A Question of the Heart

Like many another hardheaded businessman, Abell H. Bernstein was hard driven by his own restless energy. The stocky president of Bernstein Bros. Pipe & Machinery Co. of Pueblo, Colo, thought nothing of working 18 or 20 hours a day, seemed never to tire. But then he began to suffer from dizzy spells and shortness of breath. Specialists told him that he had coronary artery disease, advised him to quit work and take things easy.

Abe Bernstein ignored the warning and kept on working, but without the old zip and zest. Last May he had a real heart attack--a shutdown in a branch of the artery which feeds the heart muscle. He recalls that after he went back to work, "when I went to sleep I wasn't sure I'd wake up. I lived in fear." So far his history had paralleled that of hundreds of thousands of U.S. victims of coronary disease.

Crate Lifter. Then Bernstein heard that Manhattan's Dr. Samuel Alcott Thompson had developed an operation which quickly restored people like himself to useful, active lives. It sounded too good to be true: the surgeon just dumps talcum powder into the heart sac in a 20-minute operation. Satisfied that it had worked well on other patients, Bernstein had the operation in July. Last week, at his company's Philadelphia plant, 50-year-old Abe Bernstein put in a nine-hour day, hefted 100-lb. crates with no visible harm. Said he: "The only time I feel lousy now is when I overeat."

The operation that put Bernstein back on his feet had been performed by Dr. Thompson on more than twoscore patients since 1938. Of them, 70% were still living after several years; all but four reported themselves vastly relieved. (Most had been coronary cripples, in much worse condition than Bernstein.)

Sac Slitter. As Dr. Thompson describes it, the operation works this way: the heart sac is slit open, then two drams of especially fine talc are spread on the inside of the sac membrane. Fine as it is, the talc acts as an irritant. The sac becomes inflamed and much more blood courses through it; then it adheres to the heart muscle, and its blood-gorged vessels throw out branches into the muscle. These branches increase the muscle's blood supply and, hence, its power to keep the heart beating.

The talc stays there the rest of the patient's lifetime. Technically it is a constant irritant, but the patient is unaware of it. All he knows is that he feels better. Most who have had the operation have been relieved of the agonizing spasms of angina pectoris and the paralyzing fear. Many have gone back to work--one from a wheelchair to loading trucks.

Why has this operation been so little used? One objection offered by some surgeons is that while it increases the heart muscle's blood supply, the increase is not strong enough. Cleveland's noted Heart Surgeon Claude Shaeffer Beck invented a powder operation (using ground-up beef bone or asbestos instead of talc), then put it aside in favor of a more radical job--revamping the heart's plumbing system by an arterial graft (TIME, June 28, 1948).

In his easy North Carolina accent, Dr. Thompson calls Beck's arterial grafting "a magnificent surgical feat." But, he contends, it takes a highly skilled surgeon and a two-to five-hour operation (more than many patients can stand). In many cases, he believes, almost as good a result can be had from the shorter, simpler operation. He argues that there is room for both techniques. Of 15 other surgeons using the talc method, says Dr. Thompson, most report good results.

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