Affections of the Heart and Circulatory System

Affections of the Heart and Circulatory System


The heart is a living, pressure- and suction-pump made up of muscle (myocardium) so arranged as to form a hollow conical-shaped organ, which is divided into right and left divisions, each of these divisions being subdivided into an auricle and a ventricle, with openings provided with valves to keep the blood flowing in the right directions. The heart is lined with serous membrane (endocardium) and invested with a serous membrane (pericardium). Its structures are supplied with blood, not directly by absorption from its chambers, but by arteries that branch off from the aorta. Blood is carried from the heart throughout the body by arteries and is brought from all parts of the body back to the heart by veins. It may be affected in any one of several ways in any of its parts; hence, is subject to many “diseases.”
From the beginning of an established toxemia, evidenced by the first cold, to the fully developed myocarditis or myocardial degeneration twenty, thirty, forty or more years later, many toxemic crises come and go. Catarrhal fevers, so-called zymotic fevers, digestive derangements, with their infections, injuries and many other discomforts develop. Frequent colds, headaches, periods of not feeling well, a tired, lazy feeling in the morning, bad breath, bad taste in the mouth, coated tongue, despondencies and other discomforts, not commonly counted as “disease” or sickness, indicate that toxemia is constant, causing endocarditis and a gradual weakening of the muscle of the heart. Bad habits gradually weaken and overstimulate a good heart and the ultimate end is any one or more of the heart pathologies, finally, death.
Dr. James B. Herrick, writing in the Journal of the American Medical Association, October 2, 1937 (p. 1123), says that the classification and nomenclature of heart “disease” is very unsatisfactory.” He adds, “the condition diagnosed aortic regurgitation by one is called by another syphilis of the aorta and aortic valves; by a third aortic leak * * *, etc.” When one compares the classifications of the heart affections given in various standard works on the practice of medicine he is at once struck by the great lack of agreement these contain. It is not possible for us to follow any of these classifications in full. We shall pursue our regular policy of listing affections in alphabetical sequence.
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ATHLETIC HEART

Definition: An athletic heart, like an athletic arm, is a strong, well-developed and highly efficient heart. It is not a pathological heart.Symptoms: It is larger, more vigorous more efficient than the non-athletic heart and is capable of greater and more prolonged action than the less well developed heart.Tradition: Medical tradition has it that athletics strain the heart and produce enlargement (hypertrophy) and result in sudden death from heart failure. Athletes were said to “die young.” Man could not indulge in the activities that the lower animals do — indeed, were the medical theory true, he never could have survived the long period of time before he developed labor saving devices
Any derangements that are thought to be brought on by hard exercise, like weight-lifting running, rowing, swimming, tennis, football, baseball etc., are supposed to be hard to “cure,” and, by giving names suggestive of athletics to derangements of the heart and feet, doctors find their patients have more patience with them if they fail to get well in a reasonable time. Actually, this is one of the chief reasons why heart cases often fail of recovery. So long as the doctor is mistaken in the etiology of the case — attributes it to athletics instead of toxins — he will fail to find the true cause and recovery will not occur. A wrong cause leads to erroneous care.
Stop being afraid to use your heart. If some nitwit has warned you not to even attempt to climb a three-step stile, forget it. Stair climbing started moderately and increased prudently, will lead to cure of supposed bad cases of heart weakness. Running started moderately, Indian club swinging, tennis, swimming, weightlifting — any other exercise started moderately and increased prudently, will lead on to heart and lung development and to robust health.
If people will eat more prudently and take more exercise there will be less heart trouble. Running is, without a doubt, the best of all exercises for the heart. It must be started very carefully in cases of weak heart, but after the beneficial strengthening that comes because of it, it may be continued for a hundred years or more. It is certainly better for the heart than strophanthus, digitalis, caffeine, strychnine and the like.
Running is the one universal exercise among the higher animals. It is indulged in by children from a very early period. It has long been known to be the finest “conditioner” that athletes can employ in their training. It so builds up the heart and lungs that it gives staying power in emergencies.
The best means of weakening the heart, to let it grow flabby like the muscles of the arm, is never to give it any vigorous work to perform. A heart that is never called upon to do vigorous work does not grow vigorous and strong. If it always does light work it tends to become soft and flabby. It needs periods of vigorous work to build up and maintain its maximum strength and ability. If it is not called upon for sustained effort, it will never develop endurance. The athletic heart has greater strength, finer fibers, better quality and more endurance than the non-athletic heart.
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ACUTE MYOCARDITIS

Definition: As the word implies, this is inflammation of the myocardium, or heart muscle. The term is very inaccurate for the condition is really one of degeneration, rather than inflammation of the heart muscle. It is occasionally the part of the heart affected, but in most cases it is associated with endocarditis or pericarditis. More or less parenchymatous or fatty changes in the muscle fibers always accompany the inflammation.Symptoms: Difficult breathing, precordial discomfort, palpitation, pallor, and weakness, out of all proportion to the severity of the general condition are the important symptoms. There is usually rapid and irregular pulse, but there may be an abnormal slowness of the pulse. The heart may or may not be dilated.Etiology: Acute myocarditis occurs in such infections as typhoid fever, diphtheria, and scarlatina, and with endocarditis and pericarditis. It seems to be the result of septic infection. Medical literature tells us that modern investigation has not added much to the etiology, pathology, or diagnosis of myocarditis.Prognosis: Modern cardiology has established the fact that the weakened or damaged myocardium is the crucial factor in all heart pathology. The hope of recovery in every heart affection is in direct proportion to the capacity of the heart muscle. If the muscle can be restored to good condition, life can go on. Fortunately, this is possible in most cases.Care of the Patient: In the majority of cases myocarditis is a heart trouble resulting from a general septic condition brought on by maltreating intestinal indigestion. Besides physical and physiological rest, the most important factor in the care of these cases is a careful regulation of the diet and general habits of living to the end that intestinal sepsis may end. At the right time exercise should be started and gradually increased as the heart muscle grows stronger.
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ANEURISM OF THE HEART

Definition: This is an aneurism of the coronary artery and really belongs under affections of the arteries. It is a very rare condition.Symptoms: These are not very definite. Sometimes there is marked enlargement with tumultuous pulsations. The heart may be greatly displaced.Complications: Pressure upon the chest wall may cause absorption of the bony cage followed by a breaking through of the tumor.Etiology: It results from weakening by chronic myocarditis, or, occasionally, from endocarditis, and from the usual causes of aneurism.Care of the Patient: Even palliation is difficult in these cases. A fair degree of comfort may be established and maintained by reducing blood pressure and keeping it down, and by reducing the blood volume. Very light eating is imperative
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ANGINA PECTORIS (Stenocardia)

Definition: This is a “sympathetic” affection of the heart most commonly associated with occlusion or hardening of the coronary arteries and degeneration of the heart muscle. It is characterized by severe paroxysmal pain in the heart region and a feeling of imminent death.Symptoms: Agonizing pain which radiates from the heart to the shoulder and arm (usually the left), a sense of impending death, difficult breathing and a pale, anxious face, are the characteristic symptoms. The paroxysm may last from a few seconds to several minutes. Strong emotion, effort, gas pressure from indigestion or other tax upon the body may excite the paroxysm.Hysteric Angina is the name given a pseudoangina (a neurosis) sometimes seen in women. True angina is rare in women, in these there is no organic affection of the heart, the paroxysms are nocturnal, and are of longer duration. Stigmata of hysteria, including emotional outbreaks such as moaning and crying are usually present.Pseudo-Angina is the term given to a false form of angina that sometimes occurs in association with vasomotor disturbances and from the use of large amounts of tobacco.Etiology: Angina is strictly an affection of adult life and is a sign of premature aging. Though most cases are associated with arteriosclerosis, Tilden says that it often comes on “from an enervated state of the nervous system from over-indulgence in stimulating foods, stimulating drugs, and excessive venery.” Medical authorities tell us that “not infrequently the attacks have been preceded by prolonged mental anxiety.” Those who have cultivated an irritable state of mind and are steeped in stimulating habits, are the ones who develop angina. Angina following acute affections is not due to the acute crisis. Toxic anginas embrace those cases supposed to be brought on by tea, coffee, and tobacco.Prognosis: True angina is always a grave paroxysm. Death may occur in the first paroxysm, or there may be recurring paroxysms over a period of many years. Sudden death may occur at any time. In pseudo angina and hysteric angina, death rarely, or never, occurs. True angina is definitely remediable, at least, in its early stages.Care of the Patient: The general care must be the same as that given for arteriosclerosis, which, see. All stimulants must be discontinued. Rest in bed is essential and a short fast followed by fruit three times a day, until complete comfort has returned will give immediate, relief. These cases must learn to live abstemiously and moderately and must practice self control. Very few sufferers from heart affection, be they doctors or laymen, fail to note by experience that their comforts depend to a very great extent upon the, care they give the stomach in eating. So-called heart “attacks,” from simple acceleration and palpitation to the severe anginas, are, in the great majority of instances, due to indigestion, fermentation and distention of the stomach from overloading it.
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BRADYCARDIA

Definition: Slow heart. What is called physiological bradycardia is said to be seen in individuals and families, in the puerperal state and after exhaustion. Napoleon’s heart-beat was about forty a minute. Dr. Tilden says: “No doubt the mental strain under which he lived had a depressing effect upon his digestion and heart action. There is no question but that he kept up a constant gastric irritation from the anxiety he must have had concerning his activities. His life was so intense that his nerve energy was drained away enervating via stomach and bowels.” There must have been the same enervation of his heart.Pathological Bradycardia is seen in convalescence from severe dynamic biogonies; in gastro-intestinal affections, such as chronic gastritis, cancer, ulcer, or dilatation of the stomach; in heart block in affections of the heart muscle or the coronary arteries with severe jaundice; diabetes, chronic nephritis, and anemia; in affections of the brain, medulla and cord; in neuraesthenia, hysteria and insanity; in sunstroke, and in some affections of the sexual organs and skin. It is seen in chronic nicotinism, caffeinism, alcoholism, plumbism, digitalism, and aconite poisoning. It is thought to be due to stimulation of the vagus nerve. Returning to Napoleon’s heart, Tilden adds: “when he ate, he did not have the nerve energy to do perfect digesting; hence more or less fermentation, decomposition, and toxin poisoning took place. This produced hardening of the tissues, especially ulceration and cancer of the stomach. This is the price that an ambitious man pays for success.”Care of the Patient: This should be obvious. Correct the mode of living, discontinue all poison habits and care for the patient as directed under whatever affection he has.
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CALCIFIED PERICARDIUM

Definition: This is the formation of stone in or around the pericardium. It is a very rare condition.Symptoms: Its symptoms are those of pericarditis.Etiology: It follows peritonitis, Particularly the suppurative and tubercular forms. It probably develops only in gouty subjects and represents a perversion of metabolism.Prognosis: This is not favorable, as this condition represents an end-point in a long-drawn-out pathological evolution resting on chronic toxemia of years standing.Care of the Patient: The patient should be cared for with a view to restoring normal metabolism. Rest, fasting, proper diet, sun baths, and a corrected mode of life will accomplish all that can be done. However, as a rule these patients have been carried beyond relief by years of abuse of their bodies.
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CARDIAC HYPERTROPRY

Definition: This is an increased size of the heart with increased weight. The term means overgrowth. Two varieties are described as follow:Simple Hypertrophy in which the heart muscle is increased in thickness but the cavities remain of normal size.Eccentric hypertrophy (hypertrophy with dilatation) in which the muscle is thickened and the cavities are increased in size.Symptoms: There are no symptoms except where the hypertrophy is more than compensatory. “Excessive hypertrophy” may result in distress in the region of the stomach and symptoms of hyperemia (excess blood) in the brain — headache, ringing in the ears, flashes of light, etc. The examiner will find an increase in the area of cardiac dullness, a downward and leftward displacement of the apex beat, heavy impulse, bulging of the precordium, a loud booming first sound, with accentuation of the aortic second sound or of the pulmonic second sound, depending on whether the walls of the ‘right ‘or the left ventricle are hypertrophied, and a strong, full pulse.Etiology: Overwork of the heart is the cause of hypertrophy. Stenosis or insufficiency in one of the valves, or over-stimulation from toxemia, auto-intoxication, tobacco, tea, coffee, etc., is the cause. High blood pressure may overwork the heart and cause hypertrophy, as may also abnormal resistance in the circulation of the lungs, as in emphysemia, a cirrhosis of the lungs, or long-continued palpitation or tachycardia, as in exophthalmic goitre, or tobacco heart, and interference with the contractions of the ventricles by adhesion of the pericardium.
It is well to point out that this hypertrophy is merely an increase in the size of the heart muscle from increased work, and is no more pathological than the increase in the size of the arm from work or exercise. It is similar to or identical with athletic heart. The pathology in these conditions is not in the heart muscle, but in the heart valve, or in the arteries, or lungs, or elsewhere. The danger lies not in the increased size of the heart, but in the constant overwork of the heart.Prognosis: This hypertrophy is not a pathological state and needs not be recovered from. The overstimulation or the antecedent pathologies should be overcome if possible.Care of the Patient: The hypertrophy requires no attention. High blood pressure should be reduced, the tobacco, alcohol, tea, and coffee habits should be discontinued. Overweight should be reduced. Over-eating should be discontinued and the diet adjusted to the patient’s digestive capacity. Rest and fasting will eliminate toxemia, rest the heart and clear up the cerebral symptoms. Aconite, bromids, nitrates, and other drugs should be discontinued. .
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CARDIAC SYPHILIS

This is a name sometimes given to affections of the heart by those who believe there is a “disease” called syphilis. Writing In the Journal of The American Medical Association, of Oct. 2, 1937 (p. 1123), James E. Paullin, M.D., Professor of Clinical Medicine, Atlanta, Ga., says in an article on “cardiovascular syphilis,” that “* * * In the general detection of syphilitic aortitis, too much reliance must not be placed on the presence of a positive Wassermann reaction or on any other serologic test for syphilis. It is well known that from 10 to 20 per cent, of persons with latent cardiovascular syphilis will give a negative serologic reaction. * * * A patient who has not had rheumatic heart disease, and does not have hypertension, but who does give a history of syphilitic infection and presents any three of the aforementioned symptoms or signs (symptoms that could apply to heart ailment from any cause), even in the absence of a positive Wassermann reaction, should receive the benefits (sic) of anti-syphilitic treatment.”
The plain truth is that if there is such a “disease” as syphilis there is no way to demonstrate it and the above quotation reveals that a diagnosis of syphilis of the heart is a mere guess. There are many kinds of poisons, including alcohol, tobacco and arsenic, that affect the heart and it is impossible for the physician to tell that “syphilis” is affecting the heart. So-called “syphilitic” heart is to be cared for as any other affection presenting the same symptoms without reference to “syphilis.”
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CHRONIC VALVULAR AFFECTIONS

The heart has four valves — the aortic, mitral, tricuspid and pulmonary valves. Each of these valves may present either stenosis or insufficiency. Stenosis is obstruction of the flow of blood from thickening or adhesions of parts of the valves. Insufficiency is failure of the valves to prevent a return (regurgitation) of the blood back into the heart chamber after it has been forced out and is due to enlargement of the valvular ring or to shrinkage of the valvular leaflets or to rupture of .the leaflet from mechanical strain or ulceration.
Compensation is the ability of the heart by an increase in strength and size of its chambers, to supply the arterial system with a normal amount of blood, notwithstanding obstruction (stenosis) or regurgitation (insufficiency). This ability depends more upon the strength and efficiency of the heart muscle than upon the defect in the valve. The heart is as good as its muscle notwithstanding the condition of its valves, for a good heart muscle will compensate for valvular defects. It is well to emphasize, also, that while there are ways of improving the heart muscle, there is no means of remedying damages to valves. Merely functional insufficiency of valves may usually be completely remedied. How long the heart muscle can continue to compensate for valvular defects depends upon the strength of the cardiac muscle, the nature and extent of the valvular defects, and the hygiene of the sufferer.Symptoms: During the period of compensation there may be no definite subjective signs of heart impairment and, defects may be discovered only by physical examination, or by a lessened response of the heart to the demands of increased activity.
Decomposition is the inability of the heart to send a, normal supply of blood into the arteries, either because of weakness, atrophy or degeneration of the heart muscle, or increasing damage to the valves, or additional strain thrown upon the heart by increased arterial tension, work, pregnancy and parturition or mental shock.Symptoms: These are varied but, in general, are due to stasis, local anemia, accumulation of carbon dioxide, toxic complications from associated liver or kidney pathology, or there may be hydrothorax, ascites, or infarct of the lungs. Decompensation may be constant or only upon exertion. In many cases it is worse at night. Cyanosis is of ten conspicuous. Cardiac asthma is often a feature. Many other symptoms in various parts of the body develop but it is not always possible to tell which of these grow directly out of systemic toxemia and which are secondary to circulatory stasis. Dropsy develops in many cases, perhaps in all cases in the worse stages.Etiology: Rheumatism is given as the most common cause. Rheumatism can no more affect the heart than the tail can wag the dog. The processes that produce rheumatism were busy producing degeneration of the heart and arteries before the rheumatism developed. The same may be said for abscessed teeth, tonsils, etc., which are said to infect the heart. Heart pathologies are produced by toxemia and infection from gastro-intestinal decomposition. Putrefactive toxins are responsible for both rheumatism and heart affections as well as aortic affections.Prognosis: Only in occasional cases does complete recovery occur. In most cases compensation may be improved and maintained throughout a long and useful life. When decompensation has developed compensation may often be restored. The character and intensity of the murmur is no adequate guide to the gravity of the lesion. The order of seriousness from the most to the least is, in general, as follows: tricuspid insufficiency, aortic insufficiency, mitral stenosis, aortic stenosis, mitral insufficiency. Cases of aortic regurgitation give the most frequent causes of “sudden” death. Unfavorable factors are early childhood, advanced age, marked hypertrophy of the heart, difficult breathing, irregular rhythm, arterial tension, poor general health and bad habits. If bad habits are discontinued and the sufferer will learn to live within his compensating capacity, he may live long and well in spite of an irreparable lesion.
It is now generally conceded that murmurs are unreliable in diagnosing heart affections. They are inconstant and indefinite and their differentiation is often impossible. They are found in conditions other than heart affections, or may be present in well-functioning hearts and absent in badly embarrassed hearts. When markedly present and unmistakably due to structural lesions they are regarded as having no prognostic value. The valve lesion is considered the result of a hidden myocarditis. It is the present view that the most serious conditions of the heart are those which have no necessary connection one way or another with valvular murmurs, or even with valvular defects.
Indications of a toxic or failing condition of the heart muscle, with lesions in the conduction system of the heart, and no murmurs, reveal a much more serious condition of the heart than loud murmurs with good compensation.
Undue attention to and dependence upon murmurs often leads to a wrong diagnosis and to a false sense of prognostic security and mislead the doctor and patient as to the true situation. A better estimate of the heart’s condition may be obtained from the rate, regularity and quality of its beat.Care of the Patient: First, last and all the time it is necessary to relieve the organism of its toxic overload. Careful watch of the heart is essential during a fast. All stimulant habits must be discontinued at once and permanently. No drugs (heart medicines) should ever be taken. Eating should be moderate and of natural foods.
Regular medical men waste a lot of time and weary their patients in splitting hairs over the diagnosis and guessing about the significance of the various sounds and then, whether the sound means one thing or another, give the patient a “heart tonic” — stimulant. The heart is already overstimulated from toxin poisoning. To stimulate it more, with drugs, is criminal practice. A fast lowers blood pressure and gives the heart a much needed rest.
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CHRONIC INTERSTITIAL MYOCARDITIS

Definition: This also represents a condition of degeneration, rather than of inflammation. The heart fibers are replaced by fibrous tissue. The whole or only part of the heart may be involved.Symptoms: These are indefinite. They may be absent until death “suddenly” occurs. Arrhythmia is common. The pulse may be very infrequent, feeble and irregular, sometimes frequent. There may be difficult breathing, oppression of the heart and paroxysms of angina. The physical signs may be those of hypertrophy and dilatation of the heart.Etiology: The condition is usually secondary to pathology in the coronary arteries, sometimes to endocarditis and pericarditis. Chronic intoxication — intestinal or alcoholic — is a common cause. It occurs largely after middle-age in people subject to the causes of arteriosclerosis.Prognosis: The condition is always grave and carries with it the possibility of sudden death or death after symptoms of gradual heart failure. If its causes are removed early a long and useful life may be led.Care of the Patient: The first rule of life should be moderation in everything. Indeed, if this rule were followed from childhood no cardiac pathology would or could develop. The word moderation has valid meaning only with reference to the use of those things that bear some normal or vital relation to life. Abstinence is the only permissible rule with reference to the use of substances like tea, coffee, alcohol, tobacco, and other drugs, that bear no normal or vital relation to the structures and functions of the living organism.
Only by eliminating toxemia, restoring normal nerve energy, normalizing nutrition and correcting the whole mode of life, can the heart, in this condition, be improved and life prolonged.
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DILATATION OF THE HEART

Definition: This is a condition in which the heart cavities are increased in size and the muscle is thinned. The walls are said to sometimes become as thin as paper.Symptoms: The usual signs of cardiac enlargement are present, but the impulse is feeble or imperceptible, the first sound is short and weak (clicking), and often irregular or intermittent, commonly symptoms of venous congestion — difficult breathing, cough, edema, flatulent dyspepsia, and deficient urination — exist. The examiner will hear soft systolic murmurs, the result of relative insufficiency of the mitral or bicuspid valves. Palpitation, irregular, weak pulse, dizziness, headache, sometimes collapse, cowardice and apprehension are the chief symptoms. If the case is severe there will be a puffed face, oppression of the chest and rapid breathing.Etiology: Dilatation, like hypertrophy, is due to overwork of the heart. It is especially likely to develop in people who have been very fat for years. It is the rule that when the heart is forced to do more work its walls thicken as it grows in size. Degeneration, perhaps fatty degeneration, of the heart muscle would seem to be the explanation of those cases where the walls become thin instead of developing more muscular tissue when more work is placed upon them. It may be possible that in a few cases the heart is so greatly overworked that no development is possible. Back of the overwork of the heart are all the pathological conditions and their antecedent conditions that stress the heart.
It is the prevailing view that “compensatory hypertrophy” does not occur, it is asserted that the normal myocardium has plenty of reserve power to meet the demands of excess resistance, arising out of back-flow and back-pressure in a stenotic heart, without undergoing hypertrophy.
Dilatation and not hypertrophy is the method by which the heart effectively meets such demands, according to present views. It is claimed that the heart does not weaken because it is enlarged, but that it is enlarged because it is weakened, the muscle having been damaged by the same causes that weakened the valves. It is claimed that every enlarged heart (as distinguished from a large heart) is a dilatated heart, so that the size and postural tone of the heart constitutes an index to the seriousness of the valvular defects.Prognosis: The condition is perhaps never completely overcome but great improvement may be secured in the majority of cases. Tilden says: “the majority can be put right in the course of a few years, if they will fully consent to give up all bad habits of eating, give up all stimulants, such as tobacco, coffee, tea, and live on a very restricted diet. If the patient is in fairly good flesh, a fast of sufficient duration to bring full relief should be given. A very thin patient should be fasted very carefully and for only a short time. Non-stimulating foods — fresh vegetables, salads and fruit — are the proper dietary regimen until the symptoms have been thoroughly brought under control.”
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ENDOCARDITIS (Valvulitis)

Definition: This is inflammation of the lining membrane of the heart. The inflammation is usually confined to the valves and should be called valvular endocarditis. It is divided into simple, malignant and chronic forms.Symptoms: In many cases of simple acute endocarditis there are no subjective symptoms and the only evidence of trouble is alteration of the heart sound discoverable by the examiner. In other cases there are increase in the fever, overaction of the heart out of proportion to the degree of fever, irregularity of the pulse, difficult breathing and pain in the stomach area.
In malignant endocarditis the general symptoms may be irregular fever, chills, sweats, progressive anemia and emaciation, or the patient may present the appearance of typhoid fever or acute meningitis. Increased pulse rate, palpitation, pain in the stomach region, difficult breathing and murmur at one or more valves, are usually, but not always present. Malignant endocarditis usually lasts from two to six or eight weeks, but in some cases it may last for months.
Chronic sclerotic endocarditis presents the same symptoms as those of chronic valvular “disease,” which see.Complications: Dyspnea, and dropsy are the most common complications. In malignant endocarditis, emboli form and lodge in various parts of the body. Lodging in the lungs they produce hemoptysis; in the brain, aphasia, hemiplegia or monoplegia; in the kidneys, lumbar pain and blood in the urine; in the skin, hemorrhagic eruption; In the spleen, painful enlargement of that organ; in the eye, optic neuritis or hemorrhage of the retina; in the large vessels of the limbs, gangrene and infective aneurysms.Etiology: Acute endocarditis is a symptomatic affection and is always found in conjunction with other affections. It is the custom to credit rheumatism, tonsilitis, etc., as causes. These affections cause nothing, but are antecedent, concomitant and successive effects of the same toxic state that causes the heart affection. Years of overeating and plethory with the autotoxemic state resulting from absorption of toxins from the intestine produces both the rheumatism and endocarditis. The rheumatism may be severe, or it may be so mild that the patient does not go to bed. It seldom leaves the heart unaffected, indeed the heart is subject to toxin-infection continuously and it is possible for valvular endocarditis to develop without other rheumatic developments.
Tobacco strikes hard at the heart and blood vessels as well as at he nervous system, liver and kidneys. The use of tobacco increases the pulse rate from five to ten beats a minute, and in the case of the man who is continually smoking the increase of the rate becomes permanent. The increased pulse rate is accompanied by a small increase in blood pressure, which sets in a few minutes after smoking is started and persists until the smoking ceases. That the heart of even “moderate” smokers is less efficient under strain is well known to athletes and trainers.
Malignant endocarditis is never primary but results from pus infection from peritonitis, pus absorption, septic poisoning, etc. Gonorrhea is said to often cause it. If so, the gonorrhea must be badly abused in treatment. Pus absorption from an abscess may cause it. Toxemia is back of these developments.
Chronic endocarditis may follow one or more crises of acute endocarditis or it may start as a mild inflammation or degeneration that is not noticeable until extensive changes have occurred. It is never primary, but develops as part, of the general pathology of the body. Alcoholism, lead poisoning, tobacco and chronic nephritis favor its development.Prognosis: Weger says: “It goes without saying that every heart wears out sooner or later but even the incurably crippled heart can be so greatly relieved by a life of moderation and frugal eating that nature will tolerate the condition and sometimes carry on efficiently for many years. * * * cardiac dropsy, cardiac asthma, and the great mental and physical distress and anxiety that go with heart disease can be relieved, even in many advanced and apparently hopeless cases, by the institution of a short fast and a light diet to follow.”
Acute simple endocarditis is rarely fatal but rarely leaves the valves undamaged. Compensatory enlargement of the heart follows under favorable conditions and good health may be preserved indefinitely. Malignant myocarditis is very frequently fatal and recovery usually leaves more or less permanent damage to the heart.Care of the Patient: In general this consists of two procedures:
(1) it is necessary to correct nutrition by correcting the mode of living and by fasting and rest, eliminate toxemia and restore nerve energy;
and (2) all sources of infection must be removed. Abscesses must be drained, gastro-intestinal decomposition must be corrected, proper drainage of the pelvis re-established where it is faulty.
After the worst symptoms have ended light exercise may be indulged and this may be increased as the heart continues to improve.
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FATTY HEART

Definition: This is fatty degeneration and fatty overgrowth of the heart.
In true fatty degeneration of the heart there is actual degeneration of the heart muscle. Fat infiltrates the walls of the heart and many of the muscle fibers are turned into fat. These fibers are lost as fat can never be turned back into muscle.Symptoms: Fatty degeneration of the heart presents very little symptoms at first, but after the condition has progressed the heart often beats too rapidly, but the opposite may also be true. There is irregularity of the heart with decreased mental and physical powers. Sometimes there is angina pectoris and nervous crises. Difficult breathing is common. Sudden death sometimes occurs. In all cases, if the degeneration is not stayed, the weakened heart will fail.
The chief symptoms of fatty overgrowth is shortness of breath.Etiology: Pressure upon the heart from excess fat, declining nutrition in the aged and the progressive degeneration of the whole body, as seen in cancer and tuberculosis and alcoholism are common causes of fatty degeneration of the heart. Those who have carried a lot of fat for years are prone to develop fatty degeneration. It frequently follows toxic states, empyemia, or pus absorption from any part of the body may produce fatty degeneration. Arsenic and phosphorus are two drugs that often produce fatty degeneration. Except where due to drugs, fatty degeneration is an endpoint in a toxemic chain.
Fatty overgrowth belongs to the obese. It accompanies corpulency of the entire body. All the cavities of the body are crowded and choked by the large amount of fat. Not only the lungs, but the whole body, pants for more oxygen. Overeating is, thus, the chief cause of fatty overgrowth.Prognosis: Fatty degeneration may almost always be stayed and the condition of the heart greatly improved. If based on advanced tuberculosis or cancer no recovery can be expected. Fatty overgrowth of the heart is always a remediable condition.Care of the Patient: In cardiac degeneration the care is the same as that given for chronic endocarditis, plus the care described for tuberculosis, or cancer, or empyemia. The subject must live so that the heart is not overstimulated or forced to work beyond its strength. In fatty overgrowth the remedy is weight reduction of the whole body. For directions see obesity. If these directions are faithfully carried out recovery will be complete
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HEMOPERICARDIUM

Definition: This is blood in the pericardium.Symptoms: These are those of pericarditis.Etiology: This condition results from trauma, the rupture of an aneurism, or the rupture of the heart itself.Prognosis: Except in traumatic cases, this condition is a terminal development in long-standing heart and arterial pathology and the outlook is grave. Traumatic cases may recover.Care of the Patient: See aneurism and myocardial degenerations. As a rule these patients have passed beyond help of any kind except palliation. Years of abuse of their bodies have brought on the trouble.
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HYDROPERICARDIUM

Definition: This is dropsy of the pericardium. Chylopericardium is a very rare similar condition in which the serum is milky white.Symptoms: These are the same as those of sero-fibrinous pericarditis in the stage of effusion, which see.Etiology: This is always secondary to general dropsy and is seen in heart “disease,” nephritis, malnutrition, etc.Prognosis: The condition represents a serious state of the body. Recovery depends on recovery from the primary pathology.Care of the Patient: Care for him as directed under Bright’s “disease,” heart affections, etc. As a rule palliation is about all that can be done for these patients, for years of self-abuse have brought them so low that no help is possible.
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PERICARDITIS

Definition: This is inflammation of the pericardium — the investing membrane of the heart. It may be either acute or chronic.Symptoms: There are different forms and the symptoms vary with these. When there is but little exudate into the pericardium, it is called dry pericarditis. If there is much exudate it is called purulent, hemorrhagic, sero-fibrinous, etc., pericarditis depending on the character of the exudate — pus, blood, serum or fibrin.
Pain or discomfort in the stomach region, palpitation, difficult breathing, moderate fever, and weakness are the usual symptoms of acute pericarditis. In some cases the condition is “latent” and is discovered only upon examination. The face may be unduly pale or markedly cyanosed, the veins of the neck may be turgid, and occasionally, if the effusion is large, there may be hoarseness from pressure upon the recurrent pharyngeal nerve, or difficulty in swallowing from pressure upon the esophagus.Purulent pericarditis presents the above symptoms plus the usual symptoms of sepsis — chills, irregular fever, sweats, pallor — and sometimes edema of the tissues over-lying the stomach.Etiology: Inflammation of the pericardium is said to be always a “secondary process,” except where due to trauma. It is said to be due to rheumatism, chorea, and to extension of “disease” from adjacent structures, such as the lungs, pleura, mediastinal glands, ribs, etc., and is a terminal symptom in chronic “diseases of various kinds,” especially nephritis. It is said to be the result of an infective process, but if we try to find out what infective process has brought it about we learn that it has been caused by some “other disease” produced by an “infective process.” We get into a vicious circle following a trail of “infective processes” that seem to have no known beginning.
Tilden says, “If the student will bear in mind that, primarily, there is but one source of infection, and that is in the alimentary canal, he will have no trouble in tracing all diseases back to their own origin. Toxin poisoning from putrefaction in the intestine, plus constitutional diathesis, or plus organic diathesis, supplies the origin of all organic diseases, which should be called affections. Infection or autotoxemia starts a process known as rheumatism. The same identical cause will develop pericarditis in a subject who has a cardiac diathesis; and this is the source of the infection that causes this disease.”Prognosis: This is good in the dry and sero-fibrinous cases. In the purulent form the out-look is grave. The fibrinous form may persist for years and is followed by changes in the heart muscle. Weger says, “we have had such unexpected success in the treatment of heart affections that we hardly know where to draw the line and state with conviction in any given case that an attempt to reorganize the living habits would be futile. Everyone is entitled to his chance to improve or recover.”Care of the Patient: In acute pericarditis absolute rest, both physical and physiological, is important. If there is effusion the physiological rest will hasten its absorption. Heart infection, that is infection due to absorption from the intestine of the toxic end-products of indigestion, cannot recover so long as eating and putrefaction continue to pour toxins into the blood-stream. As this infection is always supplementary to toxemia it is essential that toxemia be eliminated also.
Weger says, “regardless of the special form of cardiac disease, the most satisfactory treatment is one that removes every possible tax on the circulation and particularly the burden of toxic poisons. With correct treatment, the body can in most instances be brought to such a high state of efficiency that infections and secondary heart complications can be entirely overcome.”
In pericarditis with purulent effusion the death-rate under regular care is about 60 per cent. With proper care it should be much lower. In extreme cases it is well to incise the pericardial sac and establish the freest possible outlet for the pus.
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PNEUMOPERICARDIUMDefinition: This very rare condition is air in the pericardium.Symptoms: These are the same as those of pericarditis, which see.Etiology: It results from trauma or rupture of an adjacent air-containing organ. Ulceration of the stomach or esophagus, a tubercular abscess, or pneumothorax or trauma may produce the condition.Prognosis: Except in trauma, this is a terminal development in advanced pathologies and represents a serious state. Recovery depends on recovery from the prior state.Care of the Patient: Care for the patient as advised under gastric ulcer, tuberculosis, pneumothorax, or whatever other pathology the patient presents. Traumatic cases are to be cared for as directed under surgery.
As a rule these patients have abused their digestion and nutrition so long that they have passed beyond help of any kind except palliation.
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RUPTURE OF THE HEART

Rupture of the heart is very rare and occurs, when it does, in dilatation, fatty heart, degeneration of the heart muscle, aneurism, etc. It occurs only in extreme cases of degeneration or indiscretion, or both, and is usually fatal.
FUNCTIONAL DEFECTS OF THE HEART

These include several forms of deviation from the normal rate and rhythm of the heart, aside from those normal deviations that occur after exercise or during rest, or while fasting, and besides those that occur because of pathology in the heart and elsewhere.

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ARRHYTHMIA

Definition: This means absence of rhythm of the heart beat. It is said that “a heart that beats regularly can hardly be a functionally diseased heart,” and “one of the first signs of deranged heart is irregularity, which may vary all the way from the apparent missing of beats to auricular fibrillation.”
By means of the electrocardiograph some nine or ten different types of arrhythmias have been demonstrated in the heart cycle, but the difference between them are those of detail rather than of kind so that imperceptibly they merge into one another and all consist in the same fundamental pathology. We will here discuss briefly the four arrhythmias most generally recognized in the order of their severity.Extra-Systoles: These are the simplest and commonest forms of arrhythmia and are sometimes called “premature contractions.” They consist of single, relatively infrequent contractions of the heart muscle which are interpolated at intervals into the regular heart cycle. They are not sufficiently numerous or frequent to upset the cycle or to interfere with the pulse, except for their own occurrence. The irregularity can usually be made to disappear with exercise. They do not indicate any impairment of the heart nor, do they add to the gravity of any existing pathology.
Extra-systoles are relatively common in middle-aged persons who are more or less neuro-toxic from intestinal sepsis, wrong metabolism, tobacco smoking, coffee, etc. They disappear when their causative factors are removed.Paroxysmal Tachycardia: Tachycardia means a rapid heart. Such a condition is seen in goitre, fever, after running and in several other conditions. This is not what is meant by the above term. Paroxysmal tachycardia seems to be a very rapid series of extra-systoles and results from the same neuro-toxic conditions of the body that produce the latter. The paroxysms begin suddenly and end suddenly, the pulse rate ranging between 140 and 220, and may be brought on by emotion, exercise or a change of position. The condition disappears when the toxic condition is overcome.Auricular flutter and Auricular fibrillations differ from each other only in degree, and from the above two conditions in no essential particular. Sir James Mackenze called it “delirium of the heart,” because every semblance of regularity is lost as the auricle of the heart, which can scarcely be said to beat at all, goes into a wild paroxysm of ineffective twitchings. The auricular rate ranges from 200 to 300 a minute in fibrillation. It should be obvious that this wild fluttering cannot long be continued without ending in exhaustion.
While considered as functional disturbances it is thought that no truly sound heart muscle, even under the influence of any save the most virulent toxins, would go into such a wild paroxysm. These severe arrhythmias are, therefore, regarded as indicative of a badly damaged heart muscle, aggravated by overwork and toxemia.
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HEART BLOCK

Definition: This is partial or complete interruption of muscular connection between the auricle and ventricle so that they beat independently of each other. It is a loss of coordination. Complete block is known as the Stokes-Adams syndrome. Partial block is sometimes caused by the use of digitalis.Symptoms: Vertigo syncope and slight epileptic paroxysms are the usual symptoms. The heart beat appears to be very slow — as low as twenty and as high as forty a minute. Cases have been reported of six beats a minute but these are doubtful. It seems rather, that only six beats were forceful enough to be felt at the wrist.Etiology: Functional disturbances of the heart’s action are usually reflex in character; that is, there is nothing intrinsically wrong with the heart itself, but its action is disturbed by reflex irritations originating in other parts of the body, such as arise out of distention of the stomach and bowels with gas; or out of hyperacidity, stomach irritation, nervous imbalance, shock, fear, excitement, overwork, or out of stimulants and food excess.
Tilden says “A flushing of the skin about the face and neck, coming in patches, indicates sympathetic nervous irritation of the heart. Where this symptom is extreme it is an indication of chronic toxin poisoning from gastro-intestinal indigestion; or it may be due to the use of stimulants — coffee, tea, alcoholics, tobacco, etc.” Tobacco causes arrhythmia which usually disappears when smoking is stopped.Prognosis: This is good in nearly all cases.Care of the Patient: “Regulating the diet and correcting the life of the patient will usually control the worst forms of this derangement,” says Tilden. It hardly seems necessary to add that all stimulant habits must be discontinued, the emotions regulated and toxemia eliminated.
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HEART PAINS

Heart pains are divided into three classes as follow:Simple fatigue pains: These are due to fatigue or exhaustion of the muscle of the heart. Fatigue pain is most commonly felt as a dull ache in the region of the apex of the heart and lower precordia. Less commonly, it may be felt at the base of the heart.Nervous heart pain: This condition is seen in neurotic — nervous and sensitive — individuals and seems to be the result of over-action of the heart. Such individuals are extremely sensitive to organic impressions, just as the subject with nervous dyspepsia is over-sensitive to digestive phenomena. There is the added fact that, such neurotic individuals are inclined to exaggerate the importance of even a slight pain felt anywhere in the region of the heart and this is especially so if they think they have heart trouble.Paroxysmal heart pain: This term is misleading, as such pains are either fatigue or nervous pains or they are true anginal pain. The term is used to designate both angina pectoris and the so-called pseudo-anginas.
It is well to emphasize that most pains in the region of the heart have no relation to the heart at all. Neuralgia, initis, rheumatism, neuritis, etc., in the chest wall, mere congestion in a muscle, gas pressure, and reflex pains from the stomach, intestine, liver, spleen and even from the sex organs, account for most of these so-called heart pains.
Restoration of good health by discontinuing all enervating habits will speedily end the pains. In neurotic individuals this is likely to require considerable time due to the mental condition.
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HEART STRAIN

Definition: This is a term formerly applied to a group of heart symptoms following exertion, to which the term “effort syndrome” is now applied.Symptoms: Breathlessness, palpitation, giddiness, precordial pain, and even fainting; in short, most of the functional symptoms of cardiac embarrassment, are present but there is no actual pathology of, the heart. The symptoms are seen chiefly in young adults as the reaction of the heart to strenuous effort, not, apparently, because of any inherent unsoundness of the heart itself, but because of troubles elsewhere. Even in middle-aged subjects a large proportion of their heart embarrassment is effort syndrome.Etiology: In medical literature we learn that “in spite of all the work done by all investigators, no one has ventured to make a definite accounting of the condition.” In our own practice, we have seen cases that were reflexes of uterine and ovarine pathology. Enervation and toxemia are doubtless the underlying causes in all cases. There can be no doubt that tobacco, tea, and coffee and other drugs help to produce the condition. We are told that “the effort syndrome” undoubtedly has its ultimate explanation in the interdependence between the heart and other organs. The heart itself may be sound, but something is wrong elsewhere in the body, or, perhaps, the mind, when the heart reacts this way to strenuous effort. The ultimate explanation of this functional failure of the heart lies not in the troubles elsewhere in the body, but in the causes of the other troubles.Care of the Patient: Alternate periods of exercise and rest improve the heart so that the condition ultimately ends. From this fact it has been declared that “the effort syndrome is not a sign of heart disease except where the symptoms fail to disappear, but rather became worse, under exercise.” A, small percentage of cases of apparent “heart strain” do grow worse and turn out to be actual cases of heart pathology. For this reason it is not safe to diagnose all cases of breathlessness, palpitation, precordial pain, etc., in young people as “effort syndromes.” Such a diagnosis is justified only after careful examination has eliminated structural or conduction defects.
Rest and exercise are, alone, not enough to remedy the condition. Complete care involves the removal of all the causes of the extra-cardiac troubles. All enervating practices must be discontinued, toxemia must be eliminated and the whole mode of living re-ordered in conformity with the highest interests of life.
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PALPITATION OF THE HEART

Definition: Irregular or forceful heart action perceived by the individual.Symptoms: Palpitation may last a few minutes to several hours, and may recur after exertion or excitement. There may, be only a sensation of fluttering with that of emptiness or distention of the ¾ heart, or there may be flushed skin, violent pulsation of the superficial arteries, rapid pulse, difficult breathing and nervousness. A forcible
apex beat may be noticeable by the patient.Etiology: Palpitation is a neurosis and grows out of over-stimulation of the nervous system from hysteria, violent emotions, the use of tea, coffee, alcohol, or tobacco, and from distention (from gas or overeating) or dilatation of the stomach. It is common in neurasthenia. Indigestion, fright, worry, and overworked emotions are common causes. Sexual excesses are frequent causes. Anemic patients suffer with palpitation. It is sometimes seen in girls coming into puberty and in women going through the change of life; in both these instances it is a nervous phenomenon.Care of the Patient: Correct the cause. Cut out the stimulants, stop the overeating, discontinue the sexual excesses, control the emotions, restore normal digestion, rest the nervous system. Build up the general health.
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WEAK HEART

Definition: Weak heart (myocardial affection) is simple weakness of the heart muscle.Symptoms: The heart is feeble with irregular pulse; there is shortness of breath on exertion, a tendency to cyanosis, and, in extreme cases, edema of the extremities, the dropsy becoming greater as the weakness grows greater.
Examination usually shows an increased area of dullness, a galloping rhythm, or even a tremulousness that almost obliterates, the ordinary heart sounds, and, in some cases, the symptoms will be those of an enfeebled, irregular heart, and signs of dilatation.
Tilden says, “Fatty degeneration, often presents about the same symptoms. The fact of the matter is that there are a great many heart derangements classified which would be very difficult of recognition, and, inasmuch as the heart disease and the variations all come from the same general derangement, the treatment for each and every variation must necessarily be about the same.”Etiology: It is safe, to say that these cases are all due to enervation, toxemia and malnutrition. It is not uncommon to find young subjects with albumen in the urine due to an enervated heart produced by sexual excesses. Heart weakness is also produced by our hurly-burly civilization with its stimulation and its denatured diets. Cowardice, dishonesty and criminality develop as a collateral asset for self-protection. The coward has no show in business life, and this sub-conscious weakness builds a low cunning selfishness. The lack of power causes the use of ponies in class work and the misdirecting of funds in business life.Prognosis: There is cause for alarm when any organ is failing to function properly and an insignificant cause, so designated by the average doctor, may end in death. These cases may all recover, but if their causes are not corrected they may all end in death.Care of the Patient: Same as for heart strain, which see.
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AFFECTIONS OF THE ARTERIES
ANEURYSM

Definition: This is a sac formed by the dilatation of a part of an artery, and is filled with blood. Several kinds of aneurism are described but these descriptions are of no practical importance. The enlargement of the artery may vary from a slight enlargement to one of such proportions that neighboring structures, even the ribs and other bones, may, by continuous pressure, soften and break down. Large aneurisms are not common, but minute ones are exceedingly so. The symptoms of aneurysm depend on its location and the condition is not readily discovered except by physical examination. Minute aneurysms give no symptoms. Larger ones present a tumor plus pulsation.Etiology: Arteriosclerosis is the preliminary state necessary for the development of an aneurysm, unusual exertion or strain may be the exciting cause. Several years of toxemia can cause the arteries to become so hard and brittle that the inner coat of the artery (the intima) may rupture in several places. These ruptures, are small and lead to a bulging and gradual production of a cyst or sac, which would rupture if the body did not protect itself by forming new tissue around the tumor which in this way soon gains a thick wall. Alcoholism, lead-poisoning, excessive muscular work and nephritis are given among the causes. There is no reason why anything and everything that lowers nerve energy and produces toxemia and indigestion will not help to produce it. “Syphilis” is blamed for most cases. No doubt the mercury, arsenic, potassium and iodides used in treatment are the real offenders. Scurvy or malnutrition lays a foundation for aneurysm.
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ANEURYSM OF THE AORTA

The aorta is subject to aneurysm in its entire length, perhaps because it bears the greatest load of pressure. The most common locations will here be noted.Aneurysm of the Thoracic Aorta: This is most commonly located in the arch, but may be located in the ascending portion. Those in the ascending portion are often small when rupture occurs.Symptoms: There are no positive symptoms. Pain is variable, usually paroxysmal, often very severe when the tumor is eroding the vertebrae or perforating the chest wall. On the other hand, the chest wall may give way and no special pain be experienced. The pain comes and goes. It often radiates down the left arm, or up the neck, and without enlargement the condition may easily be mistaken for neuralgia or angina pectoris. If the tumor presses against the bronchial tubes, a very distressing cough is likely to result. If the pressure is on the recurrent pharyngeal nerve the cough may have a peculiar wheezing sound — the so-called “goose cough.” There is difficulty in breathing, in some cases loss of voice, in others wheeziness. Hemorrhage may take place into the bronchial tubes and trachea, producing hemoptysis, or into the pleura, producing hemothorax, or into the pericardium, producing hemopericardium. An X-ray examination is usually required to positively diagnose the condition.Complications: Some of these were mentioned above. Perforation of the chest due to breakdown of bone and other tissue from constant pressure, rupture of the artery externally or into a cavity resulting in bleeding to death, are the most common complications.Prognosis: The condition is incurable and death is painfully imminent at all times. Usually death comes quickly when it does come. Weger says of the cases handled by him: “while complete recovery was not expected, so much improvement was noted when the circulatory impulse was lessened by moderation in eating that most of the discomfort attributed to the dilatation disappeared in all except the very advanced types in which rupture of the aneurysm seemed imminent. Even in the advanced form, great relief is obtained and life is prolonged by a regimen of moderation in eating.” In some cases the blood within the sac clots solidly. In medical circles this is called cure.Aneurysm of the Abdominal Aorta: About ten per cent of aortic aneurysms are abdominal. This is more easily recognized than in the chest, especially in thin subjects, but in those with thick abdominal walls and lots of fat it may be difficult to diagnose.Symptoms: The chief symptom is dull pain in the back which sometimes radiates to the sides. Often there is tumor with visible pulsation in the stomach region. Physical examination reveals a pulsating tumor, usually with a murmur corresponding to the heart beats.Prognosis: The condition is incurable. Death may result from rupture, obliteration of the lumen of the artery by clots, or by embolism of the superior mesenteric artery or by paraplegia (paralysis of legs and lower parts of the body) caused by pressure.
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ANEURYSMS OF THE LIMBS

These are small and show on the limbs as small pulsating tumors. The blood tends to harden in them and eventually they become obliterated through absorption. Or they may thoroughly dry out and the artery heals after which the tumor may be removed without injury to the blood vessels. They tend to develop at points of injury to the artery.
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ARTEROVENOUS ANEURYSM

This is commonly known as varicose aneurysm and occurs where an artery and a vein communicate together, forming a tumor. Varicose aneurysms usually develop from injuries. A few cases have been reported where the ascending portion of the arch of the aorta opened directly into the vena cava. The principal symptoms of this condition are cyanosis, edema, and great distention of the veins of the upper part of the body.Care of the Patient: Aneurysm is not a curable condition. It is best prevented. No one will ever have an aneurysm who has not lived the free and easy life of eating, drinking and being merry, that is all too common. Years of abominable and haphazard living are required to lead to the development of arterial pathology. From fifteen to forty years of chronic toxemia and auto-intoxication always precede the development of an aneurysm. If it were possible to cure the aneurysm, that is, if it could be obliterated in some manner, this would not cure the systemic state back of its development, and sooner or later this constitutional perversion would kill the patient.
All that can rationally be done, once the condition has developed, is to lower blood, pressure and keep it down and avoid the strenuous life that tends to build more pressure. Irritations and stimulations must be avoided. Intense muscular effort must not be indulged. The diet must be corrected and overeating refrained from. Emotional poise is especially important. These things done, years of moderate comfort may be enjoyed.
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APOPLEXY

While this is really the rupture of an artery in the brain, it is commonly classed as a “disease” of the nervous system. See chapter on Affections of the Brain and Nervous System.
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ARTERIOSCLEROSIS

Definition: Commonly known as hardening of the arteries, this is a chronic degenerative process of the coats of the arteries, especially of the inner coat, or intima (endoarteritis) and middle coat, with the production of fibrosis or calcification, or both; and with changes in the caliber and length of the vessels. The normal, elastic muscular tissue which constitutes much of the arterial wall, is more or less replaced by tough, inelastic, fibrous tissue, or by deposits of lime salts, or by both. This gives the artery a hard, cord-like, feeling under the examining finger and a tortuosity to its course.Atheroma is localized hardening of the wall of a blood vessel —a local arteriosclerosis.
Its usual beginning is with abnormal deposits in the internal and middle coats of an artery. At first the coats of the artery become thick. Thickening interferes with nutrition and degeneration occurs. The deposits are soft at first but later become hard. The hardening is often due to an overgrowth of fibrous matter; at other times it results from calcification: lime deposits. The extent of the calcification varies from little to much. Much lime deposit produces a rigid artery. Sometimes we see a vessel that has become one rigid piece of mineral matter. This condition properly belongs to arteriosclerosis.Symptoms: These vary as the hardening varies and as the different arteries undergo hardening. If the sclerosis is general it may be recognized by the rigidity of the arteries where they pass near the surface, by sluggish high-tension pulse, by increasing pallor and a gradual loss of physical and mental vigor. Heart symptoms may be present. Hardening of the mesenteric vessels may lead to digestive disturbances and occasional abdominal pain. Hardening of the arteries of the limbs results in painful muscular cramps, sudden lameness (intermittent claudication), neuritic symptoms — numbness, tingling, darting pains, etc. — and in rare cases by red, painful neuralgia — erythromelagia.
Frequently noted symptoms are an early, unnatural pallor of the face; an unusual intolerance of alcohol and tobacco; numbness and tingling in the extremities; and pain along the course of the arteries. Such digestive disturbances as heartburn, belching of gas, etc., are common. There are many nervous symptoms. High blood pressure is present. This is called hypertension and is due to overstimulation from toxemia, plus stimulation from habits. When this state of enervation is reached, one cigar or one cup of coffee irritates the nervous system more than six cigars or six cups of coffee did ten to twenty years previously and the high blood pressure means weakness, not strength. The organism is laboring to overcome obstruction.Complications: Degenerative changes in the entire organism have preceded or accompanied the hardening of the arteries and it is not always possible to say whether a given development is secondary to or concomitant with the sclerosis.
The unyielding vessels render it more difficult for the heart to send blood through them. Nature, as usual, rises to the occasion and, by strengthening the heart muscle, succeeds in keeping up an efficient blood supply so that for a long time the only symptom may be an increase in blood pressure. For years, the length of time depending on the rapidity of the hardening process and the ability of the system to adjust itself to the changing conditions, the subject may posses what passes for “good health.”
As time passes and the arteries grow harder, the lumen narrower and the heart increases in size and blood pressure rises, sooner or later, something must happen. Some weakened part of the arterial wall will give way, resulting in hemorrhage into some important organ — probably the brain: apoplexy. This may mean anything from a slight “stroke,” to paralysis of one whole side of the body, to sudden death. Or, the heart may be unable to meet the increasing resistance, and break down, causing serious symptoms, even death.
All the symptoms resulting from arteriosclerosis are due to a disturbance of the blood-supply to the various parts of the body, and are naturally very variable. All the arteries are affected in varying degrees. And in proportion to the degree of hardening of the arteries in the various organs of the body is the efficiency of these organs impaired. The brain, liver, spleen, pancreas, lungs, the heart muscle itself and the digestive system fail to function to the standard of full efficiency. Malnutrition of the endocrine glands results and these important organs gradually fail in their work. Because of the gradually lessening blood supply to all the tissues of the body the entire body fails and more or less premature dissolution results. Truly, “a man is as old as his arteries.”
In hardening of the arteries in the brain the most characteristic symptom, is a gradually progressive mental deterioration, associated with more or less defective memory. The subject’s “whole nature may undergo change: thus a quiet-mannered man may become irritable, suspicious, and, in fact, the very opposite of his usual self.
When the arteries that supply the heart become sclerosed, sudden death may result, from thrombosis, angina pectoris, or rupture of the degenerate heart muscle. If the renal vessels harden, interstitial nephritis may develop.Etiology: Hardened arteries do not come over-night, but there is no method of examination, with or without mechanical aids, that is able to determine when sclerosis begins. It can be detected only after the hardening has reached a certain stage. It is quite easy to say where and how it will end.
Irritation is the first step in the development of arteriosclerosis, no matter how late the stage when calcerous deposits are pronounced enough to be readily detected by feeling of the arteries. The foundation is laid in youth and is added to every day by the modern manner of living. From the beginning of an established toxemia evidenced by the first cold, to the fully-developed arteriosclerosis thirty to eighty years later, there have been many crises of toxemia, digestive derangements, discomforts, etc., with occasional respites of shorter or longer duration, in spite of excess in eating and venery, or overstimulation from rich foods, alcohol, tea, coffee, tobacco, during which people are often heard to say: “I have not been sick in ten, twenty, thirty, or more years.” They so easily forget the colds, headaches, discomforts, foul-breaths, coated tongues, bad taste in the mouth, despondencies, the tired, lazy feeling in the morning, and other discomforts which indicate, unmistakably, that toxemia is a constant — that they have not been really well in all these years.
All the years they are “healthy,” toxemia has been producing endoarteritis and endocarditis. Hyperemia and hypertension are followed by hard arteries. As time passes the arteries become harder, their lumen narrower and their walls weaker. In gouty subjects —those who tend to develop gall-stones, kidney-stones, etc. there will be deposits of lime in the arteries and even in the heart. Deposits on the valves of the heart may prevent the proper opening and closing of these.
Like all other conditions of impaired health, arteriosclerosis is caused by anything that establishes and maintains toxemia. The hardening (fibrosis) of the arteries is really an effort of nature to repair the damages caused to the arterial coats by the toxins, and to prevent rupture. The patch is inferior to the original tissue and sooner or later may give way under unusual strain.
In short, overwork of body and brain, long continued worry, overeating, wrong eating, alcohol, tobacco, tea, coffee, various excesses, the stress and strain of modern, life, all bad mental and physical habits certain occupations, such as those of lead-workers, painters, typesetters, etc., and all the many causes of enervation contribute their share to the production of hard arteries. Experimentally it has been demonstrated that nicotine injected directly into the circulation will produce arteriosclerosis. We like to kid ourselves with the belief that hard arteries are due to “old age,” whereas, in reality they are due to irritation. How fast the arteries harden will depend upon the quality of the arterial tissues and the wear and tear to which they are subjected, so that a man of thirty. may have the arteries of a man of sixty or vice versa. Hard arteries mean old age at twenty-five or ninety.Prognosis: The common view is that those who have developed hard arteries are doomed — that they never “come back.” It is indeed a Herculean task to remedy heart and arterial lesions once they have progressed to the point of actual degeneration or thickening that destroys their function by fifty per cent. And, so long as cause is unknown or unrecognized, not only will cure be impossible, but the hardening process will be allowed to progress. The early stages of such conditions, when pathology is in the making, are remediable.Care of the Patient: Knowing the cause of any condition is equivalent to knowing the cure: namely — remove the cause. If a certain mode of living results in arteriosclerosis, the least discerning should be able to recognize that the only treatment needed is to proscribe that mode of living. Whatever produced and maintains the inflammation in the heart and arteries must be discontinued. Overeating, protein and carbohydrate excess, alcohol, coffee, tea, tobacco and all excess must be given up. All enervating habits must be ended and nerve energy restored by rest. Toxin elimination is essential and nothing permits this to take place like fasting.
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EMBOLISM

Definition: This is obstruction of a blood vessel by an embolus. An embolus is a clot or plug which obstructs the blood vessel. It may be blood, fat, air or other body.Symptoms: These depend on whether or not the embolus lodges in the lungs, liver, kidneys, heart, brain, or elsewhere.Care of the Patient: The care is entirely constitutional in nature. Whether apoplexy, heart trouble, lung trouble or else has resulted, removing the toxic load from the body and improving the general health is the only “treatment worth while.”
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HIGH BLOOD PRESSURE

Definition: This is an abnormal or pathological increase in blood pressure. To understand what high blood pressure is, It is first necessary to know what normal blood pressure is.
A baby has blood pressure. As the baby, child, youth, grows, blood pressure increases, due to the increase in the size of the body and the greater increase in the size of the heart relative to the increase in the size of the arteries. This increase normally continues from infancy to complete physical maturity, increasing rapidly after puberty. As the arteries continue to grow after the heart has attained full growth there should be a slight lowering after the maximum normal peak is reached.
Blood pressure should be highest when a man is in his physical prime — from twenty-five to fifty. After fifty, due to lessened physical activities, blood pressure should normally decline. From twenty-five to fifty it should be practically stationary, except of course that there are normal or physiological fluctuations due to excitement, physical, effort, etc. Normal blood pressure for the adult, at least until after fifty, should be that of a healthy, unstimulated individual at complete physical maturity. The old medical standard of 100 plus your age is much too high. The blood pressure of an adult male should average between 115 and 130; that of the adult female between 110 and 120, being higher in larger and lower in smaller individuals.Symptoms: High blood pressure is divided into a few varieties according to cause, as follow:Accidental hypertension: This is seen in aortic Insufficiency, heart block and, occasionally, in hyperthyroidism.Nephritic hypertension: This is connected with pathology of the kidneys and is thought to be secondary to this. It begins most often about the thirtieth year and is most common in males.Arteriosclerotic hypertension: This is due to hardening of the arteries. Headaches and disturbances of vision occur. The condition may terminate in cardiac decompensation, coronary occlusion, or apoplexy.Essential hypertension: This is the most common of the four. It is also the most obscure and most important. It develops in both sexes at about middle age and is not connected with any pathology of the heart or kidneys, while the arteries may remain soft and resilient. As the above forms are dealt with under their associated conditions we are here concerned primarily with essential hypertension. Its symptoms are shortness of breath, pain in the heart, dizziness, headaches, and, of course, the high blood pressure.Complications: If persistent, high blood pressure becomes a cause as well as an effect. Sooner or later resistance is overcome in the kidneys lungs, brain, in the heart itself, or in the coronary arteries that feed it. This means the ultimate development of Bright’s “disease,” apoplexy, coronary occlusion, or heart block, angina pectoris, etc. When a precarious condition develops and the heart and circulation begin to waver, very slight causes may produce a crisis, evidenced by neuralgic pains, distress under the sternum, diminished endurance, shortness of breath, puffiness of the skin, edema of the extremities, etc.
As we have repeatedly pointed out, the heart, like most modern machinery, is designed to carry an overload, a thing it does very effectively thousands of times throughout life in meeting the shocks and stresses of violent physical and emotional strain. A leaky valve or dilatation may be compensated, thanks to, the heart’s reserve of power, and carried, as a tolerated pathology, for many years, provided its owner will slow down so that the crippled heart may keep pace with him. But, if day and night for months or years, the heart must overcome the increasing resistance of arterial hypertension, it tires and weakens.
Weger says: “The closing chapter of advanced circulatory disease in middle life is written with the purple ink of cyanosis and faint echoes come to us of incoherent muttering from lips rehearsing the account of an unwise stewardship which Providence has seen fit to terminate at fifty.”Etiology: it must be emphasized that high blood pressure is merely a symptom. It is one of many endings of a series of crises in toxemia, the first of which, was a so-called cold — a catarrhal fever. The cold, according to Hygienic philosophy, is the earliest symptom of an initial pathology, which, if its cause is not removed, leads on and on through many crises, to an ending that may be high blood pressure or any, one of the many chronic so-called organic “diseases” — diabetes, Bright’s “disease,” tuberculosis, “diseases” of the heart and arteries, paralysis, insanity, cancer, etc. . .
Until the many so-called organic “diseases,” from which people die, are recognized as end-points in a progressive pathological evolution, starting in early life and punctuated by frequent crises (acute “diseases”) along the way, sanity in the care of the sick can never exist. When these so-called “diseases” are recognized as merely different end-points in one and the same pathological evolution, and not separate and. specific “diseases,” when the principle of evolution is admitted into the realm, of pathology, doctors of all schools will recognize the folly of, directing their prophylactic and therapeutic treatments at the end-points of the pathological process and will remove the cause of the pathological evolution long before the end-point has been reached. Hard arteries produce high blood pressure. What do hard arteries mean to the average physician? Nothing,” beyond the mere recognition of their presence. What leads up to the hardening, when it has its actual beginning and how it may be overcome — these form a closed book to him.
We need give but little attention here to any form of high blood pressure save that of essential hypertension since the other forms are complications of their related pathologies. High blood pressure before middle life is due in most instances to arterial hypertension, which is equivalent to saying that it is a reflex condition resulting from over stimulation of the nerve centers that cause the arteries to contract. Calcareous deposits come later.
Nerve-irritation always precedes essential hypertension. Such irritation causes the blood vessels to contract and the small capillary vessels are almost shut off from any circulation of blood. Irritation causes the arteries to feel hard, at times almost like whip cord, and no doubt, if it were possible to feel or see the hair-like capillary vessels, we would find them hard and stiff.
Almost any chronic or frequently repeated irritation of the sympathetic nervous system will sooner or later result in high. blood pressure. A mere transitory hypertension may be due to a brain storm (excessive emotion of any kind) or irritation of the suprarenal glands. However, high blood pressure is usually more or less permanent and progressive in character.
The irritation is of toxic, emotional and reflex origins. Most people with essential hypertension are over weight and give a history of stress and strain — prolonged worries, overwork, ungratified and over-weening ambition, frequent eating, overeating, insufficient sleep, the use of stimulants — throughout their lives. Hypertension is one symptom that can be directly attributed to high pressure living and all that this term implies. “The people troubled with high blood pressure” says Tilden; “are those who are going at top-speed to a premature end, enjoying as much as they can, the pleasures of life — the luxuries of high life such as money buys, amid the luxuries of low life common to all. The poor have luxuries that belong to sensualism and there is nothing that can be accomplished so easily as partaking of the tree of knowledge prematurely. Sex-lust stands at the head, but there is also a lustful spirit — an indomitable lust for any or all the things that people desire.”
Those emotional and excitable people who lack poise and whose “blood” ran riot in the heyday of life, and those of a grumbling, grouching, fault-finding disposition, stress their heart and arteries, and thus build hardening of the tissue and obstruction to the circulation — high blood-pressure.
Toxic irritation grows largely, if not wholly out of excesses, poison habits and enervating practices.
Warm feet are essential to the highest efficiency of digestion and assimilation of food. This is literally true and forcibly illustrates the correctness of the Hygienic contention that for the recovery of health all enervating influences must be removed. If so apparently trivial a discomfort as cold feet inhibits digestion and assimilation, by producing enervation, it should not require unusual intelligence to be able to understand that other factors of a more serious import daily influence digestion and nutrition to an even greater degree.
Not merely are the nutritive processes influenced, but the excretory functions are equally inhibited. The unusable and uneliminated waste in the body, left there by impaired elimination, must accumulate somewhere in the circulating fluids and the tissues. In enervated people the accumulation is daily increased.
Perhaps the greatest single cause of high blood pressure is toxemia resulting from checked elimination. Secondary toxemia, such as that seen in nephritis and intestinal autointoxication arising out of gastro-intestinal fermentation and putrefaction, all produce enough nerve irritation to cause high blood pressure.
Any form of excess — overeating, overwork, excessive venery, over-enjoying, and overindulgence in anything — taxes the nervous system and brings on enervation, which checks secretion and excretion. Checked secretion produces indigestion with its consequent intestinal autointoxication; checked excretion produces toxemia. Learning one’s limitations in expending nerve energy and then respecting these limitations will prevent enervation, guarantee good digestion and efficient elimination, and thus insure health and long life.
High blood pressure may be a symptom of the influence of tobacco on the organism. It may be a symptom of the influence of alcohol, or tea or coffee, or of other poison habits. No one who is addicted to any of civilizations many poison vices is safe from high blood pressure. Salt, pepper and other spices and condiments produce enough nervous irritation to bring on high blood pressure.
Plethory, an abnormal fullness of the blood vessels, is a general hyperemia. It means that there is an excess of blood. This is not an ideal state. Excess tension in the circulatory system due to plethory, increases toxin poisoning.
Plethory is due to excess in eating and drinking. It is an over saturation of the body with food and fluid. Excessive drinking of non-stimulating beverages, even water and fruit juices, may in time produce high blood pressure. Excess fluid is one of the causes of obesity, and obesity always raises blood pressure.
High blood pressure may mean an excessive amount of blood and lymph (plethory), or it may also mean the opposite. For, high blood pressure may sometimes be seen in anemia.
Tilden says: “We have no trouble finding men too stout, whose double chins, thick necks and folds of fat on the back of the neck and head, heavy jaws, red face shading off to purple, heavy abdomen, and the breathing oppressed after a short walk or climbing a few steps. These are suffering with arterial tension, hyperemia, and perhaps high blood pressure, and will die in a few days, weeks, or months, and the best of them in a few years, from apoplexy, heart disease, or kidney derangement.”
High blood pressure may result from losing one’s temper every day. Suppressing anger or hate may build high blood pressure. Men and women may have high blood pressure, not from carrying an excessive amount of blood, but from too much anxiety, excessive introspection, worry, anguish, trouble, etc. The banker or other business man who is expecting to have his business closed on him at any time is very likely to have high blood pressure. The gambler who is in a constant state of tension, the thief who is afraid of being caught, the liar who is never in a state of poise, the gossip who is always under apprehension — these people are likely to develop high blood pressure.
Besides the immediate nervous tension produced by trouble, threatened loss, lying, gambling, stealing, and all forms of dishonor and dishonesty, these things all produce enervation, and enervation always produces toxemia.
Reflex irritation of the sympathetic, system, such as that produced by pressure by. an enlarged prostate may result in increased blood pressure.Prognosis: In all forms of hypertension the pressure may be brought down to safe limits and held there. Essential hypertension is remediable in all cases.Prevention: To prevent essential hypertension we must establish a different standard of living and different ideals.. There must be more striving for contentment and less struggle for riches and more cultivation of the spirit of leisure. Sport must be recreation pure and simple and not a passion conditioned on a desire to, win.. A placcid regime of living, such as our capitalistic and competitive, society cannot give, will lessen all cardiovascular and renal pathologies.Care of the Patient: Remove the causes, of which there are many, to remedy high blood pressure. Nature will take care, of the nerve reflexes if we remove the causes of the trouble. Functional and reflex irritations will all disappear when cause is removed. Without a knowledge of cause doctors merely attempt to force blood pressure down in spite of cause.
If removal of the prostate gland is followed by a lowering of blood pressure, does this justify the doctor or surgeon in declaring that enlargement of the gland causes high blood pressure and that all cases should be operated upon? Of course not. A true cure will remove, not the enlarged prostate, but the cause of the enlargement. If the gland is removed and the cause ignored, this cause will evolve another source of nervous irritation and the patient will have to be “cured” all over again.
We consider the elimination of toxins to be of first importance in this condition. Our care, being directed toward the removal of the toxic state, includes first and foremost, complete rest — physical, mental, sensory, and physiological rest. An absolute fast is essential if immediate effects, are desired. Weger says of fasting: “Most cases show immediate and marked improvement, and the results thus obtained justify the procedure and confirm the opinion that toxemia is the outstanding cause. When after a fast of ten to fourteen days very high pressure comes down to 140-90 and remains within such limits of safety under proper restraint and carefully selected diet, it seems justifiable to hold out hope to practically all who are not actually on the border line of dissolution.”
Few things can be so easily, quickly and permanently remedied as essential hyper-tension. A world of irritation is removed when the subject goes to bed, refrains from eating, and certainly from worrying, and discontinues his or her poison habits.
Will the condition return as soon as the patient returns to his former habits? Of course it will, just as surely as drunkenness will return to the sobered man who goes back to drinking.. The style of living that caused the high blood pressure the first time will produce it all over again.
Rest and fasting do not cure high blood pressure. They remove a load of toxins and irritations and blood pressure falls rapidly. But the real cure is to teach these subjects poise of mind and body; to train them in healthful physical, dietetic, emotional and sexual habits. The real cure is a healthful mode of living. For, to go to bed and fast and reduce, blood pressure, and then return to the former mode of living — the former excesses and indulgencies, to the poison vices and emotional habits, to the prior sexual excesses, and to dishonesty, gambling, etc. — is to rapidly rebuild the pathological state that produced the high blood pressure.
To see blood pressure fall consequent upon a reduction of weight and then to regain the weight is to see it rise again. If there is excess fluid intake the obesity cannot be cured until the over consumption of fluid is discontinued. It is always necessary to remove cause.
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LOW BLOOD PRESSURE

Definition: Any marked fall of blood pressure below the normal standard. It is not a “disease,” but a symptom: it is merely an indication of lowered tonicity of the whole body with an, undue weakness and relaxation of the tissues.. It is doubtful if an adult should ever consider his or her blood pressure to be low if it is above 100.Symptoms: Low blood pressure is a symptom of relatively minor importance and is significant only in connection with other demonstrable deficiencies and pathologies, which are major issues by comparison. In most cases the indications of low blood pressure are simply those of a chronic condition of subnormal health. There is likely to be weakness and a lack of energy, with a feeble, perhaps, rapid, pulse.Etiology: Paradoxical as it may seem at first glance, the same mode of living that causes high blood pressure may also be responsible for low blood pressure. We say that low blood pressure is due to the same fundamental cause as high blood pressure. High blood pressure is due to overstimulation of the vaso-constriction centers: the brain centers that control contraction of the arteries. Low blood pressure is due to toxic overstimulation of the vaso-dilation centers: the nerve anti brain centers that control dilatation of the arteries. Chronic autointoxication, resting on a basis of wrong habits, forms the basis of both high and low blood pressure.
Anything that lowers the tone of the body tends to reduce the blood pressure in the beginning. Autointoxication, for instance, may first lower and, later, raise blood pressure. In youth and early adulthood depressing emotions tend to lower pressure. In both early and extreme dementia blood pressure is subnormal.
Low blood pressure is seen in early life in cases of tuberculosis. In later life, low blood pressure is often very pronounced in cancer cases. Heart weakness may also mean low blood pressure. It should be understood that blood pressure, whether high or low, is by, no means the result of uncomplicated heart lesions alone, but that the entire circulatory system — heart, arteries, veins, capillaries, and lymph. channels — is involved.Care of the Patient: The same correction of cause that reduced tension in cases of high blood pressure will increase pressure in cases low blood pressure. Normal blood pressure depends upon normal living. Blood pressure improves as health improves and as the tone of the general system approaches normal. If there is either tuberculosis, cancer, or heart lesions, care for these as directed under their respective heads.
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THROMBOSIS

Definition: This is the formation of a thrombus, or blood clot. See Embolism.
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THROMBO-ANGIITIS OBLITERANS

Definition: This is a form of gangrene attributed to thrombo-angiitis. Thrombo-angiitis is inflammation of the inner coat (intima) of a blood vessel with the formation of blood clots.Symptoms: The first symptom is usually intermittent claudication (lameness). The pain on exercise may be mild, but is usually severe. The calf of the leg is the most common location of pain. It comes on after a certain amount of work and disappears after rest. The amount of effort before pain appears is only about one-sixth that of the so-called normal person: Coincident with or closely following the intermittent lameness, are changes in the temperature and skin of the affected extremities. When the legs are low (dependent) they become reddish and cyanotic. Elevation above the heart results in pallor. The skin temperature is low.
Occasionally the first symptom is sudden occlusion of a peripheral artery. This presents severe pain in the foot and hand, marked coldness, and extreme pallor. This may go on to gangrene, or the pain may cease, to be followed by redness and intermittent lameness.
Superficial phlebitis, often limited to, the valve areas of the veins (the so-called cutaneous nodosites of Buerger), often appear before the other symptoms. The superficial veins below the knee are the ones usually involved. These may remain inflamed and painful for a week to a month. The acute process then subsides, leaving a hard, cord-like thrombosed vein. As the pathology progresses other evidences of disturbed peripheral circulation become apparent, such as edema, trophic changes in the nails, skin ulcers, and eventually gangrene.
Finally, gangrene develops in the extremities. When limbs are amputated because of this affection, most of the larger arteries and veins of the amputated limbs are found to be obliterated over a large extent of their course, all stages of the occlusive change often being represented in the same vessel in different parts of its course.Incidences: Interesting developments which reveal the resources of the living organism with which to meet unusual emergencies and circumstances, are seen in this condition. Occlusion of the main arteries of an extremity cuts off the blood supply to these parts and unless a collateral circulation is established in the affected limbs to carry blood around the obstruction, death of the part will speedily occur. In the main, the collateral vessels are arteries which are normally present, but which enlarge in response to the demand for increased function. Five methods of establishing collateral circulation are noted, as follow:1. Anastamosis, in which a large branch arises from an obstructed artery above the point of obstruction, branches out at right angles, turns downward, and then turns at right angles again to join he parent vessel below the obstruction, to carry the blood around the obstruction.2. Lateral branching, in which an artery located near the obstructed vessel sends out small branches in a lateral direction to supply blood to the affected area.3. Prolongation, in which an artery extends beyond its normal limits.4. Terminal branching, in which many branches arise from above the occlusion and extend for a considerable distance below it.5. Network formation, in which a complicated network of arteries form at the location of extensive obstruction.. (This last seems be a combination of the above types of establishing collateral circulation.)Etiology: Originally discovered among the Jews of Russia, Poland and Gallica, and for a long time thought to be confined to these, it is now known to develop in all races, although there is still a preponderance of Jewish patients. It develops most often between the ages of 30 and 50 and is seen much more often in men than in women. Indeed so few cases have been seen in women that the theory has been advanced that certain ovarian hormones inhibit its development in females.
Tobacco appears to be the most common cause. It is said to be “not directly etiologic,” though the condition occurs only in smokers, a fact which may account for its past rarity in women. Smoking and inhaling cause a marked constriction of the peripheral blood vessels which may last for an hour; If the smoke is not inhaled the constriction lasts only fifteen minutes Less constriction is produced by the “denicotinized” cigarettes. In both men and women smoking two cigarettes results in a drop in the skin temperature of fingers and toes and rise in blood pressure and pulse rate. The drop in temperature is greater among Jewish males than among non-Jews.
The irritation of the circulatory system by tobacco is enough result in a lowering of the resistance of its tissues to toxins and septic matters from the intestines, abscesses, etc. Doubtless the malnutrition suffered by the Russian, Polish and Gallican Jews accounts for their lesser resistance. We see no reason to believe this condition is not another terminal stage of toxemia, complicated by infection and nicotinism.Prognosis: Removal of: the gangrenous limb was the former treatment. It was often followed by gangrene higher up. Death was the final result. The outlook is now much better.Care of the Patient: Medical authorities say: “The first indication in the treatment is the absolute interdiction of smoking. So definite are the contraindications to smoking in thrombo-angiitis obliterans, and so unanimous are the opinions of experts in the field, that this rule should not be modified.” It is believed by some of them that “the disease is not progressive if tobacco is stopped.” So far, so good, but why wait until this condition has developed before ceasing the use of tobacco? The rest of their treatment is “plenty of good nourishing food,” drugs, gland and tissue extracts, and amputation.
Our plan would be not merely to eliminate tobacco poisoning, but alcohol, tea, coffee, etc., poisoning, intestinal infection and toxemia. We would forbid the use of nitrites and other drugs to dilate the vessels as being equally irritating. We would also avoid the alternate hot and cold baths, passive hyperemia, intermittent arterial compression and other forms of monkey-work advocated and employed. A fast, instead of a “phospholipin-free diet, high in carbohydrates and protein,” would produce infinitely better results. Rest in bed is essential. Care must be sufficiently prolonged to allow collateral circulation to be established.
Gangrene of the toes is the most frequent, development and most difficult to prevent. The feet should be kept warm, clean and dry, the shoes should fit well and injury to the foot, such as removal of corns, callouses, ingrowing toe nails, incisions, burns, chemical irritations, etc., should be avoided.
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AFFECTIONS OF THE VEINS
PHLEBITIS

Definition: Inflammation of a vein. So-called milk-leg is phlebitis of the great veins of the legs.Symptoms: The vein is inflamed, swollen, hard and painful and much throbbing is experienced. It may be either acute or chronic.Complications: The circulatory disturbance may lead to coagulation of the blood followed by rupture. An embolus may form and be carried into the general circulation to lodge in some vital organ and cause serious trouble. Pus in the surrounding area of inflammation may infect the stagnant blood and the pus may be carried to other parts of the body.Etiology: Phlebitis may result from the extension of inflammation from adjacent structures to the vein, it may result from obstruction of the vein by an embolus; but in most cases it is due to septic infection. Sepsis may be absorbed from the digestive tract or from an abscess somewhere in the body. It is a frequent development in suppressed pneumonia, typhoid, etc.Prognosis: This is good in the great majority of cases. In old and very debilitated subjects recovery is slow or does not take place.Care of the Patient: Rest of the part is very essential, as is rest of the whole body. Physiological rest will relieve the body of its toxic and septic burden and permit healing. Sun baths after the acute stage is passed are very important. The diet after the fast should be fruits and green vegetables.
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VARICOSE VEINS

Definition: A greatly enlarged and contorted vein. The vein is dilated and overfilled with blood. The term is usually applied to a distended condition of the veins of one or both legs. Varicocele and hemorrhoids belong to this symptom-complex.Symptoms: The first sign of varicose veins is when they stand out in thick, blue, tortuous strands. These may expand until pouch-like oases form within which the blood may coagulate in hard, knotty lumps. There is no pain in the earlier stages, but they may become very painful when advanced.Complications: A blood clot may find its way into the general circulation and reach the heart, brain, lungs, or other vital spot and cause trouble. As the area of dilatation increases, skin eruptions followed by ulcers (varicose ulcer, or ulcer of the leg), may form. Extravasation of the blood may produce a dropsical condition. The usual consequence is rupture of the distended vein followed by extensive and debilitating hemorrhage which, unless stopped, quickly proves fatal.Etiology: A general lowering of tone throughout the body, together with interference with circulation from visceroptosis, pressure upon the veins by a tumor, or, in pregnancy, by the uterus is back of varicose veins. Pregnant women who over eat are especially prone to develop varicose veins. Occupations that require long hours of sitting or standing, so that the muscles of the legs are not used, predispose to the development of varicosities. An enervating mode of life is the primary cause in all cases.Prognosis: In the early stages and in young people this is very good. In advanced stages, or in old people, improvement is possible.Care of the Patient: All enervating practices must be discontinued and a general program of health building adopted. For corrective care in these cases, see Vol. IV of this series.
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HEMORRHOIDS (Piles)

Definition: This is defined as a vascular tumor of the rectal mucous membrane. It is varicose veins of the rectum.Symptoms: Piles are generally of slow development and may be present for some time before they make themselves felt. Pain at stool, slight bleeding when the pile is internal, and feeling of soreness or irritation after evacuations attend their development. Frequently there is intense itching. As the condition of the rectum grows worse the piles increase in number, inflammation of the rectum (proctitis) grows worse, the pain becomes intense and bleeding becomes more profuse. The swellings, which at first are the size of a pea, grow to the size of a plum. They tend to be forced out of the rectum with each bowel movement and bleeding may become continuous.Etiology: Hemorrhoids are not merely “diseases” as is commonly believed. They are local manifestations of a constitutional state based on enervation and toxemia. Chronic constipation with its consequent straining at stool is only a predisposing factor and not the primary cause. They are frequent developments in pregnancy, but it is safe to say that no healthy pregnant woman ever develops them.Prognosis: In young subjects and in not very advanced cases recovery is easily achieved. In old subjects and in very severe cases complete recovery is rarely attained.Care of the Patient: Dr Richard C. Cabot says of operation for hemorrhoids, that “it is not always satisfactory,” for, “if the cause that produces the hemorrhoids in the first place persists the hemorrhoids will come back again no matter how thoroughly they are operated on the first time.” This same is true of the at present popular coagulation treatment. No plan of care that ignores cause can ever be successful.
All causes of enervation and toxemia must be removed., Toxemia must be eliminated. Nerve energy must be restored, through rest. Constipation must be remedied. The tone of the whole body must be improved. The exercises given for this condition in Vol. IV of this series will be very helpful.
When hemorrhoids protrude they must be replaced. If allowed to remain outside the rectum they become irritated and painful and may suppurate. They may and must be kept inside the bowel.
We recommend the use of an occasional enema while fasting if hemorrhoids are present. This will avoid straining and aggravation of the condition when the bowels start moving after the fast is broken.
VARICOCELEDefinition: This is enlargement of the scrotal and spermatic veins — varicose veins of these parts.
Their causes, symptoms and care are the same as those given for varicose veins.
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VARICOSE ULCER

Definition: This is an open and running sore resulting from varicose veins. It results from the disturbance of the venous circulation and the preceding toxemia and quickly heals when toxemia is removed. Permanent relief from varicose ulcers depends upon remedying the condition of the veins.
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AFFECTIONS OF THE LYMPHATIC SYSTEM
LYMPHADENITIS

Definition: This is inflammation of a lymphatic gland. Retro-pharyngeal abscess, tonsilitis, appendicitis, and inflammation of the glands of the neck and groins (bubo) are familiar examples.Symptoms: Symptoms often begin with a chill or rigor, followed by vomiting, diarrhea and high fever. Locally there is heat, redness of skin, pain, enlargement of the gland and, if the process runs on suppuration, the symptoms of ordinary abscess develop.Etiology: Infection, most often of gastro-intestinal origin, but en from external sources and from abscesses, is the cause.Care of the Patient: Local care is of no value. In rare cases it nay be necessary to drain the abscess. The usual procedures for detoxicating the body — rest and fasting — are all-sufficient.
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LYMPHANGITIS

Definition: This is inflammation of a lymphatic vessel and is generally associated with inflammation of the glands.Symptoms: Tenderness, swelling and pain along the course of the lymph vessel are the usual symptoms.Etiology: Infection from wounds or bruises, or from bites aid stings, is the most common cause. Intestinal infections and infection from an abscess may also cause the condition.Care of the Patient: When it results from a wound this should be thoroughly cleansed — drained. Any abscess should be drained whenever possible. Intestinal decomposition must be stopped. Rest and fasting will complete the care.
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SCROFULA

Definition: This is a tubercular condition of the lymphatic glands and bones. See tuberculosis.