NEUROSES OF THE HEART. 385 



The nerves of the heart consist of branches of the par vagum and sym- 

 pathetic, and, besides these, it has its peculiar ganglia. If we sepa- 

 rate the organ from the nerves, and cut it out of the body, it still will 

 continue to contract rhythmically for some time ; and, even after ceas- 

 ing to beat, will recommence, if we inject blood into the coronary arte- 

 ries, or supply it with oxygen. Rhythmical contraction, then, is not 

 dependent upon the pneumogastric or sympathetic nerves, but seems to 

 be brought about solely by the cardiac ganglia, although this too has 

 been doubted. As to the effect of the pneumogastric upon the beat 

 of the heart, we know that irritation of this nerve retards its action, 

 while section accelerates it, so that we may regard the nerve as a 

 moderator of the activity of the heart. We know but little in this 

 respect, and nothing of certainty, concerning the influence of the sym- 

 pathetic nerve. 



It would, therefore, seem rash to count palpitation among the 

 hypercineses, a condition due to extreme excitement of the motor 

 nerves, as has been done by Romberg, and more lately by Bam- 

 berger. It is quite as possible that palpitation of the heart might 

 proceed from reduced energy of the pneumogastric as from over-excite- 

 ment of the sympathetic or cardiac ganglia. Besides, in many cases 

 of nervous palpitation, an increased force of the heart's action cannot 

 be observed^ the symptom being merely subjective, and perceptible 

 only to the patient. Such cases should more properly come under the 

 head of hyperaesthesiae, and be regarded as an extreme excitement of 

 the sensory nerves of the organs.* 



Romlerg defines angina pectoris as hyperaesthesia of the cardiac 

 plexus. Bamberger calls it a hypercinesis with hyperagsthesia. The 

 cardiac plexus is assumed to be the source of the pain ; but this, too, 

 must be pronounced a matter of theory only. At all events, the pain 

 which attends this " cardiac neuralgia " extends with great intensity 

 along the brachial plexus. 



Ignorant as we are regarding the pathogeny of neuroses of the 

 heart, we still have some idea as to their cause. Nervous palpitation is 

 principally seen in anaemic subjects, and is one of the most constant 

 manifestations of chlorosis. Next in frequence, we find it in derange- 

 ment of the sexual system, not only among females, where it plays an 

 important part in hysteria, but also among males addicted to venereaJ 

 excess, above all, among onanists. Palpitation is also common in hy- 



* We should be equally warranted in calling every fainting-fit an acinesis of the 

 heart. When a person swoons from psychical or other causes, the scene always com- 

 mences by a depression of the heart's action, smallness of the pulse, and pallor of the 

 skin; and it is not until then that the consequences of diminution of the supply of 

 arterial blood to the brain, loss of consciousness, etc., appear. It is quite the same in 

 a too-protracted inhalation of chloroform or ether. 



