Tensions and Hypertensions
( Originally Published 1956 )
THE director of the University of Arizona Department of Art, Dr. Harry Wood, is speaking:
"Americans have the ugliest faces in the world. They show the marks of strain, tension and inner conflict that you don't find elsewhere. And these form marks of ugliness."
According to Dr. Wood, New York is the worst city of all for faces marked with this particular type of ugliness. Why? New York is the busiest, most hectic city in the world.
There are at least 15 million Americans with these faces—and with the hypertension that causes them.
These hard-driving men and women fall into Dr. Wood's category. We have the harassed executive, straining every nerve to keep abreast of competition; the teacher, on whose shoulders rests responsibility for the future generation; the statesman, who decides the fate of the nation; and the actor, who lives by his emotions.
One hour of living on sheer emotion is equal to five hours of labor.
Let's take an example: According to Time's description of that fine actor William Holden, his face has changed during the past few years. Time called Holden a muscular man with hard eyes, the athletic type with a graceful flow of well-conditioned muscle. His face used to be an open and agreeable map of the United States, as relaxed, frank, and engaging as that of a student-council president.
But not today. His brow is now seamed with ridges of tension, and his cheeks are marked by little gullies of exhaustion. His days are spent in a nerve-shattering series of dissolves from the motion picture set to the tax man to the agent to the press.
Gone are the early, lean years. His success is assured, his talent acclaimed as one of the finest in Hollywood. "So great," says Deborah Kerr, who co-starred with him in The Proud and the Profane, "that he has yet to play his greatest role."
But in the past, parts were fewer and smaller than they are for the Academy Award winner of today, and the tensions of that past are tearing at him still. Consequently, Bill Holden suffers often from psychosomatic symptoms, ranging from actor's stomach to false coronary alarms, the latter even to the point where he is repeatedly plagued by the sensation that his heart has stopped. In the midst of public gatherings, Holden says, he has had to rush out of the building and run around the block "to start his heart beating again."
These tensions and complexities are not peculiar to Holly-wood. They are prevalent in any of our cities, where a man has to keep driving hard in order to get ahead, and harder still to stay ahead.
Such men drink to relax. And they usually drink too much. Often enough, their customary greeting is, like Holden's: "Warm up the ice cubes!"
How does this furious, this ambitious, pace affect the ones who pursue it? "It makes them nervous and a little neurotic by the time they reach the top," says Dr. Howard Hartman.
"They pay for their success in physical strain caused by their high-pressure living."
Dr. Hartman assisted in supervising the examination of 144 top executives from one of America's greatest corporations. He found a large number of these executives suffering from high blood pressure, nervousness, and some neurosis.
According to Dr. Edwin P. Jordan, of Charlottesville, Virginia, "High blood pressure, or hypertension, is not a single disease. It is not a single disease because it may result from several different conditions."
While some of these conditions can be effectively treated, some cannot. When your doctor labels your blood pressure "essential hypertension," that often means he doesn't know what causes it.
There are several conditions, including atherosclerosis, which produce, or are accompanied by, high blood pressure. In all instances the small arteries of the body become narrow and constricted. The same volume of blood is pumped by the heart through narrower and narrower channels. This makes the pressure correspondingly higher since, to maintain adequate circulation, blood must be expelled from the pumping heart chambers with greater force.
Then what happens? When this extra load of work is added to the demands of everyday living, the heart has to make adjustments. It enlarges to meet its extra work load, sometimes to such a degree that the heart, with its fixed blood supply, cannot furnish nutrition and oxygen to any more muscle.
The hard-working heart normally requires one-twentieth of the body's blood, although it represents a mere two-hundredth of the body's weight. To secure adequate nutrition and oxygen when its pumping job mounts, the heart calls upon its cardiac reserve. If this reserve is used sparingly, the heart can carry on. This is why a hypertensive should always get plenty of rest and proper nutrition. Otherwise, just as a starved man is unable to do a day's work, the blood-starved heart is unable to perform normally.
In some cases of high blood pressure the heart is enlarged to the limit of its coronary blood supply. Then it is no longer an efficient pump. Depletion of the cardiac reserve causes the heart to become fatigued and undernourished, this condition resulting in congestive heart failure. Blood backs up from the heart to produce congestion in the lungs, and it oozes into the tissues as well.
Joe Carter had this happen to him.
Joe, a big, stocky man, operates the filling station in our neighborhood. Every time I stopped for gas he would be munching something: a fried hamburger, a hot dog, cookies, or a candy bar.
"Better watch your weight, Joe," I warned him when I first noticed his shortness of breath. "Cut down on the fats and starches."
"Sure, sure," Joe said, taking a Coke out of the machine. "Diet's all right for some of you guys. But me, I work outdoors all day. Got to eat a lot to keep warm."
What can you do with a man who doesn't want to be told the truth? Joe didn't have the slightest idea that he had high blood pressure. When he developed an irritating cough because of the congestion in his lungs, he labeled it "a little touch of bronchitis." The veins on his neck stood out. He thought it was because of his coughing.
Then his ankles began to swell. Joe said: `"Cops get flat feet. I'm getting swollen ankles. Guess we're on our feet too much —sort of an occupational disease."
When he became bloated he decided he'd better cut down on his beer quota. All these were danger signals, but Joe ignored them. Finally, his vomiting sent him to the hospital, where they told him he had congestive heart failure. I went to see him while he was convalescing.
"What was that you were trying to tell me about diet?" he asked.
"Diet can help you ease the load on your enlarged heart," I told him. "Used as a preventive, diet may, in time, alleviate high blood pressure."
"I was a fool not to listen to you," Joe said. "I had to learn the hard way. But I'm ready to listen now."
"High blood pressure is too dangerous to ignore, Joe," I said. "Its symptoms don't recur often enough for the patient to diagnose himself. It strikes often during the most productive years. The average male age at the onset of high blood pressure is thirty-two."
"I thought it usually hit the executive type," said Joe "—the big shots who talk into two or three phones at once while they dictate at the same time to a couple of secretaries."
"It does," I said, "but the vast majority of these patients are just like you—working people trying to get ahead. And here's another thing: Dr. S. C. Robertson, of Northwestern University, took the physical measurements of more than ten thousand persons suffering from high blood pressure—day laborers, housewives, teachers, grocers. He came to the conclusion that the disease strikes more often the person with a short, stocky build—just like you, Joe."
According to Dr. Frederick M. Allen, of New York City, I explained, more than half the persons with essential hyper-tension ordinarily die in congestive heart failure. Dr. Allen, who in twenty-eight years' practice has seen thousands of essential-hypertension victims, reports that some of these patients also suffered from retinitis, claudication, angina, and uremia.
"High blood pressure is also one of the chief culprits causing strokes," I went on, "along with hardening of the arteries. When both are present, the condition is similar to that of the water pipes in your house when they get old and corroded. Even the normal pressure of the water might cause them to burst. But when the water comes charging through the old and corroded pipes at a particularly high pressure the pipes will burst sooner."
Strokes come without warning, but the conditions that bring them about, high blood pressure for instance, are telegraphed to you long before. Joe ignored his warning signals. He was lucky enough to survive. You might not be so fortunate.
It is up to you not to miss your body's message.
The stroke, known as apoplexy or a cerebral accident, is the third of the "big three killers," following heart disease and cancer. More than 170,000 Americans a year suffer fatal strokes, President Franklin D. Roosevelt and New York's famous mayor Jimmy Walker, for example. Even Russia's iron man Stalin succumbed to it.
There are two main types of strokes. Each is literally an accident occurring within the brain. The stroke may take the form of a cerebral hemorrhage, in which an artery ruptures suddenly and spills blood into the brain, depriving vital areas of their normal blood supply. The second form is cerebral thrombosis. This is the blocking of an artery by a clot, which, like the cerebral hemorrhage, cuts off the necessary blood supply to brain cells.
Since brain-tissue cells cannot live more than a few minutes without the oxygen supplied by blood, a stroke impairs the functioning of the body's master switchboard.
A massive hemorrhage may force large quantities of blood into the substance of the brain. When this occurs, the delicate cells and fibers are destroyed, and death can come within days, or even hours. Smaller artery ruptures cause paralysis of facial, arm, and leg muscles, the degree of severity varying.
Have you seen newsreel pictures of a city devastated by flood, with its communication lines severed? That's what hap-pens to the human body when an artery in the brain breaks down or dammed-up blood pours through the walls of a blood vessel. The nerve pathways leading from the brain—the body's communication lines—are flooded and perhaps destroyed completely by blood which has suddenly been diverted from its normal course. The severity of the paralysis, as well as the location of the affected muscles, depends on how much of the brain has been injured, and where.
Because the pathways of the nerves controlling each side of the body cross over to the opposite side of the brain in their passage through it, a bursting blood vessel on the brain's left side damages the right side of the body and vice versa.
An impending stroke may give you warning signs for several days, or there may be only a scant few minutes' notice before its onslaught. You may experience headache, dizziness, ringing in the ears, numbness of the limbs, and nausea. You may lose consciousness suddenly, often after complaining of a violent headache before collapsing.
Generally the face is flushed, although in some cases it is waxy-white. Breathing becomes labored, the lips blowing out and the cheeks flapping with each expiration. Paralysis is definitely evident in a majority of the victims: The pupil of one eye may be more contracted than the other, the face may appear lopsided, the arm and leg on one side may be more rigid or looser than on the other.
Cerebral thrombosis is less dramatic. You may awaken to find an arm, leg, or even an entire side, useless. Or you may experience an unexplained difficulty in speaking.
These things can happen to anyone. They can happen to you.
"I don't mind admitting," Joe said, "that I'm scared. If there's a list of foods I should or shouldn't eat, I want to know about it."
"There is, Joe," I said. "The primary injunction in pre-venting a stroke is to keep the blood pressure from soaring. I'll give you a diet for that—which I'll ask your doctor to approve. Add to it adequate rest, moderate exercise—in fact, moderation in everything is a good thing to remember."
"What about my weight?" asked Joe. "You told me once I should reduce. Does that still go?"
"That's more important than ever now, Joe," I said. "Weight is a big factor in determining the progress of high blood pressure. A twelve-year survey was made of more than three thousand employees of the Metropolitan Life Insurance Company. It showed that among the employees thirty-five to forty-four years of age high blood pressure was almost three times as common in the overweight as it was in the lean. It was twice as common among the overweight in the age group over forty-five. Hypertension is one of the leading causes of mortality among fat people."
"What do you know!" Joe said. "What's the reason for it?"
"Dr. D. D. Feller, of the University of Washington School of Medicine, did a lot of research on why and how fatty tissue shortens the lives of overweight persons."
"Go on," said Joe. "Tell me what he found out."
"He discovered that the heart pumps blood through the vital organs about ten times as fast as it does through the muscles and fatty tissue. As the ratio of fat in the body increases, there is a decrease in the rate at which the blood moves through the body. The fatter you get, the less blood you have to circulate around, in proportion to your body weight. For instance, Joe, a skinny person contains about one and a half times as much blood per pound as you do."
"Sounds like a clinching argument for us fat boys to lose weight," said Joe.
"It should be," I said, "when you consider that the smaller amount of blood per pound that's circulating in the stout people creates extra demands on the heart. With proportion-ally less blood to circulate, the heart has to pump harder to send the blood to the many miles of added capillaries in the fatty tissues."
Joe said, "When I'm able to go back to work again, and you drive in for gas, do you know how you're going to greet me?"
"Well, not exactly," I said. "How?"
"You'll take one long look at me, then you'll sort of smile and say, `Fill'er up—Skinny!' "
The case of Don Warren didn't turn out as fortunately as Joe's did.
Don was a hypertensive. His work as an executive in an auto plant kept him going at full speed to keep up his production schedules . . . until the day he blacked out and fell out of his chair. He picked himself up, went back to work at his desk, and blamed the rollers on his chair for the accident.
But from that day on, Don was a changed man. He became irritable, couldn't get along with people, antagonized his friends and family, and seemed completely incapable of getting his work done.
The only outward physical sign of deterioration was that he began to shove his feet along, like an old man. He took all the usual tests, and found nothing wrong—except high blood pressure. But because of this the doctor advised him to retire. During the next five years one little stroke followed another, and Don finally became completely incapacitated.
Don had been happy in his job. His mistake was this: He put his whole life into it. All of his drive, his energy, went into the job to the exclusion of everything else. He had no recreation, no outlet, no safety valve. His high blood pressure had been caused by overwork, neglect of his health through improper diet, and the pressure of production schedules.
Are you in your thirties, forties, or fifties? Then stop and take stock of yourself: Are you carrying around more weight than you should? Are you beginning to get irritable, exhausted, and short of breath?
Then, it's time to slow up in your work. Give up some of your ambitions. Tone down your aggressiveness. Cut out your tendency to run everything and everybody. Get rid of your executive paunch! Stop inviting hypertension!
John Stanton is still in his thirties. His high blood pressure is already wrecking his chances of living much longer. John was a pharmacist mate in the United States Navy during World 'War II. His wife was the daughter of a successful drug-store owner; so when John came back to join his wife and family, it was decided that John should take over his father-in-law's prosperous business. This he did, without consulting his natural aptitudes.
For fourteen hours every day of the week including Sunday, John grappled with the problems of the independent drug-store's survival in this age of big drug chains. The stiffer the competition, the harder John worked to make the successful profit his father-in-law expected.
He was mentally and physically exhausted by the time he came to see me. "Just tell me how I can keep going," he pleaded.
"I can't tell you to go back to that store," I said. "Not since you've told me what your blood pressure is. There are two things wrong with your job: for one thing, you're working too hard, for another, you don't like your work—it's some-thing for which you're not suited."
"That's right," said John. "But just not liking a job can't make me sick."
"It not only can," I said, "but it does, far more often than most of us realize. That's one of the peculiar things about hypertension. It can be a physical condition, or it can be psychosomatic."
"Of course," said John, "I've known people whose illness was psychosomatic. I just never thought it could apply to me."
"You know, John, you don't find hypertension in animals, unless it's induced in them artificially. It's a disease caused, not by the condition of the blood itself, but exclusively by the state of the arteries carrying that blood. The walls of the blood vessels in the arterial system lose their elasticity, and more pressure is thus required to circulate the blood. Doctors believe that nervous and emotional stresses which appear to have little direct bearing on a hardening of the arteries may contribute to high blood pressure."
Recently experiments were conducted in a New York hospital with a group of hypertensive patients who had been hospitalized under conditions designed to give them feelings of maximum comfort and security. Under the regular regimen —each patient was attended by the same doctor every day, was cared for by the same nurse, and received regular meals—the blood pressure of many of these patients dropped to normal.
Then the coddled patients were subjected to disturbing influences. New doctors, accompanied by medical students, came in. Strange nurses attended the patients. Their meals were irregular. Promptly the blood pressure in the improved patients shot up to the high levels present when they had entered the hospital.
"There is increasing belief," I told John, "that such things as nervous tension and feelings of anxiety, insecurity, and worry affect a person's blood pressure. You have all these things to contend with in the store. Then, you say you don't eat a balanced diet or sleep regularly. Don't you know what this regimen is doing to your arteries?"
"I'm beginning to have an idea," said John. "But go on. Maybe if I can find out the things that cause it, I'll know what to do to prevent further hypertension."
"Do you water your own lawn, John?" I asked.
"Well, sure," said John, "when I have the time. But why do you ask that?"
"Then, you know what happens inside a garden hose when you screw down the nozzle to throw a stream of water farther across the lawn. In hypertension something similar happens within your abnormally contracted arteries. Pressure increases, and the heart has to pump harder to force blood through these tightly contracted small vessels."
As a result of this, two things can happen.
Either your overworked heart becomes excessively enlarged and you suffer from congestive heart failure; or, because of increased pressure within it, a weakened artery elsewhere in the body may give way and cause a stroke.
Hypertension also hastens the development of atherosclerosis—the disease of clogged arteries. These two blood conditions are the greatest contributors to the heart disease that strikes men down in the prime of life. They cause one-third of all deaths in men under fifty-five.
Few of you can tell, without a physical checkup, that your blood pressure is high. One of the most common symptoms is persistent headache. The headache may make you pessimistic, irritable, and morose, which further increases your blood pressure. You may suffer dizziness and lightheadedness.
Vertigo, with the feeling that the world is spinning around you, occurs in extreme eases.
Your blood-pressure reading will be taken with a simple machine called a manometer. Just as the air in a tire presses again the tire's rubber walls, so your blood presses on the walls of your arteries.
The pressure is highest at the moment when the heart contracts and thrusts the blood onward. This is the systole period—the period when the heart pumps a fresh load of blood into the elastic-walled arteries, which stretch to accommodate it. The blood pressure is lowest during the diastole—the period when the heart pauses between beats to fill up with blood.
High blood pressure is commonly taken to mean high systolic pressure. However, the diastolic pressure is the more important of the two because it represents the basic pressure exerted on the arterial walls, independent of the additional pressure caused by the contraction of the heart.
Your blood pressure is not static. It goes up and down, perhaps varying during the day or from day to day. It varies with your activities, or even your peace of mind. In the normal person, these rises of pressure are temporary. Your arteries are dependent upon the functioning of the arterioles —the very small terminal portions of the arteries—which in turn are dependent upon the functioning of your nervous system.
Looking at John's tense and haggard face, I had a hunch that his functional high blood pressure was due to stress or anxiety rather than physical difficulty.
You hear the word "tension" everywhere—in offices, at luncheon tables, on the factory assembly line, and, conspicuously, on buses and in subways. You don't have to wear the gray flannel suit of Madison Avenue. You can be just as tense in your old shiny blue serge, or even Levis!
More than one-fourth of the nation's industrial labor force are tense and often emotionally upset. The psychosomatic ills of workers—high blood pressure, ulcers, migraine head-aches, arthritis—cost industry three billion dollars each year in unproductive wages and in damage to the workers them-selves and to their machines.
"Your hypertension," I continued, "is something that you can control, John, in both physical and mental ways. You can add many long, useful years to your life. Are you willing to make the necessary effort?"