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approach if headway is to be made in reducing mortality from
heart disease.
Primary preventive action, however, appears to be having
little or no demonstrable success, perhaps because the necessary
drive is absent or existing measures lack the glamour of curative
procedures or, maybe, that there is a dearth of suitable
educative material. A similar situation obtains with secondary
prevention, i.e. those measures taken in respect of patients
who have already developed clinical disease. Here, theory coincides
with experience which shows that the more advanced the
disease the more irreversible it becomes.
Although hypotensive treatment in relation to coronary disease
has yet to be proved beneficial, abandonment of the smoking
habit in doctors clearly shows that the risks are thereby substantially
reduced. Moreover, adopting a lower fat intake,
especially where these fats are of the unsaturated type, is considered
internationally to be justified as a preventive measure in
the light of existing knowledge. Screening procedures could,
undoubtedly, treble the numbers already known to be at risk
in middle age and so expose them to preventive health education
but resources, both financial and manpower, preclude this
approach in present circumstances.
To talk of retirement to the victim of a coronary attack is
contraindicated not only physiologically but psychologically too.
It destroys his will to live, throws extra strain on his impaired
circulation and, if he is a married man with responsibilities, the
damage to family relationships is incalculable. Rather, after
recuperation, should he be encouraged to take exercise every day,
keep his weight at the standard for his age, travel comfortably
without haste or overburdening cases, eat moderately (especially
of fats and sugars), cut out cigarettes, use alcohol sparingly,
avoid sudden extremes of temperature and shun people who make
him lose his temper. If he desires to extract the best out of life
he should return to his former occupation, if this is at all
possible, for this is the one which he knows best and is likely
to cause him least strain in adjustment during his rehabilitation.
Mental Illness
Modern societies are beginning to learn that sickness, pain and
premature death are not inevitable and that such afflictions are
not to be accepted fatalistically.
Although immense strides have been made in the improvement
of health in many fields, the ever-increasing problems of mental
health remain grave and further complicated by the present rapid