( Originally Published 1954 )
The normal heart is a very efficient mechanism. Throughout life it performs its function of pumping the blood at an average rate of seventy times a minute. It is a very efficient pump because it uses only about 15 per cent of its power for normal activities. Its reserve power, 85 per cent, equips this mechanism, as well as the body, for emergencies. Extreme conditions of emotional reaction, such as great joy or great sorrow, requires that reserve power. When the body is over-worked extra heart action is also required.
In most individuals the heart develops normally from its embryonic stages. Occasionally there are congenital maldevelopments of the heart which handicap individuals so afflicted. Modern surgical skill has been used to rebuild congenitally handicapped hearts. This is, of course, fortunate for people of our time. Not so very long ago people with congenital defects in the mechanism of the heart had their life expectancies shortened. Today when surgery for congenital heart disease is successful, such individuals may live out a normal span of years.
Medical knowledge also throws light on the prevention of cardiac disease. Disease of the heart is prevalent among young and old. Forty per cent of all deaths are caused by heart disease. Much heart disease could be prevented by applying the knowledge that is available on the prevention of disease.
In many cases children are afflicted with rheumatic heart disease. This type of heart disease ought to be prevented because it prevents them from growing normally, from enjoying work and play and school as normal children do.
Rheumatic heart disease has its beginning in an infection of the nose, the throat or the breathing organs, and the blood-stream eventually becomes invaded; then the heart is affected. There are certain bacteria that are particularly virulent in causing rheumatic heart disease. The bacteria to which the heart is supposed to be especially susceptible are the streptococci. These are tiny little rounded microbes. They look like dots or pinheads under the microscope when magnified about 300 times.
The cocci are named according to their special characteristics. Some arrange themselves in chainlike formations. These were mentioned above. Others arrange themselves in cluster formation. They are known as the staphlococci. Some of these tiny disease-producing microbes have special color characteristics. Some produce yellow excretions; some produce greenish excretions; some produce orangelike excretions; some live on the blood and excrete bloody pus.
The healthy body of a child or adult can never be dangerously attacked by germs that are disease-producing. Disease-producing germs are all about us. They live in the air. They may contaminate the food, the water, the clothing. The healthy body, however, has powerful defenses including chemical agents that weaken and kill the disease-producing germs that invade the organism by breeding, by eating or otherwise.
An ordinary cold that is neglected or improperly treated may weaken the body to such an extent as to permit the pathogenic bacteria to invade its blood-stream and cause rheumatic heart disease, among other diseases that often handicap individuals for life.
The rheumatic heart case, the person who is growing up with a rheumatic heart condition that began in childhood, must live wisely in order to enjoy life to middle age or to old age. The difference between a life which is cut short early and a normal span of life, in the case of a rheumatic cardiac, may be made by such efforts as to fulfill a life ambition by getting a college education, or bearing children, or running a business. Rheumatic heart disease makes one too delicate for an ordinary full life. The rheumatic heart sufferer must acquire a philosophy that will help him enjoy some of the advantages of life more fully because others cannot be enjoyed. A rheumatic individual can learn how to enjoy good reading or even writing, although over-exertion in the use of the hands may strain the heart of a rheumatic cardiac. The limbs, both upper and lower, are vitally related to the heart and its ability to do extra work. The heart of the rheumatic cardiac has very little of the reserve power which the normal heart is supposed to have—and the normal heart, as stressed above, has 85 per cent reserve power. (See Diseases of the Heart and Chest by Pratt and Bushnell.)
I have had the privilege of treating a number of rheumatic cardiacs. These patients ranged in age from 9 to 95. The remarkable survival of the 95-year-old patient was due to the extraordinary intrinsic wisdom which he showed throughout his life. He conserved his strength and was destined even to outlive four of his sons. (This patient and his case will be discussed elsewhere, perhaps in another book on My Practice).
One very important case of rheumatic heart disease that came under my care was a woman 53 years of age, Mrs. S. U. Her heart was so enlarged and decompensated that she suffered from secondary complications, such as fluid retention in the liver and throughout the tissues of the body. She was on mercuhydrin regularly every four or five days. Her daily urine output was so scant that the tissues would accumulate six to seven quarts of fluid within four to five days.
On my request while treating Mrs. S. U., her mother measured her urine within 24 hours after an injection of mercuhydrin. She had collected 27 glassesful. I was called on this case after the patient developed pain in the gall bladder region, suffering from nausea, vomiting and other "bilious symptoms."
The patient had been under ordinary medical care since child-hood. She had even risked her life after her marriage to become pregnant. One of the most outstanding obstetricians was engaged to attend her during her delivery. Fortunately she had a spontaneous and normal delivery and a normal child. That was her only pregnancy. When I came on the case this patient's daughter was a beautiful young lady who worked as a secretary to one of the bankers in town. She was certainly a good daughter and proved worthy of the risk which her mother had taken in having her.
I took this patient off ordinary foods, such as lamb chops, chicken, eggs, milk and cream. I put her on a very strict fruit and vegetable diet and allowed her to eat only one food at a time, in order to be able to determine, if possible, if any of the foods had special diuretic properties.
Mrs. S. U. was a very cooperative and intelligent person. She faithfully measured the urine output and gave me the remarkable report that certain foods were superior to others. In general all of the fresh raw vegetables and fresh raw fruits proved not only useful but life saving in this case. All the raw fruits in season were permitted. Because she had symptoms of nausea and pain Mrs. S. U. was put on a grapefruit diet for the first three meals of the day. My rule is to feed sick people a little at a time, whenever there is a normal desire for food.
Mrs. U., as a good patient, kept a written record of everything she ate and the urine output that followed it. The interesting results that were recorded in this case could be of benefit to all rheumatic sufferers the world over. On my diet Mrs. U. could go for nine to ten weeks without an injection of mercuhydrin. She also proved that fresh raw pineapple and green squash were the best foods to make her urinate more than any others. The green squash was slightly cooked without salt or butter.
This patient had been a bedridden invalid until I was called on her case. About two years afterwards she surprised me by a visit on a winter afternoon, while the snow was on the ground and it was quite frosty. But she had paid me the visit because she wanted to see my then newly-equipped Health Rest; and also wanted to visit and cheer up my patients.
My experience in this case helped me considerably in managing other rheumatic cardiac cases at my rest home.
Other types of cardiac disease that I have come across have been degenerative heart diseases among the middle-aged and the old. Patients came to me with coronary thrombosis, so diagnosed by leading specialists. This clotting of the blood in the comparatively small arteries that supply the heart structure occurs particularly in many elderly gentlemen.
I believe this is related to the fact that there are more men that smoke than women. It is my fervent belief that tobacco-smoking con-tributes in large measure to degenerative heart disease. Tobacco is known in medicine as a poison that contains many toxic irritants in addition to nicotine. It is known as a vasoconstrictor, which means that it tightens blood vessel walls. The heart of the smoker on post-mortem examinations is often shriveled, its parts smaller. (See Kellogg's Tobaccoism.) To compensate for the constriction of some of the blood vessels and the consequent poor nourishment of the myocardium or heart wall, there occurs an enlargement of some of the heart cells; in some cases fatty degeneration or fatty infiltration of the myocardium also takes place.
The normal heart is a muscular pump. It is a hard-working pump because throughout life its work goes on continuously with only slight pauses. In other words, the pumping of the heart consists of alternate stops and starts. In a minute the heart beats sixty or seventy to eighty times. This is within the normal range. If the heart-beats fall below sixty or rise above eighty, there may be a special normal or abnormal cause. Sometimes the heart beats more rapidly during happy emotions; sometimes during anger; sometimes during a climb uphill or upstairs.
The normal heart returns to its normal rate within a short period.
When increased heart action persists for more than a few minutes, the reserve power of the heart may be reduced by some pathological factor.
I have always been very strict with cardiac patients. It is a fact that the sufferer with heart disease knows that his life expectancy is precarious. It is, therefore, the duty of the physician to manage such patients so as to build up as much reserve strength as possible in the heart, by correct diet and hygiene. All food and drug irritants that these patients are permitted by some physicians are forbidden by me. Even when the patient has been permitted by a previous physician to smoke a little, to eat white meat instead of red meat, or to take a little brandy or coffee or tea, I ban all of these when I am in complete charge.
Nature, the intrinsic ability of the human organism to regenerate itself, often proves to be marvelous. In order to help the vital powers of the body to regenerate themselves, poisonous beverages such as coffee, tea and liquor are forbidden. Meat and fish are also forbidden.
If the patient is overweight, his weight must be reduced while he is resting in bed. I have worked out a very effective method of weight-reducing while the patient is on a complete rest cure, in bed. While the patient is on the rest cure he is instructed to tense the muscles of the arms, legs and abdominal wall. While he is lying flat on his back, these exercises even contribute to strengthening the myocardium.
If the blood pressure is increased, as it is in many of these cases of chronic heart disease, it comes down to normal. Very little medication is required, sometimes none at all. In a very bad case of cardiac disease with pericarditis, it is sometimes necessary to give the patient half a c.c. of adrenalin if his blood pressure is not too high. Oxygen is sometimes used to tide over a cardiac with inadequate pulmonary circulation of the blood.
Rest in bed, together with strict diet, usually frees these cardiacs from their symptoms within about a week to a month. Blood pressure is reduced as rapidly as the body responds to this treatment, and it responds more quickly than it does to the conventional medical treatment that permits the patient "a little bit of this or that" which I forbid.
Cardiacs are not permitted very much sitting around. They are not permitted to play cards. They are not permitted to indulge in any kind of excitement. Sex relations are often prohibited. This kind of prohibition is, of course, one of the important restrictions of all cardiac specialists. Even those who prescribe drugs, who permit meat, smoking and coffee, forbid sexual intercourse to some individuals who have a tendency to heart attacks.
The cardiac can live and enjoy a comfortable life by taking it easy. Work that requires exertion, train traveling, plane traveling or much excitement, is absolutely bad for cardiacs. The food need not be any different from the normal meals of any healthy individual who wants to live on without getting sick. (See "Health Menus for Normal Diet.") When indisposed, eat one or two things, limiting the food intake to fresh raw fruit, raw salad and steamed vegetables without salt or butter.
When people with heart disease are taught by their physicians to live within their limitations, we will read about fewer individuals who die in middle age from heart disease. The obituary columns of our daily press are filled too often with tragic accounts of brilliant and accomplished individuals dying from heart disease.
Women have taken to smoking in the last decade or two in large numbers. They should stop this disease-causing habit because tobacco really shortens life by ten, twenty or even fifty years.