CORONARY DISEASE

Press, Volume CVI, Issue 31198, 24 October 1966, Page 2

CORONARY DISEASE

Living Pattern

May Be Factor

Research into the cause of coronary’ disease has so far produced few positive conclusions. Dr. John Earle suggests we should start looking at the people w’ho escape the disease for the answers, says the British Medical Association’s magazine. “Family Doctor”.

“The pace of modern life no-one knows precisely what this expression means, yet it may contain more than the seeds of truth,” he says.

“As a family doctor who deals with the population of a country town and the surrounding villages, I feel that any theory must answer two questions. Why has there been a tremendous increase in coronary thrombosis in the last 40 years?

Why is it that in my own practice I have only seen three men under the age of fifty die from coronary thrombosis in the last nine years? Furthermore, why have only a few more patients under 50 had a coronary? Rate Increasing “In the first place, this increase is real. Doctors have known how to recognise coronary thrombosis, as it is seen in the post-mortem room, for more than 200 years. Based on post-mortem reports, the death rate is increasing. Tt is not merely that we are getting better at recognising the process. The population and expectation of life has risen over these years, but not sufficiently to account for the increase in coronary disease tn fairly young people. “The very fact that there has been an increase makes me feel that there must be a large enviromental factor involved. If this were not so, then I should have thought our forefathers would have been just as badly troubled. Do I hear a townsman murmuring something about the pace of life in the country or about semi-skilled labourers being exempt from coronary disorders? We could always get a tame managing director and put him in a field with a few frisky bullocks and he would find out something about the tempo of country life! “But there is a considerable difference between city life and rural life. So many that it is difficult to decide what may protect a countryman from coronary disease. It may be the exercise. I doubt if it is the diet. There are many fat farmers. But sometimes I feel we spend too much time studying an individual patient, or parts of a patient, and neglect his family and his working enviroment. Job Plays Part

“I have talked to many people in modern industry. It seems to me that some mod-

ern industrial empires are so complicated that a man ma y easily lose his identity. He almost certainly has an immediate boss, but above that boss are nebulous ranks of directors, managers, managing directors, branch managers, personnel managers, advisers in this and consultants in that. When my late father entered business in the twenties, this hierarchy was much less top-heavy. Nowadays, a man may not really know the limits of his responsibility, nor may he know what he is doing, supposed to be doing or told to be doing. And if the man does not know, then his wife and family can only take a slender interest in his work.

“On a farm, the man and wife do not work alongside one another as they may have done in mediaeval England. But they do know what each is doing and there can be very full understanding between them. In a bank, a small shop, a garage, on a farm, a man can see what he has done at the end of a day. Others can see, too. And they will probably react by praise or disapproval. In medicine, or in business, a man may well be uncertain of what he has achieved on a particular day. This is particularly true if he has been harrassed. At this stage, I must make it clear that this opinion is not the general view of the profession, nor even the view of a small responsible minority. But before you say ‘nonsense,’ would you please mark one or two other points.

Emotions "As you know, if a person is depressed or fearful, you can often see that person’s face go pale. This implies that emotions can and do affect the blood supply to the face. Could emotions affect blood vessels in the heart? “Certainly the blood vessels are well supplied with nerves, they are capable of constricting and enlarging. Also, if an examination is made on a young man who has died of coronary thrombosis, it often appears as if the blood vessels have constricted and this has played a part in forming the fatal clot “So far, our researches into the cause of coronary disease have not entirely been successful. It may sound rather Irish, but we may find the cause of this modern disease by taking a very careful look at the type of people who manage to escape it. After all, that is what we really want to do, rather than merely know the cause of the illness.”