm and even to the pit of the stomach, and be equally as dan- gerous as the pain directly over the heart. In the case of such referred pain, "neuralgia," "indigestion" and "muscle strain" may be ac- counted as the underlying troubles and home medication may be attempted. Be assured, the doctor will never lightly regard pain in or near the chest until he has first absolved the heart from participation therein. Angina pec- toris-a condition which often amounts to pro- tracted heart invalidism-frequently begins insidiously and chest pain is among the warn- ings of its approach. Again stress- ing the impor- tance of chest pain. Utterly Disordered Heart Action, strangely enough, is sometimes not recognized by persons who have it. One would think that an absence of rhythm and time would be imme- diately apparent to anyone; yet there are per- sons who are lacking in a sense of rhythm and If you have time-and rhythm-feel your pulse occasionally. ADVANCING HEART SIGNS 121 time and they are unconscious of a heart sign that warrants immediate attention. Disor- dered heart action can best be appreciated by feeling the pulse at the under side of the wrist on the thumb side, just above that point where the wrist joins the hand. If each pulsation is not rhythmic and cannot be as regularly antici- pated as the tick of a clock or the swing of a pendulum, medical advice should be sought. Swelling of the Abdomen or Ankles may occur in a variety of conditions. Some- times such swellings are due to heart defect. It requires medical training and a careful physical examination to determine the cause. No matter what folk-lore may be offered in explanation of puffy ankles, legs, etc., the fact remains that such swellings never occur in those whose health is perfect. Swollen ankles are rarely caused by tight shoes. Your doctor, after completing his examina- tions and weighing the evidence, may come to the conclusion that you have an actual heart defect. When a patient hears this opinion for the first time it naturally creates alarm,-for there is in many of us a conviction, based on impressions received in childhood, that a person with "heart disease" is a confirmed and helpless invalid, whose sole concern for the few remain- The doctor's positive find- ings are a blessing in disguise. 122 HOW IS YOUR HEART? ing borrowed days of life is to sit by motion- less and await the end. Nothing could be far- ther from the present-day truth! There is no occasion for panic. If you have a heart defect, it is far better to know it and to regulate your existence so that you may live to the fulness of years, rather than to rush along through life in that blissful ignorance which so often results in heart overstrain and sudden death amid the pleasures or vocations of life. folly to be wnwise. If the statistics could be compiled, they would certainly show that people who are known to have heart trouble live quite as long as the average run of mortals. It is those who do not know of their heart condition who sud- denly drop dead. There is a reason for this assertion concerning longevity; the man who knows he faces a crisis will husband his re- sources; the one who is in ignorance will spend prodigally and suddenly collapse. Trainedfi°rto be forearmed. There can be no better proof offered in sup- port of these statements than to cite the pres- ent-day attitude of insurance concerns. There is nothing on earth more coldly matter-of-fact than a life insurance company when it comes to appraising a "risk"-they risk mighty little, The new day dawns and light diffuses hope. ADVANCING HEART SIGNS 123 as anyone who owns stock in a going concern well knows. And yet several life insurance companies are not only accepting applicants with heart defects,-they are actually reversing themselves on former decisions and insuring many persons whom they earlier rejected on account of heart conditions! Evidently, even Wall Street is willing to gamble on your hav- ing sense enough to take care of yourself. So there is really scant reason for a blue funk on your part. Many people, however, are not concerned for themselves when they learn that they have an actual heart defect. They are apprehensive not for self, but for the future of those depend- ent upon them, for the business which needs its captain at the helm, for the ideals and ambi- tions yet unattained, for a life's work not yet accomplished. It often requires more courage to live than to die. Despite the iconoclasts, there is such a thing as altruism; and altruism attains its most sublime heights in the one who must continue to live for others. So the ques- tions arise: Just what does a "leaky heart," enlarged heart or hard artery signify? Will such a condition cripple me very much? May Brave hearts and true. 124 HOW IS YOUR HEART? I continue at business? Are my days defi- nitely shortened? Are my diversions to be foregone? To what extent must I modify my life, and what shall I do to carry out my part of the Necessity for Living? CHAPTER XII PHYSICAL FINDINGS WHICH MAY INDICATE HEART TROUBLE Frequently it happens that a person has been rejected from a beneficial order, insur- ance society, business position or military organization on account of a heart defect and the chance hearing of such words as "murmur," "enlargement of the heart," "high blood pres- sure," "hardening of the arteries," etc., during the examination leaves a lasting impression on the mind of the once happy applicant. Often he attaches to the unfamiliar words far more importance than they necessarily possess. Perhaps a brief discussion of such terms may clarify their meaning and rob them of the sinister significance which they bear when shrouded in secrecy or magnified through lack of understanding. The fear of the unknown. A Murmur means that there is an unnatural sound in the heart. Once upon a time it was believed that a murmur meant that a heart valve was deformed and out of shape. And so the phrase "leaky heart" was used as a syno- Murmurs and "leaky hearts.'* 125 126 HOW IS YOUR HEART? nym for "murmur." There are many mur- murs, however, which may be heard in different hearts and which are not signs of defective heart valves. Children may have such mur- murs and outgrow them; adults may have them after strenuous physical effort or intense strain, and the murmurs later disappear. So all murmurs do not always mean a deformed heart valve and a consequent "leaky heart." Suppose, however, that one section of a valve does not fit closely to another because it was scarred by diphtheria or some other disease earlier in life, and a little blood therefore leaks back through the imperfect closure to another chamber of the heart. That does not mean that the pump is worthless because one of its four valves leaks! Such murmurs, it is true, may indicate serious heart trouble, but when they do they are usually associated with other signs in the heart and with the bodily signs of a failing heart. This is the idea: the severity of the heart trouble is gauged by the associated signs, not alone by the murmur. What really counts is the ability of the heart muscle to squeeze down powerfully enough to distribute the blood to the farther ends of the body. And if the heart muscle is weak and does not do The muscle is of more im- portance than the murmur. IS HEART TROUBLE PRESENT? 127 this effectively, one should learn to lighten the heart load so that pump efficiency may be restored. Then the heart will, in all prob- ability, go on distributing blood indefinitely, whether a valve leaks or not. Proof of this statement is found in the number of persons now living and enjoying life who were rejected from one thing or another years and years ago simply on account of "murmurs" and alleged "leaky hearts." Enlargement of the Heart is not nearly so terrifying a thing as it seems on first acquaintance. A baby's heart is always en- larged for the first few weeks of life-for the reason that only one side of the baby's heart does any pumping until it begins to breathe, and then the other side has such a load suddenly thrown on it at birth that it must enlarge to meet the new-born demand of breathing. Gradually the heart becomes accustomed to the load and adapts itself to the new demands and the enlargement of the baby's heart dis- appears. Heart enlarge- ment is natu- ral in babies. As we approach the other end of existence the heart usually enlarges again-it is to be expected that a heart which has borne the brunt of a busy life would show the results of life's Heart enlarge- ment is natu- ral in advanc- ing years. 128 HOW IS YOUR HEART? battles by enlarging. Furthermore, the blood vessels by this time have lost the elasticity of youth; they cannot assist so well in propelling the blood by the elastic recoil of their walls; they have thickened a little and in the thicken- ing have lessened in caliber. This resistance must be overcome by increased heart effort,- and to meet the demand the heart enlarges, just as does any other muscle which is required continually to put forth ever-increasing effort. So it is natural for the heart to enlarge when we commence our existence and also when we feel the physical burden of advancing years. It is a fortunate thing for us that the heart possesses such adaptability-for where would we be during the intervening active years, in all those battles with disease and cir- cumstance, if the heart could not adapt itself to temporary increased demand by temporary increase in size? The circulation would fail- blood would not be driven to the vital centers -life would cease. Heart enlarge- ment may be life-saving during the active years. When a doctor finds that your heart is en- larged-incidentally, he may call it dilatation or hypertrophy-he has no knowledge of how long it has been that way. Perhaps that heart may have been kept enlarged for such a length Response to effort may pass into overstrain. IS HEART TROUBLE PRESENT? 129 of time that any further driving on your part might strain it to the point where it would stay enlarged permanently and lose its punch altogether. A physician is not going to take any chances with the unknown past of a heart; therefore the best place for you is in bed, where rest can undo whatever strain is attendant upon being up and around, and where the doc- tor can study the present condition and outline the future of this particular heart. High Blood Pressure is construed by some people as being the equivalent of high steam pressure-with the same possibilities of boiler explosion and the scattering of disaster. These people are the present-day equivalent of that group of an earlier generation who, when the thermometer first came into general use by doctors, thought that a high fever meant that the patient must soon be consumed. Mod- ern medical men, however, incline to the view that moderately high blood pressure and mod- erately high fever are really valuable signs, in that they show the ability of the body to react; resistance to the exciting cause is not yet lost; the body can give battle to that which threatens its integrity, and high blood pressure or high fever are as often an index of the power to High pressure is as safe as the pipes that constrain it. 130 HOW IS YOUR HEART? resist as they are an index of the virulency of the invasion. The mere discovery of a high blood pressure reading is no indication that the person will not live for years and years. There are many simple circumstances in everyday life to send our pressures shooting upwards. A person with a moderately high pressure would be sub- ject to the same daily rises as other people, and his readings would be away over the usual adult standard of one hundred plus the age. When the blood pressure is persistently high, -too high for comfort and safety,-something can frequently be done for it. The underlying cause can be sought for and perhaps be re- moved, the congestions and headaches which are associated with it can be relieved and, by proper self care, the possibility of apoplexy- which is the real danger of very high blood pressure-can be materially lessened. Reducing the real danger. How can one hope to escape acquiring a per- sistently high blood pressure? (1) By avoid- ing the emotional storms and tempests of intense natures-by living tranquilly. (2) By avoiding habitual physical overstrain-by fre- quently relaxing physically. (3) By avoiding overeating and the train of troubles that follow Live tran- quilly, relax physically, govern appe- tite, annual inventory. IS HEART TROUBLE PRESENT? 131 gourmandism-by governing appetite. (4) By an annual physical inventory, which is the safest guarantee that one is not harboring an infection somewhere which is likely to throw a monkey wrench into our smooth-working machinery. Hardening of the Arteries is the best scare-producer of all to the man who, for the first time, hears the term applied to his own blood vessels. He seems to expect that the hardening process then in progress will rapidly proceed to its completion and that soon the arteries will be as resistant as pipe stems. The fact is, arterial change likely begins about the thirty-fifth year and usually proceeds so slowly that by the time it can kill the vast majority of us we will have already died of something else. A celebrated humorist said that the most tiresome job of his life was when he had to sit around and listen to the hardening of his arteries-evidently he did not hear very much, for after a while he took to platform entertain- ing again. It is coming to the best of us, but fast living speeds up delivery. Constant use may make certain arteries feel harder than others. A man who throws the heavy levers in a railroad switch tower will have very resistant arteries in his wrists and Arterial thickening may be occu* pational. 132 HOW IS YOUR HEART? arms, yet the vessels available to touch else- where in his body will be of the elasticity ex- pected for his years. In like manner, the arteries in any part that is used habitually to excess may be more resistant than those in other parts of the body. So the extent of arterial change can be estimated only by a study of all the vessels that are situated super- ficially enough to be examined. It is, however, the finer vessels-infinitely greater in number and distributed deep in bodily tissues-which produce the familiar signs of arterial hardening (arteriosclerosis). For example, the fine blood vessels which carry nourishment to the muscles of the hand may be narrowed in caliber because their walls are thickened, and therefore the muscles do not get sufficient nourishment. Any group of muscles thus affected are crippled in the performance of their usual duties. Witness the wavering handwriting of persons who are advanced in years-the unsteady gait and leg cramps of others-the deliberate turning of the head to look at an object when the eye muscles are involved, instead of employing quick glances as in youth-the defective performances of the muscles that hold the spine erect, permitting A man is as old as his finer arteries. IS HEART TROUBLE PRESENT? 133 the bowed back that bespeaks the weight of years. Other familiar signs are present when arte- rial narrowing involves the internal organs. Should the vessels of the kidneys be affected, elimination is defective and kidney disturb- ances arise from the irritating waste material retained; when the vessels of the stomach and bowels are involved, digestive disturbances and constipation are present. Should the finer arteries of the brain thicken, memory then is poor, thought is slow, speech becomes delib- erate, dispositions change. An artery of larger size in the brain that has gradually lost its elasticity as the years advance may burst open when the blood is violently driven into it-by sudden grief, rage or effort-and the escaped blood will clot and press on the brain, causing unconsciousness; this is a stroke of apoplexy. If the pressure is made on an area of the brain that controls the action of a set of muscles, those muscles are unable to perform their tasks until the clot is after a while absorbed; this is a stroke of paralysis. We can thank Heaven-those of us who hope to make a century run of life-that this entire group of blood-vessel affections very, Poor rubber in some family tubes. 134 HOW IS YOUR HEART? very rarely attacks one individual. If we belong to a family that has always had a poor quality of rubber in their tubes, we have no way to improve the quality of rubber and we may age earlier than those whose vessels abound in elasticity. We can, however, refrain from overvulcanizing the rubber and making it brit- tle, by following the guidance of modern medicine, which teaches us to avoid in our active years emotional excesses, physical over- strain, faulty habits and various sources of infection. Thus we can hope to minimize the possibility of blood-vessel catastrophes late in life. We cannot hope to escape growing older -but we can so direct and govern our active days that we advance in years gracefully and in the lovely possession of many faculties. GROWING OLDER 135 GROWING OLDER A little more tired at close of day; A little less anxious to have our way; A little less ready to scold and blame; A little more care for another's name; And so we are nearing the journey's end, Where time and eternity meet and blend. A little less care for bonds and gold; A little less zest than in days of old; A broader view and a saner mind; A little more love for all mankind; A little more careful of what we say; And so we are faring a-down the way. A little more love for the friends of youth; A little more zeal for established truth; A little more charity in our views; A little less thirst for the daily news; And so we are folding our tents away And passing in silence at close of day. -Anon. CHAPTER XIII HOW TO LIVE WHEN DAMAGE IS ALREADY DONE An old philosopher once said: "The way to live to a ripe old age is to get an incurable dis- ease and take care of it." Treat the pa- tient rather than treat the heart. This savant had probably observed that many supposedly incurable conditions sub- merge completely under proper care and that the individual, having once learned how to live within the capacity of his physical limitations, continues thereafter to live carefully and thus avoids the exhaustions and prostrations which make the robust an easy prey for diseases which kill. Nature always provides abundantly to per- petuate that which she creates. Abundance is shown in the thousands of acorns that one oak tree will bear, although scarcely a handful of each season's crop take root and grow. Of the winged seeds of the maple, even though carried on winds to far places, only a few develop into saplings that perpetuate the tree life. In Nature's human family, abundant provision extends even to supplying bodily tissues in Nature's abundant pro- vision. 136 CARING FOR DAMAGED HEARTS 137 excess of what we need. People live with only one lung, instead of two; with one kidney, in- stead of two; and occasionally one hears of a man who parted company with his stomach on an operating table, yet digestion of food is being carried on below the excised stomach. Such people have learned to modify their lives to a degree compatible with their physical limitations and are not objects of either dis- tress or sympathy. The man with one lung could not afford the breath to play a horn; the man with one kidney would not dare be guilty of repeatedly drinking quantities of irritating liquids; the man without a stomach could not gratify the caprices of appetite nor ever eat an enormous meal. Within proper limitations, Nature sees to it that they live comfortably, although not so fully as do those to whom excess is necessary to existence. The same analogies apply to the heart. An area of scar tissue, half the size of a thumb in heart muscle, may interfere with effective contraction under unusual demands. "Scar tissue" is not altogether a figure of speech; when part of a heart has been inflamed by the poisons of some disease (acute myocarditis), that area of muscle may later be lacking in a The margin of safety in damaged hearts. 138 HOW IS YOUR HEART? blood supply sufficient to work effectively; then when the vessel-narrowing incident to the advance of years ensues, the previously damaged area is quite as muscularly inert as scar tissue (chronic myocarditis). Should a patch of affected muscle at the start be the size of four fingers, it may be expected to definitely limit ordinary undertakings. A person who has a damaged heart should estimate, by grad- ual degrees and by the lessons of experience, what constitutes the capacity of the undamaged portion. Find out how much exertion can be undertaken without distress-then live within the margin of safety. It is not possible to definitely determine the degree of heart damage. If one lung no longer functions, the absence of air and the X-ray show that the lung is useless; if one kidney no longer functions, it is possible with modern in- struments to quickly tell which one is out of commission. Manifestly, there is then fifty per cent reduction in lung or kidney capacity. Heart efficiency cannot be so easily calculated; the unaffected portion must keep at work when the damaged area no longer functions; the damaged area may involve one-fifth or three- fifths of the total heart area. The extent of Distinguish between deter- mining and estimating heart func- tion. CARING FOR DAMAGED HEARTS 139 impairment can be estimated only by learning to what point the damaged organ can carry on its work without strain, effort or distress. The individual must find this point himself, by thoughtful observation of his reactions to exertion. Having arrived at such an estimate, it is often helpful to think of heart capacity in terms of percentage. For example, a man with a "fifty-per-cent-heart" should undertake only fifty per cent of what average men of his age could do. He should take twice as much time to get to his office; he should be at business half as long; he should get twice as much rest out of each twenty-four hours, for he should reduce all of life's activities fifty per cent so that he may live within the capacity of a fifty per cent heart. A fifty per cent heart for his age. In order to live with a damaged heart, a proper mental attitude is of prime importance. Above all, do not advertise your malady. It breeds the curse of introspection. The re- peated recital of physical defects keeps the mind occupied with thoughts of ill-health which repel the strong, refreshing, invigorating im- pressions that come from outside sources. Furthermore, remember that the greeting Do not adver- tise your malady. 140 HOW IS YOUR HEART? "How are you today?" calls for a detailed exposition of symptoms only when asked by a physician. Acquaintances, however sympa- thetic, soon lose interest in the tales of sleepless nights, fears, forebodings and physical defi- ciencies. More than one business failure can be traced to the personal poor-health bulletins which were issued by the head of the firm; investors are not attracted to a concern when its moving spirit is admittedly threatened by calamity. Political rivals, too, are quick to circulate the story that a once powerful chief has "heart disease" and is a candidate for sud- den death. Thus friends, money and influence may all vanish from the person who advertises his malady. Keep in touch with friends and things that interest. Do not become a recluse. Ideals are kept alive by contact with others. Enthusiasm need never be lost, even though one must cur- tail the physical activity which it so often inspires. One has only to find a new, absorbing interest in order to find a new motive for living. Many men whose active years are spent in grinding activity to create or produce, later come to the stage where interest lags in the earlier pursuit-and they find a new raison The friends thou hast . . . grapple to thy heart. CARING FOR DAMAGED HEARTS 141 d'etre in spending for others the accumulations of the active years. Millionaires never seem so happy when stacking gold as they later seem when giving it away-they have found a new enthusiasm. The word itself means "God striving within us." And in seeking to express itself, enthusiasm finds an outlet that brings us in contact with others. Optimism is a precious asset for a heart patient. Frowning faces would have us believe that optimism flowers only in the sunshine of youth and the virgin soil of inexperience- despite its battles with disease and victories of the sick room! How truly sang the Psalmist, "A merry heart doeth good like a medicine; but a broken spirit drieth the bones." Opti- mists have three qualities that are essential to a person who is living with a damaged heart, -courage, patience and hope. Do you know how the first optimist happened to be created? A cheerful countenance maketh the heart glad. They found a lot of Courage that simmered in the sun. They blended it with Patience and just a touch of Fun, They poured in Hope and Laughter; and then, with sudden twist, They stirred them all together, and made an optimist. -Anon. 142 HOW IS YOUR HEART? Heart patients will find it to their advantage to give short shrift to the long-faced brothers who insist on growing old and whose short- ened prospective of life shortens life itself. These are the people who perpetuate that mas- terpiece of melancholy, to the effect that "The days of our years are three-score-years-and- ten," by eternally quoting the stuff as the gospel of their dragged-out days. They would have us, long before the arbitrary age limit approaches, join their somber crew and fold our wings and hush our pipes so that they might the more readily listen for stealthy steps advancing from the silence still far beyond! Seventy denotes nothing when hearts are young-and hearts are young despite the ad- vance of years as long as Enthusiasm and Optimism bloom. As he think- eth in his heart so is he. Dame Nature is at times a stern disci- plinarian, as ungoverned temperaments with heart trouble will soon find out to their dismay. Contentions of any kind-fussing, arguing and quarreling-can in a few brief minutes scatter to the winds the hard-won benefits of weeks of heart care. It is not alone in dramatic novels that persons fall to the ground in purple rages or drop helpless in towering passions. Beware of entrance to a quarrel. CARING FOR DAMAGED HEARTS 143 One such experience is usually enough to drive home Nature's abhorrence of all that disturbs the balance between heart output and blood- vessel capacity. It may explain the tranquil- lity, poise and calm that heart patients so often acquire. A person with an affection of the heart should take exceptional care not to expose himself to such minor illnesses as common colds. Ordinarily, people can sniffle along for two or three weeks with nothing more disagree- able than a feeling of heaviness and physical discomfort; but the heart patient is likely soon to have his heart reserve spent in combating the mild infection and an unexpected degree of physical prostration ensues. Common colds are usually a contagion of crowds. The scat- tering of infection by sneezes and coughs, by contact with chair arms, clothing, etc., is so likely to be encountered in churches, theaters, photoplay houses, street cars, shopping crowds, etc., that it is prudent to avoid such contacts during epidemics of common colds. Avoid contact with crowds during mild epidemics. There are other avoidable circumstances, connected with the digestive tract, which add unnecessarily to the heart load. Gastric dis- turbances and over-eating have been discussed 144 HOW IS YOUR HEART? in Chapter IV. Constipation, one of the re- sults of faulty food habits, affects a sensitive heart not only by the absorption of retained waste, but also by the constrained position and congestion of the upper part of the body when straining. In this connection should be men- tioned the danger that lies in the use of violent, expulsive cathartics. Sudden and wholesale evacuation of the bowel-contents is likely to be attended by a rush of blood to the great vessels of the abdomen, which are no longer restrained by gradually accumulating material; the sud- den relief of tension deprives remote struc- tures, such as the brain, of their blood supply for the moment, and dizziness, fainting or collapse result. Constipation and the use of violent cathartics are probably more respon- sible for the frequency with which heart patients are found prostrated in bathrooms than are hot baths and prolonged immersion in water. Laxatives-or at best only mild physics-should be used; cathartics may prove too drastic for persons with affected hearts. Recalling what has been said in Chapter VIII concerning the relation between dental defects and heart conditions, it is essential for heart patients to have their teeth X-rayed Periodic den- tal surveys. CARING FOR DAMAGED HEARTS 145 and surveyed at regular intervals. Do not forget that teeth can die painlessly. An X-ray study that revealed no fault a year ago is not a guarantee of tooth health today. There is always the possibility that a defective tooth may be adding to the load of a damaged heart. Your dentist will advise you at what intervals to report for periodic dental survey. Living conditions have a direct bearing on heart health. In the country one need have no concern over securing the necessary sunshine, fresh air and quiet; but for the city dweller every effort should be made to secure all three. Ideal conditions, although not always obtain- able, can be approached in sunny, quiet apart- ments, located above the roar of street traffic, where the air is cleaner and freer to circulate. Elevator service saves the fatigue of stairs, and with the rooms of the home on one level, strength is saved that can be expended to better advantage in other directions. There is no such thing as "growing accustomed" to city noises as far as nerves are concerned. Consciously or unconsciously the din batters away at the nervous system and thus certainly adds something to heart hurt. The heavy sleep of nerve fatigue is not the refreshing slumber Cliff dwellers. 146 HOW IS YOUR HEART? of repose. The problem of proper living con- ditions for heart patients in cities-sunshine, fresh air and quiet-is being solved by modern apartment homes. Speaking of stairs, the majority of heart patients do not understand why stair-climbing should prove so much more exhausting than other forms of accustomed activity. It is be- cause stair-climbing necessitates the lifting of heavy weight. To illustrate: let us say that a person weighs 160 pounds; with every step that is mounted, a weight of 160 pounds is lifted on one foot alone. No wonder stair- climbing is so exhausting! Taken in the aggre- gate, ascending an ordinary flight from one floor to another would be almost equal in strain to lifting one end of an upright piano-and piano moving is an occupation scarcely suitable to heart patients. Where stairs are unavoid- able, one can at least spare himself the burden of mounting them more than once a day; by treading deliberately, the body weight will be more evenly distributed; the banister can be made to take part of the load when both hands are utilized in the climb, and the whole exhaust- ing necessity of weight lifting can be minimized Over the ban- ister leans a face. CARING FOR DAMAGED HEARTS 147 by pausing for a moment's rest every few steps. The Patient's Daily Life should be well ordered and systematically lived. This in itself requires resolution in some directions and self- denial in others. Your whole-souled efforts and eager compliance with the doctor's instruc- tions will inspire his interest in your progress to a degree that money could not buy. Getting well takes a strong will and a stronger WILL NOT. If you routinely object to each restriction; if you cheat every time someone is not watch- ing, for the satisfaction of feeling that you have put one over on the doctor; if you meet each proposal of your medical adviser with a counter-proposal so that you can bargain and thus secure better terms on the stated cost- price of your individual health-oh, well, you know what the legendary ostrich does. That bird, also, deludes himself and in his wilful blindness falls into the clutches of an enemy. Birds of a feather. There are several points connected with the daily life of the heart patient upon which gen- eral advice can be given. These can be pre- sented in an orderly manner by beginning the discussion with the starting of the day. The patient's daily life. 148 HOW IS YOUR HEART? Arise deliberately from bed,-first to a sit- ting position, then to standing. Sudden and complete changes of posture may cause dizzi- ness. Exercise may consist of a few simple arm and leg movements, avoiding bending over at the waist line and avoiding movements that stretch the arms far overhead. With the exer- cise, deep breathing should be practiced,- gradually begun and gradually increased; this is often a definite aid to the circulation. The tub bath should be tepid,-the days of cold showers are over, as are also hot baths, Turkish and steam baths. Such aquatic amusements are for the robust; the shock of cold showers and the exhaustion of hot baths are not suited to heart patients. The body should be im- mersed to the waist line, and the bath be not over five minutes in duration. The rubdown may be vigorous, providing it does not cause distress from over-exercising the shoulder- muscles. Dress without haste, in comfortable garments that do not constrict the body at any point. Clothing that constricts is likely to impede free circulation and also hampers the bodily movements. Reveille. CARING FOR DAMAGED HEARTS 149 Concerning food: so many people are eager to give advice on the subject that one remorse- ful dyspeptic exclaimed in despair that every- thing he liked in this world was either wicked or indigestible. Food fads eternally beset us- some people get well of whatever ails them by drinking milk, others by eating cheese, some by a fruit diet, etc. Then, too, food commer- cialism, blaring from bill-boards, stands always ready to have us "eat more" of this or that, to have us prepare our meals with no other utensils than a can-opener, to live on some powder two teaspoonsful of which surpass in nourishment a nestful of eggs, etc. The "eat more" crowd should admonish us to eat less, so that we may patronize them longer. "Eat more'* and perhaps eat no more. Perhaps if we get down to a few fundamen- tals right from the start we can learn to handle our own individual food problems without the assistance of food faddists and advertising managers. What is to be said hereafter ap- plies to the average heart patient,-not to a person critically ill with a desperate heart con- dition. Nor does it in any wise pertain to patients with diabetes, ulcer of the stomach, wasting diseases, etc., who need all the skilled Let us get this straight. 150 HOW IS YOUR HEART? guidance in diet that individual instruction by specialists in these lines can give them. The primary purpose of eating is to sustain the body and perpetuate life. The act of living consumes certain substances that are in the body. These substances must be replaced. They are replaced principally by food. As there is a variety of such substances, they can best be replaced by a variety of food. Why eat? People speak of "going on a diet" as though it were a penance or an act of atonement, whereas the word diet simply means regulation -not necessarily restriction-of food. Visions of bran bread and water! Perhaps that is why there is usually a tone of contrite resignation in the voice that asks: "What shall I eat, now that I am going to take care of my heart?" The consum- ing question. The food is for the man, not for the heart. Therefore the man should eat what other men eat. There are a few rules that regulate this broad general principle, certainly; but there are no revolutionary changes to be made in food, either because the man has or has not a heart affection. The diet should be rational, customary and well-balanced. These desirable Diet should be rational, cus- tomary and well-balanced. CARING FOR DAMAGED HEARTS 151 qualifications, however, do not preclude food from being inviting, appetizing and delicious. Many people have learned that certain articles of food are not suitable fuel for the chemical laboratory of their particular bodies. For example, eggs will produce the most vio- lent stomach upsets in some people even when disguised in mayonnaise; strawberries will cause skin eruptions in others; tomatoes may bring on sharp attacks of asthma, even though taken in no greater quantity than is found in chili-sauce relish; and so examples might be multiplied without stint. Manifestly, it would be consummate stupidity for people so sensi- tized to disregard their established personal experience just because a doctor remarked that easily-digested eggs, fresh fruits and fresh vegetables were good food for heart patients. Bespect your food pecu- liarities. There are people who thrive by eating prin- cipally vegetables (strange that these are usually the aesthetic, cultivated, scholarly type); there are others who thrive and attain their highest production efficiency on quanti- ties of meat (strange that these are usually the physical, dominant, material type). If a mem- ber of either group developed a heart affection it would be absurd for him to completely re- A great eater of beef does harm to his wit. 152 HOW IS YOUR HEART? verse his natural diet and adopt the food of the other: yet each one might, to good advan- tage, incorporate part of the food of the other with his own. Thus the diet of the heart patient would be like the diet of other people who have arrived at the thinking age-it would be rational, customary and •well-balanced. If we keep on repeating these words- rational, customary and well-balanced-they may become a motto that will metaphorically shine from the plate when we sit at table. Such a motto would not be as hard on appetite as having an amateur Fannie Farmer seated on the left side and a would-be Mrs. Rorer on the right, each ably expounding on the chemical constituents and caloric value of every bite one takes. Chemicals somehow belong in the dirty end of a drug store, not in the dining room; and calories belong in the coal bin, along with British thermal units. Vitamines, purins, lactic acid bacilli, proteins, carbohydrates- what is the use of dragging such insides out of food at the table, when a man isn't very hungry anyhow! Do not set up a dissecting table in the dining room. Now as to a few general diet rules: it is rational for a heart patient to avoid food fads. CARING FOR DAMAGED HEARTS 153 His days of capricious eating and dietary vagaries should be considered passed. It is most irrational to bolt food-to gulp it down as though in fear that the supply might soon be exhausted. Food that is well mixed with saliva as it is chewed is better prepared for digestion in the stomach. Eating should therefore be a leisurely process. One should eat in moderation and always arise from the table feeling that one could eat quite a little more. Second helpings? No, certainly not. Do you eat to live or live to eat? The stomach is a work- house,-not a playhouse. Just as proportionately as work is reduced, so should food intake be reduced. A man who is living a fifty-per-cent life should reduce his food intake proportionately. Food should be fresh. One should see to it that the meats, poultry, eggs and butter from which one is to secure vital elements, have not resided indefinitely in cold storage. Cold storage adds nothing to the vital value of food, -it simply retards decay. As a general rule it may be said that the farther away any food is from that time when it was living the less desirable it becomes. This applies as well to You can't get much of a kick out of stored food. 154 HOW IS YOUR HEART? vegetables as to meats-as well to canned foods as to condensed foods-as well to jellies as to preserved fruits. Farmers marvel at the prodigious appetites of summer boarders from the city. It is five minutes from the garden to the farmer's kitchen; it may be as many days before the city-bred are city-fed. The farmer's table abounds in vital elements; he does not understand that the average city visitor has been starving for food rich in vital value,-for food that an hour or two before was living. The hearty meal should be eaten preferably at midday. Meat should be partaken of once a day. Breakfast and the evening meal should be light repasts. Nothing should be taken be- tween meals nor on retiring. Do not go immediately from physical activ- ity or mental concentration directly to the table. When one takes ten or fifteen minutes' rest before a meal, appetite and digestion are often the better for it. Every meal should be followed by rest for half an hour,-preferably in the lying position. Thus the blood is permitted to supply diges- tion, rather than driven into muscles that are being exerted. Let good di- gestion wait on appetite and health on both. CARING FOR DAMAGED HEARTS 155 "Heartburn" has nothing to do with the heart; it is a form of indigestion. It is not uncommon among people who stand or walk for the first half hour after a full meal, in the fantastic hope of thereby reducing their girth. Watch any creature, other than vaunted man, that has eaten and observe the attitude of repose, held for a time sufficient for digestion to get well under way. Look who's here;-our old friend the gastropod. A glass of water sipped with meals-cooled if preferred, but without ice in it-enables the digestive juices to more easily penetrate the food. The swilling of water in quantities with meals may so dilute digestive juices that diges- tion is retarded and the food ferments. Moderation even in the drinking of water. Milk is Nature's ideal food for the young. It also seems to agree with some adults when taken in moderate quantities. But Nature never serves it either ice cold or hot. Neither does Nature serve it in glassful gulps, but always in dainty, intermittent supply that adults can simulate by slowly sipping-not gulping-milk. 'Tis meat and drink to some. A cup of coffee is a desirable beverage for many heart patients. It may be expected to aid digestion; to act as a mild food-stimulant for the heart and to assist the kidneys in elimi- A draught that seems to lift this earthly frame. 156 HOW IS YOUR HEART? nation. These virtues can, of course, be turned to vices by excessive indulgence. Often when coffee seems to disagree, cream or milk may be omitted and the beverage taken black with- out further annoyances, such as belching. Heart patients have nothing in general to gain by omitting sugar from coffee, except when diabetes is present. Tea is possessed of the same properties as coffee, and its seeming innocence may tempt one to over-indulgence and be the explanation of wakefulness at night. Alcoholic concoctions are totally unnecessary as medicines in the treatment of heart affec- tions. A heart patient who is not accustomed to alcohol is far better off without it. But alcoholic beverages are necessary in the man- agement of heart affections when the patient has been accustomed to taking them. To sud- denly and utterly deprive a sick man of the customary stimulation of years-no matter what the accustomed stimulation may be-is an act totally opposed to medical experience. Legislators, in the wisdom which comes from sojourning in Washington, need have no com- punctions in attempting to control appetite by legislation; legislators are not brought in inti- Are they their brother's keepers? CARING FOR DAMAGED HEARTS 157 mate contact with the suffering and wreckage which prohibition's prohibitive prices inflict on the unfortunate habitue. Salt in excess is not desirable for heart patients. The body requires each day about as much salt as could be heaped on a five-cent piece. Some people for all they know may have a year's supply backed up in their systems somewhere, judging from the vigor with which they shake the very insides out of a salt-cellar. It is nothing but habit. A man with heart or blood-vessel trouble might better Hot allow himself to touch a salt shaker at the table; the food has in all likelihood been sufficiently sea- soned in the kitchen for ordinary taste. Exces- sive salt intake may or may not cause high blood pressure readings-let the doctors con- tinue to argue the question of salt as a cause; there is, however, no question of the fact that some continuously high blood pressures fall to normal when the diet is salt free. How use doth breed a habit I When the after-dinner mints are passed, some smug voice is sure to decline with, "No, thank you-I never eat candy," and the rest of us, overwhelmed by the abstemious virtue in the tone, feel quite like reprimanded chil- dren as we slip a confection from the bonbon The Sweet tooth and the sweet heart. 158 HOW IS YOUR HEART? dish. What possible disaster can lurk in a bite or two of candy-or if not disaster, then simply because it is exquisitely flavored, is the eating of a bonbon to be regarded as the gratifying of a depraved and totally unworthy taste? The harm from candy is found in quantity intake; in eating it between meals; in the perversion of a natural taste into a habit that harms,- as when at a certain hour, day after day, we pass a given corner and at the command of habit stop at a stated counter to purchase a particular sweet. Sugar is also harmful to the person who is a diabetic, to the sufferer from gastric disorders, intestinal fermentation, etc. For the vast majority of us, however, sugar is not only a source of physical energy,-but in moderate quantity it seems to amount al- most to a heart food. Some of the organs of the body require sugars. The heart is one of them. It is an always-interesting fact that a heart taken from the body of a rabbit was kept beating nearly four days by a scientist who, during that time, poured into the heart solutions that contained a sugar. People who shun sweets get their sugars despite the pro- scription; for Nature, in her infinite regard for the harmony of the body, changes such CARING FOR DAMAGED HEARTS 159 sturdy food-stuffs as bread, potatoes and other starches into sugars,-and then transforms the sugars into energy and force. You simply cannot beat Nature; you either play the game Her way or you don't play at all. When our starch-converting functions are at low ebb from any cause, the craving for sweets is likely to be at high tide. It is then that the tempta- tion to over-indulgence may lead to digestive disturbances. But there can be no harm in a few after-dinner confections for the vast ma- jority of us who live naturally, moderately and tolerantly. Cigars and cigarettes have become part of the menu, and this would be an appropriate place to consider the question, "Does tobacco affect the heart?" It does not seem to mate- rially affect a well heart, other than to make it beat a little faster; a hearty laugh will do the same thing. Tobacco in excess-and each individual must determine by his own reactions what amount constitutes excess-will upset the nerves and the nerves may for the time dis- quiet the heart. When a heart is already af- fected by an irregularity, tobacco may be expected to make the irregularity worse. Sir Walter Raleigh started some* thing. 160 HOW IS YOUR HEART? In the more serious forms of heart trouble, such blood as gets to the lungs to carry oxygen back to the body needs all the fresh air avail- able and more; when that air is contaminated by smoke or any other product of combustion which adulterates the oxygen, the end-result is very much like sending a boy to do a man's job,-it's a poor return for the errand. That is why many a heart patient needs to cut down gradually on the smoking habit-gradually; he may gradually cut it out and be the better off. But if complete denial of the habit of years is distressing, the doctor in charge might com- promise a bit. This hurts,- ■whether you "inhale" or not. Tobacco is frequently blamed unjustly for affecting the heart. A man who has smoked indiscriminately for years may notice that his heart acts in an unusual manner w'hen he is smoking and that the heart action is natural when he does not smoke. The first thought is that the weed at last has gripped the heart! Even though improvement results at first from abandoning tobacco, the heart consciousness later returns. In such cases it is not unusual to find that the heart affection is relieved by searching for and removing a focus of infection in the tonsils, teeth or elsewhere; tobacco was Defending the companion of our solitary- hours. CARING FOR DAMAGED HEARTS 161 simply the last straw that broke the camel's back. And these men may later return to the society of Lady Nicotine without any further evidence that such a platonic friendship is laying siege to the heart. To summarize. Tobacco does not make a good heart bad; it may make a bad heart worse. Heart patients, above all things, should learn to relax. They should relax mentally, emo- tionally and physically. It is merely a matter of practicing self-discipline and self-control. To relax mentally and emotionally is to shut from the mind all thought of anxiety and re- sponsibility at intervals during the day-to conjure pleasant pictures of restful places, to wander along the alluring paths of imagina- tion, to rearrange the evergreens that are entwined in the wreath of memory. The highways of mental travel and the by-ways of thought. In the Argonne Forest the same death- belching bombardment dinned in the ears of all the men of a sector. On first acquaintance it was as appalling to one as it was to another. Some soon learned to shut from mind even the monstrous cannonading; they diverted their thought and could find relaxation and refresh- ment in sleep. They seemed inured to sound Peace hath her victims as well as war. 162 HOW IS YOUR HEART? and slaughter. Others let dismay seize upon them; they had no philosophy of life, no abid- ing faith, whereby they could train the mind to be oblivious to disconcerting external im- pressions. Nerves broke down from increasing tension and lack of relaxation: hearts ran wild and could not sustain the tremulous bodies for even trifling exertion; the men were utterly useless for purposes of war. These were the victims of "Soldiers' Heart." Their rehabilita- tion was a tedious matter, accomplished by teaching self-discipline, self-control and by diverting the mind from accustomed ruts into fresh channels of thought. Pray, what was this but learning to relax-learning to let go! There are many cases of "Soldier's Heart" being bred in the mental concentration camps of civil life today. A midday rest on couch or bed for half an hour or longer relieves the strain which the erect posture imposes on persons with heart or blood-vessel affections. Modern industrial plants are beginning to recognize the value of such physical relaxation even for well em- ployees, and are providing comfortably fur- nished rest rooms for relaxation. An ideal situation for the noon-day siesta of a heart A noonday nap. CARING FOR DAMAGED HEARTS 163 patient is a room that is quiet, well-ventilated and darkened. Simply to throw one's self on a couch and fret, as a petulant child might do until a stated time arrives, is not relaxation. Physical rest requires the cooperation of men- tal rest-of the passive state of mind-if the midday nap is to furnish a heart patient with actual relaxation. "Early to bed and late to rise" should be the motto of a person with heart trouble. There is a proper way to prepare for sleep; faulty habits that repel repose have been mentioned in Chapter IV. As to position in bed, one will naturally take that posture which is the most comfortable; some people prefer to have the head high, others sleep best when flat on their backs, while still others sleep more comfortably on the right side. Heart patients should not fall asleep when lying on the left side. The muscular control of the chest relaxes during sleep; as the heart is on the left side, some degree of heart compression naturally arises and may produce sensations of heart oppres- sion that cause the sleeper to spring awake with a start and gasp. While no especial dam- age has been done, such an experience is always alarming and cuts down the night's To sleep, perchance to dream; aye, there's the rub. 164 HOW IS YOUR HEART? total of repose; if it can be avoided by not sleeping on the left side, the remedy is worth trying. Sufficient rest is absolutely essential in heart affections. Twenty-five per-cent increase in rest means ten hours in bed instead of the cus- tomary eight; fifty per cent increase in rest means twelve hours in bed, whether one sleeps the entire time or not. Bedtime should begin an hour or two hours earlier than usual and last an hour or two hours longer in the morn- ing. There is supposed to be some legendary virtue in arising early. However apt the early bird theory may be to business pursuits, a heart patient who has not had sufficient rest is quite as likely to be the worm as the bird in the sunrise encounter. The early bird catches some- thing; so does the worm. There is a general belief that a person with a heart affection should not marry. The belief is not a rule by any manner of means. Every- one will of course admit that a person with a heart defect that is progressing in severity should not marry; nor should confirmed in- valids, whose physical capacity is nil, enter into any sort of contracts. But the vast ma- jority of heart affections are not progressive and can, by modified living, be so kept in the Considera- tions of mar- riage. CARING FOR DAMAGED HEARTS 165 background as not to be apparent whether one is single or married. If such a person is considering matrimony, the logical order of inquiry would be to ascertain first whether the doctor considered the heart defect to be sta- tionary. The next step would probably be to inform the other person of the existence and nature of the heart trouble. If the proposed alliance were not to materially alter the modi- fied manner of living of the one; if it did not entail the hardships of travel or impose new duties that were physically burdensome: if the two were temperamentally suited to each other and had common interests that would minimize the frictions which arise during that period when dispositions are becoming adapted one to the other; there then would be but little reason to avoid matrimony as far as the heart is concerned. Indeed, the benefit which is to be derived from congenial companionship and from the renewed interest in living, frequently makes marriage an asset to a heart patient rather than a liability. There is but one other major consideration that enters into the sub- ject; it is usually not to the advantage of a heart patient to join in matrimony when either 166 HOW IS YOUR HEART? partner is many years the junior of the other. The reasons are self-evident and numerous. Motherhood may be a deterring thought to a heart patient who is contemplating matri- mony. When the considerations above set forth concerning marriage meet with no objec- tions, there can be no objection to motherhood. It is amazing with what little disturbance even badly damaged hearts will undergo the months of expectancy and the hour of birth. If the reproduction of kind is the consummate pur- pose of all living things, then it seems that Nature unlocks or creates reserves in damaged hearts, to meet the demands of reproduction -reserves that are not to be counted upon in any other circumstance of heart life. Cer- tainly there is a heart load to expectant mother- hood ; one body must eliminate for two, furnish the nourishment for two, supply from her own stores the growing demands of that completed structure which Nature is evolving. These procedures put a load of some degree on the parent heart,-but the load is a gradual one, starting from an imperceptible beginning and added to so gradually as the weeks go by that the heart readily adapts itself to the incre- ment-to a load which, if thrown suddenly in Motherhood. CARING FOR DAMAGED HEARTS 167 its aggregate upon the body, would surely overwhelm mere flesh. Recognizing then that there is such a thing as the heart load of expectant motherhood, it is wise for a heart patient to observe the rules of heart care even more faithfully at this time than at others. Obstetricians make periodic physical surveys of expectant mothers, and when early under the guidance of physicians skilled in that art, there is no reason for a heart patient to become alarmed when called to par- ticipate in the most sublime service that any individual can render humankind-Mother- hood. So far, this little volume on Heart Health has wended its way along various paths of human activities and interests without any mention of the use of drugs in heart affections. And so it will continue. Of all the organs in the body which the self-doser should let strictly alone, the heart stands preeminent. A drug which will have any direct effect on the heart is usually a poison. That is probably why the patent medicine crowd, in the heyday of adver- tising their atrocious stuff, scarcely dared ven- ture into the cure-your-heart business; to induce any heart effect by the indiscriminate use of Health is not found in bot- tles. 168 HOW IS YOUR HEART? poisons would likely have resulted in the in- sertion of advertisements in such undesirable space as village churchyards. When your doctor employs medicines in heart conditions he knows exactly what he is prescribing for,-that is why he takes so much care to examine you; he knows where the drugs come from, how they are prepared, just what effect to expect from a stated dose, and even then he makes frequent visits in order to de- termine when to reduce or discontinue the drugs. Have you ever noticed the words "Not to be refilled" on the doctor's prescription? The sentence is put there to prevent some uncharted soul from continuing to take a pow- erful drug which he no longer needs, on the theory that if a little is good more is better. Occasionally hearts are cruelly hampered and clamped as tightly in the grip of an over- administered drug as they might be in the jaws of a vise. Then too, it may happen that such a person decides to play philanthropist and he passes the prescription over to a second person who feels "just exactly" as number one used to feel. Ye gods! A business acquaintance, flippantly recommending and in two minutes Rush in where angels fear to tread. CARING FOR DAMAGED HEARTS 169 prescribing a drug which a scientifically trained physician has studied for years and still cautiously prescribes. . . . They're not all dead yet; but if such practices are allowed to go unchecked, the fool-killer will be hunting a new job. The safeguarding of human life is the first obligation which society imposes on civilized man today. Those who in any way undertake to handle for another his precious asset called life, are required to give proof of their ability to guard it safely. Even the doctor must pass examinations to prove his fitness to maneuver a threatened life from the grasp of disease. The property-owner is held responsible for ice on a sidewalk that causes a fall which injures the health or threatens the life of another. Cities are constantly policed to guard the safety of life for their citizens. The elevator in which life is intrusted for only a moment must be periodically inspected to insure safety. The boilers in public buildings, hidden far away from public view, are examined for corrosion and certified to as concerns their capacity to constrain explosive steam. When man elects to travel, his inalienable right called life is The public re- sponsibility of safeguard- ing every man's life. 170 HOW IS YOUR HEART? intrusted to others; the train on which he speeds through space is tested every few hours throughout the day and night-each wheel on the train is inspected for the crystallization of iron which might mean a wreck. The axles, brakes, couplings, safety devices-the tracks, the ties and even the iron nails called spikes that hold them together-must all give con- stant proof of their dependability to protect human life. Such are the precautions taken by others to prevent death from accident. But infinitely more people die of disease than by accident. The prevention of disease is mainly an indi- vidual responsibility. What precautions are taken by the individual to safeguard life from the ravages of disease? Do you, Mr. Individ- ual, give that body in which life dwells the periodic examinations, the repeated tests, the frequent inspections which are applied to far more enduring substances, iron and steel? When was your last health audit made ? And how HIS audit stands who knows, save Heaven? Ask ten men how their health appraisals stand today and see what shiftless accounts nine will give of their stewardship. Some will say that they guess they are all right, because Where are the Mine? CARING FOR DAMAGED HEARTS 171 they passed insurance examinations two or three years ago; others will take credit for present-day health because they were accepted by the army draft boards; still others will aver that they are in good shape because they visited the doctor last month to get rid of a cold or headache-purely local repairs; two might say that they have been intending to go to the doctor for an overhauling but have not yet found the time to do so. It is a lucky thing for the rest of us that this take-a-chance bunch is not intrusted with the responsibility of in- specting the railroad trains on which we ride today. Former heart patients are not the only people who require an annual physical inven- tory. Every person, child or adult, should have an annual audit of health made. The busier a man is the more does he need physical inspec- tion. The older he grows the more does he need it. Disease is often so sneaking in ap- proach and often so underhanded in attack that it is the height of folly to wait until one falls sick before seeing a doctor. This is a day of prevention. Physical disaster may be prevented by physical inspection! It certainly requires no more argument to convince a man Man alive I This is a day of PREVEN- TION! 172 HOW IS YOUR HEART? that an annual physical inventory is well worth his while. But when should it be done-how can one remember to go see the doctor when one is feeling fine-when aches, pains or incon- veniences do not drive one to the repair shop? There is a splendid day each year to have your physical inventory made. It is your Birthday. There is nothing much to do that day, anyhow. Other holidays are accounted for; Christmas belongs to the children, New Year's Day is given over to callers, Easter belongs to the Church, Memorial Day one ded- icates to those who have gone before and the Fourth of July is devoted to that gastronomic monstrosity called a picnic. But your Birth- day is your day; if you arrange in advance to spend an hour or two of it with your doctor, you will not forget or postpone your annual physical inventory. Secure a copy of his ex- amination each year; check it up with previous reports; know the various items that enter into your health audit,-not only your physical faculties, physical functions and organic ex- amination, but also the urinalyses, blood ex- amination, dental X-rays and such other spe- cial examinations as your doctor advises. Have your an- nual physical inventory made on your Birthday. CARING FOR DAMAGED HEARTS 173 Do you realize what a comfort it would be to you and what a satisfaction it would be to your doctor, if you fell ill, to know that your body was in good condition a few months be- fore? Neither you nor your doctor would have much apprehension as to the outcome if it w'ere definitely known that disease had not been quietly undermining your health for an in- definite time. Your first Birthday be- longed. to the doctor; so should each successive anniversary. That's it-your Birthday is your doctor's day. What a corking good Birthday present you might give yourself, in the form of a clean bill of health! There is a Bishop who has been having an- nual physical inventories made for many years. On one occasion he said to his physician: "Doc- tor, you have done some really splendid, timely things for me in safeguarding my health; I can never thank you sufficiently and I wish you would send me a bill for your services." To which the medical man replied: "No, no, Bishop; I am one of your parishioners and you are one of my patients. We wrill continue to exchange professional courtesies. You keep me out of hell and I'll keep you out of- heaven." That's fair enough. CHAPTER XIV APPROPRIATE EXERCISE FOR HEART PATIENTS Exercise was at one time thought to be a terrible mistake for a person with a heart affection. The conventional thing to do in those days was to join the wheel-chair brigade or hobble around despairingly on crutches. The heart was no more responsible then for the physical crippling, for the sighs and pains, than it is now. And now we know that the heart virtually never throws an ache into a knee joint, a crick into the back, stiffness into a leg muscle or an ouch into the grasp of the fingers. We realize that the same bodily poisons which are crippling the bodily muscles and joints are also crippling the heart muscle. Today doctors locate the source of those poi- sons and get rid of the source; then the heart patient has muscles that do not cry out in pain at every movement, the heart no longer shares in the physical protests and, by the institution of appropriate exercise for the body muscles The sinned- against heart. 174 APPROPRIATE EXERCISE 175 the heart muscle is prevented from continuing to be weak, flabby and inefficient. Restrain a perfectly good arm in the grasp of a sling for six weeks, and at the end of that time said arm will not have enough strength in it to tip your hat. It would be utterly out of the question to even try to bring those arm muscles back to efficiency by starting to strike away at a punching bag. You would have to start gradually, first by just learning to open and shut your hand; then by extending your arm; then by bending it. After several days of such gradual reeducation of the muscles, you might be able to pick up a paper weight or a cup of coffee or even handle a fork with some little regard for the formality of elbow close by the side. But it would be weeks before that arm, flabby from lack of use, could lift a bucket of water to the radiator of your car without provoking language that would distress the ladies. Let us look at it from this angle. The arm is a muscular structure; the heart is also a muscular structure. Any muscular structure gets flabby and inefficient from dis- use. Efficiency can be brought back by ap- propriate and gradual exercise. An arm muscle that has been burned or scarred will The heart asks pleasure first and then excuse from pain. 176 HOW IS YOUR HEART? certainly not be as fully efficient as it was before the damage occurred,-but one can learn to use it within its limitations, and really but little miss its one-time power. And so we see that a damaged heart also actually requires appropriate exercise. Of course no one is going to be so colossally stupid as to impose exercise on an acutely ill heart. Nor would any thinking creature per- mit a heart to send forth one avoidable beat when it might be putting up resistance against mild, occasional or recurrent attacks of rheu- matic fever, tonsillitis, influenza or any other partially hidden illness. Following any illness, even the simple exertion of walking across the bedroom floor should not be attempted until several days after the heart has so adjusted itself that it no longer shows a marked increase in rate or in contraction-force when the pa- tient sits on the side of the bed. Then gradual exercise can be started, and gradually in- creased to that point which we are going to call Appropriate Exercise for that individual heart. when^torm16 ciouds gather. Your doctor will give his instructions for gradual exercise following heart involvement or following an acute illness. The idea is to ^torm th6 APPROPRIATE EXERCISE 177 reeducate the heart muscle to its accustomed exercise response. Usually it begins with sit- ting up in bed for a few minutes one day, for a longer period the next day, then to a chair for periods that lengthen as the days pass; after a while downstairs, then to the porch, to a short walk and finally to accustomed activities. The duration of each step in re- educating the heart muscle depends on what the doctor observed about the heart when you were ill, and also depends on how the heart responds to each increasing step. You had better not try to handle this proposition your- self; it is a job for your doctor. Amateur attempts at heart directing are responsible for many of the "influenza hangover hearts," etc., that we see today. How much exertion constitutes "appropri- ate" exercise for a given heart? Is the amount of exercise measured by swinging Indian clubs ten times or fifty times-is it measured by walking one city block or one mile? Getting ready to start. You cannot measure the heart's capacity for exertion that way. A man might have been a practiced swinger of Indian clubs before his illness and thirty such movements would be no exertion at all for him,-while another man, Paddling your own canoe. 178 HOW IS YOUR HEART? who never saw Indian clubs, would from the same amount of club swinging feel that he had done a half day's work. An accomplished walker would laugh at the end of a half-mile limit, while the average unpracticed fat man would start out gamely but arrive in a taxi, still out of breath from the start. Manifestly, it is impossible to say that a stated, measured amount of any form of exertion constitutes the Emit of permissible exercise for hearts. There is only one way to estimate how much exertion an individual heart should put forth. EXERTION MUST CEASE WHEN IT BRINGS ON SHORTNESS OF BREATH, HEART HURRY, CHEST OPPRESSION, CHEST PAIN OR PHYSICAL FATIGUE. That is the best rule to regulate exercise for heart patients. It should be their creed, and it should direct and govern them in all their doings. The heart ex- ercise creed. The measure of what you were able to ac- complish yesterday is not the measure of what you might accomplish today. Perhaps you will not be able to do half as much. Yesterday you walked ten blocks, we will say, before hailing a homeward-bound taxicab, and today were all put out to find that instead of doing twelve blocks (two for today's increase) you Getting no better fast. APPROPRIATE EXERCISE 179 could only cover six before the "heart exercise creed" began to operate and stop you. That sounds pretty discouraging. A loss of forty per cent on today's capacity for exertion as compared with yesterday's; twenty per cent additional loss on what should have been to- day's increase,-a total of sixty per cent net loss on the heart's day. That is getting worse instead of growing better! There is no occasion for panic. Use your head. What has happened in the past twenty- four hours that might have primarily increased the heart action and secondarily have re- duced heart efficiency? Perhaps yesterday's ten blocks were a little too much after all; may- be there was some excitement last evening, some emotional strain, later hours than usual or a partially wakeful night. This morning, business may have been rather exacting and you were anxious to get away from it; a meal may have been hurried, there may have been a little digestive disturbance, the day itself may not have been bright and bracing. Yesterday there may have been an objective in the walk, which stimulated your interest and gave sprightliness to your step; today's exercise may have been perfunctory and dragged along You cannot eat your cake and have it. 180 HOW IS YOUR HEART? with heavy feet. Yesterday's companion may have been entertaining and en rapport with your feelings,-today's dull plodder, as far as inspiration was concerned, might as well have been chanting the Dead March from Saul. That heart isn't altogether a piece of machin- ery, you know, to grind out so much product for so many minutes' operation. It is attuned in exquisite harmony with your brain and with every other organ in the body. Tonight take more rest than usual and tomorrow try those ten blocks again and, the next day, go after the twelve-but play fair. You will find that the heart of late is quicker to resent an imposition than it formerly was; and it is not quite so good natured, perhaps, at least not until it acquires more stamina. There is one strict injunction which the heart patient should know before we discuss the various forms of exercise. The injunction ap- plies to every conceivable form of activity. It is as arbitrary in its application as were the immutable laws of the Medes and Persians- it is even more exacting in demanding its pen- alty. Too frequently the penalty for dis- obedience that is imposed by outraged Nature Defendu! Verboten!! Forbidden!!! APPROPRIATE EXERCISE 181 is horribly, tragically final. Nature's strict in- junction is AVOID BURSTS OF SPEED That is the lesson to be drawn from those who drop when hurrying for trains, when dash- ing up stairs, when reaching a climax in the pulpit, when engaged in heated argument, when bad news bursts upon them. Sudden effort, sudden emotion, sudden anger, sudden anything makes a heart patient a candidate for sudden death. Candidates often elected the first time they run. Exercise, for its full enjoyment and for the reaping of its benefits, requires an urge-a de- sire which eagerly impels one towards the thing to be done. The urge to exercise may be in- stilled by an ideal day for a favorite pastime or sport, a desire for a complete change from accustomed routine, by the call of the great outdoors, the charm of the wooded drive, the change of the seasons, by the yearning for com- panionship of a kindred sport lover, by a feel- ing that one's muscles need to be brought in play by a familiar exercise, by a desire to regain through muscular activity the former physical fitness which has been reduced by in- activity. The urge to exercise. 182 HOW IS YOUR HEART? Unless there is some such urge to exercise the stimulus is lacking and very little physical benefit can be expected. To merely go through the motions of exercise in a mechanical and disinterested way is to bore one's self and incur a weariness of the flesh which is without a beneficial reaction. The spirit must be will- ing or the weak. Companionship adds to the zest of exercise. But the presence of a companion should not tempt a heart patient to exceed his powers of endurance or ever tempt him to violate the "heart exercise creed." Competition of a mild degree is desirable; contest for supremacy is a damnable thing. Contest stimulates a heart patient to disregard the first warning signs of heart protest; the desire for supremacy causes him to overdo. Therefore heart patients should avoid all exercise in which the element of con- test enters. For example, a game or two of tennis is quite permissible for a person who has been accustomed to playing it, and such competition as the fellow-player creates is de- sirable; the game can be discontinued when the physically handicapped one so desires. But to play in a tennis match, where the supremacy of a team or school or the defending of a trophy is at stake-where the element of con- The difference between com- petition and contest. APPROPRIATE EXERCISE 183 test enters-means that the match must be fought to a decision regardless of the exertion imposed or the effort expended or the time duration of the contest. Consummate folly! Heart patients frequently ask just what forms of exercise or games are the best for persons with heart trouble. There is no special heart value resident in any particular form of exercise. As a general rule recovered heart patients should continue the familiar forms of exercise to which they are accustomed-modi- fied, of course, by gradual readaptation to the sport. Every person realizes that a man who played eighteen holes of golf before his illness could not go out after convalescence and do anything more than putter around on a green for a few minutes; he must gradually resume accustomed familiarity with his game. The old exer- cise is the best exercise. The type of exercise which any creature adopts as routine is very much dependent on the type of inherent musculature. The slender, supple muscles of a race horse are not adapted to draft purposes; nor would a heavy, sturdy Percheron be expected to develop a speedy step. A man who is muscled for the position of guard on a football team where ground- gripping stamina is essential could never get Built for speed or built for endurance? 184 HOW IS YOUR HEART? away with the position of end, where hair- trigger muscles and speed are the required physical fundamentals. Men are built for a certain type of muscular exertion, and they elect those forms of exercise to which their musculature conforms. A doctor's dictum could never make a big-game hunter out of a ping-pong player. So, generally speaking, the old game is the best game. In the first place, one likes it, and a new sport might be distasteful; again, a man has acquired facility and knack in the old game that is exhilarating, and he may find nothing but discouragement in unaccustomed practice. Furthermore, the pleasant reminiscences and former triumphs of the old game are agreeable mental pictures, while the learning of a new pastime is often tedious, even when the instruc- tor does not have a patronizing and indulgent manner. No profit grows where is no pleasure ta'en. There is one big outstanding exception to the general rule that the old exercise is the best exercise. This exception is swimming. A person who has had heart trouble should never venture in water beyond his depth, no matter how remote the earlier heart affection may be, nor how skilled a performer the Hang your clothes on a hickory limb, but don't go out in water. APPROPRIATE EXERCISE 185 swimmer may be, nor how tempting the cir- cumstance that entices the ardent devotee of this alluring sport. Sudden heart exhaustion is responsible for the drowning of many expert swimmers. The factors which call for tremendous heart output and which produce complete heart ex- haustion while swimming are apparent on a moment's thought. They include (1) immer- sion pressure, (2) increased resistance and (3) extensive muscle-group exertion. The immer- sion pressure of the water on the skin capil- laries increases the heart effort to overcome said pressure, and also makes breathing an effort. The increased resistance which the water offers to propulsion of the body is tre- mendously more than the accustomed resist- ance of moving through air. Extensive mus- cle-group exertion must be made to support the body and to propel the body,-shoulders, arms, thighs, legs are exerted at the same time and in unnatural directions, increasing heart output in a manner that taxes even robust hearts. Furthermore, there is no immediate opportunity for rest on a firm footing when heart prostration threatens. Is it any wonder that heart exhaustion is always a possibility Why some swimmers sink. 186 HOW IS YOUR HEART? and that swimming is therefore absolutely in- terdicted for a person who has or had a heart affection? Walking in the outdoors is a form of exer- cise that has everything to commend it. One should aim to acquire a sprightly and elastic step and walk not with haste but certainly with some pep and vigor in the action. Walking is undertaken for the purpose of inducing mod- erate physical exertion; it is right that it should moderately exert the heart. To saunter dream- ily among the roses in the garden may be good for cultivating tranquillity of spirit but it is utterly without effect in educating heart mus- cle to a normal exercise response. The heart must have some exertion imposed on it; it will never increase its capacity for exercise unless it learns to overcome gradual increases in exertion. A year of strolling in the garden caressing the blooms would find the heart but very little more efficient than when the indolent sauntering began. Walking for health is done with the muscles of the arms and shoulders and chest, as well as with the muscles of the legs. There is probably no other form of physical activity which is so hard to describe as the art of walking. It can be acquired only by ob- When walk- ing for health put some pep in it. APPROPRIATE EXERCISE 187 servation and practice-perhaps it is a gift. He who attempts to define on paper the knack of walking finds himself in much the same predicament as did the fabled centipede when asked for a modus operandi: The centipede was happy quite Until the frog, in fun Said, "Pray, which leg goes after which?" That wrought his mind to such a pitch He lay distracted in the ditch, Considering how to run. It does not matter much whether one walks on levels or on easy grades-whether across meadows, through the woods or along sub- urban avenues-whether in the early morning or late afternoon-so long as one remembers and heeds the Heart Exercise Creed. It is not wise to climb steep grades, for that cuts down the total time outdoors; it is not wise to walk in the face of a wind, nor to do all the talking, -both may induce shortness of breath. Walk- ing around a billiard table is good exercise in inclement weather, but one should not attempt long-reach shots. Walking over a house, attending to the thousand duties of home- making as so many women do, is good exercise; Go forth un- der the open sky and list to Nature's teachings. 188 HOW IS YOUR HEART? but indoor walking cannot be substituted for walking in the great outdoors in answer to the call of the open. Dancing is a splendid form of exercise for a heart patient-providing of course that the person does not let exhilaration of the dance lure her to respond to every encore, tempt her into disregarding the heart exercise creed or too frequently shorten her customary night's repose. When youth and pleasure meet. It is rather dictatorial to say that a girl who has had some heart trouble cannot go to a ball -it may even be arbitrary to say that she can- not stay the dance out. If she is willing to use her head to protect her heart, she can often prepare for the event by extra hours of rest before and by lengthened hours of rest follow- ing the ball, and be none the worse for it as far as straining the heart is concerned. Danc- ing is as natural to a girl as hunting is to a boy, and parents will do well not to adopt any arbi- trary restrictions in such matters with young adults, on the theory that the heart will be damaged thereby; in an intelligent youngster the heart usually refuses to make good the threat, and parental control begins to wane. The little rift ■within the lute, that by and by will make the music mute. APPROPRIATE EXERCISE 189 Dancing is also a delightful form of exer- cise for persons past (?) the age of thrills, even though the heart does show such changes as one expects when the years advance. There is no logical reason why a lover of dancing should abandon the rhythmic, graceful art just because she has arrived at the period of life when ancestral dames were wont to tread their spinning wheels in rhythm with the music of hallowed memory. Syncopation is the thief of time. Golfing has everything to commend it to a heart patient. It affords freedom from office responsibilities, open air exertion, companion- ship, leg exercise, arm exercise, trunk exercise, the exhilaration of a good stroke, the resolution of a poor one, the evolving of excuses, the memory of a wonderful score and the eternal allurement that all of one's ability may some day show itself and set a new score for the good players. Benches are always near at hand when waiting for the others to come up. One may play as little as he thinks fitting for the day and not lose interest in the game because the full course is not completed. When stooping brings on dizziness, someone else can tee the ball-and the grinning caddy can re- place the turf. Hearts in the highlands. 190 HOW IS YOUR HEART? Fishing, in all its forms, is not so innocent an exercise for heart patients as it seems on first thought. "Still" fishing from the shore or boat is excellent, and has to commend it a day in the open, a moderate degree of exertion and the stimulating element of chance. Active fishing, however, such as trudging along a trout stream, through underbrush and over boulders, with the constrained positions that are sometimes necessary in casting a fly with accuracy, may impose too much of a burden on damaged hearts. Salt water fishing is un- objectionable for those who enjoy this form of sport, providing a companion is along to relieve the heart patient of the physical strain of landing a heavy fish which may interpose a gamey resistance to the line. An art worthy the knowledge and practice of a wise man. Hunting is not so objectionable for the man who knows his heart has been damaged and who is willing to modify the activities of the day in compliance with the Heart Exercise Creed, as it is for the man who rushes pell-mell into a day in the woods. Stiff and uncomfort- able garments, stooping, crouching, hiding under cover, the effort of getting through the wild in rough and inaccessible places and the toting of game are factors that are responsible He broke, 'tis true, some statutes of the law. APPROPRIATE EXERCISE 191 for the breaks in heart efficiency which are rather frequently attributed to a day's hunting. Guarding against such strains and avoiding them, the hunter must still be deliberate in following the cry of the hounds. Horseback riding may be permissible for those patients who are accustomed to it and who do not ride furiously. Persons unaccustomed to riding horseback should not adopt it as a post-convalescent exercise. It requires skill and experience to manage a horse, which is often capricious and which interposes a brute resistance to the will of the rider, thus making a burden of what is otherwise a healthful exercise. The coursers of themselves will run too fast,-your art must be to moderate their haste. Polo playing is not to be recommended to heart patients-despite practiced equestrian skill. The sudden twists and turns, the long or awkward reaches of the mallet and the pos- sibility of collision all militate against the game. Motoring imposes a strain upon the muscu- lar and nervous system of those who drive their own cars in congested traffic or along unfamiliar highways. For those in the tonneau motoring has an exhilaration, but this can be pushed to excess and a heart patient be relaxed Motoring is not now the unalloyed joy it formerly was. 192 HOW IS YOUR HEART? and distressed if the drive has been too long continued. Suburban or rural motoring at moderate speed is to be recommended to heart patients. Congested traffic, or traveling in an unending procession of motor cars, necessitates the breathing of noxious exhaust gases from other motors. Many heart patients need all the fresh, un- contaminated air they can get, in order to purify the diminished quantity of blood that is sent to the lungs by a heart with diminished output. No one so affected would elect to sit in the clouds of smoke in a close banquet hall or railroad car; no one would voluntarily inhale the smoke from engines, factories, burning leaves, kitchen fryings, etc. Yet many of us, long accustomed to enjoying the fresh air from a motor car since the days when cars were a distinction, complacently inhale the products of combustion that hang low down on the con- gested highways of today. Worse luck- closed cars do not solve the problem; while they keep most of it out they keep some of it in and a fresh gust from heaven has no chance to momentarily dissipate the fumes. We almost need gas masks when motoring today. APPROPRIATE EXERCISE 193 If there is no way to escape this poisoning of the air by some such expedient as motoring in the early morning or along unfrequented roads, the heart patient is better off when not in the car, courting headaches, ennui, lassitude and physical depression by inhaling noxious vapors-vapors which may or may not be noticeable to sight or smell, yet which are none the less defeating to the exhilaration of a spin in the open. Canoeing is to be recommended to heart patients as a desirable form of exercise. The easy stroke of the paddle, the moderate move- ments of the trunk and the lightness of the craft cannot impose an actual physical burden. Rowing a boat laden with passengers is not to be recommended; it introduces the undesirable features of the pull and the lift, which heart patients should avoid. Rowing on rough waters or in the face of a wind or in the broiling sun are all, of course, objectionable. Thou shall not bow down thy- self. There are many forms of exercise which need not be enumerated here, for from those already presented can be learned the general principles governing muscular activity. Any exercise that appeals to a heart patient should On this hangs all the law and the profits. 194 HOW IS YOUR HEART? be scrutinized for its possibilities of heart hurt from the following angles: Exercise should 1. Avoid bursts of speed. 2. Avoid sudden movements. 3. Avoid the element of contest. 4. Avoid effort-strain. 5. Avoid pulling, lifting, reaching, stooping. 6. Avoid violation of the Heart Exercise Creed, which is that exertion must cease when it brings on shortness of breath, heart hurry, chest OPPRESSION, CHEST PAIN OR PHYSICAL FATIGUE. CHAPTER XV APPROPRIATE OCCUPATIONS FOR HEART PATIENTS Occupation is, of course, a form of exercise. The word occupation implies the employment of the body muscles as a means of livelihood. Men who employ only their brain muscles in the sedentary pursuits require physical exer- cise in addition to keep their bodies up to par. Persons who employ their body muscles in the active pursuits of life do not, as a rule, require additional physical exercise; they require rec- reation and rest rather than exercise in the active sense in which brain workers use it. So as occupation is a form of exercise, and as unregulated exercise can add to heart hurt, it is well to consider the appropriateness of occupation for heart patients. The differ- ence between the judge's bench and the carpenter's bench. Some people with heart trouble have had all the action scared out of them by well-mean- ing relatives who have no sense of proportion and no appreciation of the fitness of things. When the patient was acutely ill the doctor forbade all endeavors; during convalescence Absence of occupation is not rest; a mind quite va- cant is a mind distressed. 195 196 HOW IS YOUR HEART? the doctor only allowed such customary exer- tion as stair-climbing but once a day. No matter how far into the past those days of necessary physical restriction have receded, some relative is sure to insist that the patient must not do this and must not attempt that, and by thus perpetuating the restrictions he de- stroys the initiative and undermines the morale of the one-time invalid. So we have about us lazy heart muscle and lazier heart patients who burden households and who are often a charge on the community. Worse than that-the patient finally loses the self-respect which one feels in being to some degree a self-supporting and productive mem- ber of society. The present is empty, the future holds nothing. Eventually the instinct for industry is smothered completely and the man is perfectly willing to be kept. Some men are perfectly will- ing to be kept. It may surprise protecting relatives to know the results of statistics that were made of a group of heart patients for whom appropriate occupations were found. Some of the group had not worked for years. Over eighty per cent of these patients were on the same jobs a year later and feeling fine. Of the other twenty per cent most had learned previously Proof that heart patients can work and prosper. APPROPRIATE OCCUPATION 197 that somebody would keep them without their having to work. Only one of the group met with calamity; he was an elderly person in a clerical position, and had arrived at that time of life when men usually give up working for reminiscing. One day he passed out while at his employment-just as one of his age might have done while napping on somebody's front porch. There is no questioning the proven fact that recovered heart patients of working age are the better for working. It only remains to select an appropriate position. What is appropriate occupation for a heart patient? The general principles governing appropriateness are (1) the occupation should be moderately light, (2) it should not entail physical effort and (3) it should afford some opportunity for physical and mental relaxa- tion during the working hours. It is a fine thing, too, when the place of employment is within fair weather walking distance of one's home. The general principles gov- erning occupa- tion for heart patients. Occupation should be moderately light. That does not mean that the heart is to be kept lazy by employment that imposes no physical 198 HOW IS YOUR HEART? exertion whatever; a limited amount of exer- tion is good for the heart. Occupation should not entail physical effort. There is a vast difference between the word exertion and the word effort. Standing all day, working foot-treads; reaching repeat- edly far overhead; stooping frequently or remaining in a crouched posture; lifting mod- erate or heavy loads; climbing stairs again and again; carrying heavy things, even for short distances-these constitute effort as far as the heart muscle is concerned, whether the framework muscles of the individual protest or not. Occupation should afford relaxation. A job that drives one constantly-that requires eter- nal mental alertness-that is tedious and nerve- wearing-that never affords an opportunity to relax, is not suitable for a heart patient. These faults are often found in present-day machine operating. Many labor-saving machines sim- ply transfer the labor from the muscles to the nerves of the operator. The old job is the best job,-but unfortu- nately, it is seldom adapted to the reduced physical capacity at which heart patients must live. New jobs mean job-hunting, delays, Most heart patients are •worthy of their hire. APPROPRIATE OCCUPATION 199 physical weariness, disappointments and the discouragement of running up against the Em- ployers' Liability Act, when an employment clerk is too young, too nearsighted or too stupid to realize that heart patients make the best kind of employees. They are best because they have learned to be steady, regular and careful; they are not frivolous or trifling; they do not tire themselves out with a lot of high-speed diversion nonsense or dissipation at night, but, on the contrary, the heart patient makes a point of getting plenty of rest for the next day's duties. Some employers recognize these virtues and carry heart patients in the lighter positions where character, faithfulness and a fine sense of responsibility are necessary. But it means "job hunting" to locate such openings. It is therefore better to talk over the matter of a position with the former employer, who knows the worth of the heart patient to the firm. A lighter job certainly exists somewhere in the organization, where one will be happier in familiar surroundings and more content among old friends. A machinist no longer able to work at a lathe could assemble small parts at a bench,-even though it meant less pay. An Hang around the old stamp- ing grounds. 200 HOW IS YOUR HEART? automobile mechanic might get in the selling end of the game; the janitor of an apartment house might he successful as a doorman; and so in every branch of industry to which one is accustomed there exists lighter and less physi- cally-exacting employment which is suitable to the limited capacity of the heart patient. Perhaps a sympathetic employer may have to create a new position for an appreciated employee who is physically handicapped. Under such circumstances the one employed is the debtor; he should recognize that there is some sentiment mixed up with the business relation. The former invalid should foster this spirit, and cannot afford to lay down terms as did the quarrelsome labor agitator who de- cided to try work for a while and whose first query was: "How much pay will I get?" The employer answered: "We will pay you just what you are worth"-like a flash came the rebellious reply, "No, you won't; I'll not work for that money." The underly- ing principle. It would not be appropriate for this volume to set forth a detailed list of the various occu- pations suitable for heart patients. The suit- ability of an occupation must be gauged not only by the degree of individual heart damage Every man to his own line of work. APPROPRIATE OCCUPATION 201 but more particularly by the individual's per- sonal aptitude for a form of employment. Imagine, for example, the violent reactions of an ex-blacksmith or boiler-maker when he en- counters in a Suitable Employment List such items as "Engraving; Sewing on buttons; Putting eyes in dolls; Vase making," and never finds mention of forge-tending, tool-grinding or drop-hammer welding. There is no alchemy in a heart illness to so change a man's make-up that he can adapt himself to a form of work to which he never was accustomed. So the items that are to be considered when determining what constitutes an appropriate occupation for a heart patient include: (a) moderately light employment; (b) absence of effort-strain; (c) opportunity for relaxation; (d) contact with former associates and (e)j individual aptitude for the work. SUMMARY 1. "Heart Disease" is no longer a term of terror. 2. The heart can protest without necessarily being diseased. 3. Heart affections are usually secondary to other conditions. Let us then hear the con- clusion of the •whole matter. 202 HOW IS YOUR HEART? 4. The cause of heart protests may be found in other diseases earlier in life. 5. Faulty habits, emotional strain, excessive effort or hidden infections may cause heart affections. 6. A heart that is defective from circumstances past control does not necessarily condemn the patient to a life of inactivity and invalidism. 7. By proper self-care, heart life can be perpetuated indefinitely. INDEX PAGE Abdomen, Swelling of. ... 121 Abscesses, Dental 81 causes of 82 frequency of 88 Absorption from Tonsils. . 97 Accustomed Tasks 116 Activity and Retirement. 117 Acute Disease 60 Acute Indigestion 40 Acute Myocarditis 137 Acute Rheumatic Fever. . 68 Advancing Heart Signs. .. 114 Advertising Sickness .... 139 Alcoholic Beverages 156 Altruism 123 Analyzing of Sports 194 Ancient Views 23 Anemic Appearance 114 Anger 142 Angling 190 Ankles, Swelling of 121 Annual Inventory 172 Apartment Dwelling.... 145 Apical Abscesses. See Ab- cesses, Dental 81 Apoplexy 133 Apprehension 23 Appropriate Exercise .... 174 Appropriate Occupation .. 195 Aptitude for Employment 201 Arguing 142 Arterial Change 132 Arteries, Hardening of. .. 131 Arteriosclerosis 131 Articular Rheumatism. See Rheumatic Fever 69 Asthma . 119 Athlete's Heart ......... 45 Avoiding Speed J81 PAGE Balance, Natural 117 Bankrupt Hearts 33 Basis for Games 194 Bathing 148 Bathrooms, Prostration in 144 Bed, Time in 164 Beverages, Alcoholic .... 156 Billiards 187 Birth Defects 61 Blood Deficiencies ....71, 115 Blood Pressure 129 and salt excess 157 "Blue Baby" 61 Bolting Food 153 Bonbons 157 Bridge Whist 37 "Broken Heart" 52 Bronchitis 119 Bursts of Speed 181 Cancer 19 Candy 157 Canoeing 193 Capillary Change 133 Carbuncles 75 Cathartics 144 Causes of Dental Ab- scesses 82 Change of Posture 148 Chemistry Perverted 17 Chest Constriction Ill Chest Pain 112 profound 120 Chewing Surface Insuffi- cient 80 Chicken Pox 64 Childhood, Diseases of... 60 Chorea. See St. Vitus* Dance 63 203 204 INDEX PAGE Chronic Cough 119 Chronic Diseases 60 Chronic Myocarditis 138 Cigarettes 159 Cigars 159 Circumstances Beyond Control 60 Circumstances Within Control 59 City Dwelling , 145 Clothing 148 Coffee 155 Cold Storage 153 Cold, Working Off a 49 Combustion 192 Common Colds 143 Competition 182 Conclusions 202 Congested Appearance ... 116 Consciousness of Heart... 59 Constipation 144 Contagion of Crowds 143 Contentions 142 Contest 182 Continually Eating 41 Convalescence Insuffi- cient 105 Convulsions 62 Cooperation of Patient.. 147 Cough, Heart 119 Country Dwelling 145 "Cranky" 52 Creed, Exercise 178 Crouching 190 Crowd Contagions 143 Crowned Teeth 89 Daily Life 147 Dancing 188 Dental Surveys 145 Devotion to Duty 54 Diabetes 70 Diastole. See Filling Period 30 Diet 150 Dilatation 128 Diphtheria 66 PAGE Diseases acute 68 blood 71 childhood 64 focal origin 76 venereal 72 wasting 70 Disordered Heart Action.. 120 Disorders of Thought.... 51 Diversions, Basis for 194 Dizziness 107 "Dropped Beats" 108 Drugs 167 Early Heart Signs 105 Educating Heart Muscle.. 175 Element of Contest 182 Elevators 145 Emotional Disturbances. . 51 Emotional Rest 57 Emotional Stress 20, 35 Emotions, Barometer .... 24 Employment, Principles of 197 Enlargement of Heart. .. 127 Enthusiasm 140 Estimating Function .... 138 Excess Weight 44 Exercise abuse of 45 creed of 178 harmful 45 insufficient, penalties for. 49 perversion of 45 urge of 181 Eye Defects 118 Fainting 118 Fatalistic Attitude 110 Fatigue of Stairs 146 Fatty Heart 43 Faulty Habits 37 Feeling of Pulse 121 Fibrous Tonsils 97 "Fifty Per Cent Heart". . 139 Filling Period of Heart. . 30 Fishing 190 Florid Complexions 116 INDEX 205 PAGE Focal Infection 60 importance of 76 Folly of Ignorance 122 Food fads 149 fresh 153 fundamentals of 149 peculiarities 151 Fresh Air 145 Functional Heart Trouble 112 Function, Estimation of. 138 Fussing 142 Games, Basis for 194 "Gas Pressure" 40 Gastric Ulcer 75 Getting Old 117 Giddiness 107 "Goiter Heart" 70 Golf 183, 189 Gradual Exercise 175 Growing Older 135 Growing Pains 62 Hardening of Arteries.... 131 Harmful Habits of Thought 53 Health Appraisals 170 Hearing Heart Beats.... 109 Heart burn 155 consciousness 59 cough 119 enlargement 127 exercise creed 178 hurry 108 hurt 28 in action 22 leaking 125 loads, causes of 28, 36 protests 82 rest 29 tax, overeating 38 versus teeth 78 Heart Disease, Preven- tion of 15 PAGE Heart Trouble "Imagi- nary" 75 simple beginning of 104 Hidden Infections. See Focal Infections 60 High Blood Pressure 129 Homemaking 187 Homesickness 54 Horseback Riding 191 Housekeeping 54, 187 How to Walk 186 Hunting 190 Hygiene, Personal 59 Hypertrophy 128 Ignorance is Folly 122 "Imaginary" Heart Trouble 75 Importance of Heart Mus- cle 126 Incompatability, Domestic 155 Indian Clubs 177 Indigestion, Acute 40 Infection focal 60 under pressure 76 Influenza 69 "Influenza Hang-Over". . 177 Insufficient Chewing Surface 80 Insufficient Convales- cence 105 Insufficient Exercise .... 47 Insurance Risks 123 "Intercostal Neuralgia".. 112 Intermittent Heart 108 Inventory, Physical 172 Irregular Heart Action.. 108 Irregular Pulse and To- bacco 159 J ob, the Old r 198 Kidneys in scarlet fever 68 tax on 39 Knack of Walking 186 206 INDEX PAGE Labored Breathing 119 Lassitude 49 Languor 49 Laxatives 144 Lazy Heart Muscle 196 "Leaky Hearts" 125 Learn to Relax 161 Learning to Walk 176 Life Insurance Risks.... 123 Life Safeguards 169 Lifting 193 Lighter Jobs 199 Limitation of Effort .... 116 Living Conditions 145 Marriage 165 Measles 65 Medicines 168 Mental Rest 57 Midday Nap 56 Milk 155 Motherhood 166 Motoring 191 Mumps 64 Murmurs 125 Muscalature 183 Myocarditis acute 137 chronic 138 Nap, Midday 56 Natural Balance 117 Nature's Abundance 136 "Nervous Heart" 162 Nervousness 19 Neuralgia 16, 106 "Never III Before"..,.... 75 Noonday Nap 162 Nourishment, Deficient. . 70 Noxious Vapors 193 Occupation appropriate 195 lists 200 principles of 197 Ocular Defects 118 Old Exercise, Best 183 "Old Job" 198 PAGE Old Time Views 174 Operations, Previous 74 Optimism 141 Organic Heart Trouble. . 113 Ovale, Patulous Foramen 62 Overeating 37 Overweight 44 Pain in Chest 112 Pallor 115 Palpitation 108 Panting 107 Paralysis of heart 66 stroke of 133 Past Diseases, Effects of 50 Patient cooperation of 147 daily life of 147 reactions of 34 Patulous Foramen Ovale 62 Peculiarities in Food. ... 151 Personal Hygiene 59 Perverted Chemistry .... 17 Pessimism 142 Physical Inventory .... 172 Physical Preparedness ... 50 Physical Strain 35 Physics 144 Pneumonia 18, 68 Polo 191 Position in Bed 163 Postural Strain 56 Positive Findings Valu- able 122 Potential Heart Disease 105 Preparation for Sleep. ... 57 Pressure, Pus Under ... 76 Prevention of Heart Dis- ease 15 Previous Operations 74 Principles of Occupation 197 Profound Chest Pain. ... 120 Prostration in Bathrooms 144 Protecting Relatives .... 195 Puffy Ankles 121 Pulling 193 Pulse, Feeling of 121 INDEX 207 PAGE Pulse, Irregularity of.... 109 Purplish Lips 116 Pus Under Pressure 84 Pyorrhiea 80 Quarreling 142 Question of Tonsils 93 Quiet, Desirability of. ... 145 Rational Diet 150 Reeducation of Heart Muscle 179 Relaxation 161 Reserve Force 32 Rest at noon 162 before meals 154 period of heart 29 Retirement and Activity 117 Retiring Early 163 Rheumatic Fever acute 69 and tonsils 69 mild 63 "Rheumatic" Twinges ... 106 Rheumatism ...16, 69, 90, 99 Rhythm, Absence of .... 120 Root Resection 89 Rowing 193 Safeguarding Life 169 Salt 157 Scarlatina 68 Scarlet Fever 68 Scarlet Rash 68 Scarred Valve 126 Scar Tissue 137 Second Helpings at Table 153 Self-Control 161 Short Breaths 119 Shortness of Breath 107 Sight Defects 118 Simple Beginning of Heart Trouble 104 Sleep, Preparation for ... 57 Small Tonsils 96 "Soldier's Heart" 162 Sore Throat 99 PAGE Speed Avoidance 181 Sports analyzing of 194 canoeing 193 dancing 188 fishing 190 golf 183, 189 horseback riding 191 hunting 190 motoring 191 polo playing 191 rowing 193 swimming 185 tennis 182 Stair Climbing 146 Stomach Pressure 40 Stooping 190 Strain, Postural 56 St. Vitus' Dance 63, 99 Sudden Movements, Peril- ous 181 Sugar 157 Summary 202 Sunshine 145 Supremacy, Contest for. . 182 Squeezing Period of Heart 30 Swelling of Abdomen ... 121 Swelling of Ankles 121 Swimming of Head 107 Swimming, Perilous 185 Swooning 118 Syphilis 19, 72 effect on vessels 73 Systematic Exercise 48 Systole. See Squeezing Period of Heart .... 30 Talking in Wind 187 Taking Cold Easily 106 Tea 156 Tennis 182 Teeth versus heart 78 X-ray of 79 Theater 37 Thought, Disorders of .. 51 Thyroid Gland 44 enlargement of 70 208 INDEX PAGE Tightness of Chest Ill Time in Bed 164 Tiring Unnaturally .... 105 Tobacco 159 and infection 160 Tonsil Question 93 Tonsils and rheumatic fever.... 69 removal of 64 suspicious 99 Tonsillar Trio 99 Treating the Patient.... 136 Tuberculosis 19, 70 Typhoid Fever 68 Ulcer, Gastric 75 Undernourishment 70 Uremia 40 Urge of Exercise 181 Utterly Disordered Pulse 120 PAGE Value of Positive Fini> ings 122 Venereal Diseases 72 Vertigo 107 Vision Defects 118 Walking 186 Water Drinking 155 Well Balanced Diet 152 Whooping Cough 64 Why Swimmers Sink 185 Work, Value of 196 Work Force 31 Worry 51 X-ray of Teeth 79 Years, Advance of 133 FINIS