The Heart in Middle Age

A RECENT monogram issued by the Metropolitan Life Insurance Company, New York, on "The MIortality from the Principal Cardio-vascular Renal Diseases During the Twenty-Years Period from 1911 till 1930," shows how great a factor these diseases are in influencing the death-rate. For the age period 1-24 years approximately eight per cent. of all (leaths are due to cardio-vascular renal diseases, with the highest incidence at 10-14. Above 34 the incidence increases with each decade, and we find in the 35-44 years period a death-rate percentage of 19.8 per cent., 45-54 Years of 32 per cent., 55-64 of 44 per cent., while from 65-74 years it reaches 55.3 per cent. of all deaths. This increase in the death incidence is easily understood when one considers the changes found in the circulatory system with advancing years, and the stresses, strains, chronic and other infections to which the human frame is subject. The majority of cardiac deaths in children and young adults are due either to congenital heart-lesions or to the ravages of the rheumatic group of diseases on the valves, pericardium, and myocardium, and in many cases it is only because a relatively healthy imyocardium is able to compensate for a serious defect, that life, restricted in miany ways though it be, is prolonged for many years. In considering the heart from middle age on, we have two main groups. First, that in whlich there is a previous lesioIn, suchi as an endlocarditis or a pericarditis; and the second group, whlich becomes larger wZith each succeeding (lecade, a group includinig the high-pressure cases, the arterio-sclerotic, syphilitic, hyperthyroid, an(d those cardio-N-.asctilar lesionis associated with other chroniic or acute toxxmias. RHEUMATIC VALVULAR DISEASE. 11w icntroductionl of auscultationi, after Laennec invented the stethoscope in 1816, made the findling ancl (lifferentiation of murmurs the one imlpol-tant clinical sign of cardio-vascular diseasc. Tohe fact that a murmur was present, no mlatter how trifling the lesion, often meatnt a life of restrictions for the unfortunate patient, who frequently outlived the doctor responisible for the grave prognosis. TFlis exaggerated idea of the importance of murmurs is gradlually dying out, so thlat now one has to consider the type and clegree of the murmur in conjunction with the alteration in the size and shape of the heart, more especially as regards the response of the heart to exercise. Of the cases examinied in middle life, many have been diagnosed in …