How Much Should The Heart Patient Know Of His Condition?
( Originally Published 1921 )
The patient who has once shown a tendency to circulatory disease of a serious character must never dismiss from his mind the care of his health. By this we do not mean that it is necessary to become invalided or a hypochondriac, but that his life must be so planned that he may live out his expectation, unless he be overcome by some accidental infection or in-jury. The cure of circulatory disease is like the adjustment of a machine to the work it has to do and the conditions under which this work must be done. However well this is done, there is always a tendency toward a disturbance of adjustment.
In the human body there are many arrangements calling for adjustment. This is most often accomplished by what we call compensation. The very mechanisms themselves that are designed to bring about adjustments are just the ones that have gone wrong in those whose circulation is disordered. In the case of the circulation, nature's favorite means of compensating for defects is by an increase of the natural tonicity of the blood vessels. This is beneficent up to a certain point and prevents the patient from consciousness of the under-lying disorder, but it demands of the heart the maintenance of a high blood pressure, and, in the long run, leads to damage of the heart, blood vessels, and kidneys. So the behavior of the blood vessels should be watched by a physician trained to judge them.
The findings of the instruments now in use must be interpreted by no one but the physician, who alone knows what the findings may mean. The patient who concerns himself with his "blood pressure" is doing a foolish thing and ensuring himself endless anxiety and con-fusion. The same is true of "murmurs" and "enlargements." These matters belong in the province of the physician ; if abnormalities are known to exist, they should be inspected at such regular intervals as are determined by prudence.
As to the signs of disorder of the heart and circulation that force themselves upon the patient's notice, the patient should be made to know their true significance.
All hearts no more do their work in the same manner than do all locomotives, even tho of the same design. Engineers tell us that locomotives have individualities. So have hearts. Individuals vary as to their consciousness of the action of their hearts, even in health, and hearts vary greatly in their ability to make themselves felt. For these reasons, the patient must be guided by the advice of his physician, as to which of his conscious symptoms he must regard as important and which he must not allow to occupy his attention. The patient who has had a proper course of treatment has been taught all these things, and he will be wise if he repeats the cure as often as seems to be necessary.