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Hope from Surgery. It is too soon for Dr. Page to gauge the long-term value of today's research in his Cleveland Clinic laboratories. This is true of the work on heart-and-artery disease that is being pressed in scores of U.S. laboratories: the field is too new. However, there is solid ground for hope in the very scope of the effort now being made. The American Heart Association pays out $5,000,000 a year in research grants—half of it for basic science. Even more ambitious is the National Heart Institute's program. It is only seven years since the Public Health Service launched the institute with three men, three desks and three filing cabinets in a corner of a temporary building at Bethesda, Md. Now N.H.I, has mushroomed to an expert research force of 400. Of its $18-million budget this year, $5,000,000 will be spent within its own walls and $9,000,000 funneled out to 720 research projects across the country.
Many heart men are returning to the field of their earliest successes—surgery. To check hypertension in some cases of nervous origin there is a formidable two-stage operation, sympathectomy: whole series of nerve bundles beside the spine are cut. Increasingly daring surgery is also coming to the aid of atherosclerosis victims. Surgeons in many cities can now cut out a diseased, bottleneck section of the aorta and use a graft from a frozen artery bank as a splint while the patient's own aorta heals. For similar roadblocks in the femoral (thigh) arteries, the surgeon may slit the artery lengthwise, scrape off the diseased deposits, and sew it up again.
Toronto's Surgeon Gordon Murray has developed a still more daring procedure. The infarct caused by a coronary closure is actually cut out from the wall of the heart itself. Then healthy muscle from each side of the dead area is stitched together. The slightly smaller heart that results is more efficient.
No one can foresee whether the best answers will in the end come through chemicals or the scalpel, or both—or how much longer the tough, miraculous and mysterious sac of muscle will elude man's determination to control it. But one of the most hopeful items in medicine's advancing knowledge is that heart disease and heart attacks need cause far less of the chill dread that used to surround them (see box). "Perhaps the most dangerous thing we doctors can do in managing patients with heart or artery disease," says Page, "is to discourage them with too many don'ts. It is disturbing to me to read medical recipes for long life which first prohibit smoking, then alcohol, and tell you to cut out butter and other fats, and end by suggesting that some kinds of cancer can be avoided by total abstention from sexual intercourse. That is limiting life pretty sharply. We don't want to make invalids, but to help these people to live lives that are longer and happier and more useful. I think we are learning how to do that."
*Not to be confused with rennin, a milk-digesting enzyme.