Fatty deposit on the heart and between its muscular fibres, so common as a part of general obesity, hampers the action of the heart by giving it extra work to do, in lifting with every impulse a superincumbent weight. But if the muscular fibres themselves are healthy, they can bear this additional labor, and will even multiply, that they may the better bear it. Ordinary life is in no way endangered by this condition, and frequently, under proper hygienic measures and diet, the superfluous fat will disappear from the heart as it will from other parts of the body.
There is a stage in this process of change in the walls of the vessels which ultimately results in fatty degeneration of the heart, or disease of its valves, which should be recognized and understood, during which stage sudden deaths from apoplexy, the result of rupture of a blood-vessel in the brain, are not unusual, and another stage in which death from “heart-failure” is common in the various acute diseases which are ordinarily recovered from. Preceding the permanent change in the walls of the vessels throughout the body, which is characterized by thickening of their walls, lengthening of the vessels themselves and a diminution of their calibre, is a condition of irritation which produces contraction of the smaller vessels and renders the larger ones more tense than is normal. The heart, to overcome the results of these pathological changes, which, of course, produce obstruction to the blood-current, beats with greater force, and ultimately enlarges to compensate for the obstruction. The tension of these larger vessels is owing to their distension; they are stretched to their utmost capacity. At such a time anything which increases the force and action of the heart still further endangers the walls of these vessels in parts where they are especially weakened and are least supported by the surrounding tissues, as in the mucous membranes lining the air- passages or in the substances of the brain. Thus, a haemorrhage from the lungs or a profuse nosebleed is not uncommon, as the result of an extra effort, a violent paroxysm of coughing or vomiting or a fit of passion, in persons supposing themselves to be in perfect health. These accidents, like an attack of gout in the great-toe joint, or an attack of acute indigestion, are merely reminders that something is wrong. Unless these signals of approaching danger are heeded, accidents of a more serious nature are sure to follow, or the slow process of arterial change described above is finally developed. The most serious accident which can arise from this sudden overaction of the heart is the rupture of a bloodvessel in the brain, the result being an apoplectic stroke, with its accompanying paralysis of one side of the body, or death from pressure of the escaped blood on the brain-cells in the neighborhood of the rupture. It will be seen, therefore, that apoplexy and one of the forms of paralysis, so dreaded by the laity, are the direct results of heart trouble; for the heart under such circumstances is troubled in its efforts to overcome obstacles in the circulatory current. These obstacles are generally the result of indiscretions, such as the habitual use of wine or excess in the eating of food highly charged with nitrogen, as beef, mutton, venison; or of indiscretions of other kinds, which lead to the same result.
The other stage referred, to, is where the arterial changes have actually become established, but are progressive. With others the arteries supplying the heart-walls are involved. As was before stated, these changes interfere with the nutrition of the heart, and the heart is permanently weakened. During certain illnesses, particularly pneumonia, and pleurisy with exudation, the heart has extra work to do in overcoming obstacles the result of inflammatory processes and pressure, and being itself further weakened by the high fever and the diseased state of the blood from which it derives its nourishment, it gives out, and the patient dies of heart-failure, and not of the acute, the accidental disease. Another danger in these cases of weakened heart is that when still further weakened by disease, loss of blood or prolonged fatigue, clots are apt to form in the cavities of the organ and to be carried with the blood-current through the arteries until they finally become lodged at a point too small for them to pass. The supply of blood is cut off from the tissues nourished by the occluded vessels. If it be a vessel in the brain, a condition similar to the results of pressure from haemorrhage follows, with poorer chances of recovery, the result frequently being sudden death.
Diseases of the aortic valve or the valve which lies at the root of the aorta and by its closure prevents the return of blood from that vessel into the left ventricle from which it has its origin which is common as the result of extension of the atheromatous disease process from the aortic wall always acts as an obstruction to the blood-current and requires a careful, guarded life.
Space will not allow further consideration of the various forms of heart disease, and, as those forms resulting from these arterial changes are the most common in middle and advanced life, and are the ones which can be avoided by a discreet life, I will briefly consider the mistakes and indiscretions which ultimately give rise to them, and the errors which so often result in sudden death.
These forms of heart disease are more common among the well-to- do brain workers than among the middle classes and those who earn their livelihood by manual labor. It is exceedingly rare among the middle classes, for the reason that, in order to keep up a respectable show of appearances, they are obliged to forego certain habits of life and luxuries which tend to a lithaemic condition of the blood, the result of disturbed liver function. They are also, as is well known, a temperate class. With the laboring classes, the drinking of ardent spirits is common; but the daily physical work which they are obliged to perform is conductive to great activity on the part of the liver, and alcohol is readily consumed in their bodies; otherwise these diseases would be more common among them.
It is generally supposed that excessive brain work is the main factor in the wearing out of the heart, and that nervous prostration or neuraesthenia is at the bottom of the conditions of life which lead to these sudden deaths from heart disease among our great men. It is exceedingly rare that nervous prostration is mentioned in the newspapers as the cause of death. The following is the nearest approach to this diagnosis which has appeared of late:
“His unremitting labors since the beginning of the session, added to the great responsibility of his position, have served to exhaust his vitality and render him particularly susceptible to attacks of this nature.”
But even this only takes in a short period of the victim’s life. Would the healthy heart have entirely given out, even with this strain, were there not a factor dating back and covering a long period of years, which contributed largely to this fatal termination of a valuable life, and that factor lithaemia?
True, excessive taxation of the brain often has to do with the causes of these diseases, but a healthy brain in a healthy body will stand an amount of work which is often truly surprising; and the body rarely becomes affected by any of the organic diseases from excessive brain work alone. Numerous examples will come to the mind of every reader where, even into good old age, men who have led strictly temperate lives, have preserved their mental faculties in all their activity to the very last, and have finally died with a quiet, painless, peaceful form of death. But still, mental overwork, long contained, will bring about the conditions of the digestive organs which result in arterial changes, which, as has been stated, cause the heart to fail long before it should.
The following, taken from a medical journal, is a case in point: “One of London’s most successful physicians, a few months before his death, in conversation with a friend, said, `You see me, a little over 40 years of age, in full practice; my rooms are full, and I am making several thousand pounds per anum; all this I have done by sheer perseverance, unceasing hard work and no holidays. I have fatal disease of the heart, the result of anxiety and hard work. I know I cannot live many months, and my parting advice to you is this: Never mind at what loss, take your six weeks’ holiday. It may delay your success, but it will insure its development; otherwise you will find yourself at my age a prosperous practitioner, but a dying man.” To what profession or business will this not apply? Only recently, a lifelong temperance man of 70 came under my care for troubles resulting from chronic disturbance of the function of the liver, requiring an operation. He put the question in all seriousness, “If I have this operation performed on Saturday night, can I not go to my business on the following Monday morning?” adding, “For thirty years I have never been absent from my business a single day.” The operation necessitated his remaining at home for two weeks. His worry was evident. He seemed to believe that his business would come to a standstill if he could not give it his personal attention. At the end of the two weeks he appeared quite surprised that his son, a man of 35, who had grown up with the business, had managed it about as well as if he himself had been at the helm. Fortunately, one of these two weeks was that of the “blizzard.” The son had risen in the estimation of the father. It would certainly have been better for the further, for the son, and, perhaps, for the business as well, if these two weeks of holiday had occurred semi-annually for the past twenty years. It would be good policy for all of our business men, instead of tiring themselves out to give the young men a chance, and rest for a period from their labors. It is only necessary for a prominent business man to retire or die, and a young one will shortly spring up who will handle the reins with equal skill and success.
Hale wrote Lectures On Diseases Of The Heart, Materia medica and special therapeutics of the new remedies Volume 1, Materia Medica And Special Therapeutics Of The New Remedies Volume 2, Saw Palmetto: (Sabal Serrulata. Serenoa Serrulata), The Medical, Surgical, and Hygienic Treatment of Diseases of Women, New Remedies: Their Pathogenetic Effects and Therapeutic Application, Ilex Cassine : the aboriginal North American tea, Repertory to the New Remedies with Charles Porter Hart, The Characteristics of the New Remedies, Materia Medica and Special Therapeutics of the New Remedies, The Practice of Medicine, Homoeopathic Materia Medica of the New Remedies: Their Botanical Description etc.