386 DISEASES OF THE HEART. 



pochondriasis. As a striking instance of this hypochondriac palpita- 

 tion, Romberg relates the example of Peter Frank, who, while en- 

 gaged in study of disease of the heart, thought himself suffering from 

 aneurism. We very often see palpitation accompany rapid growth 

 about the time of puberty. It affects other persons, in whom no defi- 

 nite exciting cause can be discovered. 



Angina pectoris is found almost exclusively in persons suffering 

 from organic disease of the heart. Either ossification of the coronary 

 arteries, valvular defects, hypertrophy, degeneration, or aneurism of the 

 aorta, has been found upon autopsy of most persons who have been 

 afflicted in this manner. Nevertheless, we cannot regard angina pec- 

 toris as indicative of any of these lesions. Not one of them is con- 

 stant ; and the malady always takes the same form while the structural 

 alterations differ most widely. It is always marked by paroxysm and 

 intervals of immunity, so that we are forced to set it down as a ner- 

 vous disorder of the heart, to which organic changes merely afford a 

 predisposition. In rare instances it has occurred where no organic 

 disease existed, particularly in old and obese persons, males being 

 affected oftener than females. 



SYMPTOMS AND COURSE. Nervous palpitation is characterized by 

 an accelerated and sometimes unrhythmical beating of the heart, ac- 

 companied usually by a feeling of dread and dyspnoea. The impulse 

 is generally short and bounding ; in many cases without perceptible 

 increase of force, and in others so violent as to shake the hand at each 

 stroke. Even in the latter cases the subjective feeling of palpitation 

 experienced by the patient is greater than what the apparent force of 

 impulse would lead us to expect. The pulse and aspect of the patient 

 are not always the same. Sometimes the pulse is full, and the face red ; 

 sometimes it is small and intermitting, and the countenance is pale, 

 apparently as if the beats lacked energy, or as though they were of 

 too brief duration effectually to fill the arteries. The length of an at- 

 tack of this kind varies, lasting from twenty minutes to an hour or 

 more. It is not unfrequently accompanied by nervous derangement 

 of other kinds, dizziness, buzzing in the ears, trembling, etc. Its ter- 

 mination may be sudden or gradual, the action of the heart returning 

 to its normal condition, and weeks or months may pass without the 

 occurrence of a new attack, while in other cases the seizure recurs at 

 very short intervals. 



The intermission and recurrence of the paroxysms without known 

 cause, their appearance under conditions which do not, as a rule, give 

 rise to exaggerated action of the heart, its association with other ner- 

 vous disorders, and, above all, the results of physical exploration, will 

 serve to prevent error, and yet the disease is not alwavs easy of re- 



