NEUROSES OF THE HEART. 387 



cognition. If the exciting cause be obvious and amenable to treat- 

 ment, the malady will disappear sooner or later. This is especially 

 the case with chlorotic girls, hysteric women with curable disease of 

 the womb, and even in palpitation induced by excess in venery. At 

 other times it is extremely obstinate, and persists throughout life. 



During the intermission, physical exploration reveals nothing 

 anomalous ; during the paroxysm, we often hear abnormal murmurs 

 attributable to unnatural tension of the valves and arterial walls. 



In angina pectoris, the patient suddenly experiences beneath the 

 sternum a feeling of strangulation and pain, which almost always 

 shoots in the direction of the left arm, less frequently toward the right. 

 This is accompanied by a distressing feeling of dread and sense of im- 

 pending dissolution. The sufferer imagines that he cannot breathe ; 

 but, if forced to do so, succeeds in making a deep inspiration. He does 

 not dare to speak, but groans and sighs. If the attack come upon 

 him while walking, he stands still, seeking a support, and clasping 

 his breast. The hands are cool, the countenance pale, the features 

 perturbed. After the lapse of a few minutes, or in a quarter or half an 

 hour, the paroxysm gradually abates, nearly always with eructations 

 of gas. These attacks are repeated at first with long intervals ; after- 

 ward they become so frequent as to be of almost daily occurrence. As 

 an exciting cause, mental emotion seems to be the most common agent ; 

 physical exertion and error of diet produce it more rarely. Between 

 the attacks health may seem unimpaired, while in other cases evidence 

 of serious disease of the heart may be detected. 



TREATMENT. Treatment of nervous palpitation demands, above 

 all else, the removal of every recognizable and remediable predispos- 

 ing cause. In chlorotic or anaemic subjects, the preparations of iron 

 often render signal service. Hysterical palpitation may require the 

 application of leeches to the os uteri, and of lunar caustic to the ori- 

 fice ; a treatment which, as we shall see in the proper chapter, will 

 often effect a cure in a case previously hopeless. Hypochondriacs, 

 Kith varicosities of the anus, if affected by palpitation, often find great 

 relief from the application of leeches to the fundament. Fuller details 

 of the appropriate remedies in this affection would occupy us too long, 

 as it would include the treatment of all the maladies of which palpita- 

 tion is an accompaniment. Patients, in whom no special cause for the 

 disease can be found, should be ordered to bathe in cold water, be sent 

 into the country, made to travel, and forbidden all over-exertion and 

 luxurious living. 



During the attack, the effervescent powders, vegetable and mineral 

 acids, cream of tartar, " eau Sucre," enjoy a certain reputation. Ij 

 would be foolish to carry one's skepticism so far as to slight these 



