Affairs of the Heart

The 17,500 doctor members of the American Medical Association who convened in Manhattan last week busied themselves with their patients' most persistent, everyday complaints. These ranged from stomach troubles to surgeons' fees. But none drew more attention, from general practitioners and specialists alike, than affairs of the heart and arteries, whose diseases are far & away the commonest cause of death in the U.S. today. By coincidence, the A.M.A. also voted its highest award this year to a famed heart surgeon (see below).

"Is That Bad?" Fully 1,000 doctors packed the hall when Fort Lauderdale's Dr. Richard A. Mills (after praising the Florida climate as a palliative for heart sufferers) lambasted doctors themselves for giving a lot of their patients a needless heart flutter. Sometimes, he said, the patient misunderstands when the doctor says "Your heart is slow," "Your blood pressure is low," or "Your heart is small." If the doctor does not take the trouble to make it clear that this is good news, it may convince the patient that he is seriously ill.

Whether the patient actually has heart trouble or not, the doctor can make him think he has by listening too long to the stethoscopic murmurings. And if there is something wrong, said Dr. Mills, the physician must still be careful not to exclaim "I never saw a worse heart!" Finally, there are the cases where a doctor misinterprets the symptoms or the results of his own examination. The one thing that all "iatrogenic" (doctor-caused) heart troubles have in common, said Dr. Mills, is that they are preventable.

Doctors also criticized doctors in a panel on how best to treat the patient who has some degree of congestive heart failure. Brooklyn's William Dock argued that since many such patients are going to have to live with their disease for ten to 15 years, they should be started promptly on a simple diet which a housewife can handle without a hospital's fancy kitchen gear, and they should be given prescriptions for simple, greenleaf digitalis instead of more expensive proprietary drugs. "In fact," summed up Dr. Dock, "the main faults in the treatment of these patients are overtreatment and overprescription."

New York Hospital's Irving Wright put in a word for the defense. "The doctor is taking an awful licking today," said he. "But it is also true that the community and the family conspire to make permanent invalids of these heart cases. And industry must learn that cardiacs do as well at their jobs as other workers ... It is up to us doctors as community leaders to see that these patients are treated as useful and productive citizens."

"Quick, the Knife!" Every now & then, even in the best of operating rooms and often with patients who seem to be the best surgical risks, the heart stops or flutters uselessly. Since there is no way of foretelling such catastrophes, said Dr. Julian Johnson of Philadelphia's University Hospital, every operating theater should have emergency equipment; oxygen, an electric "defibrillator" to shock the heart back into action (TIME, Feb. n, 1952), and the right surgical instruments for opening the patient's chest.

But if these things are not handy, said Dr. Johnson, the surgeon must not wait for them. He should grab the nearest sharp instrument--whatever knife he is using may have to do--and open the chest so quickly that he will have his hand on the heart and begin massage within 15 seconds. Dr. Johnson would prefer a sterile instrument, but he added: "It's better to have an infection in a live patient than a sterile incision in a dead one."

"Don't Walk--Run." Some popular ideas about staving off heart disease are fallacies, said Boston's Dr. Paul Dudley White. Men who slow down to a walk after they hit the age of 40 may actually run into heart trouble sooner; for some unknown reason, the slowdown seems to increase the risk of hardening of the arteries. "The general warning to stop all vigorous exercise at 40 seems to me ridiculous," said the 67-year-old physician who still hunts whales (TIME, Feb. 9) so that he can do research on their hearts. And, he added, there is no proof that trick diets or drugs, designed to ward off hardening of the arteries, do any good.

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