446 THE TREATMENT OF DISEASES. 



PALPITATION. 



As a rule, we are not sensible of the beating of our hearts, but when the 

 pulsations become inordinately forcible they make themselves felt, and the sensation 

 is in many cases a most troublesome and distressing one. Palpitation implies 

 increased force, or increased frequency, or an increase both in force and in 

 frequency, of the contractions of the heart. The pulsations are sometimes 

 tumultuous also, and irregular as well as unduly forcible and frequent, but this is 

 not necessarily the case. The irregularity in the heart's action may be experienced 

 not only by the patient himself, but may be obvious to others. Sometimes a few 

 rapid and feeble pulsations occur at uncertain intervals, and are followed by others 

 that are fuller and slower. Sometimes one or more beats are left out, the next beat, 

 as if to make up for the pause, being unusually strong. The intermissions may be 

 unperceived by the patient himself; but often they are attended with a singularly 

 disagreeable fluttering or trembling sensation in the breast. There may be a variety 

 of attendant symptoms occurring singly or in groups, the most prominent being a 

 sensation of choking, a feeling as if the heart were jumping into the throat, and the 

 eyes bursting from the sockets, pain over the region of the heart, faintness with 

 actual loss of sensibility or partial unconsciousness. The pain rarely amounts to 

 more than a sense of dull aching soreness, but in exceptional cases sharp twinges 

 occurring in paroxysms may be experienced. Shortness of breath rarely occurs to 

 any notable extent, but it does sometimes, giving the patient the appearance of a 

 person out of breath with running, singing in the ears, giddiness, and confused 

 vision, headache, a hot head and flushed face, with clammy coldness of the hands, 

 and feet, may be added to the list of disturbances. In rare cases the eyeballs seem 

 to enlarge and protrude to an unnatural extent from the orbits, and this may be 

 accompanied by enlargement of the throat. In some instances palpitation is more 

 or less permanent, but in the majority of the cases it comes on in paroxysms lasting 

 for an hour or two, or perhaps only for a few minutes, and then passing off again. 

 In young persons of a delicate constitution it often occurs, in a slight degree, nightly ; 

 so that the patient on going to bed passes many hours sleeplessly, not only feeling 

 his heart beat, but hearing it. His subsequent sleep is unrefreshing, and he awakes 

 in the morning more tired and jaded than when he went to bed. A fit of palpitation 

 often terminates in sleep, and in the case of hysterical women, a copious discharge of 

 watery urine may occur at the time of release. The time during which a patient 

 remains subject to these attacks varies infinitely, as does the duration of the intervals 

 of freedom. In some cases, as, for instance, in young women suffering from 

 " whites," the palpitation is constant, the pulse beating for many days at 150 or 

 180 strokes in the minute. In very severe cases the pulse has a mere vibratory 

 motion, and cannot be counted, whilst its rhythm is extremely irregular. 



The subjects of palpitation are usually of the nervous type, persons in whom the 

 nervous element predominates, and who are what is called emotional or susceptible. 

 Thus the nervous constitution of the female sex renders women more liable to it 

 than men. Further, temporary causes affecting the emotional nature increase this 

 susceptibility, as, for example, sudden surprise, excitement, anxiety, or mental shock. 



