“We recognize now, all of us, that, in the lapse of men’s years, one long reckoning of his mortality is, and from all known ages has been, written on the walls of his vessels. We may suppose that in the primitive man, by external conditions if not by innate capacity, life was of comparatively brief duration. Domestic animals seem, as a rule, not to live long enough to use up their arteries or not to live ill enough to abuse them, and amongst these creatures atheroma, though not unknown, has not been commonly observed. We may reasonably conjecture that, as in Stable Societies human life became protracted, the arteries got time to wear out.”
There is plenty of evidence from the mummies of Egypt that atheroma and sclerosis were common, not only in advanced age, but in the middle years of life. We cannot know intimately the life that these old people lived, but we can pretty well picture from history both the height of luxury and the nervous strain. Civilization brings without doubt more comfort, more luxury, and more scientific knowledge, but it seldom brings more true personal wisdom. The philosophical calm and contentment with simple pleasures, and wise simplicity of life, are still the exception. To use a slang expression, we are nearly all of us “on the make,” stretching forth eager hands and hearts towards the will-o’-the-wisp of wealth and advancement, while we let the real values and beauties of life pass us by and so we continually miss our markets. The great war has taught us one good lesson, viz., that we can live and be well—nay, better—on much less food and on simpler than was our former custom; but it has increased, at any rate for the present, the struggle for and the pain of mere existence.
We must nevertheless be optimistic, and hope that the great advance in science may soon make life easier, and the food of the world once again sufficient for its inhabitants; then, please God, materialism may shrink into the background and things spiritual come into their own. Not, however, by a reformed and wiser life alone do I hope to show the more excellent way, but to show that modern science has placed in our hands a preventer of decay and a prolonger of life and energy. I cannot promise that this discovery will take twenty years off a woman’s life and put twenty years on to her beauty, but I know that it will give many more years of fruitful and enjoyable work, with greater strength and better health.
CHAPTER II
ARTERIO-SCLEROSIS: ITS NATURE AND ITS CAUSES
The thickening chiefly of the middle coat of the arteries that we find in this disease is the first pathological sign, and it implies that morbid structural changes have begun; but long before this occurs, the predisposing causes have been at work. The actual structural change is the visible effect of the law that over-use of a muscle produces over-growth or hypertrophy. This is not a law of disease, but of purposeful utility, designed to meet emergencies of life. Still there is a further law in nature, that long-continued excessive use of any muscle leads to a form of hypertrophy which cannot maintain its vitality, but degenerates. Arteries must be treated as muscles, for their muscular coats contract and dilate, as circumstances demand, under the control of the nervous system.
Dr. George Oliver, in his third edition of Studies in Blood Pressure, among his fundamental data lays down this law:
“Though the left ventricle—dispensing its blood under a high pressure into the aorta—is the master hand in maintaining the arterial blood pressure, the height to which that pressure rises depends primarily on the resistance encountered in the peripheral arterial system, and in the capillaries, and, secondly, on the response of the ventricle to overcome that resistance. Given a normal ventricle the arterial tonus largely determines the ventricular response and the level of the arterial blood pressure; and this is the keynote of the physiological and pathological variations of that pressure.”
Arterial tension may be described thus: During the resting-time of the heart, between each beat, the circulation of the blood is maintained by the contractile power of the arteries, which steadily urges the blood onwards into the capillary vessels, and so into the veins. This power is known as arterial tension or pressure, and it is estimated fairly accurately by the sphygmomanometer. A large number of observations have taught us what is the average pressure at different ages of life, and thus we are able to talk about a normal or abnormal pressure.
If we hope to understand and successfully treat abnormal pressure and sclerosis, we must visualize the whole of this picture clearly, wisely, and in its due proportions. This we have not always done. The heart man, as Osler wittily said, “tinkers at the pump,” while the pressure man, with his manometer, concentrates on the pipes. To give a scientific description and explanation of the physics of the circulation is far beyond me, and would be inappropriate in a small practical work of this sort, but a study of some elaborate standard work, such as Sir Clifford Allbutt’s Diseases of the Arteries, or Halliburton’s Physiology, would do much to give a fair understanding of this intricate subject: but, as they so often acknowledge, the vital problem of the circulation, with its ever-changing demands, both general and local, can hardly be solved by the known laws of physics. Heat and cold, joy and grief, anger and fear, acting through the nerves of the vaso-motor system, all help to complicate the problem and often to confuse cause and effect.