PROPHYLAXIS
Arteriosclerosis comes to almost every one who lives out his allotted
time of life. As has been noted within, many diseases and many habits of
life are conducive to the early appearance of arterial degeneration.
Decay and degeneration of the tissues are necessary concomitants of
advancing years and none of us can escape growing old. From the period
of adolescence certain of the tissues are commencing a retrograde
metamorphosis, and hand in hand with this goes the deposit of fibrous
tissue which later may become calcified. The arterial tissue is no
exception to this rule, and we have already shown that certain changes
normally take place as the individual grows older, changes which are
arteriosclerotic in type and are quite like those caused in younger
people by many of the etiologic factors of the disease.
We are absolutely dependent upon the integrity of our hearts and blood
vessels for the maintenance of activity and span of life. Respiration
may cease and be carried on artificially for many hours while the heart
continues to beat. Even the heart has been massaged and the individual
has been brought back to life after its pulsations have ceased, but such
cases are few in number. We can not live without the heart beat and the
prophylaxis of arteriosclerosis consists in the adjustment of our lives
to our environment, so that we may get the maximum amount of work
accomplished with the minimum amount of wear and tear on the blood
vessels.
The struggle for existence is keen. Competition in every profession or
trade is exceedingly acute, so much so that to rise to the head in any
branch of human activity requires exceptional powers of mind. Among
those who are entered in this keen competition, the fittest only can
survive for any period of time. The weaklings are bound to succumb. A
scion of healthy stock will stand the wear and tear far better than will
the progeny of diseased parentage.
It is only necessary to call attention to the part that alcohol,
syphilis and insanity play in heredity. These have been discussed fully
in the earlier part of this book.
We live rapidly, burning the candle at both ends. It is not strange that
so many comparatively young men and women grow old prematurely. While
heredity is a factor as far as the prophylaxis of arteriosclerosis is
concerned, of far more importance is the mode of life of the individual.
Scarcely any of us lead strictly temperate lives. If we do not abuse our
bodies by excessive eating and drinking and so wear out our splanchnic
vessels and cause general sclerosis by the high tension thereby induced,
we abuse our bodies by excessive brain work and worry with all their
multitudinous evils. The prophylaxis of arteriosclerosis might well be
labeled, "The plea for a more rational mode of life." Moderation in all
things is the keynote to health, and to grow old gracefully is an art
that admits of cultivation. Excesses of any kind, be they mental, moral,
or physical, tend to wear out the organism.
People habitually eat too much; many drink too much. They throw into the
vascular system excessive fluid combined frequently with toxic products
that cause eventually a condition of high arterial tension. It has been
shown how poisonous substances absorbed from the intestines have some
influence on the blood pressure. Anything that causes constant increase
of pressure should be studiously avoided.
Mild exercise is an essential feature of prophylaxis. One may, by
judicious exercise and diet, make of himself a powerful muscular man
without, at the same time, raising his average blood pressure. The man
who goes to excess and continually overburdens his heart, will suffer
the consequences, for the bill with compound interest will be charged
against him. It is a great mistake for any one to work incessantly with
no physical relaxation of any kind, and yet, after all, it is not so
much physical relaxation that is necessary, as the pursuit of something
entirely different, so that the mind may be carried into channels other
than the accustomed routes. Diversification of interests is as a rule
restful. That is what every man who reaches adult life should aim at.
Hobbies are sometimes the salvation of men. They may be ridden hard, but
even then they are helpful in bearing one completely away from daily
cares and worries. The man who can keep the balance between his mental
and physical work is the man who will, other things being equal, live
the longest and enjoy the best health.
Nowadays the trend of medicine is toward prophylaxis. We give the state
authority to control epidemics so far as it is possible by modern
measures to control them.
We urge over and over again the value of early diagnosis in all chronic
diseases, for we know that many of them, and this applies particularly
to arteriosclerosis, could be prevented from advancing by the
recognition of the condition and the institution of proper hygienic and
medicinal treatment.
_It is the patent duty of every physician to instruct the members of his
clientele in the fundamental rules of health._ Recently the President of
the American Medical Association, in his address before the 1908
meeting, urged the dissemination of accurate knowledge concerning
diseases among the laity. While this may be done by city and state
boards of health, it seems far better for the modern trained physician
to work among his own people. With concise information concerning the
modes of infection and the dangers of waiting until a disease has a firm
hold before consulting the health mender, people should be able to
protect themselves from infections and be able to nip chronic processes
in the bud. But it is difficult to turn the average individual away from
the habit of having a drug-clerk prescribe a dose of medicine for the
ailment that troubles him. It is really unfortunate that most of the
pains and aches and morbid sensations that one has speedily pass away
with little or no treatment. Herein lies the strength of charlatanism
and quackery. Unfortunate, yes, for a man can not tell whether the
trivial complaint from which he suffers is any different from the one
that was so easily conquered six months ago. But instead of recovering,
he grows worse. Hope that springs eternal in the human breast, leads him
to dilly-dally until he at last seeks medical advice, only to find that
the disease has made such progress that little can be done.
_Instruct the public to consult the doctors twice a year._ The dentists
have their patients return to them at stated intervals only to see if
all is well. _How much more rational it would be if men and women past
the age of forty had a physical examination made twice a year to find
out if all is well._
The prophylaxis of arteriosclerosis is moderation in all the duties and
pleasures of life. This in no sense means that a man has to nurse
himself into neurasthenia for fear that something will happen to him. As
one grows in years exercise should not be as violent as it was when
younger, and food should be taken in smaller quantities. Many forms of
exercise suggest themselves, particularly walking and golf. Walking is a
much neglected form of exercise which, in these modern days with our
thousand and one means of locomotion, is becoming almost extinct. There
is no better form of exercise than graded walking. To strengthen the
heart selected hill climbing is one of the best therapeutic methods that
we have. The patient is made to exercise his heart just as he is made to
exercise his legs, and as with exercise of voluntary muscles comes
increase in strength, so by fitting exercise may the heart muscle be
increased in power. A warning should be sounded, however, against over
exercise. This leads naturally to hypertrophy with all its disastrous
possibilities. Men who have been athletes when young should guard
against overeating and lack of exercise as they grow older. Many of the
factors which favor the development of arteriosclerosis are already
there, and a sedentary, ordinary life, such as office all day, club in
afternoon, a few drinks and much rich food, will inevitably lead to
well-advanced arterial disease.
Karl Marx in his famous Socialistic platform said: "No rights without
duties; no duties without rights." So we may paraphrase this and say:
"No brain work without moderate physical exercise in the open air; no
physical exercise without moderate brain work."
There is yet one other point that is important, the combination of
concentrated brain work and constant whiskey drinking. This is most
often seen in men of forty-five to fifty-five, heads of large business
concerns who habitually take from six to twelve drinks of whiskey daily,
and with possibly a bottle of wine for dinner. Such men appear ruddy and
in prime health but, almost invariably, careful examination will reveal
unmistakable signs of arterial disease. There is usually the enlarged
heart and pulse of high tension with or without the trace of albumin in
the urine. The lurking danger of this group of manifestations has so
impressed the medical directors of several of the large insurance
companies that a blood pressure reading must be made on all applicants
over forty years of age. Should high blood pressure be found, the
premium is increased, as the expectation of life is proportionately
shorter in such men than in normal persons.
Therefore, let every physician act his part as guardian of health. Only
in this way is the prophylaxis of arteriosclerosis possible.