INFLUENZA AND THE HEART

Evening Star, Issue 17087, 4 July 1919, Page 2

INFLUENZA AND THE HEART

SYMPTOMS EXPLAINED. LESSONS OF ARMY WORK. [From 'The Times's' Medical Correspondent.] A large number of people who suffered from influenza during the winter are now going about the world under the impression that they are suffering from heart disease. Tin's impression is founded oil certain sytnp- : tears of which they complain, usually when ! making any exertion—breathlessness, slight pain over the region where Hie hoart is situated, a. "fluttering feeling," often described as palpitation, and a tendency to giddiness. These symptoms 'commonly get worse when the barometer falls and are less troublesome when the weather is good. Moreover, the symptoms aro usually accompanied by a sense of depression and exhaustion which is very apt to lead to the idea that serious mischief is afoot. So the patient finally goes to a medical man. And now, with no disrespect to the profession, one of several things may happen. HEART MURMURS. If the doctor belongs to what may bo described as the pre-war school, and if the patient is found to have what is known as a " murmur " in his heart, he will very probably bo informed that his condition is one to be treated seriously. He may be ordered to He in bed during Jong periods, to give up iiis work, to restrict his output of energy, and ho on. He will get a fright at 11 lis advice; but the advice will not surprise him, because he already suspected that it was his "heart" which was at the bet'oni of his trouble. His'attention will tend to become focused on that organ, and very soon lie will be in a position (o say that "he never realised how ill he was.'' He will lake the utmost care of himself, and will probably become a nuisance to himself and his friends. It is unlikely that bs will die. .Suppose, however, that no murmur had been heard when the heart was listened to. in that case the patient would probably have been assured ihat his heart was "sound," but that what he was suffering from v,',r, " neurasthenia," or nerve weariness. . Ho would naturally not feel so depressed at this information, and a holiday in the country would most likely appeal to him as the best method of cure. Finally, had he gone in a doctor conversant with the most recent work on heart disease-—iho Army work —he would have fared differently again. This doctor would have listened to his heart, and if ho heard the murmur in question would certainly have discounted it. He would have dismissed the idea of liearl disease at once, and he would not have devoted much time to talk about nerve weariness. Ills main preoccupation would have been to find out what illnesses the patient had suttered from recently. And when he was told "inffutmza"' he would have said that, influenza being a curable disease, the symptoms would very soon go away of themselves—except, perhaps, for a time, in wet weather or during periods of stress and strain. TWO SCHOOLS OF DOCTORS. Now, it is quite evident that we have hero a fundamental difference of attitude which is of the first importance to the public. Une school of doctors views what arc, "called "systolic murmurs'' gravely; another school scarcely wnils to view them at all. Ono doctor would send a man with such a murmur to fish and shoot, another would send him to hi* bed. Perhaps we shall arrive, at some understanding of this difference if we think of the manner in which heart troubles, socalled, usually arise. It h;i3 been known for generations (.hat rheumatic fever tended to produce heart disease; ii lias also been recognised for very long that every convalescent from a severe illness -showed signs —breathl-essness and so on—which were more or less indistinguishable from the signs commonly supposed to poiut to heart truublc. Was there a connection, bet ween these two phenomena? There was;' and the war revealed ii. Let a man contract- malaria and not be cured of it. He will tend to become breathless on exertion, to have- giddy attacks and other signs of exhaustion. He may develop a systolic murmur. The same thing will occur if he gets dysentery, or trench fever, or even influenza. But" now treat him thoroughly for his malaria, and get him rid of it. His " heart symptoms "' will disappear. The same thing applies to dysentery. A rule at once emerges. So long as the man remains poisoned, so long will ho show the symptoms of "heart trouble"; when the poison is eliminated the symptoms go away. Wo are able with a degree of assurance to suggest that- if malaria and dysentery and intlueuza wer-i; as incurable, as ineradicable as, say, " rheumatism," these diseases would produce as many cases of heart disease as does this latter. it is here that the old medicine and the new part company. The old medicine is the medicine of organs. It looks at the heart .-.•tparateiy, so to .speak. It argues about the heart, about it sounds, about its strength, about its size. It draws its conclusions from those data. Heart disease is present or it is not present, and this is decided by signs which tho examining doctor detects. If no murmur is heard, the condition is apt to be dismissed as "' functional"; if a murmur is heard, it is called, very often, "organic," and a grave view is adopted. Tho new medicine rather looks at the heart as ono of many muscles. It is not very greatly concerned by tho importance of the heart, for nothing is more sure than that importance has been much exaggerated, of late years. If a mail is poisoned, the -wrliole nia.ii is. poiaonecL iind not xnevelv one little part of him. It is tho poison" that matters, not the symptoms and effects of it. It is the poison which is embarrassing the man's responses to effort and not his heart. One need only perceive how rapidly any poison will achieve this to realise 'that thn heart plays quite a subsidiary role. Hew, then, do these poisons act? Where do they act These are the questions to which the most modern medicine is now addressing itself. Tho great work of Gashe!! has opened the way. The work of the nharmacologUts has'carried us another step. We realise now that many poisons act directly on the nervous system, on particular parts of the nervous system, and so—since the nervous system controls the activities of all our organs—are able to embarrass the functions of tho body. The heart is a hollow muscle which opens and fills with blood. It then shuts and expels the blood. Ono set of nerves determine its opening, another set its shutting. Tho ononers are probably closely connected with the senses—the senso of sight, of hearing, of touch, and so on. Thus, when a call for effort arises it is transmitted at once to tho openers of the heat, which act. causing ihat organ to dilate and fill with, blood to a greater extent than ngrmai. The result is a larger output of blood at the next- "beat," and so a more vigorous circulation to enable the man to respond. Tho public know Uiis, and the phrase "My heart stood still" is the proof. The heart does stand still when a. violent stimulus comes along—in order that it may fill fuller with blood. NERVE POISONING. But this working at higher pressure than normal means, of course, a greater expenditure of energy. So that if a man is so "nervous" that his heart stands still at the slightest provocation, ho will tend to live in a. state of constant exhaustion. This probably is the key to our puzzle. If it bs assumed—and there is a good scientific backing for the assumption—that the poisons of disease act upon the nerves which open the heart and make these nerves unduly excitable, then every call for effort will be responded to by the poisoned person in a manner more vigorous than is necessary. He will "jump when the door bangs," and he will exhaust himself very_ easily. His heart will soon tend to show signs of weakness. Moreover, wet and damp weather, by exaggerating the excitability of his nervous system, will increase his distress. What is called his "field of response" will be narrowed, because he will have used up all his reserves on the merest trifles. Ho will consequently be breathless after efforts which occasion healthy people no trouble. Manifestly the best hope for this man is to be rid of his poison. Tho next best hope to increase the whole tone and health of his body. To treat his lieart is only to palliate "matters. But if the poison tends to die out of itself—as the- influenza poison does—then his case is good. As the poison dies away the symptoms will die away also, iie will recover—unless, indeed, he has in the interval become obsessed.with the idea that ho has heart disease, that mysterious and terrifying condition. It is well .that the public should follow this modern line of thought, because only by doing so will it be able to check intelligently the dicta of tho consulting rooms. There is no greater enemy of health than tho mystery which enshrouds so many diseases.