Methods Of Reconstruction
( Originally Published 1921 )
Reconstruction must primarily be physical. You must put your patient and his heart in the best possible physical condition. With educated people, reconstruction must also be men-tal. No matter how much you dislike the task, you must tell the heart patient all about his heart and so explain that he can understand exactly what is the matter, or you can't reconstruct it. If you do not tell him, he will go to somebody else who will. The modern man is not satisfied until he has been mentally reconstructed, so that he understands about the disease.
Along with physical and mental reconstruction you must morally reconstruct the individual put courage into him, and teach him not to be afraid. I find in practise the best way to deal with heart patients is to tell the absolute truth. If a man is in danger of sudden death and you try to hide it from him and say he is not in danger at all, he knows you are lying because he has probably read in the newspapers every day of people dying with heart disease, and has perhaps seen his parents die. You may tell him that he is liable to drop dead any moment, tho the chances are that he will not.
What is true is that he may possibly drop dead. He will accept that as a fact and then forget it. This seems incredible, yet I find that in ninety-nine cases out of a hundred if I acknowledge to a person that he is liable to sudden death, he accepts it' as a fact and forgets it. He is like the soldier going into battle. If you tried to persuade him that there was no danger, you would waste time and nothing would be gained. But if you tell him of the danger and that he must undergo it, he seldom makes personal application, but usually thinks the other fellow is going to get shot while he himself escapes. So it is with the heart patient. The quickest way to dispose of the fear of death, then, is to acknowledge the danger. That is part of the moral reconstruction of the heart patient. It is particularly necessary in people who are suffering from angina pectoris. The minute you stop arguing about it, you need have no more trouble about the fear of death.
There are certain medical procedures in the reconstruction of heart disease that are quite definite, and one of these is what I call digitalization. To show the occasional good results from excessive dosage, I often refer to a romantic quack who lived in New York within a few blocks of me for a number of years, and people went to him for treatment. Some of these I met and so got to know what his methods were. He put to bed those who had bad forms of chronic rheumatism and gave them huge doses of Colchicum until they almost died of diarrhea and were torn to pieces with nausea. They came out of the place looking as if they had been through a terrible ordeal, but a certain percentage of them got better and praised the doctor.
In the treatment of a serious heart case, of course properly selected and everything considered, it is often a wise thing thoroughly to digitalize the patient that is, to give digitalis up to the point of saturation of the heart, even to the point of diarrhea and vomiting and a definite impression on the heart. The heart that has once been thoroughly digitalized is always after that much easier to control with that drug. Until the heart has been digitalized you do not get the best effects from the treatment.
So, with all the precautions that are dictated by common sense, I believe every heart patient who has a decompensation should sometime or other be thoroughly saturated with digitalis. Then stop the drug entirely until he completely recovers from all the digitalis symptoms. After that, resume it in moderate doses and carry them on for months or years, as may be required. I have known a man to go for many years without benefit from digitalis, always taking small doses and never getting the real benefit of the drug. I have seen that same person, after being thoroughly digitalized, go for another series of years with exactly the same dose and great benefit. Hence I consider digitalization of the heart as so definite a procedure that I go at it just as I would go at a surgical operation. It produces a definite change in the chemistry of the heart that is never harmful and is often advantageous.
In general, the best remedy for heart disease is graduated exercise of course I am speaking of chronic conditions where the inflammatory processes have come to an end. That is really the only remedy I know for certain functional disorders of the heart.
Palpitation is like the poor it is always with us. If there were a real remedy for palpitation, it would certainly have found publicity by this time. There is no medicinal remedy for palpitation. But there are a number of methods which give relief in individual attacks. The only permanent remedy is exercise. The person who walks out of doors for a certain distance every day is not liable to serious attacks of palpitation, unless, of course, they are founded upon some definite disorder of the heart beat. There is a special group of people who suffer from palpitation which is due to auricular flutter. Those cases are specifically cured by digitalization of the heart, but of course the flutter can be proved only by the electrocardiogram.
In this somewhat desultory chapter, I have rather given my general impression as to the reconstruction of heart patients than specific details.
In approaching the treatment of the heart patient it is well to tell him that what he needs is a course of treatment. Tell him that you haven't any more specific remedy than castor oil or digitalis in one form or another. Most people, I think, have not had them properly administered. But to most sensible people say, "you need a course of treatment." Call it reconstruction, if you like. Four weeks is the shortest time, and two months is better. Primarily, you put the patient to bed, then with draw all remedies he has been taking, prescribe for him a plain diet, and give him a few days rest. Then start with graduated exercise a half block the first day, a block the second day, and so on, and see if by a simple process of gradually increasing the range of exercise you cannot reconstruct him. If that doesn't succeed, you can have possible recourse to various forms of baths. I prefer the Nauheim baths,' but other baths are useful, and then, last of all, you have recourse to the medicinal remedies.
Diet in heart disease is important, and the ideas of the public as to what is good for the heart are upside down. All heart conditions are combined with stomach conditions, and this is no cause for wonder. I wish that you could see the hearts that I see with the aid of the X-ray every week in my office, see people's hearts sitting right on top of the diaphragm. Underneath this is a lot of air, and when the heart goes up and down in that air bubble on top of the fluid in the stomach, is there any wonder that heart and stomach troubles are mixed up in their symptoms?
Most people think that disorders of the heart come from the stomach, and they have an idea that starches and sugars make gas and so become prejudiced against starch and sugar. Now the heart, is a combustion engine that runs by the explosion of food products, and cane sugar is the best fuel for the heart. An Englishman once wrote a book on treatment by cane sugar.
He got good results by feeding cane sugar to people with weak hearts. I had a patient last ' year, a woman who had been very stout and had had a reduction treatment in which all starches and sugars had been taken from her. Her heart was exceedingly feeble, and in desperation I put her back on sugar and starch and her heart got better. I have read that Englishman's book on cane sugar, and altho I haven't had much experience with it, there was this instance where it seemed to give the heart the useful fuel.
The energy of the heart is best obtained from starches and sugars. An unreasonable proportion of meat is attended by so much waste product that it behaves like fuel that clogs up the carbureter. Consequently the lacto vegetarian diet is the best for heart patients, and if you give them plenty of exercise and plenty of castor oil in serial doses, and so on, the chances are that their hearts will behave much better than they would on a protein diet.
After resting your patient and trying out exercises and the lacto vegetarian diet, you can, if necessary, go back to digitalis and the other remedies. In the meantime you are reeducating your patient mentally and morally, and when you have reeducated him physically he is completely reconstructed.
When I was a child, there was kept in the house a box containing upward of one hundred small bottles, with a number on the top of each cork. These bottles contained small pills, and there was a book that went with them, in which you looked up the name of the disease and were told the number of the bottle to choose. The book was used to find the number of the bottle that was to cure the person who had the disease. No one thought of using the book itself as a remedy, but I have an idea that if a sick child had swallowed a piece of one of the pages it would have done him just as much good. This, however, represented at least an attempt to reduce the practise of medicine to a science, and it represented the opinion, held by many people of that time, that such a combination of a book and a box of bottles could encompass the cure of people afflicted with disease.
Now, soldiers have returned from abroad with all kinds of disabilities, and we hear hardly a word about the treatment of their troubles, but we hear much about reconstructing them so that they can. take their part in the affairs of life.
These are the extremes of what constitutes the practise of medicine. In between is the happy medium the proper and intelligent use of medicinal substances and the mental, physical, and moral treatment of the individual to ad just him to his surroundings and duties.
As already noted, the word reconstruction is much used at the present time, but reeducation has been a favorite word for the past ten or fifteen years. Before that the same idea was always held in one form or another. MY idea is that in reconstruction in heart disease, the material in this book is to be used for remedial purposes, is not to be swallowed but to be carefully read by those afflicted, so that they may receive the mental help and the moral uplift that comes from a clear understanding of their problem, and from an exposition of the direction in which improvement takes place.
The first step in reconstruction is, of course, diagnosis. The person who named the disease in selecting the bottle from the box did not perform an act of diagnosis. Diagnosis, as the derivation of the word implies, means thorough knowledge of the condition, and to obtain this the study of the disorder must be carried on a long time after it has been possible to name it. First a thorough knowledge of the condition, then a preparatory course of treatment with medicinal substances, then a revision of diet and habits of exercise, and then a course of physical reeducation. It is not only the young soldier with heart trouble who needs reconstruction, but also the older person who has never been taught the true nature of his disease and how to handle it.
It is an old saying that there is no royal row] to learning, nor is there any royal road to reconstruction. It requires knowledge, perseverance, and patience; but the result of reconstruction is the restoration of a human being to usefulness, and if successful it means the person's rescue from invalidism.