3. "ALL THAT HUMAN HEARTS ENDURE."

Although the fact that the heart is the center of the body's circulatory system was recognized almost 5,000 years ago by the fkst physician of whom we have any record—Imhotep, an Egyptian—our folk remedies appear to have a rather limited number of specifics for the relief of heart and circulatory ailments.

Possibly this is because of the frequency with which heart ailments were diagnosed as other disorders. Modern medicine concerned with the circulatory system generally is conceded to have actually begun in 1628 with Harvey's revelations concerning circulation. In 1664, a Dane, Niels Stensen, proved that the heart is a muscle. More than 30 years later, in 1698, Pierre Chiaric, a Frenchman, discovered that the heart will stop beating when a big coronary artery is blocked off. Stephen Hales did his blood pressure experiments between 1727 and 1733. William Heberden described angina pectoris in 1782, although Seneca, who died in 65 A.D., described what probably was his own suffering from angina pectoris, or more accurately, a coronary thrombosis, writing: ". . . To have any other malady is only to be sick; to have this is to be dying."

Shortly after Heberden's observations were made, Edward Jenner related angina to hardening of the arteries. In 1785 William Withering published his observations about foxglove in relation to dropsy. At that time dropsy was thought to be a disease in itself and not the result of another disease, espe­cially inadequate heart action.

A significant aid to diagnosis came in 1761 when Joseph Leopold Auenbrugger published details concerning his methods of chest tapping (percussion). The method still is an indispensable help to doctors.

The stethoscope was brought into the medical world in 1819, discovered by Laennec, another French physician. The familiar instrument that transmits chest and heart sounds to the doctor's ears has been called the greatest single aid to diagnosis of conditions of heart and lungs yet invented.

In 1827 Richard Bright discovered the kidney's function in the circulation. Other important discoveries were reported in "this era. In 1878 Adam Hammer of Baden published an account of the first correct diagnosis of coronary thrombosis. Albert von Koelliker found the electrical current that accom­panies the heartbeat.

As understanding of the heart and circulatory system be­came accelerated, three discoveries in equipment were almost as important as the anatomical discoveries themselves.

First came the sphygmomanometer, which enables a doctor to measure blood pressure and was a result of a method de­scribed in 1887 by Ritter von Basch of Germany.

In 1895 Wilhelm Konrad Roentgen brought the world the X-ray with its permanent photography techniques, as well as the fluoroscope which enables the doctor to make a close study of a patient's chest, without taking a picture on a film. The fluoroscope enables the doctor to actually watch the heart in action.

In 1903 Willem Einthoven of the University of Ley den made ingenious use of the knowledge gained by other re­searchers who had proved the existence of electrical impulses in the heart. He devised equipment that could exactly record the electrical impulses from the heart. This was the advent of the electrocardiograph into the area of heart ailments. In many cases the electrocardiogram obtained from the equip­ment is of extreme value in diagnosis, and sometimes this information is the most important diagnostic information that the doctor obtains.

The test is especially important to the doctor after a patient has suffered a heart attack. From the electrocardiogram the doctor can ascertain where the heart muscle is damaged and how widespread the damage may be.

Today a patient reporting to his doctor for a heart examina­tion probably will go through almost the same series of examinations and tests from any well-trained physician.

Tom Jones, 42, a salesman, recently went to his family doctor, Dr. Greystone, when he noticed that he was unusually short of breath after minor physical exertion. Because Jones is a life insurance salesman, he was fairly familiar with medi­cal procedures and he made a point of having a physical examination once a year.

In this instance he knew that there was nothing painful or mysterious about the heart examination that his doctor prob­ably would give him.

For a few moments he sat at the doctor's desk while the physician quickly reviewed Tom's case history, on file in the doctor's office.

The doctor put down the case history. "Just checking, Tom," he explained. "Wanted to see if there is anything in your past history to indicate trouble now."

"Such as?"

"Scarlet fever or rheumatic fever when you were a kid. Nothing there. Tell me—any pain in the center of your chest?"

"Sometimes. A little. Sort of squeezing sensation."

"Arms?"

"Down my left arm. Not much. I don't know, Doc—"

Dr. Greystone continued to ask questions. Was there pound­ing of the heart? Any swelling over the ankles? About the chest pain—when, and how often? About the shortness of breath?

After he had obtained his answers he asked Tom to strip to the waist. He took Tom's pulse to determine the rhythm of Tom's heart: slow or fast, strong or weak, irregular or regular.

He wrapped a rubber cuff around Tom's arm and checked his patient's blood pressure—when the heart contracted and when it was at rest. A higher-than-average pressure may be quite important. It depends upon how it affects the patient's heart, arteries, and other parts of the body, especially the kidneys.

Dr. Greystone nodded and removed the cuff from Tom's arm. He picked up another instrument that enabled him, with a bright light, to look into Tom's eyes. The doctor could see the tiny blood vessels in back of the eye. These blood vessels give the examining doctor indication about certain important changes in the circulatory system.

By tapping Tom's chest the doctor could determine the size and position of his patient's heart. That portion of Tom's chest occupied by air-filled lungs gave a clear sound when tapped. Over the heart the sound was dull and flat. Later the doctor used a fluoroscope to get more information about heart size, location and action.

Dr. Greystone used his stethoscope to listen to the sounds of Tom's heart as the valves opened and closed. Frequently such sounds tell the doctor if the patient has damaged heart valves, or if other disorders are present.

"I want some laboratory tests," the doctor said. "We'll check the kidneys and run a blood test."

"And a cardiogram?"

"We'll take one when you're at rest. Then we'll have you go over some steps on a stile for a bit and take another."

As they walked toward the room where the electrocardio­graph was located, Tom eyed his doctor uneasily. "Heart disease?" he asked.

Dr. Greystone smiled at him. "Stop worrying," he said. "You might have some trouble there—but so have about ten million other Americans. And that terminology—'heart dis­ease'—is a little ambiguous, Tom. Actually, there are more than twenty different kinds of diseases of the heart and the circulatory system."

"But some kinds are more common?"

"Certainly. About ninety per cent can be chalked up to three disorders. High blood pressure is one. Coronary heart disease, as a result of hardening or narrowing of the arteries, make a second. And the third is rheumatic fever, which usually strikes kids and young adults. Adults past forty usually make up the bulk of the other two types of patients."

"Hardening of the arteries—isn't that arteriosclerosis?"

"Right. It's caused by calcium in the middle coating of the arteries."

"Then what is atherosclerosis?"

"That's a good question. We believe that atherosclerosis is possibly the worst villain. It means the narrowing of the walls of the arteries and it's getting to be generally believed that it's caused by deposits of cholesterol inside the arteries of the heart. We'll talk about that later. We'll get the cardiograms now."

From the cardiograms, laboratory tests, and other diag­nostic indications, it was determined that Tom had coronary artery disease. He was placed under treatment and was able to continue a normal life.

From this quick review of what happened to Tom Jones and the method of diagnosis, with the equipment necessary to make such a diagnosis, it is obvious that pioneers living on frontiers could hardly make a proper diagnosis of a true heart disease. Nor were they in a position to give proper treatment with use of drugs and techniques that were unknown a few decades ago.

Quite probably, a great many persons who were treated with folk medicines for "colds on the chest," pleurisy, rheu­matism, asthma, sore muscles, exhaustion, indigestion, and other ailments may have been suffering from heart ailments.

An excellent example of the lack of knowledge common to this field many generations ago may be found in the ter­minal illness and death of King Charles II, as reconstructed from a report made by Dr. Scarburgh. The doctor was one of a dozen or more physicians called to treat the king who— it is now believed—probably suffered from an embolism (a floating blood clot which plugged an artery).

King Charles was being shaved in his bedroom on this Monday morning, February 2, 1685. The barber had just made a skilled stroke with his razor when the king suddenly stiffened and fell backward in a severe convulsion.

"Help! The King! The King!" The barber's voice was shrill with alarm. A maidservant saw the fallen monarch and screamed. Down a hallway several persons ran toward the chamber.

The barber stared down at the fallen man in fear. Obvi­ously something terrible had happened to the king. Thank God, there was no sign of blood! The king had not been cut by a careless razor.

An important attendant rushed in and bent over Charles. He looked up and shouted at the barber to run for the court doctors.

The scene became one of confusion. A physician rushed into the chamber, examined, prodded, observed. More doctors and officials of the court arrived. Consultations followed con­sultations. Voices were hushed and serious. Doctors frowned in worry.

"He must be bled," one doctor finally announced. The other doctors nodded sagely in agreement. Preparations were made to cut into a vein in the patient's right arm. A pint of blood was taken.

Shortly after the first bleeding, the attending physicians decided upon another bleeding. An incision was made in one of the king's shoulders and the area was "cupped" to suck another eight ounces of royal blood.

Meanwhile, drugs were being assembled preparatory to the drugging that was indicated by the various physicians. The record reveals that the following treatment was imposed upon the king during the few days that he managed to stay alive, although—fortunately—unconscious most of the time:

A purgative and emetic were followed by a second purga­tive which was then followed by an enema containing rock salt, beet root, linseed, saphron, camomile flowers, mallow leaves, antimony, sacred bitters, fennel seed, aloes, cinnamon, cochineal, and cardamom seed.

After two hours the enema was repeated and another purgative was given. The head of the monarch was shaved and a blister raised on his scalp. A power derived from cow­slip flowers was given him to "strengthen his brain." A sneez­ing powder of hellebore root was administered, while cathar­tics were repeatedly used, along with a drink made of sweet almond, licorice, and barley water.

The king also was given drinks and dosages of white wine, absinthe and anise, as well as extracts of mint, angelica, rue, and thistle leaves. Melon seeds were administered, and black cherry water, slippery elm, manna, and extract of flowers of lime, peony, lavender, lily-of-the-valley, dissolved pearls, gen­tian root, cloves, quinine, and nutmeg.

A plaster of pigeon dung and Burgundy pitch was applied to his feet. Forty drops of extract of human skull were given to allay convulsions. Bleeding and purging were continued.

As death appeared to be imminent, the frantically working doctors prescribed Raleigh's antidote which contained an enormous selection of herbs and animal extracts. Bezoar stone (frequently made from gall stones from animals) was given as a last specific resort, only to fail. The king continued to sink toward death.

"Alas! After an ill-fated night his serene majesty's strength seemed exhausted to such a degree that the whole assembly of physicians lost all hope and became despondent," Scar-burgh explained. "Still so as not to appear to fail in doing their duty in any detail, they brought into play the most active cordial."

Thus, as the king was dying, a desperation mixture of Raleigh's antidote, ammonia, and pearl julip was forced down his throat. The king died shortly after the final concoction was administered.

Today, in such a case, the diagnosis for an embolism or a thrombosis or a cerebral vascular accident (stroke) would be wholly accurate. Treatment for the condition would be well defined, and the administering doctors would know precisely what they were attempting to accomplish, how the treatment would work, and how successful it might be.

For instance, when another head of state, President Eisen­hower, suffered a coronary attack in 1955 the trouble was quickly diagnosed and the President was immediately placed under effective treatment. His recovery and ability to carry on with what probably is the most difficult job in the world demonstrates the great strides made in medicine since the days of Charles II.

The research into heart ailments has been markedly intense since President Eisenhower's attack and a vast amount of money has been spent since then in probing into the causes and treatments for cardiovascular diseases.

Before we look at some of these new medical developments in the area of the heart and circulatory system, some atten­tion might be given to what has evolved from folk medicine in this field of treatment.

Digitalis already has been mentioned and is comparatively old in treatment of certain conditions. Almost invariably such treatment comes under the direction of physicians who are familiar with the drug, dosages, and reaction. A few other drugs have been in vogue at one time or another for the various heart complaints.

Toward the latter part of the last century aconite, a poison­ous drug that was considered to be almost a cure-all by some doctors, was recommended in minute doses for "excessive action of the heart . . . valvular disease of the heart, even chronic, worse in spring and fall . . . hypertrophy of the heart . . . palpitation from congestion . . . apoplexy of full-blooded persons."

The above suggestions about the use of aconite comes from one of the many "doctor books" that were popular for house­hold use in the latter part of the 19th century.

Another such book suggests in the treatment for apoplexy (a stroke condition caused by acute vascular lesions of the brain) that mustard plasters on the calves of the legs might draw the blood from the head; that strong purgatives should be given in difficult cases, sometimes accompanied by electric or galvanic action.

Use of nitrates to dilate small blood vessels and relieve "angina pectoris" was in use during the last century and is still popular in the form of nitroglycerin, usually in the form of pellets to be placed under the tongue where the drug is immediately absorbed into the system.

The term "angina pectoris" is thought by many to mean, solely, the anginal type of heart failure. Doctors now are discouraging use of the terminology because it causes so much fear and anxiety. They prefer to speak of the more accurate "cardiac pain" or "heart pain."

This pain results from a scarcity of oxygen for the heart, which is a muscle. The pain and discomfort usually continue until blood brings the heart sufficient oxygen through arteries that may be clogged or narrowed as a result of coronary-artery disease. Dilators, such as nitroglycerin, relax the arteries and enable an increased flow of oxygen-carrying blood to pulse through them.

Pain resulting from a coronary thrombosis is much more severe, and, in the past, was frequently called "angina" so that those who have witnessed or experienced the pain associate the experience with dread.

Undoubtedly other pains often are self-diagnosed as heart pains when they actually may be caused by gall bladder dis­ease, duodenal ulcer, anxiety or some other emotion, localized infection not in the heart, or spinal or vertebral disease.

Consequently some folk remedies that may have seemed to be effective for "heart pains" actually may have been effec­tive for indigestion or some other disorder.

Occasionally, there is reported an old folk remedy that is said to be as effective today as it was many years ago. Some of these reputed remedies may be relatively obscure.

Dr. Jarvis reports that Dr. Weston A. Price of Cleveland discovered that natives of Peru used kelp to "guard the heart."

According to the report, Dr. Price was doing dental re­search among natives who lived in the high altitudes of the Andes mountains. During the course of his research, he learned about individuals living at 16,000 feet. Some were brought down to him for study and each individual carried a small bag of kelp that had been brought from the coast many miles away.

Dr. Jarvis writes that he prescribed 5-grain kelp tablets at mealtimes for two of his own patients who had histories of heart pains. The pains were said to have disappeared after use of the kelp.

The Vermont doctor also describes Vermont folk medicine for high blood pressure: increase the daily intake of acid in organic form through apples, grapes, cranberries or their juices, and apple cider vinegar; balance the protein and carbo­hydrate intake; exchange wheat foods for corn; use honey to draw excess fluid from the blood "lowering blood pressure and, being helpfully sedative, alleviating any tension disturb­ing the nervous system."

Nevada Indians used a cactus root tea as a cardiac stimu­lant. Cactus also is noted as a relief for "sudden squeezing at the heart, like the grip of an iron hand" in The Medical Genius by S. Jones, M.D., 1887.

Even as we find a certain vagueness and confusion about "heart conditions" in annals of folk medicine, we may en­counter almost as much confusion—although much less vague­ness—as we watch modern medicine come to grips with ail­ments of the heart and circulatory system.

While we may know so very much more about the diseases than we did even a decade or so ago, there are so many ob­servations, experiments, research projects, conclusions, and conflicts of opinion that the layman may well be extremely confused.

Yet the news and findings of heart research is of paramount interest to millions. This is evident when we realize that the first cause of death in the United States is heart and artery disease, claiming more than 900,000 victims each year.

One area of research into artery disease has stirred up a medical controversy that has been in the news for almost ten years. It revolves around the part played by cholesterol in arteriosclerosis (which includes atherosclerosis). Since nearly three out of four Americans suffer from some degree of artery disease, the conclusions resulting from this particular controversy are pertinent to a great many persons.

Cholesterol is a fatty chemical found in eggs, meat, milk, butter, and cheeses. It is yellow-white in color. Cholesterol is needed by the body to manufacture important hormones and to build cells. To obtain the substance, the body makes its own in certain organs, mainly the liver. If the cholesterol is not metabolized by the body, small pellets of the undigested substance may attach along arterial walls to make them narrow and rigid. Blood that flows through the clogged arteries is slowed. Clots may form to cause a heart attack by interrupting the flow of blood through the vessel.

The controversy has given rise to many terms that have become familiar to the American public: "animal and vege­table fats," "unsaturated fatty acids," "lipoproteins and try-glycerides," "hydrogenated and unhydrogenated cooking fats," are a few that can be mentioned. The use of corn, cotton and sunflower oils for cooking have come into prominence because of the cholesterol problem, being recommended in place of animal fats or vegetable fats, which have been hydrogenated as a result of processing into hardness.

Included as a salient point in the controversy has been the question of whether or not eating high-cholesterol foods might be responsible for high cholesterol levels in persons.

During the 1960 American Heart Association scientific sessions some of the answers may have come clearly to light.

Thirty-two papers were presented in discussions of heart-artery disease and exploration of the part that cholesterol plays in the disease. The overwhelming conclusion was so positive that most skeptics were ready to concede that ab­normal quantities of the substance in the blood should be regarded as a major factor in producing the disease.

Dr. Ancel Keys, Minneapolis physiologist and a recognized authority on the problem, said after the 1960 heart sessions:

"No one can say that the maintenance of a low level of blood cholesterol will positively prevent development of artery disease. We don't know that this is the answer in whole or even in large part. But it's like a person with hypertension; we can assume he'd run less risk if his blood pressure were lower."

During his studies about cholesterol and heart disease, Keys became interested in the comparatively low rate of coronary disease among Italians. His research led him into an examina­tion of the normal Italian diet and his conclusion that pectin in the Italian foods restricted the cholesterol level. He ob­served that 15 grams of pectin daily for three weeks lowered cholesterol levels a "modest but significant amount" that averaged about ten milligrams.

He observed further that the 15-gram daily dose of pectin is about the amount that might be found in two ripe apples. Which brings us back to one of the oldest folk medicine quotations: "An apple a day keeps the doctor away."

Dr. Keys, who is director of the laboratory of physiological hygiene at the University of Minnesota, has taken a strong stand about the subject. In November, 1960, he released a statement that he believed the time was at hand for official agencies like the American Heart Association to speak more decisively on the relation of diet to heart disease.

In a news story from the Chicago Daily News Dr. Keys said there is sufficient evidence to prove that a diet high in fats from dairy and meat products promotes heart attacks. He said that the American Heart Association should go further and point up the relationship of non-vegetable fats to the raising of the cholesterol level in the blood and the devel­opment of heart disease from high cholesterol levels.

By coincidence, the news release appeared almost at the same time that two more notables suffered heart attacks when Ward Bond, star of TV's "Wagon Train" died of an attack, and Clark Gable, screen star, was hospitalized by one, and died a few days later.

Although the controversy about cholesterol would seem to be rather conclusively settled for the time being, in America, a leading British surgeon, Sir William H. Ogilvie, scouts the theory that links animal fat intake with heart disease. The chief cause of heart disease, said Sir William in September, 1960: ". . . is simply lack of exercise."

Whether caused by cholesterol or something else, the fact remains that arteries apparently do become narrowed or clogged, blood flow becomes hampered, blood clots can clog passages, and heart attacks result. If the heart is to function as it should, there must be an adequate, unobstructed coronary blood flow.

It would appear that if some method of measuring the blood flow could be devised, it might be possible to determine if a patient is courting a heart attack.

Two doctors finally have perfected a technique at Okla­homa's School of Medicine where, through the use of radio­active albumen or radioactive iodopyracet and a formula, the coronary flow can be determined fairly accurately.

The American Heart Association is financing additional research such as this through grants. At Portland, Oregon one such project, working under a grant from the association, is engaged in research amplification of the above described technique. Volunteer heart patients take part in the research.

Jim Donner, a heart patient who has aided in the project, described what happened. Here is his own account:

When my doctor asked me if I'd be interested in the re­search, I was happy to do so.

Two and a half years previously I had suffered a heart attack. In my case there had been virtually no warning that I might have coronary heart disease. I was a fairly tall, very thin, middle-aged, active man. I didn't seem to fit the picture I had of the typical heart patient.

My first warning came with "distress" in my chest, and pains down my arms. I went to a doctor and after electro­cardiograms were taken—before and after exercise—the distress and arm pains were diagnosed as coming from coro­nary heart disease. I was placed on medication and given instructions.

Three days later I had a heart attack that sent me to a hospital for six weeks.

When I was sent home from the hospital I learned how carefully I must learn to build my strength and "tolerance" back to what could mean a normal life for me.

I started with a few moments of walking. A little longer each day. A careful record of pulse each time. A careful ob­servation of rest and sleep and diet with gradually increased exercise. My walks lengthened. Finally, I could leave the yard.

Eventually, I learned every side street and byway in the neighborhood, to say nothing of the neighborhood dogs who liked to accompany me on my daily walks. Then, at last, I was back at work.

After two and a half years of carefully observing my doctor's orders, I am living a quite normal life. Perhaps I am ready for bed a little earlier than I was a few years ago; per­haps I avoid the more strenuous exercises; nor am I so eager to walk hurriedly and rush through a busy day at a breakneck speed.

I've learned to live with a heart that can express its dis­pleasure with "distress" if I overdo. But my tolerance grows better every month. My health is excellent otherwise. I prob­ably feel better and look better than I ever did. I no longer smoke—and I don't miss two packs of cigarettes a day. I eat simple, low-fat meals. I rest more, sleep more, enjoy life more.

But I remember that if—several years ago—there had been a simple way to detect atherosclerosis and those clogged blood vessels in the earlier stages, I might not have had the heart attack. I might have slowed down to a more sensible pace when there still was time; watched my eating, my rest, my exercise.

So when my doctor asked me if I'd like to participate in research bearing upon this type of medical detection, I was happy to do so.

I appeared at the hospital early in the morning, and—as requested—without having had breakfast. I was sent to the "isotope" laboratory. There, a young male technician politely questioned me about the briefing I had received for the experi­ment, and then explained that I would have to rest for forty-five minutes.

I stretched out on a wheel chair and dozed for half an hour in a room that was distinctive for the complex-appearing equipment it held. Panel boards mounted with nobs, meters and dials were indicative of electronic mysteries beyond my comprehension.

Across the room a Geiger counter occasionally stuttered lazily as I rested. A long, metal tube that appeared to be made of chrome, and which was three or four inches in diameter, was on a stand by a padded examination table.

The young technician returned and asked me to get on the examination table.

"We'll be ready in a few moments," he explained.

A young doctor entered the room. He introduced himself.

"This test is virtually harmless and will take only a few moments," he explained. "Are you allergic?"

"To some things—yes."

"Then we won't use one of the drugs we normally use," he decided. He explained that the drug is introduced into the body hypodermically and causes a bitter taste when it reaches the mouth. This obviously enables observers to determine a phase of timing in relation to circulation.

The metal tube was positioned over my heart. It was con­nected with a Geiger counter and a recording machine. A tube was tightened around my arm.

"Make a fist a couple of times," the doctor instructed.

I did so and the doctor made an injection into the arm below the constricting band.

"What are you injecting?" I asked.

"Albumen tagged with a radioactive substance. When it gets to your heart, the Geiger counter will tell us."

He released the constricting tube around my arm. The recording needle began to record. The doctor and technician watched it.

"A good, steady rise," the doctor said.

"Fast," said the technician.

The Geiger counter's casual stuttering picked up speed into an alarmed buzzing. The radioactive substance obviously was in my heart.

"A good flow," remarked the young doctor.

The main part of the test seemed to be finished. They con­tinued to take recordings for a few moments and then a blood sample. The test was finished.

I was only one of many who will be part of the research project. The data has all been recorded and later it will be analyzed. Possibly I may then learn something more about my heart and coronary flow. My doctor said he'd let me know.

That really isn't the important part to me. What is impor­tant is that perhaps I've helped just a little in eventually pre­venting someone else from having a heart attack.

Instructions that doctors give to heart patients might be good general rules for anyone. The rules include avoiding tiredness, overweight, unbalanced meals that are too heavy in calories or fats, too little sleep, lack of exercise, arguments, worry, too much coffee and tobacco.

During the 1960 scientific session mentioned above, top researchers pointed out that the main ingredients of a save-your-heart prescription would include:

Regular exercise and activity. There is evidence that regular exercise and activity tend to protect the heart to some extent. (As Sir William Ogilvie indicates.)

Cutting down on fats and excess calories in general. Eat a varied diet including proteins, fruits, and vegetables. Don't eat too many eggs. Since cholesterol seems to be associated with greater risk of heart attack, and other fatty materials may also be involved, diet changes may be advisable to avoid too much fat. Extra pounds, say the experts, add up to fewer years of life. They suggest eating a little less as we grow older, or increasing activities to burn up excess fat, or doing both.

Researchers also suggest that a letup on smoking will help. Studies of death records and living persons indicate that the person who smokes heavily—two packs or so a day—runs two times the risk of heart attacks as does the lighter smoker.

Beyond these preventive and post-attack techniques, im­portant new drugs are aiding tremendously in saving lives from heart ailments, and surgeons are doing astounding things in heart operations.

Drug-wise, a significant step was begun in 1938 when a heart specialist, Dr. Irving S. Wright, suffered a blood clot in a vein. At that time no anti-clotting compounds—anticoagu­lants—were available to thin the doctor's blood and reduce the clot. The doctor could only hope that the clot would not reach the lungs. It did not and the experience inspired the young doctor to begin his pioneer work on anticoagulants.

Since then, thousands of lives have been saved by careful use of anti-clotting drugs such as Heparin, Dicumarol and Coumadin.

New drugs are now available to help control high blood pressure, to dilate blood vessels, prevent constriction of blood vessels, and to act as diuretics in reducing the edema (ab­normal fluid in tissues) of congestive heart failure (dropsy). In June, 1960, triparanol, a chemical said to be effective in dropping the cholesterol level, was placed on the market for prescription use.

Most drugs for heart and artery disease are quite powerful and must be prescribed with considerable care.

Radiologists are discovering new and better diagnostic techniques for heart trouble, and there is exciting promise that X-ray might be effective in treatment by dilating blood vessels and increasing blood flow to heart muscles.

Heart surgery has progressed amazingly since World War II. Some of these new developments include artificial heart valves, substitution of arteries made of nylon and other ma­terials for damaged or clot-closed ones, delicate electrical apparatus that can be implanted in the body to maintain the heartbeat, and a mechanical heart massager that can be slipped over a heart during surgery to start a heart that has stopped beating.

Some 15 years ago there were three or four heart opera­tions—of importance—that could be performed. Most of them were used to correct congenital defects, such as the famous "blue baby" operation. Now at least twenty heart operations can be performed.

New anesthetics and new techniques employing heart-lung machines, to assume the task of pumping blood into the body during an operation, enable a surgeon to open a heart wide and even stop it while repairing defects.

As with a number of other areas of medical research, the field of heart and circulation is so actively busy with develop­ments that there seldom is a week when some new discovery is not announced.

Certainly the advancement since the days of folk medicine, and even the "modern" medicine of 15 or 20 years ago, is so great in artery-heart disease that we can hopefully anticipate more major "breakthroughs" almost any time.

Meanwhile, probably everyone would be wise to follow most of the suggestions offered by the experts quoted above.

If you should have a heart attack, take a lesson from the experience of Sam Johnson.

When he awoke suddenly in the black of night, Sam realized that he was in serious trouble. A pain in his chest was like a relentless, smothering clamp. It was difficult for him to breathe. He was conscious of a pain down his left arm.

"Alice! Alice . . !" His cries for help were little more than gasps, but they awakened his wife.

She turned on a light and her eyes widened in alarm when she saw the pain in her husband's expression, and felt the coldness of his face.

"Heart . . ." Sam gasped.

Alice Johnson nodded. Her father had died of a heart attack. She knew from experience what she could do.

Quickly she got extra blankets and covered her husband to combat his severe chill.

"Be as quiet as you can," she told him. "Ill call Dr. Hard-man. He'll tell us exactly what to do until he gets here."

Her voice reassured Sam, although trying to be quiet and relaxed seemed an impossible job. He wanted to tense with the pain, to move, do anything to relieve it, yet instinctively he felt the need to be quiet and to relax.

He watched his wife dial the bedside telephone and listened to her quick explanation to the doctor. She listened attentively and answered a few pertinent questions before she hung up.

"He'll be here right away," she told Sam. "He says you are to be quiet and not to worry." She took his hand and smiled more reassurance. "Try to relax, Sam. That's the main thing."

The doctor arrived within moments and Sam survived the attack. He was hospitalized. An electrocardiogram helped determine the extent of damage. He was given a sedative. An anticoagulant was administered. After three weeks he was able to return home and soon was back on his job.

Another type of attack is manifested by a smothering sensa­tion without pain. Often the victim awakens in the night frantically fighting for air.

A sitting position may be best for this condition. The patient needs oxygen. Frequently victims are carried in a chair to a car and then rushed to a hospital where oxygen is available. Most large cities have emergency squads that carry oxygen tanks as part of their equipment. If a doctor cannot be found immediately, and if the situation appears to be serious, a call to a police or fire department for help may save a life when a smothering attack strikes. In any event, be certain to call a doctor.

Finally, there are important facts that the American Heart Association would like to impress upon everyone:

Today, hearts are being saved because heart research is making vital, new discoveries—because people are beginning to know these five hopeful facts:

1.  Some forms of heart disease can be prevented ... a few can be cured.

2.  All heart cases can be cared for best if diagnosed early.

3.  Almost every heart condition can be helped by proper treatment.

4.  Most heart patients can keep on working—very often on the same job.

5.  Your heart 'symptoms' may or may not mean heart disease. Don't guess—don't worry. See your doctor and be sure.

Thus, as we review the progress of medicine against heart disease, which has killed kings and commoners without dis­crimination, we may be reminded of Samuel Johnson's lines written in the 18th century:

How small, of all that human hearts endure, That part which laws or kings can cause or cure!

For now we may look with justifiable hope to the research­er's laboratory, and to the physician's growing knowledge and skills, for an understanding of the cause, and the possibility of a cure, for much that the human heart may endure.

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