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SOI,VED :
THE
RIDDLE OF
HEART
ATTACKS
BRODA O. BARNES, M.D ., Ph .D .
CHARLOTTE W. BARNES, A.M .

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 SOLVED :
THE RIDDLE OF HEART ATTACKS
by
Broda O . Barnes, M .D ., Ph .D .
and
Charlotte W . Barnes, A .M .

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Preface
The rapid rise in heart attacks during the 20th century has caused
panic in the public and confusion among the scienti.cts . Diet has received
most of the blame, although cigarettes, a lack of exercise, and various
environmental factors have also been suspected .
Autopsy studies clearly indicate that the major factor is a change
in man himself . Eliminating deaths from infectious diseases at an early
age has led to a NEW POPULATION of adults never seen before .
Those escaping premature deaths from infections are highly susceptible
to hardening of the arteries and to heart attacks .
Animals deprived of their thyroid glands show both a susceptibility
to infections and hardening of the arteries . Administration of thyroid
to such animals prevents damage to the artcries .
In man, those individuals with symptoms of low thyroid function .
including a subnormal body temperature, are prone to tiardening of
the arteries . Thyroid administration to such individuals has markedly
reduced the incidence of heart attacks .
Copyright 1976, Broda O . Barnes After presenting overwhelming evidence that thyroid deficiency
Ali rights reserved No part of thu book may be reproduced in is the culprit in atherosclerosis, the final chapter urges the abandon-
any manner without pe^II1ssjpO1n '"r^LfOg' eicepr in case of brief ment of polyunsaturated fats in our diet . In both experimental animals
qttotacionsembodud in critical articles and reviet+s .
and man, in addition to toxic symptoms, a rise in cancer has been
reported after prolonged ingestion of polyunsaturated fats .

Robinson Press, Inc .

Fort Collins . Colorado d0522
pnnted in thr Ututed Statasof Arnefira

111

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Table of Contents
~ Biography
Chapter I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Broda O . Barnes was born April 14 . 1906 in a log cabin on the
THE RIDDLE IS SOLVED
side of a rocky slope in southern Missouri . His interest in research began
as an undergraduate in the chemistry department at the University of Chapterll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. 7
Denver . He taught physiological chemistry for two years at Western WHAT IS A HEART ATTACK?
Reserve University where he received a Master's degree in 1430 . He HOW OFTEN IS THE DIAGNOSIS WRONG?
earned a Doctorate degree in physiology in 1931 at the University of
Chapter III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Chicago ; for five years he taught physiology there . During this interval
THE CAUSE OF HEART ATTACKS
many publications on research on the glands of internal secretions
appeared . He finished his Medical degree in 1937 at Rush Medical ChapterlV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
College, interned at Illinois Research Hospital, and began the practice SYMPTOMS OF THYROID DEFICIENCY
of medicine . For two years he was Assistant Professor of Medicine at
Chapter V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
the University of Iilinois, then b-came Chairman of the Health Educa- . . . . . . 35
tion Department of the University of Denver . He was called to the EFFECTIVE PREVENTION OF HEART ATTACKS
military twice- 1943-46 and 1950-51 . He became Professor Affiliate OVER A FORTY YEAR PERIOD
in the Deparur ent of Physiology at Colorado State University, 1969-68 . Chapter VI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . 45
In the practice of medicine F is interest has been prevention rather than
THE FALLACY OF THYROID FUNCTION TESTS
treatmens alone . Although engaged in General Medicine for 40 years,
ttie thyroid gland has always enjoyed the center of the stage . Over Chapter VII . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
100 publications in scienufic journals and three booka have summarized TIPS ON TREATMENT
his endeavors .
Chapter Vlll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Charlotte Webster Barnes received her A .B . and A .M . at Oberlin . 55
College in geology •vith graduate work a- Bryn Mawr College and at A tJEW LOOK AT STRESS
rhe University of Chicago . From the time of their marriage in 1952 ChapterIX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
she deserted the fossils to help in the field of medicine . PREVENTION : THE KEY TO PROGRESS IN MEDICINE
2858 W . Elizabeth Chapter X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fort Collins, Colorado 80521 . 67
THE DEMISE OF THE CHOLESTEROL THEORY
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

IY 1 Y

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 CHAPTERI

The Riddle is Solved

No longer is there a secret about the cause of the explosion of
heart attacks in the 20th century nor about the manner in which they
occur . Mother Nature may have a magic wand on the TV screen, but
when she +s disrobed in the laboratory, she is only another female per-
forming her tasks in the most precise and efficient manner so char-
acteristic of her sex. For the busy reader, lacking time for all the con-
troversial theories, the bare facts are expressed in this chapter . and
disctssions are left to subsequent pages .
In the race among many diseases to terminate mankind's earthly
existence . Feart attacks were unknown at the turn of the century ; today
they are Public Enemy Number One . In the sports world, a new cham-
pion is crowned when he defeats all challengers in competition . Diseases
compete in much the same way to eliminate mankind ; periodically a
new champion is recognized . A prizefighter, because of age, may lose
his crown to a younger, more vigorous challenger . AIl of the diseases
are under a threat of extinction from the progress of medical science .
The reducteon in deaths from infetsiotu diseases played a major role in
ehe rise of heart attacks .
For a century, tuberculosis had been "The Captain of Death"
ruling the roost like an overgrown bully among a group of small boys .
Tuberculosis had won the championship not as a result of its own
superiority but because an obscure physician, Dr . Jenner, had found
that smallpox could be prevented by vaccination . Smallpox had led
the pack for many years, decimating babies and children at an early
age . Its conquest had permitted a larger sect :an of the population to
live into an older age bracket . History leaves no doubt that tuberculosis
was the statistic replacing smallpox .
During the last half of the 19th century, public health measures
opened a counter_attack on tuberculosis . Bed-rest in a sanitarium not
only conserved the energy nf the victim allowing him to live longer, but

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2 SOLVED :THERIDDL.EOFHFART AITACKS THE RIDDLE IS SOLVED g

it also isolated the source of the infection, thereby preventing its spread of n .dividuals with damage to their coronary arteries (arteries to the
to other people . The net result was that thousands of deaths deserted heart) was aparoximately doubled in 1945 compared to 1939 . and the
the old champion, tuberculosis, and for several years, he wobbled on degree of damage to each one affected was about twice as great . In
weak knees . However, he was not completely knocked out for the count other words, the low cholesterol diet had not only failed to protect the
of ten until the birth of the antibiotics . The major reason for the modem arteries, but the damage was increased four-fold .
change in death patterns is the appearance of the antibiotics and not Then why had heart attacks dropped so suddenly? The answPr
the result of changes in our environment . was very simple, when all the causes of death were investigated . Tuber-
It is well tc bear in mind that tuberculosis became the champion cuiosis had jumped more than heart attacks had decreased . This was
because of the conquest of smallpox, a disease of babies and children . the real reason for the drop in heart attacks ; the patient was not living
The eradication of smallpox allowed many babies to live into a more long enough . Furthetmore, a careful look at the arteries in the hearts
advanced age group. and tuberculosis happened to specialize i i young of both groups clinched the interpretation . Adult patients, dying from
adults . Hence, for a century the majority of deaths among young adults tuberculosi :i during the war, had a very severe degree of damage to the
was due to tuberculosis ; however, the average age of survival had gone arteries of their hearts . In fact, had not tuberculosis won tiie race, the
up . Progress was being made . identical individual would have died from a heart attack in a very short
The antibiotics stopped deaths from many infectious diseases, and time . The conditions of war had altered his resistance to tuberculosis
the major conquest was in tuberculosis . Now the young adults by the and moved his death from the statistics of heart attacks to that of
millions began to live into another age bracket, the average age of tubercutosts . Diet had nothing to do with it .
survival making the biggest advance in history . This again indicated Two years later the conditions were reversed . The antibiotics
progress and not the end of the world . Heart attacks are a blessing in against tuberculosis had become available, and deaths from this dis•
disguise ; they :an be eliminated any time merely by bringing back ease fell like a lead pipe . Immediately deaths from heart attacks started
tuberculosis and lowering the average age of survival . to rise . The autopsies gave us the answer, the adult dying from a heart
This may sound facetious, but it has actually happened . During attack had healing tuberculosis in his lungs . The antibiotics had stop•
World War If the incidence of heart attacks decreased precipitously ped immediate death from tuberculosis giving the advanced arteridl
in Europe . This was hailed as final proof by the diet faddists that cho damage in the heart achance to become the winner . This is a very
leszerol was the villain in heart attacks . Choiesterol foods were scarce simple explanation for trne modem rise in heart attacks . It fits all t4e
during the war. Both observations are true ; cholesterol foods were facts and does not involve theoretical changes in the environment and
unavailable and heart auacks decreased, but the interpretation was diet . These may have a minor effect, but they are un ;mportant when
100 percent in error . The mistake was made because the "cholesterol compared to the tremendous number of lives saved from tuberculosis .
activists" bad not bothered to look at the protocols (records) of the The details of this investigation were published in 1974 .' li was pointed
autopsies carried out during the war, but had only counted those who out that the conversion of tuberculosis sanitariums to general hospitals
had died from heart attacks . is timely ; the instttutions are now caring for heart attacks . Twenty-five
I have personally reviewed 70 .000 autopsy protocols at Graz . yeats ago, the identical individual might have entered with tuberculosis .
Austria, carried out between the years 1930-1970 . Much more will be This is not the first association of tuberculosis and atherosclerosis
said later about this invaluable storehouse of knowledge ; only the (hardening of the arteries) . As early as 1919 . Herxheimer' noted in the
important facts will be presented here . At Graz, heart attacks dropped routine autopsies in Munich that patients dying with tuberculosis had
75 percent between 1939 and 1945, and it is true that people were not an advanced degree of arterial damage . I confirmed his observations
eating cholesterol foods during the war . However, the low cholesterol in reviewing the autopsy protocols at Graz ; it was unusual to find macro-
diet did not protect their arteries from hardening . A look at the arteries scopic (visible to the unaided eye) damage to the arteries of t'e ,se below
of the entire series of 2000 autopsies in 1945 revealed that the number the age of 30 . However, when suctL a case did occur, it was usually in a

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 THE RIDDLE IS SOLVED 5
4 Il K 1'J U 5 3 V O~OLVED : THE RIDDLEOF HEART AT-fACKS

person who had died of tuberculosis . In the adults having died from against heart attacks but are highly vulnerable . This is a NEW POPU-
tuberculosis, advanced atherosclerosis was the rule . LATION appearing on the scene during the 20th century .
The development of the science of Pathology gave new tools for In nature there is a simple explanation for each occurrence al-
the early diagnosis of atherosclerosis . Cutting tissues into thin slices, i though the answer is frequently elusive . Sometimes the answer is as
staining with appropriate dyes, and studying these preparations under obvious as the nose on your face, but we fail to see it . The physiology
the microscope permitted detection of damage before it would be explaining the association of infections and hardening of the arteries
obvious at a routine autopsy . In 1925, Zinserlingt studied the arteries has been around for a long time, but the forest has been obscured by
the trees . It will be learned in Chapter 5 that one of the most potent
of a series of children who had died from infectious diseases . He noted
that in some, beginning atherosclerosis was apparent as early as six facton in heart attacks is a thyroid deficiency . This was clearly estab-
months of age . In others, it was not present until the age of four, but lished in the last century, but it was forgotten since there were no heart
after that time, it was the rule to find detectable atherosclerosis . Strong attacks around at the time . The details will be revealed later ; only a
and a team of investigators' in 1969 confirmed Zinserling's observation few salient facts will be taentioned here .
in a study of tissues from the Charity Hospital in New Orleans . Central Thyroidectnmy (removal of the thyroid gland) in animals or in the
human soon leads to atherosclerosis . Thyroid administration will delay
America . South America, and in South Africa . All of the children in
this large group had atherosclerosis after three years of age . Since mosL or prevent this degenerative process . It was firmly established in the
children tiie from infectious diseases, it would appear that the individual last century that the thyroid-deficient animal or human was unusually
susceptible to any infectious disease is highly vulnerable to atherescler- susceptible to infectious diseases . Sherlock Holmes would not have
missed these two interlocking clues . If deaths from infection were
osis . Tuberculosis does not have a corner on the markec .
There seerns no doubt from thr last two references that children stopped, one might expect that the process of atherosclerosis would
dying from infectious diseases have started the process leading to heart continue until "death do us part ." It has happened . The details of how
it is accomplished are also quite simple . In 1877, Ord' demonstrated
attacks . !t is apparent that the conquest of tuberculosis, frneumonta,
that in the tissues of thyroid-deficient patients a glue-like substance,
meningiti.s, septicemia (infectton in the blood) and scores of other
derrastattsg infections by !he antibiotics has been the ntajor factor in called mucin . held on to water and started degeneration . In 1955 .
the explosrye rise of heart attacks . The number of individuals surviving Andersenr found that this same glue-like material developed in the
tissues of children torn without sufficient thyroid . The tissue content
beyond middle age has mushroomed ; consequently, a NEW POPI.'LA-
TION' of adults is alivr_ for the first time in history . was normal as long as thyroid was administered, but within six weeks,
The significance of Zinserling's observations escaped detection for if thyroid therapy were stopped, mucin rose rapidly . If thyroid therapy
were started again . the mucin content returned to normal .
many years because heart attacks were rarely seen at the time . Yet they
laid the foundation for a clear understa .iding of why heart attacks have The story now seems complete . Heart attacks were rare as long as
become so numerous. During all of recorded histo,y, part of the popu- infectious diseases killed off the susceptible individuals at an early age .
lation has survived into old age . Heart attacks were so rare among them [r+ previous centuries over half of the population never reached middle
that the disease was not established until the 20th century . These indi- age, and consequently had no opporturtity of dying from heart attacks .
viduals were relatively immune to arterial degeneration . The other Better medical care and the antibiotics during the 20th century have
segment of the population died comparatively early from infectious stopped the carnage from premature deaths dut to infections . It has
diseases . As soon as those susceptible to infections began to live beyond now been demonstrated that those susceptible to infections are also
middle age . heart attacks expiodcd . Zinserling found that this section more vulnerable to heart attacks . This NEW POPULATION is the
of society began forming atherosclerosis in their arteries by the age of major factor in the explosive rise of heart attacks in the 20th century .
six months. Individuals susceptible to infection have no immunity Does this represent a deterioration in the state of the health of the

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 !i itS0G53005
6 bOLVED THE R[DDLE OF HEART A'ITACKS

world'r Quite to the contrary . Many more years of fruitful living have CHAPTER Ill
been added .
This improvement can be well demonstrated by my studies' on the
routine autopsies at Graz . Austria, which were mentioned above and
which were reported in 1974 . Between 1930 and 1970 heart attacks
rose 1000 percent, far more than any other disease . This cause of death
was replacing only dearhs from infections as no other diseases showed
any decrease. Heart attacks were not occurring at an earlier age since What is a Heart Attack?
the average age of death from this disease in 1930 was 68 years and in
1970 was 66 years ; this diffc-rence is not statistically significant . Further-
How Often is the Diagnosis Wrong?
more . in 1970 with the tremendous rise in heart attacks only 6 percent The heart, situated behind the left breast . is the most impirtant
of them occurred before the age of 50 years . The senior citizens are piece of meat in the human bcdy . Its sole purpose is not for love but
responsible for most of them with 58 percent appearing after the age for carrying fresh food to each of the billions of cells in the body and
of 70 years . for carrying away garbage . In other words, it is a pump that moves
The tremendous improvement in health, in spite of the rise in blood -ontinuously through the blood vessels - much like a river car-
heart attacks, is seen from the average age of survival . In 1950 only rying commerce to various cities .
47 percent of all deaths occurred above the age of 50 years ; in 1970 Anatomically the heart is a complex bundle of muscles and nerves
this had risen to 67 percent . It is obvious •-•at heart attacks signify that containing four cavities which are equipped with valves that insure
health has been benefited to the point that patients now live long the flow of blood in the proper direction . The muscles on the right
enough to contract the disease rather than dying at a much rarlier side of the heart are not as thick as those on the left since the right
age from infections . Our problem is not how to stop heart attacks, heart forces blood only through the lungs and again back into the left
per se . but how to prevent the minority of them occurring at an early side of the heart . The left side of the heart must move the same quan-
age . There is a physiological difference between the patient who dies titv of blood not only thr, agh the head on one end but also the feet on
with coronary occlusion (interruption of blood flow to the heart) at the other end and finally back into the right side of the heart . The
23 years of age - the lowest in my experience - and another at ige 130 . more powerful left side of the heart must have a greater blood supply
The following chapters offer a rational approach to the preven- for its muscles-
cion of early heart attacks . Leading from the left side of the heart is a large tube called the
"aorta" whose branches must °F-rry blood to the far corners of the inai-
vidual . The first branches to lea,•e the aorta are the coronary arteries
which supply the muscles of the heart . They run over the external sur-
face of the heal t in small grooves so thac they are not compressed when
the heart muscle contracts . Any paehological process ineerJerrng rudih
the blood floweng through the coronary arteries may catue a heart
attack .
In a broad sense, any means of interfering with proper heart con-
traction may produce sudden death . An electrical impulse spreads
through the heart causing the muscles to contract in an orderly manner .
An electrical shock such as from lightning or from an electrical current
may interfere with the propagation of the electrical impulses in the

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 !{000530 t,
8 SOLVED : THE RIDDLE OF HEART ATTACKS WHAT IS A HEART ATTACK? 9

heart in which case a heart attack would occur at once . Such deaths values were well within the normal range . In September he collapsed
seldom happen and are usually dassed as "shock" rather than "cardiac ." at work while enroute from one office to another . There had been no
The usual heart attack - the one that is feared - is due to the warning or evidence of serious disease . The coroner's verdict would

hardening of the arteries or atherosclerosis . This is an insidious process have read . "hearx attack." had not an autopsy been performed . The
that may have been going on for years before the restriction of blood post•monem revealed a normal heart . Sudden, painless death was due
flow causes any symptoms such as chest pain or shortness of breath . to rupture in the brain of an artery that had been dilated since birth .
Rarely a tiny clot may break off elsewhere in the body, lodge in a cor- The second was a surgeon in his late sixties who had had an ele-
onary artery, and lead to instant death without any pain There may vated cholesterol for some years and in whom one might have expected
be no damage to the structure of the coronary artery in this instance . hardening of the arteries . While playing golf - his favorite pastime -
Only an autopsy will disclose the true cause of death in ttiese rarely- he suddenly collapsed with extreme weakness . He died in the ambu-
seen cases ; they are termed "coronary embolisms ." lance enroute to the hospital . Another heart attack? No . The autopsy
The coronary arteries may also be occluded suddenly if a blood revealed that the large artery, the aorta, which carries blood from the
clot forms locally in ther,e particular arteries . This happens frequently heart to the abdomen had ruptured ; consequently he had bled to death
in arteries containing considerable atherosclerosis ; the clot is only the internally . Again only the autopsy prevented another wrong diagnosis .
end point . Ofren the degree of hardening of the artery is mild and has These two cases illustrate clearly that sudden, unexplained death
not caused any chest pain . These clots, superimposed on the atheroscler- frequently may be due to a cause other than a heart attack ; - ithout an
osis, may occur at night when the circulation is diminished . The indi- autopsy the clinical diagnosis is often a very poor guess . No one knows
vidual may die suddenly without being awakened by the clot . ~ how often such mistakes are made, but the following facts, illuminated
The usual course of events. however, is for the patient during by two series of autopsy studies, indicate that among sudden death,
exertion to experience chest pain which disappears in a few minutes heart attacks are in the minority .
if one lies down- This limitation in activity increases as time elapses ;
eventually vigorous activity must be abandoned . Medications that WHAT ISN'T A HEART ATTACK
dilate the arteries will give some temporary relief, but they do not elim-
inate the cause of the problem . As the artery carrying blood to the flsy sudden, unexplained death not due to occlusion of one or
heart progressively narrows due to atheroscleresis, the heart screams more coronary arteries !s not a hcart attach . Yet in the absence of an
with pain from a lack of circulation, and effective muscular contrac- autopsy, such a death is usually signed out as a"hean attack" by the
tion is lost . Death soon ends the misery . family physician or by the coroner, in case the patient was not seen
Unfortunately sudden death has become synonymous with heart by a doctor recently . Granted that more of these individuals die from
attack . No doubt heart attacks are numerous, but many other diseases coronary disease than from any other single disease, still the total of
may cause sudden death . The death certificate must carry a diagnosis, non-coronary, sudden deaths exceeds the total of heart attacks .
and "heart attack" is convenient . A discussion of other causes of death One seldom hears about the deaths from the multitude of other
will follow . but two instances of my acquaintance will illustrate the point causes since the only way they are recognized is from the autopsy . Rarely
A 51-year-old male was employed by a Building and Loan Asso- are postmortem examinations made due to public apathy . Experience
ciation . He had retired from 20 years of service in the Air Force and in Austria, where autopsies are mandatory, clearly indicates that,
had always passed his military examinations without evidence of disease . once established, the public thinks no more of a routine autopsy than
For 12 years he had been a patient of mine and was on thyroid therapy . of a tonsillectomy or excision of the gallblader . As a matter of fact, the
Annual examinations included a chest x-ray, electrocardiogram, autopsy is far superior to surgery since the patient does not awaken
urinalysis, many blood tests, as well as the interim history and the with the ronfusion, vomiting, and headache so often encountered
physical examination . His last examination was made May 28 . and all after an operation .

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lU SOLVk.D . rHE RIDDLF OF HtART AITAr ::KS W HAT [S A HEA RT ATTACK? t t

The renowned Empress Maria Theresia invited the Dutch F•hy- were more than 40 .000 autopsies studied between January 1942 and
sictan, Gerhard van Swieten . to come to Austria in 1745 . He become January 1946 . Those under 40 years of age, having died unexpectedly,
physician-tn-waiting for the Empress . taught at the medical school . were studied by Mortiz and Zamcheck (Archrves of Pathology 42 :459,
and held directorship of the court library . The public Fealth of Aus-ria 1946) . Here was a group of apparently healthy men who had passed
was in a hornble condition at the time . Van Swieten pointed out that physical examinations to enter service, and were under close medical
at the municipal hospital . out of 600 consecutive births . 580 children supervision . They had available free medical care including hospital-
perished . A law was passed that each death in a hospital should have ization, the Utopia so strongly urged us by some politicians of the
an autapsy - an edict that still stands today . moment . None of them were incapacitated for more than 24 hours, or
Austria became the Mecca for medical education . They no lorger they would have been forced on sick call by their superiors .
guessed at the cause of death, but in each case the physician could see There were approximately 1000 cases between the ages of 18 and
any mistakes he had made . So many of the American physicians flocked 40 . Were these sudden deaths all heart attacks? In civilian life they
to Vienna for post-graduare study that a group of them founded the would have been so labeled unless an autopsy had been performed . In
American Medical Soctety of Vienna in 1879 This organization is still reality, less than one-third were due to heart attacks . It is apparent
in existence and arranges courses for itinerant physicians visiting the that the significance of heart attacks below the age of 40 has been, as
home of music and the waltz . It was through the American Medical Mark Twain said about the reports of his death . "grossly exaggerated ."
Society of Vienna that I became acquainted with the invaluable records Space allows only time to mention two other conditions causing
of routine autopsies which solved the riddle of heart atta• :ks . This will sudden, unexplained deaths in young soldiers . Ten percent of the total
be discussed in a later chapter . were due to hemorrhage in the brain . Even socialized medicine can do
If the American physicians retutning from Vienna for the past nothing toward the detection nor the prevention of these untimely
100 years had insisted on routine autopsies in America . the Riddle of deaths . Rupture of the blood vessels do not depend upon exertion
Heart Attacks would not be news today . and countless millions of dol- since one-third occurred during sleep and only 17 percent during
lars as well as precious time of many scientists would have been spared . exercise .
Little did Maria Theresia realize two hundred years ago that her proc- Another 10 percent of the young adults suffering sudden death
lamation would solve the major problem in medicine in the 20th century . was caused by meningitis . Death usually occurred within 24 hours
Although most deaths in ti :e United States are not autopsie,l, it after onset of symptoms, and 7 of the 110 deaths in this group were
is only from the infrequent ones that the true incidence of heart att acks dead in the barracks without having been on sick call . About 15 percent
can be assessed . The abuse of calling each sudden, unezplained death of the young, sudden 3eaths had nothing to explain their deaths even
a heart attack was the subject of an editorial in one of our leading at autopsy, but heart attacks could be definitely ruled out . Hence, it
medical journals (New England fournal of Medicine, 262 :149, 1960) . is apparent that to label all sudden deaths "heart attacks" is as serious
Entitled "The Convenient Coronary ." the article discusses a review o ; an error in mathematics as a drunken husband's alibi .
3557 death certificates in Peratsylvania where the error of diagnosis The second reponl clearly indicating that heart attacks are in the
was estimated to be between 27 and 63 percent . Such errors are hardly minority of sudden deathe . comes from a series of 275 consecutive
an educated guess . Yet, it is from these inaccurate statistics that money autopsies among ages between 20 and 45 seen in New York City by the
is raised for research, and the figures are used to convince the pt•blic coroner . Only 28 percent were due to coronary artery disease, less than
that the world is coming to an end . one-third of the total .
Only two sets of autopsy data will be mentioned here to refute Deaths from respiratory diseases accounted for 18 percent and
the clairns that heart disease must be stopped at all costs . The first one•seventh of these were due to tuberculosis . This disPase cannot be
comes from autopsies of military persortael during World War fI . Tltere written off as unimportant in spite of antibiotics . Pneumonia, asthma,
and other respiratory diseases completed the picture . Deaths from dis-

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 h K1005 :50 ~ ~ SOLV ED- THE RIDDLE OF HEART A ITACKS
12

eases of the central nervous system accounted for 22 percent of the CHAPTER III
total . Hemorrhage and meningitis accounted for most of them just as
in the soldiers in World War 11 . The gastrointestinal tract made up
13 percent of these tmtime :y deaths, while 4 percent were due to diseases
of the urinary tract with kidney infections predominating-
These two excellent autopry sttudies clearly indicate that more
than ttoo-thirds of the sudden deatqs, tursally listed as heart attacks,
are due to diseases that may arise anymi+ere in the body . The phobia The Cause of Heart Attacks
against heart disease must stop, and a more rational explanation for
Credit for realizing that thyroid deficiency is one of the most potrnt
our changing death patterns :nust be found . Certainly more medical factors in causing heart attacks must go to the pathologists of Vienna
care is not going to solve the problem, since the military with unlimited
about 1890 . They did not appreciate the significance of their discovery
medical facilities has about the same ratio of sudden deaths as is seen
since heart attacks had not been described as yet ; they could hardly
in civilian life. claim credit for ct :ring a disease that did not exist . However, their keen
if the actual number of heart attacks are less than one•third the observations led to some experimental work in which atherosclerosis
number recorded, are they the menace that they are alleged to be?
was produced in animals, again long before the new disease in man
The answer is an emphatic, "NO ." The misleading figures are being was described . For 85 years conclusive evidence has been accumulating
used by those investigators ao anxious to feather their nests from more
to substantiate their observations, but we must go back even further to
grants from the government or from the donations to health agencies
understand how the pathologists happened to make their outstanding
that support research . By keeping the exaggerated problem before contribution .
tlie public, Congress is spurred for larger sums to be appropnated for
Our story begins in 1873 when Sir William Gulls discussed before
investigation . This seems to be an unjustified waste of public funds .
the Clinical Society of London Fve peculiar cases in women . These
A practical method of eliminating premature heart attacks is
patients had many of the features of cretinism, a condition known to
presented in the following chapters . be associated with a lack of thyroid activity . Cretin children fail to
grow and develop normally either physically or mentally . In Gull's
adults the condition appeared long after growth and development were
completed ; otherwise, there was similarity in appearance and behavior .
Another astute London clinician, Dr . William M . Ord .' was for-
tunate enough to obtain an autopsy in 1877 on a similar case in whom
he had watched the disease progress for six years . There were no unusual
diseases in her family . She had borne two normal children, went through
the menopause at age 44 and had considered herself well until the age
of 49 when she began to have "shivering spells" and on occasions wouiri
pass bloody urine . Previously she had worked hard as a seamstress to
support her ailing husband . Soon her hands became numb and clumsy ;
to handle a neadle was difficult . Her mental faculties decreased ; her
movements were slow and awkward ; she had difficulty in speaking,
and she fell asleep unless she was moving about . Her efficiency de-
creased to the point that it took her two hours to dress . Her skin and

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 THE CAUSE OF HEART ATTACKS 15
l; SOLVED tHERIDDLEOFHEARfr\IIACKS

especially the face became swollen until there was no expres,ion . She had been produced in the animals by removing the thyroid, leaving
died at the age of 60 in a coma . no doubt about the cause of myxedema . Consistently, autopsies on
At rhe autopsy there were several outstanding findings, the most humans confirmed a decreased function of the thyroid gland .
remarkable of which was a swelling of the skin and of all of the con- About the same time, Professor Kocher, a surgeon in Berne, :
Switzerland, was making some similar observations . For centuries, in
nective tissues . Apparently, the fluid was held in combination with
something such that the cut surface did not release water . This was some regions of the world, the thyroid gland would enlarge so much
quite different from cases of kidney failure in whom fluid would run that the windpipe would be compressed, and the patient would suffo•
cate . These growths were called goiters and their regions of occurrence
freely from any incision . Other findings relative to our present discus-
were called "goiter regiona ." Kocher" perfected a technique whereby
sion were : (i) the thyroid gland was replaced with fibrous tissue, and
12) the entire artenal system showed advanced atherosclerosis . The the entire thyroid could be removed with a reasonable chance of saving
arteries to the kidneys, to the brain . as well as the coronary arteries to a life, and in 1889 . reported 101 cases . Not long after removal of the
the heart were lined with deposits limiting the flow of bhwd . Ord entire thyroid, symptoms similar to those described by Ord in 1877
decided that the absence of the thyroid gland was responsible for these began to develop . Kocher called this miserable condition "cachexia
strumipriva," or debility due to loss of the thyroid . He had prevented
pathological changes .
He called in an expert chemist to determine the nature of the strangulation only to have the patient die from myxedema in a few
sufistance that was binding the water in the tissues . This was a new years . He soon modified his operation and left some of the thyroid
intact ; this practice is still used today .
phenomenon that had not been encountered in the past . Chemical
analysis revealed that those tissues with a high water content contained Professor Billroth (the eminent Vienna surgeon who perfected the
an unusual amount of mucin, a thick, glue-like material . This sug- stomach-ulcer-operations that are still used today), was also seeing
gested a name for the new disease, and Ord coined the term "Myx- some of the huge goiters . His experience was the same as Kocher : after
total tFyroidectomy, the patients soon died from myxedema . Austria
edema ." "Myx" - coming from the Greek word meaning m .lcin, and
"edema" - describing the water-logged tissues . This name has per- was in a unique position to make a major contribution ; in compliance
sisted to the present day and signifies a marked degree of thyroid with the law, all hospital deaths were autopsied . The pathologists soon
deficiency . Still, there are patients with subnormal thyroid function noted that after total thyroidectomy autopsies revealed an exaggerated
in whom the tissue-swelling is not so prominent . hardemng of the arteries . This confirmed Ord's autopay of advanced
At once, orher physicians tecognized similar cases, and realized athersclerosis in his original case of 1877 .
that this new cliaical entity was rather frequent . So much interest was Professor Billroth was a scientist as well as a skillful surgeon . The
aroused that in 1883 the London Clinical Society created the first marked damage to the arteries aroused his curiosity . He assigned one
"Think-tank" in medicine to thoroughly study the new disease . Some of his students to investigate the arterial changes in animals after
of the leading clinicians, a chemist and a physiologist made up the removal of the thyroid gland . The report by von Eilsberg'2 in 1895
13 member Commission . For five years they collected similar cases, clearly showed that removal of the thyroid from the sheep or goat
corresponded with investigators in foreign countries, and tabulated would produce arterial degeneration in arteries throughout the animal
information totaling over 300 pagec in the published report of 1888 .10 including the coronary vessels supplying the heart . It was fortunate
Over 100 cases of myxedema had been collected . The ch•emist had that herbivora - animals that cat only plants - were chosen for the
confirmed that mucin was the agent holding on to water . Sir Victor experiment since these animals never eat cholesterol-contatntng foods .
Horsley . the physiologist, had removed the thyroid gland from the Cholesterol is not found in the plant world . Thts was long before cho-
monkey, swine, sheep and donkey . In each instance within a matter of lesterol was associated with atherosclerosis . This early experiment
a few weeks, the experimental animals developed swellings and an clearly demonstrated that thyroid deficiency, and not dietary choles-
excess of the mucin in their connect ;ve tissues . The clinical syndrome

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16 SOLVED THERIDDLEOFHEARTA"tTACK .S THE CAUSE OF HEART ATTACRS 1 7

terril . was implicated in arterial degeneration whose characteristics Anitschkow's laboratory in 1965 there came an explanation for the
were similar to those in the human . observations on rabbits . Malasheva10 reported that huge doses of
By this time active preparations were available for treating thyroid cholesterol suppressed the thyroid function in rabbits as completely
deficiency . In lb .l1 Murrayts found that a glyrrrine extract of fresh as thyroidectomy . As pointed out above, any means of reducing thyroid
animal thyroida could be injected into humans suffering from myx• activity leads to atherosclerosis . The atherosclerosis in the cholesterol-
edema, with complete relief of the symptoms. In fact . the first patient fed rabbits was due to the low thyroid function and not due to the
whom Murray treated began medication in 1891 and stopped treatment cholesterol itself .
in 1919 when she died at the ripe old age of 72 . She had been shifted to Even war sometimes makes a contribution to science . It was dur•
oral tablets after it was found that the hormone was not desttoyed by ing World War I that the next great stride was made in establishing
digestion . However, her life had been saved by the glycerine extracts thyroid deficiency as the culprit in atherosclerosis . Zondek," a Ger•
started 28 years earlier . man physician, noted that some cardiac cripples displayed many of
A few years after von Eilsberg h-+d produced arterial degeneration the signs and symptoms of myxedema . Such cases failed to respond
in the herbivora by thyroidectomy, Pick and Pineless,'• also in Vienna, to the usual therapy of digitalis (a heart medication) . Their hearts
repeated his work and carried it one step further . Not only were they were enlarged . their tissues were water-logged, they were short of
able to confirm the degeneration in the arteries going to the heart of breath . they were weak, and some were bed-ridden . To his amazement,
goats . but if they gave thyroid hormone to the thyroidectomized animals . thyroid therapy soon restored their health and they were back to work,
they could prevent the atherosclerosis . Then the story was complete . or if in the military, they returned to duty . He named the new entity
A disease of man could be produced in the experimental animal merely "Myxedema Heart ;" it differed in no way from myxedema described
by removing the thyroid gland, and the administration of thyroid above except that the heart failure was predominant .
hormone could prevent the disease in the susceptible animal . Thus, Following the war, Zondek wrote a book, Diseases of the .Endocyine
before heart attacks were described as a clinical entity . their cause and Glands, published by Williams and Wilkins . Baltimore . Md . This was
cure were known . However, there was no place to use this knowledge . translated into English :n 1944 . Every physician should read this
and it was forgotten by the time it was needed . masterpiece . In the chapter on Myxedema, page 180 . he shows electro-
In 1913 a Russian physiologist . Anitschkow" reported an experi- :ardiograms displaying the low voltage as a result of the feeble beat
ment on rabbits that was ro change the history of atherosclerosis for of the heart . Following thyroid therapy, when the heart is contracting
60 years . He fed huge doses of cholesterol to the rabbit, a vegetarian . in the normal manner with more power, the voltage on the clectro-
that never eats cholesterol-containing foods and whose liver is not cardiogram (EKG) is retumerf to normal excursion . I have found that
equipped to excrete the excess . The concentration in the blood went often the low voltage on the E+tG reflects the status of the thyroid better
up several hundred percent ; such concentrations proved toxir, . Stress than the commonly used blood tests .
caused some atherosclerosis of the blood vessels . This was not a physio- In 1919, another Gerr,tan physician, Assmann,'s confirmed Zon-
logical experiment, but a pathological finding . Anitschkow realized dek's observations on Myxedem Jeart and pointed out that no age is
that it had no practical significance, and never suggested tF.e use of exempt . His 20-year-old lieutenant had to be evacuated from the front
diet in controlling atherosclerosis . lines because of a loss of memory, extreme fatigue, and inability to
Similar administration of cholesterol to the rat, the dog . or even carry on his duties . The heart was markedly enlarged . there was edema
the human is not followed by such elevations in serum (blood) choles- of the skin and extremities- the temperature was quite low, the pulse
terol or atherosclerosis in the arteries . These species ingest cholesterol was 50 and the blood pressure was low . There was no response to digi-
in their diets, and their livers possess enzymes that destroy the excess talis and diuretics (medication to help eliminate excess water from the
cholesterol . Although it will be pointed out in the final chapter that body), but following Zondek's lead, thyroid therapy promptly elevated
cholesterol is not imponant in atherosclerosis, it seems timely that from tne pulse, the blood pressure, and the energy . The heart returned to

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Iti 5tjLVED 7 HE RIDDLE OF HEART ,1TrAC1:5 THE CAUSE OF HEART ATCACKs ! 9

norma! sL :e . and the other symptoms all disappeared . !t rs obttous that IeveL and the atherosclerosis by simultaneously giving some thyroid
young :nditadrsal.s can devetop severe, incapacitating heart disease as hormone . He reasoned that the thyroid was controlling the other fats
a result of thyrord deficiency and that this disease rs readily amenable in the blood as well as the cholesterol . Any of the fats might be affect-
to thyroid therapy ing the atherosclerosis . He et•en advocated the use of thyroid prophyl-
Myxedema Heart came into focus all over the world . Scores of actically in the human for those with an elevation of the serum fats . If
reports soon appeared : only a few will be mentioned . Several important this contribution had been pursued, atherosclerosis would have been
lessons were soon iearned . but some physicians were negligent in keep- conquered years earlier and much time would have been saved .
ing up with the new information . Christian" in Boston had one patient In addition, Simonds brought out the close association of the
who died suddenly before any medication was given . An autopsy re- thyroid with fat metabolism in 1932 .'r He found that making dogs
vealed marked narrowing of the coronary arteries so typical of heart hyperthyroid (too much thyroid hormone) with administration of extra
attacks . The same author had another patient . a 73-year-old woman, thyroid, the animals could tolerate much larger quantities of fat with-
who had been taking thyroid for 25 years . She stopped the medication out elevating the level of fats in the blood . if the fat levels in the blood
because she felt it was causing a pain in her shoulder . Soon she developed are elevated in hypothyroidism (too little thyroid hormone) . it is no
angina (chest pain) and other symptoms of an impending heart attack . surprise that they should be found low in hyperthyroidism since the
After returning to small doses of thyroid . again her symptoms dis- elevated metabolism would burn up more fat .
appeared . Hurxthal . a physician at the Lahey Clinic, where many hyper-
For 10 years . hundreds of patients with evidence of heazt disease thyroid patients were operated, was in an excellent location for the
were improved by small doses of thyroid . [t was soon learned ch .at the study of this question . In 1934 he found that the patients with coo
thyroid could not be used recklessly for heart failure, as digitalis had much thyroid secretion had serum cholesterol levels below the normal
been in the past . lt was customary to give large doses of digiialis . and range ." After the thyroidectomy, the cholesterol would start to rise,
then curtail the dosage as improvement began . But, the largr doses of and if too much thyroid had been re .•noved, the cholesterol would rise
thyroid put too much of a load on the heart, and death might occur above the normal range . Under these circumstances administration of
in a short time . On the contrary . a small dose of thyrota in the begin- some thyroid hormone would bring the cholesterol down to the normal
ning . followed by a gradual rise in dosage, lead to a marked improve- !ee•el . The relation of cholesterol to the metabolic rate was so sensitive
ment in the angina, in the size of the heart, and in the condition of the that Hurxthal suggested the use of the serum cholesterol as a diagnostic
patient . In 1925 Stnrgis'° reported in the Jourrtal of the A merican test for thyroid function . He suggested that an elevated serum choles•
Medical Association 26 well-studied cases from Harvard . For individuals terol was an indication for thyroid therapy . if no other reason could be
with heart disease only one grain of thyroid daily was recommended found for the elevation .
in the beginning a:id usually not more than 2 grains were necessary Hurxthal's observations were on adults and in them the cholesterol
for maintenance . does often reflect the thyroid state . I have routinely run cholesterols
As time passed . it became apparent that heart attacks aere more on all patients during the past 25 years . Those patients with elevations
than a disturbance in the cholesterol in the serum . It seems ;ronic that usually need thyroid therapy, but some adtilts and most younger patients
Anitschkow should be frequently quoted for his choleaterol-feeding to may run normal or below normal cholesterol readings, yet be in dire
rabbits which he admitted at once had no significance, yet rarely does need of thyroid . Two conditions, both rare and easily ruled out . may
one find any reference to a major contribution from his laboratory by elevate cholesterols and still do not need thyroid . One is nephrosis, a
one of his students . Friedland .s1 The latter began working on choles- condition in which large quantities of protein are lost in the urine .
terol and other fats in 1927 and published his full report in 1933 . He Since much of this protein must be manufactured in the liver, this may
found that if he fed the rabbits large quantities of cholrsterol, as interfere with the elimination of cholesterol by that organ . Liver dam•
Anitschkow had done, he could prcvent the high serum cholesterol age may al:o be associated with an elevated cholesterol since the excre-

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!O SOLYED THE RIDDLIi OF HEART ATTACKS THE G1USE OF HEART ATt'ACKS z l

tory process is retarded . But . these two exceptions do not interfere fats would respond to thyroid therapy in small dosages without any
with the routine use of thyroid for hypercholesterolemia (too much evidence of harmful effects .
cholesterol in the blood) . During the 20-year-interval since Zondek had described Myxedema
Some additional information on feeding rabbits cholesterol was Heart, hundreds of patients were successfully treated with thyroid
added by Turner in 1938 .24 He repeated Anitschkow's work of 1913 as hormone . It became obvious during this interval that the new disease,

well as Friedland's in 1927 . Indeed, some strains of rabbits developed heart attack, was becoming much more frequent, and autopsies left
a high serum cholesterol and atherosclerosis after prolonged adminis- no doubt that they were due to atherosclerosis of the coronary arteries
tration of cholesterol, while other strains . fed in the same manner . so intimately associated with thyroid deficiency in either expenmental
developed neither the elevation in serum cholesterol nor the damage to animals or spontaneously in man . Many patients with the symptoms
the arteries . He found that the response was related to the function of and physical findings suggesting an impending heart attack regained
the thyroid . If he administered thyroid al .,ng with the cholesterol to their health on small doses of thyroid .
the strains developing arterial damage . they were protected from Then came a terrorist's bomb . In 193826 a recently graduated
atherosclerosis just as Friedland had reported . These results suggested physician, lacking in experience and apparently unacquainted with
that it was the thyroid deficiency which was responsible for the damage the enormous literature establishing thyroid as a safe medication in
and not the cholesterol itself. Proof was found by thyroidectomizing idyxedema Heart, wrote a scathing attack on the use of thyroid in
the strains of rabbits in which cholesterol feed :-ig produced no delete- heart disease . His single experience was in a female f•S years of age
rious effects- These animals then lost their immunity and developed who had 'ueen diagnosed hypothyroid five years prevtously and had
both elevated cholesterol levels in the serum and atherosclerosis in been treated successfully with thy-roid by another physician . She had
their areries . not received any thyroid for two years when she consulted the young
Thus, years before the rapid rise m heart attaclrs, cholesterol was physician for anginal pain requiring nitroglycerine (which dilates
exonerated as the culprit, and thyroid deficiency wa, Jirmly establisieed arteries) for relief . The basal metabolism was minus 41 percent and
as the cause of atherosclerosr's . Another much neglected report was by the serum cholesterol was 540 mgs leaving no doubt that she had Myx-
Gildea2' from Yale University in 1939 . He and his colleaP.~ues were edema Heart . She was put on 4grazns of thyroid daily ana died with a
studying a series of patients with elevations in the serum fats . Of the heart attack on the 8th day.
fatty acids in the blood . 50 percent is united with phosphorus and Obviously this physician was not acquaittted with scores of reports
protein, the so-called lipo-proteins . 25 percent is combined in triglyc- over the previous 20 years nor with the warning of Sturgis in 1925 that
erides . 20 percent is united with cholesterol and only 5 percent is free such patients with heart disease should be started on one grain daily
fatty acids . Some investigators have felt that the elevated lipo-proteins and seldom needed more than 2 grains for maintenance . The recent
are responsible for atherosclerosis rather than cholesterol . Others have graduate then reviewed the literature and emphasized that eight deaths
blamed the triglycerides alone . Gildea found that all of the serum had been recorded previously . These were the cases that had occasioned
fats could be brought down to normal levels with the use of nothing the previous warnings for the use of a small dosage . I reviewed each of
but thyroid therapy . these reports and found that from 4 to 30 graens daily had been used
Some of the patients in his series were definitely hypothyroid with in the fatal cases . Such colossal errors in therapeutics would lead to
the usual symptoms and low metabolic rates . Others had neither the disaster with any med ;zation . The neophyte investigator made no
symptoms nor the low metabolism . but both groups responded to mention of the hundreds of cases treated successfully with the proper
thyroid therapy with a lowering of the fats in the blood . In retrospect . dosage of thuroid, but only emphasized the "potential danger" of such
it seems plausible that most of the patients had some degree of thyroid therapy .
deficiency since the basal metabolism test for thyroid function is not Years of progress were lost because few physicians had the oppor-
fool-proof. At any rate, it was clearly demonstrated that eievated serum tunity to review the extensive literature, and only Look the latest report

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22 sOLVEU tl IE RtDDLE OF HEART A ITACiIS THE CAUSE OF HEART ATTACKS 25

as 'gospel" on the subject . To this day many physicians, nurses and University Clinic, with an average age of 61 years . Many in this group
health educators remark that thyroid therapy is likely to c .mse heart had evidence of atherosclerotic damage to the heart and other organs .
disease and would not think of using it as a prophylactic proc,•dure . The third group was still older and averaged 67 years of age . They
It was probably this tragic publication that caused a ven, seasoned were confined to an infirmary and presented advanced generalized
invesugator to err in the opposite direction . tn 1946 the latr Dr . Paul
atherosclerosis, some even having the arteries in their legs showing
Dudley White and Jakob Lermant' made a series of metabolic studies calcium deposits on the x-ray .
on 28 patients under the age of 40 recovering from heart attacks . The Some of each group served as controls while others were put on
majority showed low metabolic rates and high serum cholesterols rang- small doses of thyroid over the following five years . The number of
ing up to 490 mgs . Thyroid therapy was tried with gratifying results : heart attacks or strokes were recorded for each age group and for
no angina was precipitated in those free of this complaint ; angina both the controls and the treated subjects . Among the younger business
present at the start disappeared in all but two cases ; the basal metabolic
men there were no deaths among the thyroid treated subjects . but
rate tended to go up . and the cholesterols fell . among the controls 15 percent had fatal strokes or heart attacks . Ob-
These investigators were on the threshold of a successful preven- viously- the patients with low thyroid function were susceptible to
tive and prophylactic program for heart attacks . but their observations atherosclerosis, and if thyroid therapy were started by age 55, many
were not pursued . Years later when my own work indicated identical premature deaths could be prevented .
findings I wrote to Dr . White to inquire why he had abandoned the
In the patients with demonstrable moderate atherosclerosis aver-
use of thyroid . He replied that after a few months the cholesterol levels
aging 61 yeats of age, the results of thyroid therapy were again dramatic .
began to rise again, and he had felt chat this was not the arLswer . The Among those receiving thyroid therapy, a 3 percent mortality occurred .
last line in his letter revealed the tinfortunate mistake . He said that In contrast, the controls suffered a 19 percent loss - over 600 percent
perhaps their dosage was to smal for they had be n using only oneh tenth to one greater death rate . Even in the advanced-age and arterial-damaged
.yuarter grains daily . The scare in 1938 may well have group, thyroid therapy again demonstrated its efficacy . At the end of
influenced their judgement, or I would not be writing this hook in an i
tite observation period these patients had an average age of 72 years .
attempt to straighten out the confusion . If White and Lerman had
yet there were one-half as many deaths among those receiving thyroid
used the previously recommended one grain daily, the riddle of heart as among the controls . These clear-cut results should have started the
attacks undoubtedly would have been soived many years earlier . It was investigators back on the use of thyroid . This was the iirst controlled
Dr . Whice who was called from Boston when Pres+dent Eisenhower had study reported . Furthermore, there were no dangers from thyroid
his heart attack in Denver . therapti among this large group of patients . The errors in dosage. which
In ! 951 a milestone was passed . Professor Wdliarn B . itiountz'0 of had caused the scare in 1938, were avoided .
Washington University in S. . Louis decided .hat the physiolrgy pointed However . by this time many of the xientists and clinicians were
clearly to thyroid deficiency as the culprit in atherosclerosis . ::n a rr,ona- off on the cholesterol tangent . Huge sums were being appropriated
graph entitled . Tltyrotd Function and its Possible Role itt Vascular for research in this field ; the money must be spent so more would
Degeneration, he reviewed the literature up to that time as mentioned
follow . There was no time to consider any other approach since the
in Chapter One, and did not fail to use small doses of thyroid as sug-
theorists promised that all that was needed was to lower the cholesterol
gested by Sturgis in 1925 . He r.ollected 288 patients with low basal
levels in the blood, and the food manufacturers guaranteed that it
metabolic rates . many of whom had elevated serum cholesterol levels .
could be done with polyunsaturated fats . This mammoth error will
The patients were separated into three age groups, the first being
be unmasked in the last chapter . It became obvious as time passed that
business men . with an average age of 55 years . who were privite patients
heart attacks were climbing year after year in spite of modifying living
in his practice . Many of them had very little evidence of atherosclerosis habits and diets . Obviously there was an error some place, but the
at the stan of the study . The second group were out•pattents at the

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24 SOLVED THERIDDLEOFHEARTATI'ACKS fIIECAtJSEOFIILARi Af IACKS 25

cholesterol enthusiasts have a professional standing to p:otect, and they be tightened periodically to restrict the flow of blood through the
are going to fight to the bitter end . kidney . In hypothyroidism there is a reduction in blood-flow through
The final proof that the thyroid deficiency was the missing link all the organs including the kidneys . Atherosclerosis in the kidney
in atherosclerosis came from Denmark in 1955 . The mucin, causing artery could further reduce the blood•flow as effectively as Goldblatt's
the edema in Ord's original autopsy in 1877 and promptly appearing clamp. Hypertension is very common in hyporhyroidism . Rarnes3l has
in Sir Victor Horsley's thyroidectomized animals in 1888 . has received recently reported that thyroid therapy alone was found to relieve
a tremendous amount of investigation in the meantime . It has been 80 percent of the elPvatetd blood pressures seen in a general practice
found tt.at there are many compounds having the property of holding during the past 25 years . Children from patients with hypertension
onto water ; they have been renamed mucapolysaccharides . They are have been found low in thyroid function, and thyroid therapy in the
always present in atherosclerosis and in most other pathological states offspring with hypertension has been quite efficacious .
such as cancer . arthritis, hype:tension, diabetes . etc . They are combi• The observations of Andersen leave little doubt that thyroid
nat,ons of complex proteins with one of the sugars in the molecule . defiriency can be a potent factor in the genesis of atherosclerosis and
It is probabiy more than coincidence that their concentration in the hypertension in children . Obviously, if prevention is to be achieved,
connective tissues promptly increases in thyroid deficiency . Andersen,t' one must look continually for hypothyroid symptoms from the time of
using a tiny punch-biopsy of the skin on the atm, studied the mucopoly- birth . The earlier a diagnosis of hypothyroidism can be made and
saccharide content in 99 children between the ages o[ three tnonths appropriate therapy started, the better will be the chances of avoiding
and 15 years . Among the group were 52 children with no evidence of a premature death from a heart attack .
thyroid deficiency ; none of them showed any elevation of the muco-
polysaccharides in the skin . There were 26 with symptams of thyroid
deficiency and were on therapy . If the thyroid were stopped for a
month . the skins began to show an abnormal accumulation of the
mucopolysaccharides . If the youngsters were again put on thyroid
therapy. the concent,ation of the deleterious mucins declined . Andet :sert
suggested analysts of the skin for mucopolysacc'tarides as a superior
methnd for diagnosing thyroid deficiency in children .
This clear demonstration of pathological changes in the tissues
of a baby three months of age gives a rational explanation for the
established fact that hypertenston or atherosclerosis may begin in
childhood . Both diseases occur freyuently in some families and not
in others . The same is true for hypothyroidism . It would appear that
the low thyroid function even in an infant can start the pathological
damage to the blood vessels by depositing the mucopolysaccharides in
the walls of the arteries . This process could be the forerunner of the
accelerated atherosclerosis which has been demonstrated in all of the
arteries of thyroidectomized animals and in humans with low thyroid
function .
Hypenension (high blood pressure) is closely related to kidney
function . Go'dblattrO produced fatal hypertension in dogs raany years
ago by placing on tne kidney artery a simple metal clamp that could

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 CHAPTER IV

Symptoms of Thyroid Deficiency

My interest in the thyroid gland grew out of necessity rather than
choice . The late Professor of Physiology, Anion J . Carlson, arbitrarily
a:aigned this subject for my doctoral thesis when I entered his depart-
I menc at the University of Chicago over 45 years ago . I would have pre-
ferred another subject, but during the depression one was so happy to
find any job permitung the continuation of education that no objec-
tions were raised . As time passed, the wisdom of this great educator's
decision was more than justified . He was aware that many secrets of
this tiny gland remained undiscovered, but I am sure that he had no
idea that this humble beginning would solve so many of the problems
in medicine Heart attacks had not appeared on the horizon at that
~ time . Neither of us foresaw the solution of this major problem of .ne
century .
My duties included teaching the medical students a class in endo-
crinology on the mysterious glands of internal secretion . One of the
glands would be remov~d from an experimental animal, and the stu-
dents would follow the development of disease caused by the glandular
deficiency . If the pituitary were removed, growth and development
ceased, and many organs of the subject malfunctioned- Removal of
the parathyroid glands led to muscular contractions as a result of the
drop of calcium in the blood . If the pancreas were removed from a
I dog, diabetes developed at once, and the students could follow the
treatment . Removal of the adrenals soon led to disturbances in the
I mineral metabolism and the blood sugar : death promptly occurred .
The role of the ovary in the menstrual cycle aad reproduction was
i studied in the white rat where the cyclr is repeated every four days .
However, the most dramatic story was the loss of the thyroid in
baby rabbits only 3 weeks of age . Within 2 weeks, growth was retarded,
the fur became dry and brittle, the ears drooped, and mus,les became
weak with the development of a poc•belly . Bone development was

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abnormal, and body temperatures were subnormal ; they did not develop the century . Having seen that bizarre symptoms could be relieved in
sex characteristics, were sterile, and they seemed to lack normal intel- the cretin rabbit by thyroid therapy . I was prepared to try thyroid
ligence . They became sluggish and did not play together as normal eherapy for similar symptoms in the human . During 40 years of clinical
animals do . they became anemic . were susceptible to repeated respira• observations, I have found relatively few patients suffering from psycho-
tory infec :ions . and died at an early age with pneumonia . Animals or somatic disease . It is reasonable to suspect that a clue has been missed
humans presenting these bizarre symptoms are called cretins . It was in those not showing organic changes . Some of my contemporaries
apparent that every cell in their bodies was affected by loss of their feel that 90 percent of their patients are plagued with mental disorders .
thyroid glands . These results are not surprising, fo- although it is still There has been a*teady stream of these coming to my office : in most
not known all that the thyroid hormone does . it certainly controls the cases thyroid deficiency has been overlooked . Some colleagues are
rate at which each cell burns the food that gives us energy . Hence, convinced that it is I who has psychosomatic disease, but if relieving
every part of the organism is sff :cted by loss of this important hormone . patients' symptoms with thyroid therapy will cure their miseries . I shall
After teaching this course and doing extensive research on the be glad to carry the accusation to my final resting place .
loss of the thyroid hormone in experimental animals for ftve years . I Observations on the baby rabbit left no doubt that symptoms of
then finished medical training and began its practice . Past experience thyroid deficiency might originate any place in the animal . Years of
of having seen such bizarre symptoms disappear with thyroid therapy experience with the human has reasserted that the same is true for
in animals alerted me to look carefully for similar ail .nt:nts in the man . Symptoms may appear soon after birth, or they may be recog-
human . It soon became apparent that many patients were going from nized first in old age . No age is exempt, nor is any part of the body : a
doctor to doctor with a variety of seerningly unrelatetl complaints : headache on one end may be just as significant as cold feet at the other
accordingly, with no definite diagnoses made, they were called "hypo• extreme . Skin infections on the exterior may signify a lack of thyroid,
chondriacs ." while just as important is the presence of anemia, indicating that the
Soon after entering private practice . I encountered setch a patient . bone marrow at the center of the bones is malfunctioning . Growth
She had been through a well-known midwest clinic with multiple com- may have been retarded, and the individual may have a short stature :
plaints but with no definite diagnoqis . Her blood pressure was low, and yet, in another patient growth may have continued too long, arrd a
fatigue was an outstanding symptom . She was told that she was suf- seven-footer resulted . As strange as it may sound . both are due to a
fering from neuro-circulatory asthenia and that she should go home lack of rhyroid . Paradoxes are common in hypothyroidism ; for each .
and get used to it . Many of the symptoms seen in the baby rabbits were there is a rational explanation .
present including a low Basal Metabolism . Thyroid therapy gave her Since the newborn cannot talk, symptoms must be picked up in
a new lease on life with elimination of most of her complaints . Neuro- other ways . Here is another paradox : the baby may sleep all of the time
circulatory asthenia is seldom seen in the literature today ; in its place and may require being awakened for feeding, or on the contrary, sleep
has arisert a new, wider connotation, "psychosomatic d :sease ." If the may be frequently interrupted with crying and irritability . The mother
physician does not recognize the illness at once, he assumes that the may be very happy that her baby sleeps all night as soon as she arrives
complaints are figments of the patient's imagination . The patient is home from the hospital, but this is a danger signal ; she should check
hurried off to the psychiatrist to re-orient his thinking . The best that the Basal Temperature . A markedly thyroid•deficient baby must be
the psychiatrist can do is to teach the patient to tolerate his symptoms treated before 6 months of age since this is the period of rapid develop-
and live with them . Occasionally a patient is told that his symptoms ment of the brain, and without adequate thyroid, permanent mental
are not mental . retardation may occur . The tongue of the baby may appear too large
i
One of America's greatest physicians . Sir William Osler, contended for the mouth and may protrude through the gums . This alnne will
that if the physician would let the patient talk long enough, the patient make the diagnosis when present, but like all symptoms, it is not always
would make the diagnosis . This is as true today as it was at the turn of in evidence . The child who is slow in cutting teeth . slow in talking and

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30 SOLVED THE RIDDi .h UF Ht .AR'f A ITACKS SYMPTOMS OFTHYROID DEFICIENCY gt

even slow in learning to walk is always suspected of being low in thyroid Pinkeye or infections around the eyeball are more common in the
function . The muscles and tendon, do not develop profwr strength ; if patient with low thyroid activity, and styes are likely to occur in the
this is not corrected, even in aduh life, there is abnormal mobilit, of hair follicles o1 the eye lashes .
the joints . In the circus, the freak who can tie himself into knots owes The cold hands and feet of the hypothyroid patients signify poor
his talents to a thyroid deficiency . Skin diseases in babies and children circulation to the skin which results in a susceptibility to skin infeaions .
are usually eliminated by thyroid therapy whether they are due to The amount of blood going through the skin per minute may be only
infections, dry scaly skins, or eczema . 60 percent of the normal quantity . This accounts for the chilly feeling
A susceptibility to respiratory infections may be present at birth and a desire to be in a room uncomfortable to normal people . A variety
and continue to old age . It is often more important to the preschool of skin infections such as impetigo, erysipelas . boils . and several others
child, although exposure to other children may be ;ncreased in the are common . Prevalent pimples of adolescence are due to a disturbance
classroom . Not only are the common colds frequent, but the complica- in fat metabolism in the skin with superimposed localized infection .
tions . such as tonsillitis . sore throats, middle car infecttons . sinusitis, Over 90 percent of the acne patients clear up on thyroid therapy since
and pneumonia depend to a great extent upon the resistance of the the circulation is increased and the fats are better metabolized . Older
patient . The hypothyroid individual can raise the resistance remark• patients in whom acne has persisted are usually low in thyroid func-
ably by thyroid therapy in about two months, but the benefit is lost tion . A male of 61 came in after having had a heart attack . His back
after six months if therapy is stopped . Removal of the tonsils will stop was covered with acne which disappeared as soon as he could tolerate
tonsillitis, but does nothing about the resistance to the other complica- small doses of thyroid to discourage the atherosclerosis . There are very
:ionsy f:ertainly more than half of the initial infections can be prevented few patients with skin diseases of any kind who will not be benefited by
with thyroid treatment, and the complications are rarely encountered thyroid . More than one-half of the cases of psoriasis respond favorably .
after the resistance is built up . One of the most serious skin disorders is lupus erythernatosis . Many
ln severe thyrnid deficiency, the resistance may be so low that the years ago the British discovered that the form affecting only the skin
antibiotics are relatively ineffective . I have never seen a death from a clears nicely with thyroid . Another variety may aifect the internal
middle ear infection, yet at Graz . Austria . where the entire population organs causing changes similar to arthritis . I have found that a com-
has been low in thyroid secretion for ceuturies . deaths from middle bination of thyroid and a small dosage of prednisone are very useful
ear infections are still prevalent in spite of antibiotics . in these patients .
Pneumonia seldom occurs in patients on adequate thyroid therapy . The reproductive organs need a correct supply of thyroid hor-
Furthermore, a patient with a history of pneumonia in the past will mone to function properly . Long before thyroid hormone was available
usually have other symptoms confirming the presence of low thyroid for treatment, it was known that in the goiter regions the reproduction
function . Resistance against the virus diseases is also increased by diminished, attd entire families disappeared . Any abnormality in the
thyroid administration . Among the senior citizens influenza shots are menstrual cycle is an indication for a Basal Temperature check . Some
not necessary if the thyroid function is normal . girls start their periods early - one of my patients at the age of five .
The susceptibility to infections is not limited to the respiratory On the other extreme are those who begin beyond the age of fifteen .
tract . The urinary tract is a favorite site for repeated infections . and Both groups are low in thyroid, and proper dosage will usually correct
each attack will cause some damage to the kidney whuse function is the condition . Irregular periods are common : some girls may have two
gradually lost . During the past 30 years routine thyroid therapy to this periods a month while others may skip several months between periods .
group of patients has completely stopped the loss of kdney function Profuse flowing is not unusual in the thyroid-deficient girl, clots of
with uremia and the requirement for kidney transplants . The vaginal blood may form in the uterus and their expulsion causes cramps as
tract is another favorite area for infection, and the trea :ments may be severe as childbirth . More than 90 percent of the menstrual disorders
unsatisfactory unless the resistance of the tissues is raised bv thyroid . I are improved with adequate thyroid therapy .

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S'.'. 5OLvkD iHEKIDDLf-OFHEr'INI AffACKJ SYMPTOMS OF THYROID DEFICIENCY yg

The most frequent cause of sterility is a lack of thyrotd hormone . women with normal thyroid function : hence, prophylaxis is the course
The Basal Temperature should be checked on both wife and husband to follow here .
before the more sophisticated tests and expense are undertaken . One Babies who are born dcad at term or those who die shortly after
of my happiest couples had tried in vain for 17 years to have a family . birth have been a mystery . Also of great concern is the so-calied "crib-
As 3o,)n as the husband was seen . it was realized that he also needed death" in which the baby appears normal for one to two months then
thyroid therapy . She had her first baby at age 39 . and two years later is found dead in the crib with no apparent illness . I have seen only one
carried another uneventful pregnancy to term . such case . and in that instance the mother was low in thyroid function .
Miscarriages are more often due to a lack of thyroid than to any In domestic animals, such as the swine, a high death rate among the
other cause . One of my patients had had 15 pregnancies and only five newborn occurs if the diet of the stnvs is low in iodine . A mother giving
babies . tier history left no doubt that she had been an unsuspected birth to a dead baby or to one who succumbs to a crib-death should
hypothyroid most of her life . When she appeared, it was a little late take her Basal Temperature and be put on thyroid if indicated . The
for any help with reproduction : she was 65 at the time . Howevcr, a viab.'lity of both a mother and baby will be increased by thyroid therapy
high percentage of women with histories of repeated miscarriages can if her thyroid function is subnormal
usually carry babies to term under appropriate thyroid therapy, but Some patients may have only one or two symptoms of a thyroid
during the pregnancy the dosage may have to be increased because of deficiency while other patients may have several complaints . The
the extra load on the mother . maiority, however, will have some degree of fatigue . This may be
Toxemias of pregnancies• including high blood pressure . protein manifested by a requirement for more sleep : after as much as 9 or 10
in the urine, and marked retention of water are usually due to a lack hours they may feel as tired in the morning as they were before retiring .
of thyroid . During 20 years of obstetrics, by watching carefully for Some patients will fall asleep if they sit down for a few minutes . even to
evidence of hypothyroidism . only one case of toxemia was seen . In that watrh TV . Routine duties that are easily accomplished by the normal
instance . her fi :st visit was a week before she was due to deliver . The individual may overwhelm the hypothyroid . This is called the "tired-
blood pressure was high . she was swollen with fluid, and the urine was housewife's syndrome" and is usually considered psychosomatic in
loaded with protein . Usual treatment was instituted, but she went into origin . Still, the same patient on adequate thyroid therapy - without
convulsions three days later. An emergency Cesarean•sectton fortunately the fatigue - can efficiently take care of her duties and have enough
saved the lives of both her and her baby . This is one place where an energy to engage in outside activities . Her depression is soon lost, and
ounce of prevention is worth far morc than a pound cf cure . she enjoys what she is doing .
There would be much less gynecological surgery if the thyroid An entire book could be written on the mental problems asso•
function of the female were balanced during her lifetime . The average i ciated with thyroid deficiency . These msy begin with the temper tan
physician may have 20 candidates annually for dilation and scraping trums of the infant, the fears of the small child , the failure to adapt to
out of the uterus to stop abnormal menstruation . In 20 years not one I the routine of the family or the schoolroom, or anti-social behavior of
has been necessary in my practice . Within a period of six months l the tecnager, incompatibility of a marriage, failure to hold a job, or
have seen three women below the age of 25 in whom the uteri had been even in old age the ideas of persecution or the lack of memory ; often
removed to stop vaginal hemorrhage . In each case the history and these are relieved by thyroid therapy . The child who does poorly in
physical examination indicated that probably thyroid therapy would his school work is unable to concentrate ; the attention•span is short .
have controlled the menstruation and allowed each to raise a family
rather than to remain childless . Ovarian cysts are common in the
i and although his intelligence may be above average, he fails and be-
comes depressed . For three years I saw all of the failing students at an
engineer;ng school . The curriculum was difficult . Those students in
t hyroid- deficient patient : if detected early, they will usually disappear
on thyroid administration . Fibroid tumors of the uterus are rare in attendance represented "the cream of the crop" for only those in the

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 NK®00 ;302+
34 Sn1 .VED 7 HE RIDDLE r)F tIFART A'rrACKS

upper l0 percent of the high school classes were accepted . Nevenheless, CHAPTER V
a few would fail, sometimes in the first year or even in the final year .
Thev would become depressed ; one at;empted suicide . Fortunately
he was not successful, and when his thyroid was adjusted, he graduated
at the head of his class . No failing student in this group missed show•
ing symptoms and physical findings consistent with thyroid deficiency,
and each responded satisfactorily when placed on therapy . My per-
sonal feelings are that if thyroid deficiencies are recognized in children Effective Prevention of Heart Attacks
and treatment is continued throughout life, most `psychosomatic I
comtiiaints" will disappear .
Over a Forty Year Period
I
It is obvious that symptoms may originate anywhere irn thr body ; For 13 years, thyroid-deficiency problems occupied my time .
in fact, thyroid deficiency may mimic any disease . Only two more con- Patients with such complaints were numerous and their gratitude for
ditions will be mentioned, but remember that it is well to take one's firding some relief was rewarding to me . Suddenly in 1950 a new
Basal Temperature regardless of what the symptoms may be . I tragedy entered my practice . I saw my first patient with a heart attack .
The low temperature is the most common cause of anemia . The I knew very little about this new "epidemic" :hat was sweeping the
red cells are formed in the bone marrow in the spine :and in the upper country . Although my medical education had been at Rush Medical
parts of the arms and legs . The temperature of the extremities pro- College in Chicago where Professor James B . Herrick in 1912 had
gressively decreases towards the hands and feet ; no blood is formed in described the saccessful treatment of cases of sudden collapse, this
the cool pan of the bones . This is easily demonstrated by using the disease was so rare when I was in school that very little time was devoted
white rat's tail . Curving the tail around and suturing the tip inside the to it . We spent many hours on rhetunatix fever, congestive heart failure,
abdominal wall will lead to blood formation in the lip at the higher hypertensive heart disease and other cardiac problems, but my notes
temperature, while the loop of the tail will form no bl-wd . The patient are almost devoid of coronary disease . In the meantime . I had been
with susceptibility to anemia should check the Bas31 Temperature . too busy to keep up with the literature on a disease which I had not
None of the treated patients need extra iron . sern . Now a new nightmare was to haunt me .
Migraine headaches are disabling at frequent intervals . They run This heart attack had occurred in an acquaintance who had not
in families just as hypothyroidism does. The fatigue may alter the been a patient on thyroid therapy . The electrocardiograms were sub-
fluids in the body . and the tissues swell . These patients learn that at mitted to a cardiologist in a distant city who reported that the artery
the time of a headache their shae-laces must be loosened because the on the back of the heart was occluded on the first clay, followed by a
feet expand . The brain cannot expand, and the pain may even lead to second attack the next day with occlusion of the artery on the front of
vomiting . The patient goes to bed, the rest eliminates the swelling, and the heart . The consultant gave little hope of recovery . However, the
recovery occurs . Thyroid therapy will raise the threshold of fatigue, patient surprised everyone, and was able to return to work in a job
and about 95 percent of the migraines can be avoided Excessive fatigue requiring considerable responsibility . After it had become evident that
may cause a recurrer.ce at any time . Headaches frorn sinus infections th•rroid therapy should be beneficial, he was started on treatment . He
are far more common, and some improvement in tnese will occur if did very well for 9 years, but died from a second attack at the age of
the resistance to infection is ra :sed with thyroid . 68 after having omitted his thyrc id medication for several months . I
Regardless of your complaints . take your Basal Temperature ; had moved to another state, and he had become negligent .
maybe "you are not so hot ." Obviously my interests had to be widened to include another
major disease . Why had I seen no heart attacks during the previous
19 years during which interval this disease had become number one in
importance? Had I been preventing heart attacks with 'thyroid therapy

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 y, SOLVED : THE RIDDLEOF HEAR I' .41"1 ACICS EFFECTIVE PREVENTION OF HEART ATTACKS 37

so commonly employed in my practice? it seemed incredible that this A review of the literature mentioned in Chapters l and 3 left little
could be true . Yet the thyroid had been involved in so many diseases doubt that thyroid therapy would decrease the incidence of heart at-
in which it was unsuspected that the possibility coulcl not be lightly tacks . So strong was the suggestion that if half of the patients had been
discarded . put on therapy and the other half kept as controls, the physician's con-
Elevated cholesterols had come into the limelight and were being science would have been disturbed for not bringing the most promising
accused as the culpnt in heart attacks . I well remembered that the therapy to the benefit of each patient . All of the other methods of
thyroidectomized rabbits had elevated serum cholesternls . The work of approach were being employed by many institutions and practitioners .
several investigators had demonstrated that the elevated cholesterols It was certain that comparisons could be made in time . The Public
could be brought down to normal with thyroid therapy . I had a back- Health Service started the Framingham Study in Massachusetts where
logof patients who had been on thyroid for 13 years hew patients with more than 5 .000 residents were studied by techutques very similar to
the symptoms of thyroid deficiency were arriving every day . How was those being used in the present investigation . The essential difference
thyroid adnt~nistration affecting their cholesterols? o4o one was in a was that patients in Framingham were probably receiving alterations
better position to investigate this problem : hence, a nev, field of endeavcr in diet and other modes of living because of their proximity to Harvard .
was initiated . ft was fully real'u.ed that many years of fatierice and hard Publications by the Framingham Study" in 1957 confirmed observa
work would be necessary to determine thP role of thy :oid deficiency in tions of previous workers that hypertension, high cholesterol levels, sex
heart attacks. and advancing age were important factors increasing the incidence of
Subsequently, the routine examination included an x-ray for heart attacks . In younger individuals, males were affected much more
heart size, an electrocardiogram, and a battery of blood tests . Periodi- often than females, but in the older-age groups, as more men died off,
cally at one• to two-year intervals the tests were repeated so that any the females passed the "stronger" sex in deaths from heart attacks .
changes would be evident . In 1951 the controlled study by Dr . Kountz The Framinghant Study included over 5000 patients between the
using thyroid therapy . as mentioned in Chapter 3, added interest and ages of 30 and 62 . They represented the majority of residents in a typical
effort to the project . It seemed reasonable that if vascular deaths could small Americarn to•rvn . At the time of the initial examination, there
be delayed in elderly people . earlier treatment should be even more were 76 cases of atherosclerotic heart disease . The purpose of the study
effective. was to uncover risk factors in heart attacks . After 20 years of the scien-
Some valuable lessons had been learned from the five-year asso- tists' time and millions of dollars of the tax payers' money . no new risk
eiation with the late Professor Carlson . One of his requirements for e factors were uncovered . The normal occurrence rate of new heart
legittmate experiment was to alter only one factor at a rime . Accord• disease was established . At a relatively constant rate which did not
ingly, if we were to study the influence of adding thyroid, all other impt-ove in spite of all the propaganda about smoking . diet . exercise
conditions shouW be left as closely as possible to their previous state . and unsaturated fats, over 30 new cases of heart disease were uncovered
Hence, no one was taken off cigarettes . Alterations in the diet were dis- each year . This amounted to more than 600 in the 20 years, or an aver•
couraged ; this was often difficult due to the propaganda to the laymen . age of 150 per 1000 patients .
Extra exercise was discouraged and when jogging became fashionable . In my thyroid•treated group using the same methods of examina-
patients werz told that time would prove the folly „f it Disease is not tion and similar criteria for detection, only 4 new cases were encoun-
cured by exercise : when a patient becomes ill he is put to bed to con- tered for the total 20 years on over 2000 patients or an annual rate of
serve energy for fighting the disease . Tuberculosis was conquered by 2 per 1000 patients . It would appear that 75 times as many new cases
bed-rest and not by jogging . lf one is going to be rngaged in fighting of heart disease developed in Framingham in spite of the fact that
or must run to keep out of fights, there is an excu x for being in first many of them had adhered to the advice about diet, smoking, exer•
class condition . Otherwi-e . exercise for pleasure ,'s commendable, but cise, etc .
no one has proven that it will prevent disease .

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 yg SOLV ED : THE RIDDLE t YF HEART ATTACKS LFFECTIVE PRkVEtr I lON OF HEART A fI-A( :kS 39

One can never be sure how rr.any patients follow the physician's their weights, stop smcking and get more exercise . None of these were
advice . The marked increase in the sale of unsaturated fats and the recommended in the thyroid-treated group . There seems little doubt
ruination of the dairy industry leave no doubt that many patients did that the thyroid therapy reduced the rate of formation of atherosclero•
sis in the arteries of the hearts .
alter their diets . We have no way of knowing how aany in the Fram•
ir.gham Study altered their diets, nor do we know how many of my Prevtous chapters have indicated that thyroid deficiency is a potent
factor in the origin of heart disease . Personal experience indicates that
patients ate polyunsaturated fats . Some of them did continue with the
animal fats; 62 percent of the male population on thyroid smoked about half of the population suffers from some degree of thytoid defic-
iency . All of the patients in the present study were low in thyroid futtc-
cigarettes . The fact remains that the big differenc : between the two
groups was that my patients were on thyroid therapy . tion and benefitted from therapy in many other wa)•a in addition to
At the end of 20 years the results of thyroid therapy were com- less heart damage . One might have expected twice as many new cases

pared with those of the Framingham Study . At that time, 1569 patients of heart disease in the present study as were found in the Framingham
had been treated with thyroid and could be compared with those in Study, if the thyroid therapy had not been efficacious . Yet actual
Framingham . Females below the age of 60 years, without any elevation comparison of the 4 cases observed with the 72 expected from the
of the blood pressure or cholesterol in the serum, had the least danger Framingham Study shows that 94 percent of new pattents with heart
disease were avoided . No other suggestions for preventing heart attacks
of developing new heart disease . In this category 490 patients had
received thyroid therapy in the present study . Over the period of obser- have approached these results . They deserve the attention of those
interested in reducing the carnage among the younger population .
vation . one might have expected more than 7 new rases of heart dam-
age, but none were observed . In the present study . there were 172 Another five years have passed since the above studies were pub•
women below the age of 60 with hypertension and/or high cholesterol lished .y The number of patients on thyroid therapy for the prophylaxis

readings . Theae cases are more susceptible to atherosclerosis, and they of heart attacks is growing rapidly, and now more than 2000 are in•
should have added more than 7 additional new cases of heart disease . cluded . The success has not diminished . Seldom does a new case of
None appeared in the thyroid-treated patients . Women between the heart disease appear . It is only during excessive stress that symptoms
ages of 60-62 are far more susceptible to heart damage, and although and laboratory confirmation of a new heart attack occurs . Stress will
one would have expected to see 8 new cases in the L82 patients in this be discussed in a later chapter .
category . none occurred . I These results are very similar to those of Dr . Kountz . The essen-
Men are more susceptible than women . and cetntintting the com- tial difference is that he ran controls simultaneously, and followed
parison with the Framingham Study, in men below the age of 60 with- only the deaths in the two groups . In his study thyroid therapy was
more efficacious if it were started in younger patients . Thnt was true
out any high-risk factors . one would have expected 13 cases of new
heart disease in the SB2 subjects : only one case occurred . There were in the present srudy since the youngest patient developing new heart
186 men below 60 years of age with elevated serum cholesterols and/or disease was 56 years of age . His father had died with a heart attack at
age 54 . Hence, it is reasonable to assume that atherosclerosis had been
hypertension . This group should have produced 19 new cases of heart I
disease . Only two were detected . For the men between 60-62 years of progressing in the patient for many years before he was started on
thyroid . He was first treated at rhe age of 51 . and in retrospect, the
age . the risk is the highest of all . Among the 157 men in this group, one
would have suspected 18 patients to develop new heart disease . Only dosage may have been inadequate . He was only on two grains daily,

one case occurred . and had not been rechecked in the meantime . Kountz pointed out that
It is apparent that the thyroid therapy has been remarkably effec- even in older patients up to 67 years of age, thyroid the-apy would
tive in preventing new heart disease in all age groups and in both low- teduce the incidence of vascular accidents . The rarity of tiew cases in
and high-risk subjects . Undoubtediy, the patients in Framinghant the present report is probably best explained by the fact that many of
were encouraged to correct their style of living . alter their diets, reduce the patients were younger when therapy was started . 1-rom Andersen's

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 au SOLVED 7 HE RIDDLE()F HEART A IZACttS EFFECTIVE NREVFJVTION OF HEAR7- .1TTACKS 41

report . in the last chapter . it is obvious that the atherosclerosis starts How unfortunate that the designers of the Coronary Drug Project
in the hypothyroid infant, and early therapy should be more efficacious . did not include desiccated thyroid among the agents lowering chr les•
Another clear indication that thyroid therapy has a place in pre- terol levels in the blood . Animal experiments and all of the other evi•
venting heart attacks comes from the dropouts in the oresent study . It dence on rhe human, presented in the last chapter . have clearly indi-
is difficult for young people to believe that they are susceptible to cated that this would be the physiological approach . Solving the heart
serious disease . Their pride is hurt in having to t .tke pil's to prevent attack problem by any means other than diet or reduction in cholesterol
somnhtng that they have every hope of a•-oiding . C.onsequently, more would put the designers in an uncompromising position . Their careers
than 30 individuals discontinued therapy against ad% ice that they con- have been built on the cholesterol theory . and they are unwilling to
tinue . Fatal heart attacks occurred in each within a six-year period . admit rhat they have been in a blind alley . In February . 1976 . they
Thirteen of them were under 60 years of age at death . with two in announced that a new super experiment would be tried (Family Physi-
c+an, Vol . 13, page 132) an 12 .000 patients, half of whom will be en•
their 20' :.. one in his 30's, two in their 40's, and eight in their 50-s . These
corresponded to the early deaths seen in the Framingham Study, and couraged to stop smoking, to reduce the fat in their diets and to follow
were not found in those who continued their thyr,-)id therapy . There treatment for their hypertension . The article states that other large-
seems little doubt that the young hypothyroid patient is unusually scale studies have begun using aspirin and aspirin plus another syn•
susceptible to heart attacks . This is confirmed by the fact that 13 of the thPtic compound on patients who have recovered from heart attacks .
30 fatalitiec were under 60 years of age . This premature mortality is How long must this witch-hunt go on before the taxpayers' money can
considerably higher than that reported in Framin¢ham . All of these be directed toward something more promising?
dropout patients in the present study had been diagnosed and treated The Coronary Drug Project and the new Multiple Risk Factor
for hypothyroidism . The evidence indicates that an effective prophyl• Intervention Trial cannot .plead innocence about the benefits of thyroid
actic program of small doses of natural thyroid can markedly reduce therapy . In January . 1962, one of the authors of the above projects sat
the carnage from heart attacka in young patients . next to me at the meeting of The Oregon Academy of General Prac-
The clearest indication of the efficacy of thyroid comes from the tice in Ponland, Oregon . The symposium was on "The Causes and
treatment of the patient who has had a previous attack . In this instance. Treatment of Atherosclerosis ." I presented thyroid therapy as outlined
there is no question about the susceptibility of the individual, since a in this book . He talked about estrogen treatment . Less than two hours
I
i
premature hean attack has occurred . This was thc group of patients after he delivered his presentation, he heard my lecture . In the intcr•
upon which the British tried polyunsaturated fats and found that diet vening years he has never mentioned my work, but he has buned the
had no effect on recurrences of heart disease . It was also this type of estrogen therapy .
patient that the Coronary Control Group wasted more than five years The only excuse for not using thyroid therapy in some of the mul•
and much expense with female hormones . cholo•an . clofibrare and tiple mass studies may be another mistake in dosage comparable to
niacin on over 8000 patients . None of these compounds reduced the the 1938 scare . For a time . Gofman and his associatessa felt tha• the
incidence of recurrent heart attacks . and there had been no experi• elevated beta-lipoproteins were responsible for the damage to the
mental workk to indicate that they should . All of the chemicals reduced arteries in atherosclerosis . They suggested the use of thyroid for lower-
the blood cholesterol some, but as so clearly pointed out in the final ing them . To test the prolonged effects of thyroid therapy on the beta-
chapter, cholesterol has nothing to do with heart attacks . The choles• lipoproteins, they administered to mental patients sufficient thyroid
terol is elevated in many patients suffering heart attacks, but the thy• to completely suppress their own secretion . It took 5 grains daily, and
roid deficiency is responsible for the deposition of mucopolysaccharides the authors concluded that thyroid therapy could be used . Some clini-
in the arteries . These mucopolysaccharides and not the cholesterol cians interpreted their findings to mean that 5 grains daily could be
cause atherosclerosis . used in patients with heart damage . This only confirmed the observa-
tions of many physicians . reported prior to 1988 . Had they used one

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 4'L SOLt't!)• THk RIDDLE OF HEART ATFACKS EFFECTIVE PREVENTION OF HEART ATTACKS 43

or two grains daiiy- as had been suggested . their results would have mone level near the normal requirement during the individual's life-
been more than encouraging and their disappointments would have time, it would appear that a heart attack can be delayed until advanced
been avoided . age when fair wear and tear may end one's misery . The most susceptible
Over the past 25 years . rarely has a patient c :rr thyroid therapy patients are the major problems at the present . Since they represent
had an initial heart attack . Many patients have been seen with a his- only 27 percent of the total heart attacks . it seems reasonable that
tory of heart attack and hospitalization prior to seeing me . They have thyroid therapy may be able to eliminate these untimely deaths . There
been put on small doses of thyroid . usually an initial dosage of one-half is adequate evidence that more than 27 percent of the population are
grain daily . After one or two months, the doszge has been increased deficient in thyroid hormone . Further evidence indicates that these
one half grain at a time . and in some casesa over a pt•riod of six months, individuals are depositing mucopolysaccharides until thyroid therapy
has attained as much as 2 grains daily . What results have been obtained begins .
by this cauttous approach to the use of thyroid after a heart attack? Other investigators have also confirmed the work of Kountz .
The number treated w,th thyroid in the present study is too small for Dr . Murray Israel,'4 in New York . began treating cases of advanced
statistical analysis . but during the past 25 years a death amcng these atherosclerosis with thyroid therapy before I entered the field . He
pattents has rarely occurred . Most of them are surviving the normal found, as others had previously, that the requirement for vitamin B is
life ,pan, and when a second attack does occur, it usually can be at- increased when the metabolism is raised . During periods of growth,
rributed to some exceptional stress . This rare occurrence among those pregnancy and any other condition with an elevation in thyroid secre-
on thyroid is in sharp co ntrast to a mortality of 5 to 10 percent annually tion, rr.ore vitamin g must be administered or symptoms of a deficiency
among patients with a previous heart attack rreated by conventional appear .
i
therapy . With the usual therapeutic doses of desiccated thyroid, Israel has
I
l he fact that stress may overcome the beneficial effects of thyroid added an excess of several vitamins . To hasten the utilization of fat and
is illustrated by the fcllowing example . A 44-year-old male had his lower the cholesterol, he has added another tablet containing Choline .
first attack in July of 1962 followed by three mor•=, each proven by Inositol and Pyridoxine . As many as 30 of these tablets daily may be
hospitalization, before I saw him in May 1963 . Thvrc .id Lherapy was . adminiitered . In addition to the oral therapy, frequent intravenous
started cautiously, and the anticoagulants (hjuod thinners) were injections of still another preparation composed of synthetic thyroxine,
stopped . His dosage was gradually increased to 2 grains daily . He did synthetic vitamin B-12, calcium gluconate and gelatin are given .
very well and was back at work . He was convicted of a felony . and a As far as can be judged from the published reports, a single appro-
penitentia .y sentence was imposed . The stress of the trial and his priate dose of oral thyroid supplemeuted with Brewer's Yeast tablets,
;nsist?nce •..f innocence was overvhelming, and he died from a fatal for those in whom more vitamin B is needed . has given about the same
heart attack in July of I°67 5efore incar :eration . 'rom his improve- results as the more expensive method of Dr . Israel . Since Friedland's
ment during the prevtous four years, he should have survived much demonstration in 1927 . repeatedly thyroid therapy has corrected the
longer without this unusual stress . elevated serum fats and cholesterol in most cases . In hundreds of
Personal observations have fully confirmed and extended the patients treated in the last 25 years, 95 percent of the cholesterol levels
excellent controlled studies of Dr . Kountz . Apparently thyroid therapy have returned to notmal with only thyroid therapy . No premature
has no influence on the advanced arterial damage . A few autopsies heart attacks have occurred in the 5 percent whose elevated cholesterols
on patients who had occluded coronary vessels prior to starting the persisted in spite of thyroid therapy . As pointed out frequently in the
thyroid revealed that the vessels were stili closed : but the relief of hypo- present report, atherosclerosis results from the thyroid deficiency and
thyroidism seems to stop the deposition of the mi ecopolysaccharides not from the elevated serum fats that accompany it .
and the further progression of the atherosclerosis . If we can learn to Wren" in two reports has confirmed the efficacy of thyroid therapy
diagnose the susceptible ones in childhood and keep the thyroid hor• in cases with coronary heart disease . A total of 347 patients with evi•

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 44 SOLVED 1HE RiDDLE .OF HEART ATTACKS
~
~" dence of heart disease were studied . Only 9 percent of them were low CHAPTER VI
CZ) in thyroid furnction according to standard tests, but all were treated
_-1) with thyroid since it was realized that the thyroid iunction tests did not
~ reflect the clinical condition . The serum cholesterols fell an average of
0 22 percent . In 41 patients . angina was present at ti~e start of the experi-
.
Q9 ment . No new cases of pain appeared during thyroid administration
x in 29 less pain and more exercise tolerance occurred, while in 12 there The Fallacy of Thyroid Function Tests
~ was no change in angina . The expected mortality over a 5-year period
When I began writing prescriptions 40 years ago, it was difficult
was reduced by 58 percent . His results are quiu! similar to those of
. Wren to accurately diagnose thyroid deficiency . Ttme has not changed the
Kountz in a similar-aged population . In a small sevies of patients
problem . For years only the Basal Metabolism test was used . "Basal"
also injected synthetic thyroxine in a manner sinlilar to that used by
means that the patient has been resting for several hours, no food has
Israel, but could see no difference in the results Crom those receiving
been consumed, no exercise has been taken, and no excitement nor
only oral thyroid therapy .
tension are present . Each of these factors raises the oxygen consump-
The consistent results of numerous authors over the past 40 years
tion . An attempt is made to measure the minimum amount of oxygen
leave no doubt that thyroid therapy is efficacinus in delaying fatal
necessary just to sustain life's processes . Hence, the ideal time to make
heart attacks . Since the process begins in childhood . the earlier the
this measurement is immediately upon awakening after a good night's
diagnosis . the greater will be the benefit . Often patients with low thy- sleep .
roid function will have symptoms originating anywhere in the body . If
The apparatus necessary for the Basal Metabolism consists of a
each of these symptoms is treated at its first appearance, health of the
tank of oxygen, a motor to circulate the oxygen to the patient, and
individual will be greatly improved . A fringe benefit will be a reduced
tight-Gtting rubber connections to prevent the escape of oxygen . A
danger of a premature heart attack .
clothespin-like clamp is placed on the patient's nose, a rubber tube is
stuffed into his mouth, and he is told to "just relax ." Thereby arises a
problem . A patient with claustrophobia tears the mask from his face,
convinced that he is about to suffocate . A patient under tension may
double his oxygen intake . Obviously, this apparatus is not available
in each home . nor is a trained technician waiting in the wing for the
~ patient to wake up . If the patient spends the night in the hospital,
tension is present . If the patient sleeps at home and upon awakening,
goes to the hospital or laboratory . this activity raises the oxygen con-
sumption . ln spite of all these difficulties, the Basal Metabolism gives
results as accurate as the modern functional tests .
In the early days the physician obtained a careful history, made a
detailed physical ?xamination looking for confirmatory evidence, and
did not let the Basal Metabolism overpower his judgment, if he thought
the patient needed thyroid therapy . Often he used the therapeutic
test . He knew that small doses of thyroid would do no harm ; a short
trial frequently confirmed his suspicion . The patient was very happy
to see his symptoms disappear .

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 ae SOL%EU T}IERIDDLI_OFHEARTATTACI+S FALLACY OF THYROID FUNCTION TESTS 47

Scientific medicine came to replace the art . Laboratory tests % :ere It is shocking to think of the thousands upon thousands of patients
devisPd to aid the doctor in his diagnosis . This is an excellent idea, if
during this interval who were denied therapy because of a faulty labor-
~ a specific test can be elaborated, but unfortuuau•ly the "tail began to atory rest . It was during this sa .ne g5-year-period that psychosomatic
7 wag the dog .'- At the present time, out of 30 testr- being used . not one complaints became so prevalent . Eaving seen hundreds of these patients,
~ gives an accurate index of the amount of thyroid hormone necessary
who had symptoms of thyroid deficiency and whose complaints were
~ for health of the patient . The blood tests measun! the amount of hor- relieved by thyroid therapy, I have little doubt that these patients
~ mone circulating in the blood screarr., but the thytoid does not exert
should have been referred to someone understanding thyroid problems
0 its influence in the blood . The blood level only gu .t : antees the presence
rather than to a psychiatrist "for psychosomatic complaints ." Some
ag of an adequate supply in case a cell, far distant frcu : the thyroid gland, psychiatrists have ber.ome aware of the frequency of thyroid deficiency
= suddenly needs more thyroid hormone . The thyroid hormone per• zmong their referrals . and have found that thyroid therapy has solved
= forms its duty on the inside of each nf the billions of cells all over the many problerts .
body . We have no means of measuring the concentration of hormone A rash of new thyroid-function tests began to appear . Otviously
in each of the cells . none of them were reliable or there would be no necessity for finding
Regreccably, medical students are being taught that, unless the a better onz . I never order the thyroid•function tests since two or three
blood level of the hormone is low, the patient d3es not need thyroid are commonly employed, and they may disagree with one another .
the:apy . The use of symptoms, the corroborating physical findings, I am not smart enough to know which one to believe, so why waste the
and common senst have been discarded . The end-result is that thyroid patient's money?
deficiency is the most common illness entermg the physician's office, I
An expenence is worth recording . One of the commercial firms
and it is the dragnosr's most often mtssed . This opinion was expressed wanted to market a new product of thyroid hormone . They asked me
by Dr . A . S . lackson,'6 a thyroid specialist in Madison, Wisconsin, in to compare the effect of substituting the new product in place of natural
the Journal of the American Medical Assoctation in 1957 ; it is just as thyroid which had satisfactorily controlled symptoms in 40 consecu-
true today as it was then . tive patients . They requested that each of the 40 volunteers should
The multitude of thyroid tests do not justify space for a detailed
have three thyroid-function tests before the medication was changed .
discussion here, but enough will be presented to how the reader that The initial samples illustrated the unreliability of the thyroid•function
he cannot rely on thyroid-function tests . If he has symptoms for which tests . All of the patients were free of syrnptoms and had been for pro-
the physician can find no diagnosis . he will do we)l to continue search- longed periods . In 20 percent of the cases, a single specimen of blood
ing for a doctor who realizes the fallacy of thyroid function tests . gave three diagnoses: one test indicated that too much thyroid hormone
The frrst citemical blood test measured the Protein-Bound-lodine, was present, the second text revealed that the concentration was just
called the PBI . ft came into use about the time that I began to prac- right, and the third test found that too little was present . When tests
cice . The theory for it was excellent : iodine was present in the thyroid only create confusion, the patient's money should be saved .
hormone which was bound to protein in the blood . I soon learned that A few words about the most recent test to appear . It is called the
some patients with clear signs of thyroid deficiency had normal PBI "radioassay for thyroxine" (a part of the thyroid hormone) and is sup-
readings . Furthermorc, treating these same patients with thyroid cured posed to be the latest improvement . The laboratory doing my blood
their complaints ; the PBI was still in the normal range . This happened work added this new test, without additional charge, to other tests
so frequently that I never adopted the PBf test . Most of the profession being run . Otherwise, I would have missed a chance to evaluate this
went overboard for it ; some of the moat able thyroid specialists "swore recent thyroid-function test . Forty•eighc new patients with classical
by it ." but I continued to "swear at it ." It took 35 )ears to win the argu-
symptoms and physical findings of thyroid deficiency were tested . The
ment, but eventually all investigators agreed that :he PBI could not be normal range of results is considered to be 5 .4 to 13 .0 units . The lowest
used to diagnose thyroid disease . value among this group of patients was 6 .0 and the upper limit was

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 ~ u~~ C J-5 -~tiLVLD I HL RIDDLE OF HEART ATTACKS F .1LLACY OF I IIVkO1D FUNCTION TFSTS
49

14 .1 units . Hence . there were supposed to be 47 normal individuals especially in the thyroid-deficient patienL for whom thc diagnosis by
and one wtth too much secretion from the thyroid . Trhe average reading the physician is so frequently wrong .
for the group was 9 .52 units . Interspersed with these new patients were Laboratory tests have become big business . One of rhe leaders
32 former patients who were being rechecked . All of them were on in the field markets six tests for thyroid function and informs the stock-
thyroid and were symptom-free . All of them gave values within the holders that it is a 45 million doliar business . Why do we need six
normal range by the new method . The average for the group was worthless tests when a diagnosis can be made more accurately without
9 .09 units or identical with the group needing therapy- Had I followed
any? Predictions are that in five years the thyroid function tests will
the indication for thyroid function by the test and rot started therapy amount to 100 million dollars for this company . The doctor is at the
on the new patients . I would not have made many friends and would
mercy of the salesmen who extoll the advantages of the different
only have influenced patients to change doctors . It is no surprise that methods . This reckless waste of the patient's money is a big factor in
patients from 49 of the 50 states have had to come to my office to get the thrust for socialized medicine - a nightmare the public should
thyro•d therapy denied them by physicians relying on thyroid-function be spared .
tests . No disease is easier to diagnose than hypothyroidism, if one knows
A considerable amount of time has been vpent in trying tu find all the symptoms and the reliable physical findings . Combine these
an oblective indicator of thyroid activity . When usin3 the Basal Metab-
with the Basal Temperature, and few mistakes will be made . The
olism test . it was always necessary to check the patieilt-s temperature at physician and the patient as well, must be acquainted with the bizarre
the time of the test . If any fever were present, it wouid raise the metab-
symptoms which may occur, or each may feel that this is a case of
olisrn about 10 percent for each degree elevation . Consistently the psychosomatic complaints .
patients ran sub-normal temperatures . if no infecion were present .
For a century it has been known that the patient urith too much thy-
roid activity runs a low grade fever, while the hyporhyroid runs a sub-
noiutal :emperature . The thought occurred that th : patient could get
a Basal Temperature with no cost or inconvenien :e . This work was
published in 1942 and has been used continually since that time .s1 The
thermometer is shaken down and placed by the bedside . As soon as the
patient awakens in the morning after a good night's sleep, the ther-
I
mometer is placed snugly in the armpit for 10 minutes- The normal
range is 97 .8 to 98 .2 Fahrenheit .
This test is not specific for th+roid activity since starvation, an
adrenal deficiency, or a pituisari dr,ficiency will aho give a low read-
ing . These conditions are relatively rare and easily differentiated from
a lack of thyroid . The temperature will usually rise a little with thyroid
therapy, but it is not quantitative . If too much thyroid is administered,
the Basal Temperature will go above normal in about 10 days . Hence,
the test can be used as a guide in therapy . More will be said about this
in the chapter on treatment . Needle4s to say, the profession has not
been willing to adopt the Basal Temperature test . Ir is too simple, and
no money can be made from it . Many physicians resent the patient
trying to make a diagnosis on themselves . This practice is absurd,

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 CHAPTER VII

Tips on Treatment
No disease is easier to control than thyroid deficiency if the patient
is intelligent and cooperative with the physician . Although the diag-
nosis can be made from the history and the Basal Temperature alone .
it is well to have a comprehensive examination including a chest x•ray .
a cardiogram . a urinalysis, a battery of blood tests and a physical about
every two years for those under 50 years of age and yearly for those
older . This type of examination picks up any other diseases in the
beginning rather than after it is too late . Of course . anytime that some
new complaint develops, this calls for_ a conference with the doctor
at once .
A few things should be kept in mind in order to avoid trouble .
The initial dosage should be small . A baby needing thyroid will tolerate
one quarter grain of desiccated thyroid daily until the age of S or 4 at
which time the child may need as much as one•half grain . Becween
ages 6 and 12 one grain may be necessary, and above that age, the
dosage can Le adjusted as for an adult . Females in the teenage group
- 3s well as adult females - can safely be started on one grain daiiy,
i
while males of similar age and older, weighing more than 150 pounds .
I may require an initial dose of 2 grains . In rhe adult, if a previous heart
attack has occurred, the initial dose should not exceed one-half grain,
and a longer interval snould elapse before the dosage is raised .
The initial dosage should be continued for at least a month after
which time it is advisable to re-evaluate symptoms and Basal Tem-
perature . If the symptoms have all subsided, the starting dosage may
be continued indefinitely even though the Basal Temperature is still
low . On the other hand, if some or all of the symptoms have persisted
and the temperature is still low, the dosage may be raised by 50 per-
cent for the next month . Re-evaluation is again made and the dosage
adjusted as before . This procedure allows a gradual change in the
pbysiology of the individual, and seldom will any difficulty be encoun-

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 i

52 SOL%t•D 77ik :RIDDLEUFHEARr Af-rACKS I IPb uN I HF.A'I h7k .N I 53

wh.•n the physlcians realized that thyroid therapy was needed This
cered . The patient with a previous heart attack should not be raised to
more than 2 grains daily except in the hands vf an expert wah plenty product is as archaic as a one•horse•shay on Fifth Avenue . Obviously,
of experience . Either male or female adults without heart trouble may the patient was not being relieved of the symptoms . or another doctor
take as much as 4 grains daily if needed . If symptoms still persist, some would not have been sought . The failure was due to the fact that thy•
other cause should be sought for the symptoms . roxine is only a part of the thyroid hormone : it is similar to wearing a
What side effects can be expected? In ths vast majority of cases blouse without a skirt . Thyroxine was isolated from the thyroid in 1917 .
it had some of the properties of the natural hormone . Many clinicians
there are none . Thyrord is not a drug whtch is tre:ng taken, but a com-
plemeru to one's normal hormone production that has been found felt that this was the answer . and insisted that nothingelse be used .
In 1949 another active compouttd, sodium liothyronine, was Iso-
inade:fuate . If too much is administered, a new set of symptoms will
lated from the thyroid gland ; it was found to be 4 times more potent
appear such as nervousness, loss of weight in spite of a voracious appe•
than thyroxine . Naturally the producer tried to convince the physician-
cite . profu-e sweating, a rapid heart, inability to sleep many hours, yet
too much energy when awake, and of most importance . an elevated that this was the product to use, and some doctors took the "bait " The
Basal Temperature above 98 .2 Fahrenheit - Iheee call for cutting the new compound stimulates the heart more, and rapid beats are very
common with it . Each of the synthetics will relieve some of the symp•
dosage at once . Sometimes worry over financm, family problems . or a
variety of other conditions may produce some of the symptoms of too toms but not all of them . The next step was to combine the two syn•
much thyroid honttone, but the Basal Temperature will rule out every- thetics into a single tablet : two such preparations are now available,
thing else except some systemic infection . Rapid hearts are most often one called Thyrolar and the other Euthroid Each contains 4 times as
due to coffee, tea, chocolate, or caffetnated drinks . tnuch thyroxine by weight as liothyronine Personal experience with
There are a few individuals, probably not more than one percent both has indicated that when one of these synthetics is substituted in
of the total, who will feel worse on thyroid therapy from the start, yet patients accustomed to the natural thyroid tablets, about 20 percent
they thought that they were half dead in the beginning . Zondek men• will experience rapid heart beats . There is probably a little too much
tions these in his book, but in spite of his tremendous experience, he of Ihe liothyronine in the mixttlre : it may be significant that in Europe
never understood why some patients failed to respond . Quite by acci• sintilar preparations have a ratio of 5 to one instead of 4 to one .
dent I found that this same type of patient was also deficient in adrenal No one can guarantee that these two active synthetic compounds
represent all of the physiological activity present in the natural gland .
secretion . The use of 5 mg of prednisone daily, along with the thyroid,
changes a failure into a resounding success . Cortisone has such a bad I have tried the various new preparations on patients who had been
name from otaer•dosage in the treatment of arthritis that most patients on the natural gland for years, and no one has preferred the synthetics .
shudder when they find that they need one of the adrenal hormones . I repeatedly see patients who have been on one of the other prepara•
Again . in this small dosage of 5 mg . it is not a drug but another of the tions and still have some symptoms or physical findings which disappear
hormones desperately needed . The combinati•)n of the limited dosage on the whule•gland therapy . I consistently have used one of the standard
with simultaneous thyroid therapy has given ntt side effects over several brands of desiccated thyroid powder U .S .P . made into tablets . Since
years . this is a research program, the same product has been used ; it is obtained
Which thyroid preparation should be u"? Thcre is a variety of directly from the pharmaceutical laboratory, and is furnished to the
preparations on the market, but the average physician depends upon patients . The present volume exceeds one million tablets annually .
information brought to him by the salesman who has a vested interest Any of the standard brands of desiccated thyroid will be found
in his product . The company can make more money from the synthetic sattsfactory, but a word of caution about unmarked tablets . The manu-
hortnones ; hence . the salesmen are pushing them with the pitch that facturer's emblem should be stamped on each tablet . Patients have
they are "pure, more p .,tent, better standardized . etc ." I am amazed to brought in tablets without identificat :on marks . purchased at the drug
see the number of patients who recently have been placed on thyroxine stores . Apparently the potency was subnormal, and symptoms were

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 HN100530S.5
3o SUL%t:D 1 HE RlDtJLk:OF HEAR l' A7-I At;KS A NEW LOOK A f S I RESS 57

tite Koican conflict and even Vietnam . Stress was behind the four-fold than in any other tissue in the body . During stress, the cholesterol in
increase in civilian atherosclerosis observed at Graz during World the adrenal falls rapidly, but it is quicklv testored after the stress is over .
War 11 and discussed in Chapter one . The c nly premature deaths Dr . Hans Selye . a scientist in Montreai, has spent many years
obsened in the present study on patients treated with thyroid were studying stress .9B He finds that there are 3 stages in the reaction of the
under heavy stress at the time . The marked reduction in heart attacks adrenal gland : at the beginning of stress (a) an Alarm Reaction occurs
with thyroid therapy would indicate that some stress is being reduced at which time there are both an increased production and secretion of
at the same time . hormones . This stage is fdlowed by (b) Adaptation, if the stress con•
In the past the adrenal gland has held the c enter of the stage with tinues : during this period the demand is met by increased production

stress . The time has come when we must add thyroid to the picture . of hormones . Finally, if overwhelming stress persists, the adrenal be-
This does not detract from the well established role of the adrenal . but comes (c) Fxhuusled and death follows . In the course of his experiments .
it gives us a prophylactic approach to stress which the adrenal prepara- Dr . Selye administered potent extracts of the adrenal cortex to experi-
tions can not do . The late Dr . Walter B . Caanpm . one of our leading mental animals over prolonged periods . The animals developed hyper-
I
physiologists, in his work at Harvard showed that in an emergency the tension . and some of the tissues showed changes resembling rheumatic
adrenal medulla (the interior part of the gland) gave a burst of adrena- fever or arthritis . It appears to Dr . Selye that degenerative diseases
line into the biood stream which immediately p .-epared the individual might be the result of chronic over-production of adrenal hormones,
for f,ght or flight . The pupils of the eyes dilate . digestion ceases at and he c .,Ils the alleged state "Over Adaptation ." Occasionally, each
once ivith the blood shifting to the periphery, the heart rate increases, of the endocrine glands does produce too much of its hormone for
the blood pressure goes up . the blood clots faster, the mental processes some unknown reason, but it seems unlikely that one gland would go
are stimulated and the individual has abnormal strength . berserk and produce degenerative diseases in the elderly .
I can remember that . when I was only a small boy, the lightning A more plausible explanation is now possible for the results of
struck my uncle's barn . His wife and daughters rushed out and pushed Dr . Selye's prolonged administration of adrenal conical extracts . In
a wagon loaded with hay from the burning structure . The following 1949 cortisone was isolated from the adrenal, and its synthesis gave
day they could not budge the load . The adrenaline had given them unlimited supplies for experiments . It was soon learned that this com-
abnormal strength during the excitement . At one time : was studying I pound would save many lives from stress and adrenal exhaustion .
the cholesterol content of deer's blood . After catching the animal, the lnjecting the compound for a few days gave the body a chance to
drawn blood would often clot before I could remove it from the syringe . recover . Arthritic patients "never had it so good" ; pain and swelling
The adrenaline of excitement had accelerated the clotting - one of disappeared . joints limbered up . and many patients could return to

Mother Nature's methods of reducing hemorrhage in case an accident work . These results do not suggest that the aithritis had been caused

causes a laceration . by an over-production of adrenal-cortical hormone, but rather that

Any type of excitement will call forth a bu,-st of adrenaaine from there had been a deficiency of these valuable compnund .% Unfortu

the adrenal medulla, but if the emergency lastr, for more than a few nately, the dramatic effects of cortisone soon wore off with the result
minutes, the cortex of the adrenal (the exterior portion of the gland) that the patient was worse than before treatment . At first stght, this
would fit into the "Over Adaptatiori" theory of Selye .
begins to secrete more of its hormones . The latter are not so rapid in
Ht,wever, in 1950 a report from Hill at Harvard erased the con-
action, but their effect lasts much longer . Several hormones are pro•
fusion ;s' yet no one detected its significance and for 25 years it had
duced in the cortex : they control mineral metabclism, aid in maintain-
been forgotten . He was not interested in arthritis . nor especially in the
ing blood pressure, and aid in keeping a supply of sugar in the blood .
thyroid gland, but he investigated the effects of large doses of cortisone
The cortical hormones are manufactured from cholesterol ; therefore
it is not surprising that more cholesterol is storet ; in the adrenal cortex on thyroid function . He found that the production of thyroid hormone
was markedly suppressed . In other words, he had created hypothy .

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55 SOLVED THER1DDLEOFHEAKI A'I-rACLS A NEW LOOK AT S'I RESS 59

ruidism by an excess of cortisone . Now we can uttderstand why Selye fundamental question is, what makes the difference in the two groups
had produced hypertension and arthritic changes Nrith the chronic and how can Type A be converted to Type B? The success in preventing
injections of cortical extracts . The thyroid deficiency led to the arthritis . heart attacks during the past 25 years merely by treating those suscep-
just as Swain had demonstrated in 1929 .40 Mencd reported in 1950 that tible with thyroid would indicar : that Type A may be deficient in this
thyroid therapy was efficacious in hypertension ." "Over-Adaptation" hormone . Some of Friedman's data would confirm this suspicion . The
of the adrenal had not produced stress . but it had produced hypothy- cholesterols are higher in Type A . I rise further during stress : a high
roidism which in turn had produced mucopolysaccharides described cholesterol is common in hypothyroidism . The glucose tolerance test is
in chapter one . These compounds are present in all of our degenerative somewhat reduced in Type A patients : this is a common finding in
diseases resulcing from stress . the patient lacking thyroid . Type A patients have a reduced tolerance
There is no doubt that the adrenaLs are invaluable in combatting for fats : this again may be related to thyroid function, as mentioned
stress . but it seems obtrtout that stress can not be prevented by admin- in Chapter 3 concerning Simonds work ."
isterrng an excess of adrenal hormones . How<ver, a•,ordtng thyroid Dr . Friedman decided that the Type A patient was not hypo•
deJ:crency offers an excellent method for reducing stress . thyroid on insufficient data . He ran only a few patients for the serum
Infectious diseases have been the bane of man's existence for thyroxine level and found no abnormalities . As pointed out tn the
centuries . Raising the tesistance of the hypothyroid patient with thy- chapter on thyroid function tests, the blood tests are unreliable, and
roid therapy and avoiding the infection is far sttperior to allowing the furthermore, thyroxine does not represent all of the thyroid honatone .
infection to develop and using antibiotics to avoid death . Repeated The therapeutic test of using thyroid therapy for symptoms of thyroid
irtject:ons damage the lungs leading to emphysema . damage the heart deficiency over many years and on thousands of patients with sub-
leading to r/teurnatrcfever, and damage the Judneys leading to uremta; normal temperatures would seem to carry more weight than a fallacious
yet thyroid therapy alone can awtd most of these stresses . Repeated blood test . The absence of premature heart attacks in this group of
infections weaken the individual leading to arthritis in millions of thyroid-treated patients leaves little to be desired . Without psycho-
patients . By treating children low in thyroid function . the deposition therapy, the reduction in mucopolysaccharides seems to avoid the
of mucopolysaccharides can lre avoided . anc.t the development of ravages of atherosclerosis . I might say that often the excessive drive of
atherosclerosis and hypertension can be delayed . The atherosclerosis the Type A patie .tts is lost without any deterioration in their ability .
responsible for tile complications of diabetes can be prevented by Their efficiency seems to be increased, and they can accomplish more
thyroid therapy . Thyroid deficiency is responsible for more stress than withcut extra effort . Apparently mental stress . similar to that from
all other conditions known at the present time . For the prophylaxis of the environment, is reduced by thyroid therapy .
stress, begin with thyroid therapy when it is indicated . One of the most controversial subjects on atherosclerosis is the
So far, only enritonmental stresses have bcen considered . but of role of exercise . The Europeanc have walked more than the Amencans,
Pqual importance are those arising within the mind . Dr . Meyer Fried• and have had a lower incidence of heart attacks . The physical culture
man ." a phystcian and investigator in San Francisco, has spent years enthusiasts credit exercise for the difference . A more plausible expiana-
studying this question 1-fe has dividad ths population into two types : tion would be the higher incidence of tuberculosis and other infectious
Type A is quite susceptible to heart attacks and is characterized by a diseases in Europe . This could explain the discrepancy . Work is stress
personality with a drive to succeed, eagerness to compete, a desire for and exercise is work . This should answer the problem, but it has not .
recognition, propensity for deadlines, and determination to accelerate It is well to remember that the laborers are not exempt from heart
physical and mental functions . Type B is the op .posite in nature and is attacks . The pick and shovel workers do not ^njoy greater health with
much less susceptible to heart attacks . long survival . They appear older than their years, and do not survive
Dr . Friedman is correct in his division of the population, and their peers . The athletes who must keep in excellent physical condi-
many of both typel. have been encountered among my patients . The tion with maximum exertion are not immune to premature heart

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 HKI00550~i
oU SOLVLD• THk . RIDDLE OF HEART ATTACKS ANEWI .OOK .11'SIRtSN bt

attacks . as demonstrated by deaths on the football field and by two normal- The patient was returned to his room . About 30 minutes later
f5 tahties in professional wrestlers beFore the age of 50 . chest pain developed, he collapsed and died with a typical picture of
Each tissue in the body has a certain amount of reserve beyond a heart attack . The autopsy revealed a very recenl total occlusion of
that required for usual work and play . There is no evidence that we one of the coronary arteries . This is not the first such case to be reported .
can increase that reserve with exercise . By graded training the heart and it is apparent that the electrocardiogram is not infallible . fhere
can tolerate more punishment for longer periods . but has that added is no difference between the treadmill and jogging except the ambu•
longevity to the heart or has it used up some of the reserve and shortened lance does not have to pick up the victim . The cost of the treadmill
the life span? This is a difficult question to answer, and no controls test ( ;80-$1501 seems excessive fot the opportunity of committtng
can be run . It is true that following a heart attack, if death does not suicide .
occur . some new vessels may open up, and the individual may tolerate Nature gives us warning when we have over-stressed . Curtailing
more exercise than he did before the attack . This does not mean that activity a little at the time is more reliable than laboratory tests- As
more reserve has been added to the heart muscle . The blood supply one grows oldei it is prudent to gradually reduce one's work as well as
has been shifted and another area of the muscle is now in jeopardy if exercise . If playing a strer.uous game of tennis appeais to you, that is
another emergency occurs . It iu r,ot recommended that the patient your privilege ; however you should give it up when you are made weary
should spend the rest of his life in bed just to prolong life . That would by it unlrss you want to do some heart damage . One should Pxerrrse
not be living . But it does signify that he should not cry to become super- i for pleasure . but dum+ss the rdea that it uu(l :+rolong life . My most
man, or he will soon use up his reserve . remarkable patient exercised only by lifting his pencil . He was an
A few years ago jogging became the rage . From the ')eginning I accountant still working at age 80 . was alert and spry . No doubt exer
took a dim view of this attempt to strengthen the heart . It would not cise would have killed him at a much younger age . Stress is the greatest
harm healthy individuals, but why should it help them? On the other accelerator uf atherosclerosis, have respect for it .
hand, those who needed it the most had a reasonable chance of being Another mystery about heart attacks has been the higher tncidence
damaged with it . Some of the older members of society did not have among men . For a time it was felt by some investigators that the female
that much reserve left in their hearts, and should develop a heart sex hormone was protecting the "weaker" sex . Attempts were made to
attack as a result of the additional stress . It happened . More lives treat men recovering from the first heart attack with the female hor .
were lost than were benefitr,ed and jogging is no longer advised by mone . Two things happened : (1) the men developed breasts and lost
t.hose seeing the results . their potency, (2) the second heart attack occuned earlier than ex•
Now a new procedure for improving health is being advocated pected . The deleterious effect of the female sex hormone on males was
by some very competent physicians . It is advertised over the radio and clearly demonstrated from another angle . The Veterans Administra-
TV with great promises for benefit . "Check your heart on the tread• tion used estrogen in treating a large series of men with cancer of the
mill or exercise machine and determine yout tolerance ." The danger prostate . arA found that the growth of the ca icer was retarded . How
of such a procedure is admitted by the fact that it must be done in the ever, the men died from heart attacks sooner than they would have
hospital with one or more doctors in attendance and requires 2 hours . from cancer . Exce•.s of female hormone creates a stress in Lhe male .
In theJournal of the Rrrserican Medical Rssociatron for February 23, For tnany y%:ats it has been continually demonstrated that females
1976 a fatal case is reported The 56-year-oid male was admitted for have more resistance to infectious diseases than males . This does not
removal of the prostate . Although the electrocardiogram w3s normal give support to the thesis that health can be built up with exercise . If
he was given r.he exercise test which again showed no evidence of heart only tuberculosis is considered, the excess cf deaths among men is
trouble . The exercise was stopped when his heart rate reached 150 per almost identical with the excess of heart attacks among males . It was
minute . Throughout the test the cardiogram was normal . Following pointed out in Chapter one that the nse in heart attacks today has been
the test the tracings were repeated at 2-minute-intervals . and all were a result of reducing the deaths from tuberculosis . If this is true, the

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 62 SOLVED THE RIDDLE OF HEART ATTACKS

escess of males formerly afflicted with tuberculosis could account for CHAPTERfX
the excess of heart attacks among the stronger sex . But why should the
males be more setsceptible to infectious diseases? Certainly the stress
of exercise must be considered among the possibilities . Until the age
of puberty there is no difference between the sexes in the incidence of
fibrosis of the heart muscle . Fibrosis indicates da :nage to the muscle
fibers as a result of various diseases . While the girls are assisting their
mothers, the boys are engaging in competitive sports . fighting, and
Prevention : The Key to Progress
building up the muscle-mass to become He-Men . Fr3m that time on in Medicine
there is more tibrosis in the heart muscle of the male . This extra stress
could be a factor large enough to account for the excess of both tuber- it would appear that heart attacks may not be cured, but they
culosis and heart attacks in the alleged "Stronger 3ex ." What Price can be prevented - at least those occurring early in life can be delayed
Glory( Women's Lib may be their greatest achievement, but rj the until advancing years when other degenerative diseases have an oppor-
extra stress to meet the competition lowers their vetalr'ty, it may be their tunity to enter the competition . The rapid rise of heart attacks in the
darkest hour . 20th century was not due to changes in the environment . such as
cigarette smoking, too much animal fat in the diet, a lack of exercise .
etc . It was the result of the conquest of infectious diseases by improved
medical care and antibiotics which prolonged the lives of over half of
the population . It is obvious from previous pages that those individuals
susceptible to infections are likewise susceptible to atherosclerosis ; pro•
longing their lives permits them to live long enough to develop heart
attacks . At the present time, natural consequences have a far greater
influence on public health than have environmental factors .
In reviewing the history of the scourges of mankind, one finds
that the prevention of smallpox changed the leading cause of death
from this killer oi young children, to tuberculosis since the population
was permitted to live longer . Then when tuberculosis was deterred, a
new champion of death had to emerge . At the turn of the century, if
a meeting of the minds had been held to predict which disease would
come to the fore in case infections were conquered . no one would have
mentioned "heart attacks" - they were not as yet in our vocabulary .
When heart attacks did appear, they were so frequent that they shook
the halls of science at their very foundations . Had another plague
arrived to decimate mankind? The researchers failed to realize that
the average age of survival was climbing rapidly . The health of the
nation was the best in history .
The solution to THE RIDDLE OF HEAR'1' ATTACKS again
came from preventive medicine . Because of a thorough knowledge of
the physiology learned from teaching the subject for five years and

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 w 5ULVt:D 1HERIDDLtOFfII:ARTA7'fACKS PREVENTION KEY TO PROGRESS IN MEDICINE 65

demonstrating to university students the effects of the removal of the attacks by 94 percent . We owe a huge debt to the baby rabbits that
thyroid glands in baby rabbits . some of the problems in medicine were gave their lives that man might live .
solved . Patients highly susceptible to infections were similar to the Unfortunately, some other rabbits started a different train of
thyrotdeccomized baby rabbits . Thyroid therapy raised the resistance . thought and implicated cholesterol in atherosclerosis . This has delayed
and many infections could be prevented . Women with menstrual or progress for 60 years, but the mistake is explained in the final chapter
reproductive problems had some of the same rymptoms as the baby of thisshon treatise .
rabbits . Thyroid therapy relieved many of the problems in the human .
Fatigue and lethargy were characteristic of the baby rabbits . Patients
with these symptoms responded dramatically to thyroid administration .
When it became obvious that elevated cl:alesterols were often present
in adult patients with heart attacks, it was recalled that the baby rabbits
had high cholesterols . Several investigators had found that thyroid
I
therapy would lower the cholesterol level in the blood .
The prevention of infections, of menstrual disorders, of fatigue .
and many other atlnents with thyroid therapy continued in my patients
for 13 years . Suddenly it was realized that none of the treated group
had developed heart attacks . It was only then that the idea arose that
thyroid deficiency might have a role in atherosclerosis and heart attacks .
Searching the litetature revealed socrtc astounding facts . In the last
century, long before heart attacks were understood, marked athero-
sclerosts was reported in an autopsy on a patient having no thyroid
gland . Funhermnre . removal of goiters to prevent suffocation was
followed by accelerated atherosclerosis . Also, removal of the thyroid
frum animals led to damage of the arteries carrying blood to the heart .
Administration of thyroid hora .ane to these animals prevented the
artertai damage Thyroid therapy had been found life-saving during
World War I in patients with heart disease and low thyroid function .
All of these observations were known before heart attacks had become
numerotu . but they had been forgotten .
it was in 1950 that a program was started in a busy general prac-
tice to see if detecting all of the thyroid deficiencies and treating them
wttit thyroid would prevent premature heart attacks . After 25 years
of this regime . there can be no doubt that thyroid therapy alone now
offers more hope for reducing the devastation of heart attacks than all
other methods combined . This was accomplished only from the prac
tice of preventive medicine and without any financial aid from the
government or private research sources . The results indicate that any
physician without special equipment or without hospitalization of his
patients for special studies can reduce the number of premature heart

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 CHAPTER X

The Demise of the Cholesterol Theory

In science, theories are created to explain the correlation of some
known facts and to assist in designing experiments for the collection
of more pertinent data . Very often the collection of more facts makes
the theory untenable, and it must be abandoned . The cholesterol
theory was born to explain the rapid rise in heart attacks in the 20th
century . Many facts, present before the theory arose, were not explained
by it, and many new facts, accumulated during the past 25 years, fail
to support the theory . The time hoa come to bury the theory that
cholesterol caases heart attacks, some of the deeds of this shady char•
ncter preclude a furseral with ' full military honors" or burial in one of
our National Shrines .
A few words abnut the facts upon which the theory was founded
are in order . The first was the presence of a high incidence of choles•
terol in atherosclerotic blood vessels . This is always true . but as early
as 1858 Virchow .40 the father of modern Pathology, clearly showed
that cholesterol did not start the proce :s but that it was the end product
of degeneration . Damage to the tissue became evident first, then came
an accumulation of fat, and itnally, as the scar tissue was fonmed . a
high content of cholesterol appeared . It was part of the healing process
of a wound from damage caused by something else . This sequence of
events was confirmed by Leary .•• a modern Fathologtst, at Harvard .
Hence, the first evidence that cholesterol causes heart attacks must
be discarded .
The second major evidence incriminating cholesterol was the
scarcity of heart attacks in the underprivileged countries whose popu•
lations eat relatively little animal products containing cholesterol . This
fact is well established, but does it prove that the absence of cholesterol
was responsible? Absolutely not, for . as noted in Chapter one . Strone
found atherosclerosis in the arteries of all of the children by the age
of three coming to autopsy in the underpririleged countries as well as

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 Nh@OG53GG1
btl SOLVED T11E RIDDLE OF HE.ART ATTACKS I
i
i
Uk.MISk OF 711ECHOLF-c t'EROL t'Hk .ORY bs

in meat•eating countries . In fact . Higginson's and others have found amount of hydrogen in the molecule . Both are composed of long car•
more atherosclerosis in the younger Bantu than is found in America . bon chains as illustrated here :
Then why do the Bantu have such a low rate of heart attacks? Again,
in Chapter one the answer was pointed out from the autopsies at Graz .
Austria . In countries with a high incidence of deaths from infectious I H It H H H H II 1~ Ili I~ II Ilf
diseases . pattents die from infections at an early age before hean
attacks can occur . Proof for Ihis among the Bantu comes from a report I -~-~-i-I-I-I- -i- l
Illi-L = L -c-c-
by Laurie'b who found a rapid rise in heart attacks as tuberculosis
declined . The second evidence against cholesterol now has a more
I H H H
~ A
~ r1 H H I~I
plausible explanation . Saturated Fat Unsaturated Fat
The third and final proof that cholesterol was responsible for
heart attacks came from Europe during World War II . Heart attacks
that had been rising rapidly frll precipitously during the war when ; In unsaturated fats there is a double bond uniting two carbon atoms .
cholesterol•containing foods were unavailable . As mentioned in Chap• Since carbon has only 4 bonds to unite with other elements, there is
ter one, autopsies proved that heart attacks fell as much as 75 percent, nothing to hold the hydrogen to the carbon at the double bond . This
but atherosclerosis increased four times in severity . Tuberculosis ex- double bond linkage is relatively unstable and tends to break apart
ploded ; patients were dying from it before heart attacks could occur . into two smaller molecules either in the laboratory or within the body .
The absence of cholesterol from the diet had offered no protection to The double bond is similar to cutting a notch in a stick . Any attempt
the patients' arteries . The most potent evidence for the theory must to bend the stick may cause a break at the notch . If the fat breaks up
be discarded in view of the facts . into two sections the carbons on either frayed end have a powerful
It is apparent chat the cholesterol theory has become a myth ~ attraction for any other compound with an opposite charge . Some of
causing a tremendous loss in time and money . But that is not the most the compounds formed from the breakdown of unsaturated fats are
serious part of the story . Evidence has been accumulating that grave toxrc to the body . Some of them have been demonstrated to form
damage has been done by a shift in diet trying to prove the cholesterol cancer when injected into or fed to animals
theory . From time to time . hard water, sugar . coffee, and a host of Normally the saturated fat molecules are oxidized or burned or .ly
other ingredients in our diet have been accused of causing heart attacks, at thr end of the chain, two atoms of carbon being eliminated each
but they have received little attention in comparison to that devoted to time . There are no toxic compounds created under these circumstances .
saturated fats . Saturated fats are more abundant in the animal world However, the unsaturated fats have a weakness for oxidation at the
and unsaturated fats predominate in the vegetable world and in frsh . double bond . Two unnatural carbon linkages are available if tlie chain
This has been part of nature's adaptation to the environtnent . and breaks at this point . If there are two or more double bonds irt the par-
does not sigrafy that a mistake was made in the creation of warm-bloadrd ticular fat (polyunsaturated), the increased number of notches on the
animals . There is no cholesterol in the plant world, yet no animal can stick weaken it further ; accordingly, there are more chances of Itbera-
survive wishout it . [n man, the brain and spinal cord make up only tion of abnormal carbon atoms with the subsequent formation of toxic
2 percent of the body weigut : still 23 percent of the cholesterol is in compounds . Is this theoretical and academic? Far from it ; evidence .
rhe central nervous system . If for eons man were to feed on food low though fragmentary, clearly indicates that polyunsaturated fats cause
in cholesterol . he might wind up with the brain of a jellyfish . more toxicity than those with only one double bond .
The layman may understand the dangers of eating too much poly- Were diets high in unsaturated fats tried on animals before the
unsaturated fat if a few words are devoted to the difference between demands were made that the human diet he changed? Absolutely not .
the saturated and the unsaturated varieties . They differ only in the The theorists were so sure the world was coming to an end from heart
attacks that there was no time to wait for experimental pioof of their

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 HK®+7L 5 s 0J ti '
70 SOLVED : THE RIDDLE OF HEART ATTACKS DEMISE OF THE CHOLESTEROL THEORY 71

theory . If this sounds like a fairy tale, note the followir .g which occurred mation under the rug . First, however, what were the details? Soon after
as late as 1970 . At a symposium on "Diet and Cardiovascular Disease" the diet alterations were suggested, a controlled study was undertaken
refereed by Frederick J . Stare, M .D .," an outstanding nutritionist at the Veterans Hospital in Los tingeles . n total of 846 men were
from Harvard, it was concluded that - the computed cost in tetm9 matched and divided into two groups : one received the customary diet
of human lives alone of waiting for ultimate proof for the prevention including animal fats, the other group was fed the same quantity of
of coronary disease by lowering the serum cholesterol with diet is up polyunsaturated fats . Over a period of 8 yeats, careful records were
to one million lives in the next five to seven years in the U .S .A . alone - . kept including autopsies on the majority of deaths . There were a few
In the same anicle, dangers of such a diet, although acknowledged . more deaths from heart attacks among the men on the saturated fats,
are dismissed without consideration . but variations from this disease are not unusual . Of far greater im-
It is obvious that the theorists have totally disregarded the fact portance, there were almost twice as many deaths from ra-t :.er in the
that the average age of survival has continued to climb all during the group on polyunsaturated fats . This came as a surprise, for deaths
rise in heart attacks and is now the best in history . Their obsession for from cancer do not show the variation in incidence that is sten with
diet is often motivated by vested interests of the manufacturers of heart attacks.
uneaturated fats with their exaggerated claims without foundation . In the previous volume of Lancet there appeared a letter to the
The latest colossal mistake is the circumcision of the yolk from the egg . Editor from Harman,ts an investigator from the Veterans Hospital in
Egg yolk contains one of the unsaturated fats essen :ial for growth and San Francisco . He cautioned against the use of polyunsaturated fats
health . Its necessity has been proven without reasonable doubt ; no one in human diets because of the cancer•producing compounds that can
has demonstrated any harmful effects from the cholesterol in egg yolk result from the breaking of the double bond, mentioned above . He
which is being eliminated from the diet . also pointed out that the Japanese have a much higher incidence of
If the literature is scanned for evidence of toxicity of unsaturated cancer of the stomach than is seen in other countries . He suggested
fats in the diet . one report precedes the cholesterol theory . In 1945 that the high content of polyunsaturated fats in the fish diet of the
Rausch'I at the University of Wisconsin noted that adding cnrn oil to Japanese might be a major factor in the incidence of cancer . He further
the diet of rats increased their susceptibility to tumors . This observa- stated that some reduction in the breakdown of unsaturated fats could
tion alone should have called for a thorough investigation of this group be obtained with an increase in Vitamin E in the diet, since it is an
of compounds before they were applied to the human . Perhaps the anti•oxidizing agent .
cholesterol activists considered unsaturated fats safe since cancer among The last statement is probably well-founded . Vitamin E was sel-
the underprivileged populations had been very low . It is well to bear dom used before the introduction of unsaturated fats in abnormal
in mind that the reason is identical with the scarcity of heart attacks - amounts . At the present time, it is suggested for everything from falling
most of the people die from infections before they reach the age at hair to fallen arches, and if one is eating an excess of polyunsaturated
which cancer or heart attacks might be expected . fats, any tissue in the body might be poisoned without it . It seems foolish
It is a sad commentary on the American scientist that the potential to administer a poison requiring an antidote for neutralization ; it
danger of unsaturated fats had to be brought to their attention by an would appear more logical to avoid the unsaturated fats in the first
abnormal number of cases of cancer in patients ieceiving diets high place .
in unsaturated fats for the prevention of heart disease . In 1971 a report A few publications or. cxperimental animals began to appear
by Pearce" appeared in L.ancet, vol . 1 . page 464 . entitled, "]ncidence after these reports . In 1960 Ershoff" found that fish oil used as 10 per-
of Cancer in Men on a Diet High in Polyunsaturated Fat ." Why was cent of the diet in growing rats stopped growth and produ_ed diarrhea .
this article s~nt to Englend where unsaturated fats have never been Vitamin E was found to be ben-licial . In 1967 Norkinbs reported more
popular? Was it refused publication in American journals? It seems cirrhosis of the liver in rats fed corn oil than in those fed a saturated
strange, but regardless, there has been an actempt to sweep this infor- fat, coconut oil . This undesirable effect could be prevented with extra

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 I' KIROL'5 304 •,
%, SOLVED- THE RIDDLE OF tIkAR I' ATTACKS Dl:N7tSEOFTHE CHOLESTEROL THEORY 73

Vitamin E . In 1968 Carrol" in Canada produced more mammary saturated fats . Dr . Mackie felt that this was a factor in causing the
cancers in rars fed corn oil than in those fed coconut oil . In ] 968 in the rare disease .
New England Journal of Medicine Ritchies• reported seven premature It will take a tremendous number of cases and considerable time
babies suffering Irom edema . hemolytic anemia, and abnormal blood to test the role of unsaturated fats in the origin of cancer . There is no
cells . Because of the propaganda about saturated fats, they had been doubt that an increased incidence has occurred in experimental ani-
started on pre•dtluted . skimmed cows' milk, vegetable oils and iron . mals . Why have not more studies in animals been undertaken? Finally
They responded to large doses of Vitamin E Some common sense, the American journals are beginning to publish articles on the dangers
with the old fashioned formula using milk-fat, no doubt would have of unsaturated fats . An editorial by Pinckney" in the lune 1973 issue
prevented this near tragedy . of the American Heart foursutl reviews evidence that the unsaturated
Now 19 years ajter tlte tuarnrng ehal unsalurated jats might cause fats hasten aging of the skin, are toxic to both animals and man, and
caruer, polyunsaturated fats are being thrust upon the public by the furthermore, that the use of such diets has not prevent°d heart attacks.
press, radso and T6' . Similar evidence from a pesticide, a food additive, It is apparent that the use of polyunsaturated fats in concentra-
or a pollutant in the environment would call for immediate action tions of 10 to 15 percent as recommended by some of our scientists is
with cessation of the use of the suspected item until it was proven safe . highly controversial . There is no concrete evidence that this alteration
Nothing has been done about the potential danger of unsaturated in our diet over a period of 25 years has benefitted our health . There
fats except some feeble attempts to discredit the observations from Los is positive proof that the polyunsaturated fats are toxic to experimental
Angeles . There have been four other reports of somewhat similar animals, and additional Vitamin E must be added as an antidote if i
nature although fewer patients were used and the interval of study reasonable quantities of such fats are eaten . A single report on pre-
was shorter . These were reviewed by Ederer" in 1971 . One report from mature babies indicates that the human may also be poisoned by this
Oslo confirmed an excess of deaths from cancer in the patients on concentration of polyunsaturated fats . Both babies and oldsters are
unsattirated fat diets . The three other studies - one from Finland, known to be more susceptible to medicines and toxins than are young
one from Lo^ +on, and one from the University of Minnesota - shuwed adults . The suggestion from two independent reports that the aged,
no differe.: _i the incidence of cancer in the experimental and con• fed polyunsaturated fats, may develop more cancer cannot be dis-
trol diets . It sounds like the World Series with the best three out of missed . If this type of diet has no demonstrable benefit . WHY SHOULD
five trials showing no effect . Ederer conrlt,ded frotn a statistical treat- IT BE USED?
ment of all five studies that it is unlikely that cancer is a hazard in the The American Cancer Society was shocked at a 5 percent rise in
dietary treatment of heart disease . He does admit that the patients in cancer the first seven months of 1975 when a one percent had been
the Los Angeles studv were 20-25 years older than those in the other anticipated . In the frantic search for causes of the rise in cancer cer-
four studies . This may well be the important part of the argument . tainly the increase in polyunsaturated fats for the past 25 years cannot
Car.cer is a disease of older age groups, and studies on young patients be neglected . The housewife followed the scientists' advice 25 years
ir•, no way can be compared with those on older populations . ago when the circums :antial evidence indicated that heart attacks
Another report recently incriminates unsaturated fats in cancer . might be avoided by crowding in more polyntnsaturatr.d fats and avoid-
Dr . 4Tac9.ieS6 of Sydney . Australia, reported itve cases of malignant ing animal fats . Now it is apparent that the saturated fats were not
melanoma (pigmented cancer) appearing in a matter of 12 weeks . This causing the rise in heart attacks . This change in the death pattern was
highly fatal disease is quite rare ; five cases constitutes an epidemic . caused by eliminating infectious deaths allowing a NEW POPULA-
All of the cases were in sunbathers exposed to ultraviolet light . Cancer TION to reach an age capable of developing heart attacks . The evi-
of the skin is common in farmers and frsherrrten, but melanomas sel- dence that the polyunsaturated fats are toxic and may cause cancer
dom occur . Eacit of the five cases had shifted their diets to polyun- is not tlteoretical ; tt is far more conclusive than the evidence that
saeurated fais were causing heart attacks .

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 TI KYdQU JJU ,1 r~
74 SOLVED . THE RIDDLE OF HEART ATTACKS

It is time for the housewife to make another decision . Can she

afford to continue the unsaturated fats with their demonstrated tox-
icity and run the risk of cancer in her family? It was difficult to deny
the members of the family their eggs, bacan, etc . . but mothers have
a way of achieving a desirable change . Now she has found that a mis-
take was made and she should be just as eager to reverse her stand and
prevent some new tragedies . It will be hard to ignore the propaganda
that the saturated fats cause heart disease . That propaganda will stop Bibliography
abruptly when the housewife passes up the unsaturated fats and fills
y/ 1 . Barnea BO . Ratunhofer M . Gui R : The role of natural consequences in the
her basket with cream, butter, eggs, lard, fat meat . and the other changing death patterns Journal Amencan Geriatnu Society 22 :176 .1974 .
goodies which the family has been craving . The propaganda for un- 2 . Herxhenmer G : Grnndlagen der Porhologtschen Anatomte . Muenchen und
saturates is perpetuated only by the vested interests of the manufac- Wieebaden . Verlag von JF Bergman . 1921 .
turers . The few pennies saved on the budget by purchasing cheaper 3 . Zinseding WD : Researches on atheroscleroais : on the aorta fat in children . Vrrchouu
Arch Path Anat 225 677 .1925 .
margarines and oils may be a poor investment compared to the pro•
4 . Strong JP. McGill HC : The pediatric aspects of atherosclerosis . Journal Athero•
longed and horrible death from cancer . If the polyunsaturated fats
icferosts R^search 9 :251 .1969 .
are safe, let the manufacturers prove it on animals before a new plague `,.5 . Barnes BO and Barnes CW : Heart Attack Rareness m Thyrord•treated Plretents .
develops from the false statements that unsaturated fats will prevent Springfield, Illinois. Charles C Thomas, Publisher, 1972
heart attacks . 6 . Ord WM : On myxedema . a term proposed to be applied to an essential condi-
tion in the cretinoid infection occasionally observed in middle aged women .
Everyone should have the privilege of playing Russian Roulette
Tranaactions Med-Churg Society London 60-61 .57,1877-78 .
if it ts desired, but it is only fair to have the warning that with the use 7 . Andersen H . Asboe-Hansen G. Quaade F :' Histopathologte examination of the
of polyunsaturated fats the gun probably contains live ammunition . skin in the diagnosis of myxedema in children . Journal C(mical Endocrmology
and Metabolism 15 .459 .1955
8 . Luke JL . Hrlpern M : Sudden unexpected dcath from natural cattrm in young
adults . Archives Pathotogy 85 :10 .1968
9 . Gull W . A cretenoid state supervening tn the adult life of women . London C/trucal
Society Tranaactions 7 .180 .1875
10 . Report of a committee of the Clinical Society of London to investigate the subject
of myxoedema . Transacttons C4rucaf Society London, supplement to vol . 21 .1688.
1 I . Kocher T. Arc4 f Khn Chir 1883 .
12 . von Faselsberg AF On vegetative disturbances tn growth of animals after early
thyrosdectomy . Arch K!m Ciur 49:207,1895 .
13 . Murray GR : Note on the treatment of myxoedema by hypodermic injections of
an extract of the thyroid gland of slrcep . 8ruuh MedrealJournaf 11 -796,1891
14 . Pick EP, Pineless F : Research on the phyaiologically active substance of the thyroid .
Esp Path Thm 7 .5i8.1910.
15 . Anitschkow N : On variattons in the rabbit aorta tn experimental cholesterol-
feeding . Bercr Path Anat u alfgem Path 56 379 .1919 .
16 . Malysheva LV : Tissue respiration rate in certain organs in experimental hyper•
cholesterolemta and atherosclerosis Federation Proceedings 23 T562 .1964
17 . Zondek H• The Myxedema heart . Munchen Med Wschr 65 1180,1918 .
18 Assmann H . The myxedema heart Munchen Med Wschr 66 :9 .1919 .

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 !iK®00530A5
70 77
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19 Chtutian Hr1 1hr luart and its manaKement in myxrdrma Rhod : lsland 40 Swatm 1'I Chronic arthritis . lurther metabuhsm studies journal Amrruan
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Medical As .,orratton 43 :259.1929
20 Scuigs CC Whtuug WB Ihe trcatmrm and prognosis in myxedrma journal 41 Menof P New method fot control of hypertenston South A/rrran A1rd+ralfoumal
.! mrrrean .Nedrra( .f ssoctatron 85 2013 I qLS .
24 17'G . l95(l
21 Fr,rdland IB- In .esugauon .a on the mBurncr ol thyroid preparations on experr
42 . Friedman M . Roseman Rai Assonanon of spruf•tc oven behavior pattt•rn with
mrntal hyperrholrstrrolrmta and athrrosclerosts Z Ges 6xpMed fi7 1385 .1933 blood and cardiovascular flndtngs journal American Medtcal Assorratron 169
22 Simonds JP Helper OE Fat tolerance in hyperthyroidrsm journal American 1286.1959
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•f3 . Virchow R . Die Cellularpathologrc Berlin . Verlag von August Htrschwald, 185it .
23 Hurxthal LM Blood cholesterol and thyroid disease . Archioes fnternal Medr•
page 30ts.
crne 53 762 . 1934
44 Leary T . Lxpenmrntal athrroxlerosts in the rabbit compared with human
24 Turner KB . Present l ;H . Didwrll WH . The role ol the thyroid in the regulation
(coronary) atherosclerosu Arc/ttees Palhology 17 •i59 .1934 .
of the blood cholesterol of rabblts . Journal Espertmenfal Dfedtctne 67 :111 .193 .1 45 Higgtnson J . Pepler WJ Fat tntakr . serum cholesterol concentrauon . and atheru•
25 . Gddea EF . Man fB . Peters JP Serum Irpotds and proteins in hypothyrotd•ent .
sclerosis in the South African Bantu . Part II Atherosclrrosis and coronary arcery
journal Clnsrcaltnvesttgatton 18 :739 .1939 disease JournalClmtcal fnuest :gatron 33 1566 .1954 .
26. Smyth CJ Angina prctorts and myocardial infarction as complicattons of myxe•
46 . Laurie W . Woods jD . Roach G Coronary heart disease in the `,c.uth Alrtcan
dema . Amencan Hearr fournal 15 652 .1938 Bantu AmenrartJournal Cardrology 5 .48 .1960
27 . Lermen J . Whtte PD Metabolic changes in young people with coronary heart
47 . Stare FJ frefrtref . Rathman DM . Stockton JR Melnick D• Dynamu utrhration nl
duease .Journal Clmrtallnvestrgatcon 25 914 .1946 .
recent nutritional ftndings . diet and cardiovasc ular disease . CRC Critical Rrclrw,
28 . Kouncz W8 . Thyroid Funcrror and ets Possible Role in Vascular Degeneration
. in Food Technology I 331 .1970
Springfield . Illinois. Charles C Thomas . Publrsher . 1951 .
48 .^.usch HP . Kline BE . Baumann CA. The mBuencr of calnrrr rrNtnruon and uf
29 Andersen H . Asboe Hansen G . Quaadr F• Htstopathologrc examination of the dietary fat on the tumor formation with ultraviolet light Canrer Rrtearch 5 431 .
skin in the diagnosis of myxederna in chddren . journal Clrrucal Endocrmology and
1945 .
,bfetabolnm 15 .459.1955
49. Pearce ML, Dayton 5 : Inctdence ol cancrt in men on a diet high in pofyunsatutatni
30 Goldblact H Studies on experimrneal hypertension : pathogenesis of expenmental
fat . Lancef I 464 .1971
hypertension due to renal tschemta . AnnaLt Internal Medicine 59-347 .1997 50. Harman D . Arherosclrros6 possible rll-elfrcts of the use ol highly unsaturated
~ 31 . Barnes BO Hyprnension and the thyroid gland . Clmrcal and Fxpertmental
lats to lower serum•cholestrrol levels f.ancet 11-1116 .1957
Pharmacology and Phy3rology Supp12 .167,1975 51 . Ershoff BH Elfects of diet on fish oil toxicity in the rat journal Nutntron 71 45 .
32 . Dawber TR . Moore FE . Mann CV- Coronary he : .rr disease in the Framingham
1960
study . AmencanJournat PubGc Hcalth 47 .4, 19 :7 .
52 Norkin SA Experimental nuuuional ctrrhosts in the rat Archrues Pathologq
33 . Struower B . Gofman JW . Galiont EF, Rubmger JH, Ponleau J . Gurvtck P : Long
83 31 .1967 .
term effect of dried thyroid on serum Iepoprorein and serum cholesterol levels . 53 Carroll KK . Gammal EB . Plunkett ER• Dietary fat and mammary c anrrc Canadian
Lancet1 .120 .1957
Medical Assocratson Jourrtal 98 .590 .1968
34 . Israel kf . f .cog-term thyToid-vnamm treatment of atherosclerosis in ehrontc
54 . Ritchie JH . Mathews BF . McMastrrs V . Grossman M : Edema and nemotytu
d,seases. Sourhmestern Medicine 94 .January .l963 .
anemia in premature infants . Neo, Engfand Journal Medrerne 279 1185 .1969
35 Wren JC : Thyroid function and coronary atherosclerosis journal Amencan
55 Ederer F. Leren P . Turpemen O . Frantr ID Cancer among men on cholrsterol
Gerratncs Socuty 16 :696_ 1968 .
lowertngdtets . Lancef 11-203 .1971
N,'rrn JC : Symptomattr atheroscleroais: Prevention or modification by treatmnn
56 . Mackie BS- Malignant melanoma and diet 6ledtralJournai AustrnGa 1 810 .1974
wuh rfe.accatrd dtrrotd. Joarrcal A mencan Genatrtes Society 19 :7 .1971 57 Pinckney ER The potential toxtnty ol excesatve polyunsaturates . American Heart
36 . Jaclawn AS . Hypo:hyrotdisrn journal American Medur! Assocwrion 165 121 .1957 . Journal85 723 .1973 .
,,,37 . Barnes BO: Basal :emperature versus basal metabolism journal American
Med.cal Auocruram 119 1072,1'J42 .
38. Selye H . Scudieyon adaptation Endocrrnology 21 169,1937
39 Hill SR . Reiss RS . Forsham PH . Thorn GW : The effect of adrenocorttcotroptn
and cortisone on thyroid functton• chyroid•adrenocortical interrelationships .
journal Clmual Endocrrnology 10 :1375.1950.

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 {iK®oa53oQ6

INDEX
Acne. 31 Auropates
Adrenal aiherwclaate in children . 4
and ch.olesterd . 57 athero.cleroau, hypothyroidum. 21 . 64
hormone . dosage . 52 compulsory in Austna . 10
removal of. 27 heart attack crre . 61
instreas, 56 heart auaclu and infecttoua diaearea. !, 6, 68
Age. advancing heart attacks. World War 11, 2
and heart attacks . S7 mysedema care (Ord's), 14, I S
American Cancer Society cancer, VA hosfaul, pnlyumaturated [at, 71
cancer rise. 73 value of. 9
Arr.ermcan Medical5ociety of Vienna . 10 World War 11, 1 [
Andersen, H
and hypothyroid children . 5, 24 . E5 . 59 Bantu
Angina pain . 22 . 44 atheroscleraia in . 68
Anemia Barnes, B. O.
hemolytic . in babies . 72 basal temperaturr, 48
and low temperature . 34 heart attack rute, 9
Amexhkow . N New Populatton, 4 . 5 . 75
choleuerol • fed rabbiu. 16. 17 . 18. 20 thyroidtherapytn hypenenuon .3.5
Anubtoucs Basal metabolism. 21 . 22 . 28
teducuon of infections. 3 . 3, 4. 63 and ba .ai temperature. 48
Anu-oatdising agent te4t, defined. 45
in unsaturated fat toaicity, 71
Basal Temperature
Aorta defined, 48
location, 7 and thyroid dosage . 52 . 54
rupture of. 9 use with hypothyroid syreptoen . 29 . 31,
Artener 32 .33
hardening of (see Atherosclerosis) Beta- liproteins . 41
Anhntts Btllroth . A ., 15
and cortiaone . 167 Blood preaure, elevated (tee Hypertefmon)
mueopolyaaccharidea in, 24 Boils, 81
and thyroid deficiency. 58 Brewers yeart . 43
Aaptnn . 41
Aesmann . H . Cache:ia aerumipriva . 15
my.edema heart . 41 Calcium glueonate, 4 5
Atheroaclerosia (hardening of the arteries) Canada
in artenal system . 14, 15 Carmll's work . 72
in "Carun and Treatment", 41 Cancer
rn children . 24 . 25 . 58 estrogen treatment . 61
m Gras autopsies 2 mammary, in rats, 72
in heart attacks . 8. 21 rnucopolv.aarharidea . 24
and hyperchoiesteiolemia. 38 unset urared fats. 69 . 71 . 74 . 74
and hypertenuon . 78 Cancer producmg compounds, 71
increase in severity . Graa. 68 Carbon atom
and tnfesrrons . S, 65 in (at molecules, 69
in ktdney artery . 25 Carhon . A. j . 27. 86
in Kounii xudy, 23 Carnrvora (animalal . 68
and mucopolysacchandes, 59 Carroll, K . K ., 72
prevenuon with thyroid therapy . in Children
rabbrts . 19 athermderasia in. 4
in rabbits . 20. 65 Gholetaerol
and tuberculosis . 9 . f in adrenal dunng urets, 57
Austna in central nervous system . 68
autopsies at Gras . Y . 6 in egg yolk . 70

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 HK1Q053047
NU I N UhX I \I I)hX m
rrd w r abbru I b . 17 F Itg rulk . 70 and dirt . 71 73 symptome oi . 29. 90. 31 . 32 . !S, 54, 52
in Fnrdmaa s I Vpe A 59 Eggs . 74 due t o at hrrosc Irrons. 8 treated wnh thyrord . 44
a, hrarr atrar k wspn t . 2 So b5 . 6tl .un Fasrlsbrrg . A . F 15 . Ib Graz Austria. 3 68
I.dsunsaturatrd far. and 23 FJerrrw ardrogram 17 . 60, 61 :n Ihr mtnunty . ol suddrn deatha. 9 . 11 . 12 Infecttom
in rabbns high aftrr ahyru :dretamy . 2U tmphvsrma prrmaturr . 64 middle rar . 90
serum hrgh mrtabulum lor. 22 1..11owrng r•peared rnlrrtrons. 5b resulung lrom drereasr in infrcuoua Infectloua diseases
rh .ro.d definenry and . 15. 96 . lrF tnrrronmmt . S dtseases including luberr ulosn . I . 2 . 9 . associated with athcrosclrrtnts, 5. 59
and thvrmd he-ne to rabbns . Id . 19 I, r.hofl, $ A ., 71 4. 5.5 in Bantu. 68
thvrordtherapyand 38 -1I 44 Far roRen . 41 thyroid defturncy . factor in . 19 damage from . 58
Chulr,rrrul rnnurnrng Ioods 2 . 68 F.urhrord 53 Heart drseaae . 1 a reduttmn of. reaulting in nw of heart
Chotrsrrrcd Iher.ry 67 68 Farrcue . 36 47 . 99 . S9 . b0 bl b9 atherosclerotic 37 attacks. 1 . 2 . 4 . 6
Chohr.r 4s Faugue l lrar t farlurr . I S re.istance to . raised by thyrord thrrapy .
( :rtolosrn r0 symptom of hypothyrordum in human . 53 Hemorrhage . 12 Israel. M
Chrlstran H n 18 symptom of hypothyrordrsm in rabbit . 64 in brain . I I treatmenl of hypmhyroids 43 . 44
(:rgarrun 9b .6S Fa1s Hrrbirora, 15 . b8
Grrhusrs nr the Irtrr poiyunsaturatrd . 29 .40 .68 74 Herrrck . J B . 55
Jackson . A . S . 46
mraro 71 saturated . 63 . 68 74 Herehermer G Japanese. 71
aI i .rrny a/ L .nd .n 19 u nsatu r ated . 97 . 98 68 74 mberculrau and arterral damage 3 Jenner . E I
l.dd , ummun 30 Fau .arrd . . 20 Hrgganson .J
Joggrng. 36. 60. 61
r .dd raurnnrres . SI Female atherosr Irrosu in Bantu . 68
l:.nnud hran damage 98 Hr11 .S R
orardrrr 70 71 .72 Ktdney
Women s Lrb . 62 thyroid depressed by cortisone . 57
a: .oronatYarrmn 7 8 alherosclereau of . 25
Frbrosu . 62 Honnoneys)
(aotunarr arrrry dnrase . 11 35 Fuh 68 .71 hypertenston . relation lo . 24
female . to prevent heart attacks . 40 . 61
(wrronarn Control Group. 40 uremia . 30
Ftsh od synthetrr thyroid . 52
t:oronarv embolism d in rar drel . 71 thyroid blood teus. 46 . 47 Koc her . T . I S
(:ornnarv orr luumn (ser Heart attark ) Framrngham . Mw . Heart Dtsease Studies . thyroid to prevrnl atherosclerosis in Korean conBict . 56
Corr-nr 57 .58 Kounrz . W B
37. 98 . 39 . 40 anrmals. 16
(:rrun 2d Ihyrord therapy program. 22 . 36
Franro•Grraran War thyroid . suppressed by corttsone . 57
Cretmnm IS strrss. 55 Horsley . V .
Friedland I B . 18, 20 . 43 Ihyroldretomy in ammab . 14 Laune, W
Deaths sudden Friedman . M . . 58 Hursthal . L M nu in heart attacks wrth decline in
aurupsrn . mthtarq . World War I1, I I hypothyrords wrth high chulearrols . 19 tuberculoars, in Bantu . fi8
hean attacks . in mmoruv ot . 9 . 12 hypenhyrotds with low rholestrrola. 19 Leary . T . 67
Grldea . E F. . 20
Crgrnrr .t .on Glur ase loleranrr test . 59 Hydrogen atom in fal molecule . 69 Lerman . J
artrnal I (rofman . J . W ., 41 Hypercholesterolemta, 20 . 37 study of recovered prematue-hean attack
in athrrosrlerosts. 5 67 in Framingham study . 37 patients . 22
(;oner . I S
.oronary . 3 . 9 Hypertension Lipo proteins . 20
Goiter regrons 31 . 64
tu krdnrys . 14 in Coronary Drug program . 41 Lroer damage . 19
Goldblatt H
tlegrnrrauredruasn. 57 . b8 hypertension . dogs . 24 25 result of corucal extracl to animals . 57 . 58 London Clinical Soctety Commusmn . 14
Drprnuon !9 Gnr Austria Framingham stud) . 37
Dnn, ated rhyrmd . 51 . 54 autopsy records of. 2 . b . 68 r Goldblatt clamp . 24. 25 Mackte . B S
Urabetrs luan attacks. 2 . 6 men with. in present study . 38 cases of malignant melanoma . 72
a-h-rosrleroys prevrntrd bylhyrord .58 rnlecnons 6 Menofs-hyrord therapy for . 58 Malqs)
mruup+fryrcnandn 24 str-ss . 5b mucaoolysacch arides . 24 estrogen treatment of. 61
Drre 37 9n 41 Gt,n . W . women rnth, in prrsrnt study . 59 stress farror in heart drsrase . 42 r,2
Luraset •• myaedrma casnt l i Ifypenhyroldtsm . 19 an Ihyratd . less bean duease . 36
coer•nartry artery . I I Hypochondriacs . 28 Malysheva, L V .
degrnrrause .57 b5 HypothyrotdOsm) thyrold depressed with eaces4 choleuerol,
Hardenmg of thr artertrs tsrc athrrosclerostsl
Inlr.ttuus (tee Infectious drseasesl Ilarman D . 71 atherosclerosurn . 40 rabbru .l7
rnprr atory I 1 dragnoses 49 Mana Thereua, Emprem
Heart . 7
Dosage rsrc Thyrord dosagrl Heart atlarktsl wrth elevated fats in blood . 19 . 20 mandatory autopsies in Auuna . 10
autop7y study nf . World War 11 . 10 . 11 hfetlmr of therapy . 54 Melanoma, malignant . 72 . 73
Fiamra So muropolysacch andes . 24 Men (•ee Maln)
a c ase . !5
Edrma o .,erdosagc with thyroid in . 21 +(eningltu
chetesterol as a suspect . 2
tn babr,* 72 result of eacesl cortisone . S0 . 58 sudden deatha cauaed by . 11 . 12
defrnrtion . 7
Ede)er . F . 72 subnormal remperatu•e 48 Menof. P
dlagnosrsbyautopsy 9

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 I

HK ® 00 5 3 4 4 r ,
INDEX INDEX m
thyroid thnapy tn hypererrutnn . 58 Ptmu ary . 27 I
ma)onty due to other cawes . 11 . 12 for lowenng serum fats . 20
Mnut rual drsorden Pneumoma 50 Su.ccpubihty to hean atrack, 45 in mental problems. 35, 59
corrected by thyrotd therapy, 31 . 64 Polyunsaturated fats. 23 (see Fats . Svatn• L . T in mtgraine, 34
Memal problems polyunsaturated)
anhrit'n from thyroid deficiency . 58 tri myaedrma heart . 17
associated nrh thyrord deftciency . SS . 59 Predrnwrte van Svreten• Gehard overdoyage,21
Migraine headaches . 34 small dosage wish thyrord therapy 51
compulaory autopsy law in Austria . 10 in reproductive organs . 9 1, 92, 33
Mtrcarrragr. 32 Pregnancy. 52 Symptomt• hypothyroidum (ree Hypo• relief of thyroid aymptoms . 28
Monta Prostate . 61 thyrordsm• symptoms) raising resistance to infecttom, 64
premature, sudden rmlttary dearht, I I Protc in Bound Iodine 1 PB I 1 . 46
Temperature(tee Basal temperature) result of rtopprng medreatton . 40
Muan "Psychosomatic complaints" I Tesn• fattwatory (aee Thyroid function «ns) results compared to Framengham Study. 47,
renamed, mucopolysacchandea, 24 relief with thyroid therapy . 84, 47
Thyroid administration (see Thyroid therapy) 58,59
myaedaaa . 14 Psychosomatic disease . 28 . 29 I Thyroid deficiency (see also Hypothyroidism) in slun diseases . 51
rn thyroid tlefrr tcy . 5
basal rrretabohan reat for. 45 rn strers . 56
Muropolysar•.aridn, 24 . 59 Rabbits basal temperature tew for . 48, 49 Thyrotdeetomy (lora of thyroid)
depovcronm injured tissue . 55 cholesterol feedmg tn . 16. 17. 20
thyromd defict, ncy . reponsibte factor for . I commonly overlooked d'norder. 29.46 of baby rabbits . results . 27• 28
ehyrotdectomired• 36 . 64 . 65 lea dr ng to a t herosc lerosu . 5 . 2"
40 .42 .49•54 in extreme degree . myxedema. 14
Radioasaay for thyrosine, 47 leading to nr in serum cholclerol, 19, 20
Myaedema (sn also Hypothyrordum) patient hwtory• basal temperature,
Rauxh . H . P. . 70 comprehensive examination for preventtng atheraacleroris by,hyrmd
came of, 5 Reproducuveotgans Atagnosing, 51 therapy, in animals . 16
defimnm•• 14 need forthyroid hormone .81 PBI tea for, 47 t ot r, r. lea di ng to mysede ma . 15
M urray s t : eatment lor . (6 Resutance to tnfecttons
Myaedema hea.t, 17 18 . 21 precursor of atherusclerow. 13 . 21 . 24 . 25 Thyrolar. 53
raued w th thyroid therapy, 30, 64 precursor of heart disease . 16 . 39 Thyrosrne. 43 . 52. $e . 59
Natunlcoroequenra,6S Respiratory infection . i0 precursor of mucopolysauhandea. 40 Toxemia. 32
Nervc us ryatern Ritchte, J H
radioassay test for . 47 Totiaty
in hypothyrotd'um 54 toctcityof unsaturated fau• in babies . 72 eymptornsof, 29 . 50, S1, 52, 33 . 84, 55 rrth unsaturated r .u, 69. 76, 75 . 74
Neuro ctreufarory asthenu . 28
i susceptibility to infections in . S Treadmill . 60 . 61
New Populanan Saturated fats (ute Fau• aacurated) I Thyroid, desrccated . 41, 45, 51 Triglycerides. 20
survietng infections . 4 Sexes Thyroid doaagea . 18• 22, 23 . 51 . 52 Tuberculosis
more wtcepuble to heart attacks . 5 . 73 in i nctdence of heart attacks . 37 I Thyroid function . 44 and arherosclerorn, 5, 4
Niacin . 40 Seyle . H . and choleeterol, 17 in rhe Bantu . 68
Norkur. S . A. rrraa• adrenalstudree . 57, 58 low (ree Hypothyroidism) eaeera of male deaths, comparable to heart
arrbasuof hver in rata . 71 Shock . 8 Thyroid function teua attack deaths. 61 . 62
S'unonds. J P basal meubolism• 45 at Graa. Arutria, 3
Oils . 74 thyroid and fac metabolism . 19. 59 basal temperature. 48 being replaced by heart attaclu . 2 . 65
Ord . W M Sinu9ru• 50, 54 protein • bound todrne ( P81)• 46 replacing smallpox. 1, 63
early autopsy audyof myxedema patient . Skin diseases radiousay for thyroarne . 47 Tumon
IS. 14 in hypmhyroit(ism. 50, 31 I fallacy of t hymid function teata . 44 • 49 in rats. 70
cotnrng "rnyaedema" Smallpox . 1• Y . 63 Thyroid hormone Turner. K . B.
demomcratron af mtuin causing Smoking. 57 . 59 . 41 rupprcmed by cortisone . 57 cholesterol feeding to rabbits . 20
degenendon• 5 . 24 Sar talittd medicine . 49 i and thyroid function teus• 46 . 47
lack of thyrnid gland, 14 Sodrum hothymmne. 59 thyroaine . a pan of . 55 Underprivdeged counanes
Osler . Srr William . 28 Stare. F . J . . 70 ~ Thyrnwdrherapy low cholateml mtake in . 67 . 70
Os)o. 72 StenLty . 52 in anemia• 54 atherosclerosis in children in . 67
l]danan cysu . 52 Sr• es aided by prt•drnuonr• 52 high early death rate from rnfentona tn 68
Ovary . 27 and atheroaclerosn . 55 . 55. 6 1 far delaying atherosclerosis . 5 . 42 Uremia. 90, 58
and choleterol, 59 in delaying hean attacks . 44 Uterus
Pancrei+, 27 and hnn attack . 89, 42 in delaying mucopolysacc hande deposits . dilatwtr and eurettage . 52
Parathyrord.27 Stroko 42, 48 . 54
Pathology .4 hetnorrhagein bratn 11 in elderly patients . 22 . 28 6 agtnal traa . urfection of, 80
Pearce . M. L vastvlar accidents. 39 tnfaugue,99 Vascular accidenu. 39 fsee Strokesl
cancer. polyumxtunted fats . 70 Strtmg . J . P. I tn hean attack patienl . 35 Vegetable oils. 72
Phyucal frndings, hypothyroldtsm . 46. 49 . 51 acherorcleraais in chtldren• 4 in hnn dtsease• 18 Veterans Administration Fbspruh. 6l . 71
Pick E P Sturgis . C C . in hypertension . 25 Vienna,l0
tbyrotdeaomy, herbrwra . 16 thyroid dosage mra6 . rn heart dasnre, 19 . 21 I inadequacy of thyroaine, 52 . 58 American Medical Society of . 10
Ptnckney . E P. . Sudden deaths I h.ounta program . Y2• YS Vi,-tnamvar . 50
on uruaturatcd fats. 73 minority due to heart acack+, 9 lifetime medication . 54 Virchos• R . 67
for lowering elevated cholmterola, 19 . 36 Vitamen B . 43

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%uamm B 12 . 45
~ uamn E
amedaar lor Polyunaaturarrd lat roatuty . 75
am . o.rdumg agrm 71 72

War Decreax en hrarr atracks

World War II . 2
War 5rmsg and athrrusrkrasu
Franro Gcrman . 55
Korran .56
V tet nam . 56
World War 1 55
World War II 55
War Suidrn mehtary draths
World War 11
War Thyroid therapy in myardema hean
World War I
Wnght 39
White Paul Dudiey . 22
Women Iser Femalel
Women s Lrb . h2
World War 1 . 17 . 55
World War l1 . 2 . 10 . 55
Wrcn J C
rhyrotd therapy rnroronary hea .r duease .
43 .44

7amr heck
autopes . rudden deatha in mtloary .
Wo .ld War II . I I
Lrrsrrl-ng W. D
autupstrs . atheroxlrrosis rn children . 4
Zondek H
thvroid thnapy in mya^drma hran . 17

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