Why do we die?

by T. Bodley Scott

As age advances and our teeth fail in power we are apt to slip into the way of eating chiefly soft, well-cooked foods, in which what are known as vitamines are almost destroyed, but they are as essential as ever, and some uncooked fruit, salads and unboiled milk should enter into our diet.

When one thinks over the luxurious habits of our predecessors, the enormous amount of food, in excess of body needs, taken at big dinners, one must realize how we and they sinned against the light. The great war has taught most of us, with the exception perhaps of the new rich, how little we can live on and work on with complete efficiency. Economy of food, simplicity of life, mean economy of waste and of expenditure of vital force, and our bitter war experiences should prove to be the path to longer lives, and to lives with a higher standard and greater results.

The question of alcohol in sclerosis is difficult, but very important. In the first place it depends somewhat on what a man has been accustomed to take. If he has taken a moderate amount with his food during the greater part of his life it does not always do to stop it. Alcohol is not a pressure raiser, as many think, but rather the reverse, and, if stopped suddenly, the digestive powers may be lessened and the tone of the body depressed. Lauder Brunton says: “All the Alcohols tend to dilate vessels, to diminish blood-pressure, and ultimately to diminish activity of the nervous tissues, although at first sight they may seem to have a stimulant action.”

Alcohol contains so little nutritious food (with the exception of the sugars and extractives of wine and beers) that in itself it may be said to give nothing to the body; but there is something a bit beyond this—the bitter of the hop and the flavour, the bouquet of the grape have a stimulating effect on the nerves of taste and smell, and so produce, with some people, a better flow of saliva and gastric juice. This probably is how wine and beer in moderate quantities help digestion and appetite. There is still further the effect on the general nervous system. Alcohol without doubt enables a man to draw on his reserve of force, though it probably does not increase those reserves. This is, of course, drawing on one’s capital, but the ability to do this may be of great use in emergencies, for it can help a man to live over evil times. But it must not be forgotten that such calls, if too large or often repeated, must in the end empty the reservoirs and leave him powerless and defenceless.

This question of alcohol must be regarded by physicians with common sense backed by scientific knowledge. The world is never going to be cured of alcoholic intemperance by intemperance in language and inaccuracy in thought.

Before I go into the more detailed treatment of sclerosis, I must just touch on the question of tobacco. Nicotine, without doubt, is one of the most powerful raisers of arterial pressure known, but in ordinary smoking very little gets into the system. Tobacco chewing and snuff-taking, both nearly extinct, probably introduce more nicotine into the body. The combustion in cigar smoking is so nearly complete that very little poison remains except on the lips. In ordinary cigarette smoking the combustion is about as complete as in the case of cigars, but, if the smoke is habitually inhaled, the absorption through the bronchial mucous membrane is much greater and, I think, must have an appreciable effect on blood-pressure. As in alcohol, so in tobacco, we must not lose sight of the effect on the general nervous system: on many people tobacco, in moderation, has a distinctly soothing influence, and so leads to a quietude of mind which compensates for any other small evil effect. Used in excess, it certainly weakens both nerve and will power, and often heart power. The first effect in experimental nicotine poisoning is greatly raised blood pressure, but at the end dangerously low pressure, and so we find that the ultimate effect of excessive smoking is a feeble, low-tension pulse that is often irregular. Oliver found that, in ordinary people who were not excessive smokers, tobacco raised the systolic pressure 10 to 15 mm., but that the diastolic was unaffected; the variations between the two thus becoming abnormal. This effect generally subsides in a quarter of an hour after smoking is finished.

It follows, I think, that a man with sclerosis should think this out for himself, for he is not in a position to take any unnecessary chances. Of another of our daily habits, it is wise to remember that coffee raises pressure more than tea, and China tea less than Indian.

There is no doubt that an indoor, sedentary life tends to high pressure far more than an active, outdoor one. This is partly due to the mental work and concentration that goes with it and partly to oxygen deficiency. The inhalation of oxygen lessens the viscosity of the blood and consequently the work of the heart and of the arterial muscles, while an excess of carbon-dioxide in the air increases the viscosity and the necessary heart force that must be expended. The amount of oxygen we inhale in the open is necessarily more than in confined buildings, and we all feel how difficult it is to drive our brains in a close, stuffy atmosphere. This points to the economic value of ventilation and space. Wise, moderate exercise also tends to lower pressure by promoting a general quickening of circulation throughout the whole body; the stagnant pools are flushed out and oxygenation becomes more perfect. Even severe exercise in health only raises pressure temporarily; the subsequent level in health is below the original. But where there is evidence of cardio and arterial disease, exercise must be taken wisely, moderately, and only slowly increased. This is done very effectually in some health resorts, where the patient is trained to mount gradually increasing slopes. The same effect is reached by graduated exercises. In all these methods pulse rate and arterial pressure are tested and serve as guides to further advance. Certain Bath treatments, such as Nauheim and its English adaptations, help materially to lower pressure and to hasten a sluggish blood flow. These act chiefly by dilating the blood-vessels at the surface of the whole body and thus relieving internal congestions and increasing oxygen exchange.

The nature of our games and exercise in sclerosis needs careful thought. Golf, for instance, is very good if taken quietly, but some courses are so hilly that there is a good deal of strain put on the heart. If one is compelled to play on such a course, one must take it slowly, and not allow the spirit of the game to run away with one. Quiet sculling is one of the best exercises, for it works all the muscles of the body slowly and symmetrically, and the strain on heart and lungs is entirely under one’s own control. Swimming, again, is a most healthy exercise, if taken quietly and not in very cold water. I know of nothing that improves one’s wind so quickly. But all these exercises must be taken under advice and never pushed to the point of real fatigue or exhaustion.

The need of rest is as great as the need of the right sort of exercise. Late hours should be absolutely avoided and little brain work should be done in the evening, so that the brain and all its important arteries can sink into relaxation and sleep at once. The rest to the heart and circulation is of course never so prolonged, but nature has designed them to get their rest only in moments. The heart in an adult rests more than thirteen hours out of the twenty-four, under quiet normal conditions, the time of rest being the diastole, and the time of work being the systole or contraction. There are few healthy men who could not walk a thousand miles in six weeks, walking about eight hours a day and resting for the remainder of their time; but there are not many men who could walk a thousand miles in a thousand consecutive hours, as the late Captain Barclay did, because the frequent interruptions to their sleep would exhaust them completely. In the same way, if the heart is forced to beat more quickly, it becomes sooner exhausted, for the extra work is taken from the diastole, the sleeping or resting time of the heart.