Idiopathic cardiomegaly

Robert L. Levy

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This relatively small group of cases represents a distinct clinical and pathologic entity. The condition is not congenital, for we have observed two patients in whom the heart was normal in size, by x-ray examination, several years before death. There is no demonstrable connection between any specific infection and cardiac hypertrophy in the histories of these patients. Syphilis certainly is not concerned. We have not encountered a familial form, as described by Evans.6. The cause of the hypertrophy, then, remains obscure. Apparently there can be an association between massive enlargement of the heart and other conditions, such as rheumatic fever and coronary atherosclerosis; but the question as to whether the relationship is other than coincidental remains unanswered. It is possible that these cases represent a single disease picture observed at different stages of its development, or that they are of varied origin. The diagnosis is made largely by exclusion. The prognosis is poor, for once symptoms have appeared, the duration of life is usually not more than two years, with progressive cardiac insufficiency or sudden death as the terminal event. It is a rather somber "likeness" that has been delineated. And so, by way of contrast and at the risk of injecting a personal note into these remarks, I propose to relate an episode which left an indelible mark on my memory. It has been my good fortune to enjoy, since college days, the friendship of Francis Trudeau. The incident to which I refer occurred when we were first-year medical students at The Johns Hopkins University and concerns Francis' distinguished father, Dr. Edward L. Trudeau, whose fame and achievements have brought glory to this Adirondack region. Dr. Trudeau had been elected president of the Congress of American Physicians and Surgeons, an organization now out of existence but then composed of the most prominent members of the profession. The meeting that year was to be held in Washington and, on the way down from Saranac, Dr. and Mrs. Trudeau planned to visit their son in Baltimore. Soon after their arrival Dr. Trudeau, who throughout his adult life was plagued by the tubercle bacillus, showed an elevation of temperature: In spite of feeling ill, he insisted on going on to Washington and I was invited to accompany the family in the role of an aide. It was a proud moment for one who was just beginning his medical studies. But an even greater thrill was experienced on the following day when we sat with Mrs. Trudeau in the front row of the hall while the president, weak and feverish, delivered his address. It was entitled "The Value of Optimism in Medicine." Several months later, a reprint arrived, inscribed simply-"This is to remind you of the evening in Washington. E. L. Trudeau." It is one of my valued possessions. A few sentences taken from that address, given on May 2, 1910, will make clearer the meaning of the title: "To the practising physician and surgeon optimism is even more necessary than to the scientist, for besides moulding the doctor's character and guiding him in his decisions as to the case, his optimism is at once reflected to the patient and influences his condition accordingly. How great this influence may be we are learning more and more to appreciate. In his hour of need the patient has no means of judging of the physician's intellectual attainments; it is the faith that radiates from the doctor's personality that he seizes upon and that is helpful to him.". Optimism assuredly is one of those intangible ingredients which, when mixed in the proper proportions, go into the making of a good doctor. But it is the total character that defines the individual; and the core of character is honesty, not only in relationships with others but in appraisal of oneself. In his daily work, the practitioner is faced with a number of paradoxes. On occasion, he must proceed with promptness and vigor; at other times, considered delay is the wiser course. He must show firmness, yielding only when compromise will avoid petty frictions. He should be sympathetic; on the other hand, humor may save an awkward situation. He must tell the truth as he sees it, but not always the whole truth. His knowledge often is incomplete; yet, regardless of its imperfections, he must act. It is his creed to serve, as best he can, those who seek his aid. And so he must be, above all else, a cardiomegalic; for a big heart and humanity are inseparable.

Original languageEnglish (US)
Pages (from-to)292-296
Number of pages5
JournalJournal of Chronic Diseases
Issue number3
StatePublished - Mar 1955
Externally publishedYes

ASJC Scopus subject areas

  • Epidemiology


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