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62
bearing on the differing incidences of coronary disease. Thousands
of post-mortems carried out in the original survey demonstrated,
however, that scarring of the heart was most prevalent in those with
light occupations and least in those with heavy jobs. This shows that
exercise opens up collateral branches of the coronary arteries which
are of inestimable value when a main branch becomes occluded.
Epidemiologically, heart disease is proving to be modern
society's greatest menace for it ranges over the whole span of life,
from genotypic conditions, through those acquired as residual
results of rheumatic and other diseases, to types concomitant with
old age.
Surgery is gaining a considerable measure of success in connection
with congenital heart disease (which causes a large number
of infantile deaths) and also in respect of the acquired disabilities
but preventive action is having little or no demonstrable effect. This
may be due, in part, to the fact that preventive measures lack the
glamour of the curative procedures and perhaps to the dearth of
suitable educative material being dynamically presented.
In the light of present day knowledge, there are a number of
aetiological factors which are thought to have a bearing on the
increase in heart conditions, especially within the middle-aged
groups. These are, excess animal fat in the diet, producing a rise in
serum cholesterol—dietary imbalance—lack of physical exercise
with a consequent rise in body weight—smoking—the connection of
coronary disease with 'stress and strain' and with diabetes—genetic
tendencies. Several of these predisposing factors have their origins
in self-indulgence and the remedies are obvious. However, until our
knowledge of cause and effect is complete, it would be unwise to
delay introduction of preventive measures such as the adoption of a
balanced diet and the restriction of the intake of animal fat, weight
reduction, control of smoking, introduction of regular exercise and,
most important, the dissemination of reliable information by health
education officers.
In a recent investigation in the U.S.A. into the effect upon
osteoporosis of fluorides in the water supply it was found, quite
fortuitously, that there was a striking difference between the high
and low fluoride areas and the number of calcified aortas—the
difference being in the order of 40% less in the high fluoride area.
Confirmation of such a discovery would emphasise the significant
role which fluoride consumption could play not only in the treatment
of osteoporosis and dental caries but also in preventing calcification
of the cardiac vessels.
Cancer
Serious though the problem of malignant disease is, some
effort should be made to maintain a proper perspective. As Dr. Doll