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Partitioned Patient. What has worried Dr. Page most is that overspecialized modern medicine has not organized itself properly over the years to take broad-front action. Not only the disease but the patient has been senselessly partitioned. A man's brain, if he had a stroke, was in the province of the general internist. The gangrenous toes of his friend who suffered from Buerger's disease went to the angiologist. His heart belonged to the cardiologist, who grudgingly took responsibility for high blood pressure—but could do little for it. His kidneys were annexed by the urologist. Pleaded Dr. Page at New Orleans this week:
"Without coordination we have cardiologists, angiologists, cardiac surgeons, peripheral vascular men and, of late, the more glorious nephrologists . . . Unfortunately there seems to be no term to cover the entire circulation. But in our own thinking, let us make a fresh start and consider the heart as only a 'specialized nubbin' on the whole vascular tree and reintegrate the heart and blood vessels back into the unified system that it really is."
As doctor after doctor reported on his studies and experiments, a unified pattern was, at first, scarcely apparent. Nor would it be from the odder bits of work in progress, ranging from male volunteers who are taking female hormones, willing to run the risk of being feminized in hopes of having their artery-hardening arrested, to Duke University's Dr. James Warren, who is about to head for Africa to learn more about how the giraffe keeps its blood pressure under control.
But all such diverse experiments fit into a growing, if often elusive body of knowledge about the heart.
Where Is the Villain? The earliest, most dramatic progress came in the field of heart surgery. When they could deal with disease by the use of scalpel and mechanical ingenuity, U.S. doctors have worked wonders, e.g., the complex blue-baby operation, opening the mitral valve inside the heart, heart-lung machines, even the use of a dog's lung to substitute for the patient's during an operation.
Other successes were scored against heart disease caused by diphtheria and syphilis, both virtually wiped out. Another form of the enemy is being routed largely through penicillin: rheumatic heart disease. But the situation is more complex in regard to the two commonest forms of heart trouble, which account for more than 90% of all heart disease in the U.S.:
¶Arteriosclerosis (artery hardening), of which atherosclerosis (mushiness and hardening) is one of the commonest forms, and the most dangerous because it so often occurs in the heart's own arteries, the coronaries.
¶Hypertension (high blood pressure), ranging from a benign form not severe enough to hamper or endanger life to rapidly fatal cases.
Actually, the two disorders are closely related—how, in scientific detail, no one knows. While it is true that many victims of arteriosclerosis show no hypertension, every victim of hypertension examined after death shows arterial damage of some kind. Hardening of the minute arterioles—the slenderest twigs at the extremities of the arterial tree—almost always goes with high blood pressure. Its immediate cause seems to be loss of elasticity in the arterioles' thin muscular walls.