1,500 Hearts

Fifteen hundred pickled, waxed and diaphanous hearts, several hundred pickled, waxed and diaphanous pieces of blood vessels, and several dozens of intricate machines for examining the health of living hearts and blood vessels were on exhibit at the New York Academy of Medicine last week. Twenty-two authorities and 150 clinicians were present to lecture on curious aspects of heart disease. President John Augustus Hartwell of the Academy, a great surgeon, introduced them. Dr. Emanuel Libman, a great internist whom they will honor with a "homage book" next year, gave them his encouragement. In that way the Academy began a fortnight's thoroughgoing post-graduate course on the U. S.'s worst affliction.

Worst Ailment, worse than pneumonia or cancer, in that it handicaps or kills more people yearly, is the group of ailments called heart disease. William Harvey (1578-1657), whose memory the post graduate students honored last week by viewing a cinema version of monumental discovery, first demonstrated the circulation of the blood.* The heart pumps blood into the arteries normally 72 times a minute. The blood pulsates through the arteries to tiny arterioles, whence it seeps into capillaries. From the capillaries the blood seeps into minute venules, then flows through the veins back to the heart. On the way the blood delivers oxygen to the body cells and picks up carbon dioxide and other waste products. The polluted venous blood which the heart receives it drives into the lungs. The lungs remove carbon dioxide from the blood, add fresh oxygen. Then the blood goes back to the heart for further circulation. Valves in the heart and veins prevent the blood stream backing up.

At every point in the circuit trouble may develop. A person may be born with one or another of the troubles. For example the American Journal of Obstetrics & Gynecology last week reported a baby born with one of its four heart chambers missing. The infant could not aerate its blood properly, turned blue and died of asphyxiation three days after birth.

Germs may get to the heart by way of the blood, affect the valves and keep them from closing tightly. Then there is a "leaky" heart. The walls of veins may become weak; then varicose veins. The arteries may become stiff and unyielding to the pulsating blood; this hardening of the arteries. A clot of blood may be caught (thrombosed) in a narrowed artery causing a damming of the blood flow and a bursting of the vessel.

Sugar-coated Hearts. The heart itself is contained in a double sack, or pericardium. The inner sack fits snugly against the heart. The outer sack is just big enough to let the heart expand comfortably. Often enough to concern doctors the sacks become inflamed, from pneumonia, rheumatic fever and other infectious diseases. The sacks may stick together. Or the outer sack may adhere to the inside of the chest wall or to the upper side of the diaphragm. Or fibrous bands may develop and constrict the heart. During early pericardiac inflammation, Dr. Lewis Atterbury Conner of Cornell University pumps a little nitrogen-rich air between the two sacks. The gas holds the tissues apart until the inflammation goes away. Inflammation causes an exudation from the sacks. Doctors have merry names to describe the appearances of the exuding membranes--bread & butter pericardium, when the facing surfaces of the two sacks look like the slices of a bread & butter sandwich pulled apart; shaggy pericardium, when the surfaces are rougher than in the bread & butter state; icing, frosting, sugar-coated heart, when the sacks acquire a glassy surface. Dr. Claude Schaeffer Beck of Western Reserve University has devised delicate operating room technique which allows him to lay open the pericardium, remove any constricting tissues which may be there.

Blood Vessels. Two very similar diseases of the leg arteries got much consideration last week--intermittent claudication (limping) and thromboangiitis obliterans (Buerger's Disease). In both exercise causes intense agony. The arteries in claudication shrivel, prevent circulation. In the other case the walls of the arteries are inflamed and swollen until blood cannot get through.

Dr. Alfred Washington Adson of the Mayo Clinic reported the cure of many cases of Buerger's Disease by stripping from the affected arteries all the nerves which transmit irritating stimuli.

Sir Thomas Lewis, editor of the English journal Heart, gave a new explanation of the pain of intermittent limping. During muscular activity, he explained, certain products called metabolites are given off. At the same time extra blood is forced through the debilitated vessels of the limbs. The extra blood washes away the metabolites during the exercise. But when movement ceases and circulation returns to its defective condition, there is not enough blood to flush out the metabolites which the muscles continue to form for a while. The accumulated metabolites cause the lameness and agony. This is the probable explanation. Until more research makes the explanation certain, Sir Thomas is calling his pain causer Factor P.

In treating varicose veins, Professor John Homans of Harvard protested against the common use of ice bags. The cold interferes with the already damaged circulation. Better to use warm applications and rest, help the injured veins help themselves.

*Harvey made his discovery, the first in modern physiology, by vivisection which "has always been my delight." He was a hardbitten, "small and choleric" man, physician to both Kings James I and Charles I of England. Of Francis Lord Bacon, philosopher and statesman, who was his patient, he once sneered: "He writes philosophy like a lord chancellor. I have cured him."

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