Needless restrictions imposed on cardiac patients.

z /[ANY physicians appear to be too strict and particular in the rules of diet and regimen, which they deliver as proper to be observed by all who are solicitous either to preserve or recover their health. The too anxious attention to these rules hath often hurt those who are well, and added unnecessarily to the distresses of the sick."' These are the opening sentences of William Heberden's Commentaries on the History and Cure of Diseases, published in 1802, the year after his death. The thought which they convey will serve as a text for the remarks which follow. Any person with a disorder of the heart or circulation, regardless of its cause or the degree of functional impairment, too often is looked upon as an invalid. His condition is a cause for concern. Accordingly, it is common practice to classify him as unfit to pursue his customary way of living and advise that he follow regulations which, in varying degree, restrict his activities and curtail his pleasures. To consider the basis for some of these restrictions and to inquire into the reasons why physicians are so ready to impose them is the aim of this discussion. SMOKING Patients with any form of heart disease usually are advised to abstain from the use of tobacco. Yet it has been our experience that, over a period of years, most of these individuals can smoke moderately without apparent harm. If one may judge by the amount of tobacco consumed, smoking affords a good deal of pleasure to a large number of persons; for many it provides emotional stability. Numerous studies have been made of the effects of smoking on the circulation. It is doubtful whether the prolonged use of tobacco is a contributing cause to the production of athero-matosis. The more immediate effects can readily be observed. These are due almost entirely to nicotine. In our laboratory it has been demonstrated that, in the individual, the degree of reaction varies directly with the nicotine content of the smoke. Estimation of cardiac work, using the low frequency, critically damped bal-listocardiograph, has indicated that tobacco smoke causes relatively little change in the cardiovascular system. There is considerable variability of effect in both normal persons and patients with heart disease, but this depends to a greater extent on individual susceptibility than on the presence of a cardiac disorder. Smoking rarely induces anginal pain, even in …