This steady, untiring labor is one of the causes of the wearing out of the heart; but this pulsating organ will last a long time if, added to this, there are or have been no grievous indiscretions in life.
It is claimed by some pathologists that derangement of the nervous system is the direct cause of organic disease of the heart. But this is far from being proved, and is doubted by the best authorities. Certain it is that when these affections exist in such subjects, it is found that the heart is not alone involved; and it is more than presumable that its diseased condition is secondary to, or a complication of, disease of other organs, aside from the nervous system.
Throughout this paper, the phrase “functional disease of the liver” has been repeatedly used; and to this condition, long continued, has been attributed the changes in the walls of the vessels which ultimately lead to organic disease of the heart and heart-failure. It will be well to briefly explain what is meant by this condition. This great glandular furnace and chemical laboratory, the liver, is really chief of the organs concerned in the digestion and assimilation of food. In perfect health, in youth and early manhood, it can be taxed considerably without serious disturbance of its chemical functions; but if for a length of time, even in the healthiest, it is overtaxed, it rebels and refuses to do its work. One of its principal functions is the transformation of excess of nitrogenous waste into the highly soluble excrementitious substance known as urea. This excrement is eliminated from the blood, with which it becomes combined, mainly by means of the kidneys. In certain derangements of the liver the nitrogenous waste is not converted into urea, but into uric acid, a comparatively insoluble and toxic substance which is with great difficulty eliminated. Its accumulation in the blood gives rise to the condition known as the “gouty diathesis,” or lithaemia, and from this condition, it is generally conceded, result the arterial and capillary changes which are ultimately instrumental in producing certain forms of organic disease of the heart, kidneys, liver and nervous system. The writer unhesitatingly asserts that the forms of heart disease which kill so suddenly, and which do not result from an endocarditis or the presence of a specific poison in the blood, in nearly every instance arise directly from the pathological condition known as lithaemia.
Conceding, then, that liver disturbance is the primary cause of the premature wearing out of the heart, it is proper to ask: What gives rise in an otherwise healthy man or woman to this disturbed function? The answer in brief is: Indiscretions in living on the part of the patient or his ancestors. In what does this indiscretion consist? What mode of life will prevent these diseases? When they do exist, how shall a life be regulated so as to avoid sudden death, or the rapid failure of that most vital of all the organs, the heart?
It would carry me too far were I to attempt to give to these questions answers that should be perfectly satisfactory to the inquiring scientific mind. The answers given, however, are founded upon careful study and observations, and supported by the opinions of the best pathologists in this line, on our own and the other side of the water.
Chief among the indiscretions referred to is the habitual though moderate use of drinks containing alcohol. With but few exceptions, the exhilarating, the damaging ingredient of all of the so-called stimulating drinks is alcohol. It matters not whether they are in the form of spirituous liquors, cordials, still wines of high or low grades, the most delicate champagnes, ales or beers. Independent of the effect of alcohol in disturbing the function of the liver, its presence in the blood, as well as actual contact with the delicate structures of which the body is composed, does injury which aids in the production of the changes which finally result in the wearing out of the herat.
Second in importance of these indiscretions is the excessive use of meat as an article of diet, and the excessive use of other kinds of food
Third.- Sedentary habits, with a lack of a proper amount of physical exercise in the open air and lack of healthful mental exercise.
Fourth.- Mental strain, too close attention to business, accompanied as it generally is by a lack of a proper amount of diversion and amusement; irregularity in eating, which generally results in dyspepsia and loss of appetite, and too little sleep, which finally results in insomnia or inability to sleep.
Fifth.- The habitual and indiscriminate use of drugs and patent medicines.
In a very large majority of the cases of weakened or diseased heart there have been two or more of the above-mentioned factors concerned in their development.
Added to these are certain unmentionable indiscretions which, by their direct action on nerve-centres, disturb the functions of all of the organs of the body, and finally result in premature wearing out of the heart as a part of a general process. Many of our cases of supposed organic disease of the heart in young persons, really cases of irritable heart, purely nervous affections, are attributable to these indiscretions, which may finally result in organic disease of this organ.
The answer to the question, What mode of life will prevent these diseases? is simple enough. A discreet life, temperance in all things, and particularly the avoidance of the above-mentioned indiscretions, especially the habitual use, even in moderation, of stimulating drinks and the ingestion of too much meat.
Finally, when these changes are known to exist, how shall a life be regulated to avoid sudden death or the rapid failure of the heart?
In the Medical Record of April 14th is found such a complete and satisfactory answer to this question, and it is so in accordance with my own views and experience in practice, that it will be quoted in full:
“Dr. George Harley ends his lectures on the effects of moderate drinking upon the human constitution with the following conclusions: `1. That alcohol, when indulged in even well within the limits of temperance, has a most prejudicial effect on heart disease. 2. That mental excitement is a cause of rupture of atheromatous bloodvessels. 3. That sudden spurts of muscular exertion act most deleteriously on all forms of organic cardiac affections. 4. That mere extra distension of a stomach by wind may suffice to fatally arrest a diseased heart’s action. The knowledge of these facts has for some years led me to make it an invariable rule to impress upon all patients laboring under diseases of the circulatory system, who desire to minimize the effects of their complaints and ward off as long as is possible the inevitably fatal termination, to pay strict attention to what I call the following three golden rules (1) Take exercise without fatigue, (2) nutrition without stimulation, and (3) amusement without excitement.'”
In closing this article, which has already outstepped the bounds of its intended limits, the author proposes to leave the sphere of his own profession and make a suggestion in political economy to the law-makers of our land, which, if favorably acted upon, would be the means, in many instances, of preventing the wearing out of the American heart, lungs, liver and kidneys, and of saving to the nation many valuable lives lives that cannot well be spared. For the innovation he asks pardon of the lawyers and statesmen.
The suggestion is this: That a corps of expert medical examiners be appointed by each State, whose duties shall consist in the making of a thorough and scientific physical examination of every adult citizen at least once a year, and that the result of that examination be given in writing to each person examined the expense of such examinations to be borne by the State the examiners to be salaried officers, who shall not be permitted to engage in private practice, and that such examination shall be compulsory.
By this method, and this only, could men active in business or profession be kept informed as to the actual state of their health. Few, till reminded by symptoms of which they are conscious, trouble themselves as to their physical conditions. The time for medical skill to be of service is often before the evidence of disease have been made manifest to the patient; and indiscretions are often indulged in which would be avoided did he know that by such indulgences health or life was endangered. Our life insurance companies and our national banks are obliged by law to submit sworn statements annually regarding their financial condition. Paid examiners, experts, are provided by the Government, whose duties consist in carefully scrutinizing the books of these institutions, to see if their financial statements are correct. Is money of more value than life? Had the late Chief Justice known that his heart was weakened, probably from the very conditions mentioned above, would he have insisted on attending court and participating in an important and exciting decision, while in a feeble state of health, the result of a cold? Would a late former commander-in-chief of our armies have risked his life by an unnecessary and sudden muscular spurt, had he known that his heart was unequal to such an effort, and that death would result from it? The very recent sudden death of Mathew Arnold was the immediate result of a violent and unnecessary muscular exertion.
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.