STRAIN AND OVER-ACTION OP THE HEART. 7 



look with you at those which shall best illustrate the general 

 argument of the lecture. 



There is, first, the " irritable heart." This is a condition 

 which became familiar to manj^ of you during the late war; 

 and I shall but ver^' briefly recall its main features — the 

 more briefl^'^ as I may refer you to a full description of it I 

 published in the American Journal of the Medical Sciences 

 for January, 18T1. It consists chiefly in extremely rapid 

 action of the heart, attended with pain in the chest, dizzi- 

 ness, and oppression. The pulse is small, and readil}^ com- 

 pressible ; its frequency is greatly lessened by the recumbent 

 posture. The impulse of the heart is extended, abrupt; the 

 first sound is short, the second very distinct. Occasionally 

 the first sound is replaced by an inconstant murmur; the 

 respiration is not hurried or frequent in proportion to the 

 pulse. The general health often appears good, or at least it 

 may be fully restored while the cardiac malady remains. Hard 

 field service, particularly excessive marching, and diarrhoea 

 act as the predominant causes. Digitalis and rest are, on the 

 whole, the most successful remedies. 



Here you have a short statement of the irritable heart 

 of soldiers. But it is my object now to call your attention 

 to the phenomena j^ou meet with in jom ordinary professional 

 life, and in so doing I take the opportunity of supplementing 

 my observations on the irritable heart of soldiers with obser^ 

 vations on the same malady as I have encountered it in private 

 practice. In truth, excepting that the disorder is less violent, 

 and the cardiac pain usually less severe, the malady is iden- 

 tical. I have noticed it in persons who, without previous 

 training, had suddenly undergone great and sustained exer- 

 tion, as pedestrians, or in climbing. Handfield Jones, in his 

 work on Functional Nervous Disorders, in commenting on the 

 cases I have described, mentions that he had had personal 

 experience of the malady ; for after making a long mountain 



