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Heart And The Kidneys

( Originally Published 1921 )


THE question as to whether the heart or the kidney comes first into the physician's consideration is a difficult one. When the evident physical disability antedates the evident kidney trouble by many years, the logical conclusion is that the heart comes before the kidney.

The recent upheaval in Europe has brought under review the entire youth of the United States with particular reference to their hearts, and it has taught us that changes in the heart having their origin either at birth or early in life are fairly common, and that for a long time many people are not suspected of having heart disease, because the heart does not hap-pen to make enough noise or a noise which is sufficiently characteristic.

The examination of the heart by modern methods, with the X-ray, makes that organ as visible as if it was outside the body between the sun and the observer. The electrocardiogram gives a knowledge of the action, of each muscle of the heart. We are thus able, even in late life, to tell by the manifestations of the heart at that time whether the trouble was of early origin.

People who start life with hearts that are not constructed according to regular plan, or who have acquired in early life a difficulty as to the passage of the blood, always work at a disadvantage, and as time goes on that disadvantage is apt to be emphasized. It is true, however, that those who, when their health is good, have been most active physically, will turn out to be those who are able to keep active longest. The reason this or that man has gotten along so well is because the circumstances of life have been such that he has been compelled to keep himself in good physical condition. I congratulate people of this type if their heart trouble has not been discovered early in life, because the world is only now waking up to the knowledge that rest is the worst thing that can happen to the person with heart trouble. Rest may be necessary, but the heart sufferer to whom it is not necessary is much more fortunate. The world is waking up to the difference between natural exercise of a function and strain.

It is generally recognized that the person who is healthiest in mind and body is the man who has the right quantity of the right kind of work to do and does it, and also that the worst thing for a person is not to have enough work, or not to do that which he has. A third bad thing is for a man to have too much work to do and to try to do it. There is a happy medium where people get along best.

The recent draft accepted men having hearts with defects either acquired in early life or existing from birth. A fair proportion of these, after the government told the doctors not to dismiss everybody with a heart murmur, went into service and through training and even fighting, and came out much better than when they went in. Those who broke down under training of course dropt out. But the draft had not gone far before the camps established certain groups into which people were put who were evidently short of breath when they went under training, or had other evidence of heart weakness, and the training was started in a much more gradual way. A fair proportion of the men who were utterly unable to endure training according to the original strenuous plan were by a more gradual method put into the ranks and from that time went on all right.

Of course those who did not respond to training were sent home.

This experience bore put the teaching of the really great specialists in the last fifty years. Every heart specialist makes one discovery, and that is that exercise is the best remedy for heart disease. The ignorant public condemns the person with heart trouble to a life of inactivity. Fatigue, pure muscular fatigue, is one of the greatest luxuries that is given to human beings. The man who is tired in mind and body from physical labor enjoys food and enjoys rest. He does not worry, and he has more than the average of human happiness and contentment.

While the chief enemy of the heart patient is inactivity, another enemy is strain. Given the proper amount of the proper kind of labor, work is the best thing for a person with diseased heart conditions which he has acquired early in life.

In many instances the tendency to poor circulation, which goes with heart trouble after a, comparably long time, finally leads to the presence of albumen in the urine. This condition of the urine does not necessarily mean serious kidney trouble. It means that the kidneys are threatened. The albumen will diminish under rest and perhaps increase under labor. That does not mean necessarily that labor must not be undertaken. It is simply a characteristic of the disease, and we must, accept the establishment of a certain amount of albumen as part of the natural history of a person who has had heart trouble for a long time. It represents a mile-stone. We are sorry when we have passed the mile-stone just as we are sorry that we have come to the point where young men get up and give us their seats. It does not mean that there may not be many other mile stones, but when we pass one, it must be recognized.

A person with heart trouble of long standing develops a little trouble with the kidneys and must recognize the mile-stone ; but it is a mistake to let it discourage him, because that man, with his condition fully recognized, is likely to outlive most of his cock-sure, reckless friends who boast of having nothing the matter with them.

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