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Masks .Made from Athletes' Faces
?t the Moment of Supreme Effort, the Agonized Expressions Being an Indication of the Strain Their Hearts Are Undergoing. Such Strain if Long Continued Results in Permanent Enlargement of the Heart and Thickening of Its Muscles. (From Photograph Copyright by Dr. Mackenzie.) By Wm. Brady, M. D. MURM URS are adventitious sounds of a musical char acter which not every heart can produce. A person who is anemic is likely to have a beautiful murmur, and a victim of goitre almost always owns one. In fact, a great many people in whom we can pick no flaws by the most delicalc tests of medical science harbor murmurs. And, what is more discouraging, the most serious types of heart disease present no audible murmurs. For instance, a pronounced valvular leakage, with a dilated, failing heart, commonly produces no murmur when conditions are most alarming. If rest, and care proves successful in re storing fairly competent, heart action, then, as the pa tient's strength and efficiency return, back comes the murmur, too. musical as ever, like a song of chcer. So the presence of a murmur in or near the heart. In stead of being a bad omen, is generally a favorable sign, or else insignificant. Suppose there is a leakage of a heart valve. The valve leaflet has become slightly distorted as a result of the slow contraction of a scar left in it by some former inflamma tion?perhaps not recognized at the time it occurred. The distortion prevents perfect closure of the valve at each henrt beat, and so a little blood leaks back again into the ventricle from the great artery (the aorta), or into the auricle of the heart, from the ventricle, as the case may be. In leaking back the blood passing over the iense valve set^it vibrating just as the column of air sets the reed of an organ pipe vibrating, and in this way an ad ventitious sound, called a murmur, is produced, a sound which intrudes upon the ordinary music of the heart. It is a checrful sound because it is the sound of ef ficiency; it signifies that the heart muscle, reacting to the increased demand put upon it to compensate for the back flow or leakage, has responded by increasing in bulk and strength sufficiently to maintain a competent circulation under ordinary conditions. A man with valvular heart disease must have a stronger heart than one with undam aged valves in order to be comfortable. Hundreds of per sons with.valvular leakage of this sort are so comfortable and feel so well in every way that they never suspect :here is anything wrong with the heart, unless they hap pen to be exposed to an insurance examination, or come down with some severe illness like typhoid or pneu monia, which places an unusual strain upon the circula tion: or unless they attempt a mode of life which proves too strenuous. Heart failure is by no means the sudden, unexpected or mysterious seizure popularly imagined. On the con trary it always gives signals far in advance of an attack. The victim too commonly ignores the signals or misin terprets them by the aid of his friend in the corner drug store, or a nostrum advertisement, or the weather, or busi ness anxieties or other means of miscalculation. But no victim of heart failure who succumbs can be said to have been stricken unwarned; he goes down because he has placed the mattev of personal health in a secondary posi tion in his scheme, of life. The most modern studies of pathology have taught us that the earliest symptoms of heart failure are felt by the patient long before the condition becomes manifest, to the physician. The symptoms are produced by beginning ex haustion cf the reserve power of the heart. If you run some distance you grow short of breath, be cause the exertion uses up the ordinary available energy of the heart and calls upon the reserve. The reserve en ergy is jealously conserved by nature and expended grudgingly. But if you keep on running, supposing you are sound and true, you will presently get your "second wind" and find yourself able to run a long distance at moderate speed without getting quite out of breath. You arc using the reserve power. By practice, by training in telligently, you may so increase the reserve power as to withstand an extraordinarily big strain. This is what happens when an athlete trains for a con tost : ? The muscles of the whole heart, but principally the vcntriclcs, undergo a process of hypertrophy or thicken ing, just as the biceps may be increased in bulk by exer cisc; and the right ventriclc, which pumps the blood through the lungs, is"able to do much more work, keeping the blood much better aerated in time of great physical exertion. An athlete has a large heart. He must'have enlargement of the heart in order to endure the great' strain of a contest. If he keeps up moderate athletic work the year round he will be comfortable, but if he sud denly begins to loaf following the big contest, then that big heart is likely to begin to bother him considerably, like a powerful automobile engine with the clutch thrown 2 N out. This sort of trou ble ? "Ath lete's heart" ?is natural ly more fre quent in high school lads, and it is the best of rca s o n s why f o o t. b a 1 1 training should be ab solutely pro hibited in high schools. One of the early signs of heart failure The Diagram (X) Shovrs How Liko the Action of the Heart Is to That of a Force Pump. On the Left, the Condition During the Resting Period Between Beatn When Blood Is Flowing In; on the Right, the Condi tion When Blood Is Being Pumped Out. Below?A View of the Valves of the Heart, Showing Right Auriculo-Ventri cular Opening, Closed by the Tricuspid Valve; Left Auri culo-Ventricular Opening. Closed by the Mitral Valve; Fibrous Rings; Aortic Opening and Valves, and Pulmonic Opening and Valves; Muscular Fibres. is shortness of breath, not ncccssarilv very rapid breathing or panting, but inability to "get your wind" on moderate exertion. But heart failure, remember, does not mean the awful end the coroner too often mentions in his renort when the actual cause of death is a matter of surmise. It means a gradual loss of efficiency in a heart damaged by disease of any kind, such as valvular distortions result ing from former tonsillitis, quinsy, so-called "rheuma tism," or neglected teeth, or a fatty degeneration of the heart muscle from prolonged indulgence in alcohol, for example. A man subject to heart failure is always aware that he has lost his former "pep," that, he is no longer able to do his former physical or mental work without being abnormally fatigued, that his health is below par, that he has "dyspepsia" or "gas" or some other more or less constant trouble which a healthy man has no business entertaining. If disaster finally overtakes him?and it certainly does not in the majority of eases of heart dis ease?it is only because he has failed to undergo an annual physical examination. It was just observed that heart disease does not prove fatal in the majority of cases. Ninety per cent of all victims of heart disease die like the rest of us, from every day preventable diseases like pneumonia, Briglit's disease and typhoid fever. And the very few who do succumb suddenly are far outnumbered by the victims of sudden death from apoplexy, uremia, shock and poison. Many a coroner's case of "heart failure" would prove to be one of these conditions if the truth were sought by a complete post-mortem investigation. A deplorable circumstance which has much to do with the subject of the death rate from heart disease is the popular use of patent medicines and "ethical" or medically prescribed nostrums for the temporary allevia tion of symptoms in reality due to a failing heart, but misinterpreted as "nervousness." "neuralgia." "head ache," "run down condition," "overwork." "need of a Ionic." "dyspepsia," "bronchial trouble," "insomnia" and Ihe like. Worse still, many of the popular nostrums taken for the relief of such symptoms contain, as a "kicker," quan tities of acetanilide, phenaeetin (neetphenetidin) and other coal-tar derivatives which do bring relief to pain, fatigue and nervousness, for the time being, but at, the same time break down red blood corpuscles, seriously impair the functional strength of the heart, and, if frequently used, soon start a habit which is ruinous. There are several simple physical tests by which an individual may determine for himself whether the machinery needs expert care. These tests do not specific ally indicate just which part is worn or defective; they simply prove that there is something radically wrong with engine, cooling system or transmission. It. is for the medical expert to locate nnd remedy the. particular defect. Sit at rest for an hour or so ami try how long you can hold your breath. A healthy adult can hold his breath thirty-five or forty seconds by the watch. Then comes tho breaking point and he must come up for air. If the blood and tissues are inadequately supplied with oxygen, that is, if the proportion of combustion products (carbon dioxide and other acids) in the blood and 1 issues be excessive, then it is impossible to hold the breath so long. One with an impaired circulation cannot stand out much more than thirty seconds, or, perhaps, even less. When a patient is unable to hold his breath more than twenty-five seconds, no matter what his illness, the advisability of giving an anesthetic for any operation Copyright, 1917, by tha Star Company. How To Keep^four . Heart from Breaking Diagrammatic Scctional View of (ho Heart. (A) Tricuspid Valve. (B) Semilunar Valves. (C) Eustachian Valve (1) Pulmonary Artery (2) Aorta (3) Vena Cava .Superior (4) Vena Cava Inferior. The Ar rows Show the Course ?f the Blood Through the Heart Science Explains Why This Vital Organ Often Fails and Shows How You Can Detect When Something's Wrong with Its Delicate Mechanism Method of Recording the Heart's Beat by Means of Sinoke Rings on a Paper Tape, and Some Actual Records of the Heart's Action Under Different Conditions. is always questionable. That the test indicates the presence of excessive amounts of carbon dioxide and other products of combustion in the blood and tissues (acidosis, as doctors now call it), is made evident by a further test. Having determined your breaking point ? say thirty-five seconds ? just breathe a trifle more than usual, but not faster than sixteen times a minute, and not forcibly at, all, for two minutes. Then hold the breath. You will now easily last a minute, perhaps a minute and one-hnlt. or even longer without another breath. You have-satur ated the blood with an excess of oxygen for the time bring. A Yale student breathed in this way for five minutes, then took a few whiffs of pure oxygen from a tank, and held his breath right minutes. A Lcland Stanford man tried it and held his breath for thirteen minutes. Here is a second test: Count your pulse after you have been lying at rest for an hour or so. Then sit up and Groat Britain Rights Reserved. *1 r your circulation is good your pulse will resume its normal rate within three minutes after standing up and then squatting like this twenty times in moderately quick auccesaion." count it. Then stand up ant! count it?a minute each time. The aver age normal adult has a pulse of, say, 66 per minute when lying at rest, 70 when sitting up, and 74 when standing erect. But if the circulation is inefficient the com parative increase upon assuming the upright positions will be con siderably greater. Next count the pulse after you have been at rest an hour or so. Then stand up and make twenty deep knee flexions (squatting) at a moderate rate. The pulse will become quite rapid and remain rapid for some time. If the circulation is good, however, the pulse will return to its normal rate after three minutes of rest in the ?sitting posture. Should it. fail to do so, the chances are that you have either a defective circulation or tl^at you ar? subject to nervous exhaustion. Tn either case, your ma chine needs the attention of a skilled human mechagia.