Thickening Of The Arteries - Organic Changes
( Originally Published 1921 )
A woman asked me one day, "Has high blood pressure as yet resulted in organic change?" I replied, "I hope that it has, because I think your condition is one in which high blood pressure is sure to keep up. It is a compensatory provision of nature to make your kidney do its work." Nature knows better than the person himself what the blood pressure should be, so that, as a general matter of policy, blood pressure should not be .interfered with. If anything is done to change blood pressure, it should be done after mature consideration, and after it has been decided definitely that it is best that blood pressure should be interfered with in that particular person.
In other words, blood pressure should never be treated as you treat a headache. It never should be treated as a symptom. You give a person relief from a headache, because headache is often the principal evil. The cause of the headache may be something that is past, like a night of dissipation. You treat headache symptomatically to relieve it. You must not treat blood pressure that way. You would not go into a factory and, finding high pressure on the boiler, blow off the steam because you objected to high pressure in the boiler. 'What you ought to do, if you had. authority, would be to inquire what the safe resistance of the boiler is.
I went down to a clinic of which I am president, and it was my duty to inspect the building from top to bottom. The engineer said, "I am carrying 110 pounds of steam. The city authorities have just been in and inspected my boilers and tested them up to 210 pounds." He was carrying 110. If I had said, "110 pounds of steam is too much, let some off," I would have been behaving in an irrational way, because the engineer knew that he needed 110 pounds of steam to run the elevators and to warm the building. The boiler had been tested, and this pressure was perfectly safe if needed. In the same way, there is no reason why a person should not have the amount of blood pressure he needs, provided the heart is able to produce it and the blood vessels are able to carry it. Let the blood pressure alone).
The thickening of the arteries is not easily detectable by feeling of them. It is so hard to tell the difference between the pressure inside of the artery and the resistance of the arterial wall. There is a natural difference in the thickness of the arteries in different people, and some people's arteries are so much nearer the surface that the judgment we form of the condition of arteries by feeling of them is not satisfactory.
The artery is a muscular tube which is liable to be contracted or dilated, according to the needs of the system. When it is contracted, it feels hard, and when it is dilated it feels soft. The actual thickening of the artery usually corresponds to the needs of the person. I have long since given up worrying about thickening of the arteries.
Those who have arteries like pipe stems are suffering from an entirely different disease. They are suffering from calcareous degeneration of the arteries, which is the deposit of lime salts in the arteries, and has nothing to do with arteriosclerosis, which is a thickening of the fibrous structures of the arteries and not the deposit of lime salts.
If people live long enough and come of gouty families, they are quite sure to get lime deposits and arteries which feel like pipe stems. In my work in former years, when I had charge of a home for old people, I observed these hard arteries in some people who had passed a hundred years of age. So calcareous degeneration of the arteries, unless some accident has occurred to break the arteries, does not shorten the life and has nothing to do with arteriosclerosis.
A question often asked is, "What is the prognosis in my case?" I became an exclusive heart specialist about fifteen years ago, and gave up all the rest of my work treating typhoid fever, and family practise, and everything else. Soon after I became a heart specialist I gave up another thing, I gave up prognosis. I consider prognosis ninety-nine times out of a hundred an evil thing which does no good to anybody, imposes a lot of extra mental work, and is generally disagreeable. I make it a point to take the most cheerful possible view of every medical problem that comes my way, and am perfectly willing to have people say that I don't know what is going to happen. The person who has heart trouble usually has the experience of attending the funerals of many of the people whom he knew when they were perfectly well. I prefer to shirk the task of prophesying and let the other fellow do it.
Now about your treatment. Take castor oil every other day for three days; skip a week, take one dose; skip two weeks, take another dose ; skip three weeks, take another dose, and then take it once a month during the rest of your life. Stick strictly to your diet, and exclude such animal protein foods as the medical adviser directs. Don't be afraid of anything that people tell you about other food, unless by actual experience you find that it hurts you. There is no agreement on the subject of diet. It is a matter of individual adjustment. With your defect ,of kidneys I know that animal proteins are unfriendly to you. Quiet out-of-door exercise is your best friend, along with castor oil and diet.