PALPITATION. 447 



Certain periods, as the commencement of the menstrual flow, and a short time before 

 it, render females periodically liable to it. It often comes on after excessive indul- 

 gence in tea or tobacco. It is common in the subjects of Bright's disease, and in 

 those debilitated by any chronic illness. Youth, too, is more subject to palpitation 

 than adult life. It rarely occurs in those under fourteen, except as the result of 

 some sudden start or shock ; but it is frequently met with in middle-aged adults, in 

 women chiefly, but also in nervous men. The more the nervous system in men 

 approaches the feminine type, the more likely are they to suffer from palpitation. 

 There is, however, a great diversity in this respect some women seem as little likely 

 to suffer from palpitation as the majority of men do to become pregnant. 



Palpitation of the heart often depends on a disordered condition of the stomach ; 

 in fact, it is more frequently due to that cause than to any other. Palpitation may 

 occur as a symptom of stomach derangement even when indigestion causes no other 

 inconvenience. We have already related a case in which persistent palpitation re- 

 sulted from excessive indulgence in tea (see DISEASES OP THE HEART). The 

 active principle of tea theine is a powerful neurotic agent, and when indulged in 

 to excess has a very decided action upon the heart, rendering it irritable, excited, 

 and irregular in its action. In such cases the withdrawal of the tea is absolutely 

 essential to successful treatment. Regarded chemically, the composition of coffee or 

 cocoa is closely allied to that of tea, and it is not easy to believe that the symptoms 

 produced by excessive indulgence in tea are relieved by substituting for it those of 

 allied vegetable products, but so it is. It is said that tea contains, in addition to its 

 principle, theine, a volatile intoxicating oil, and it may be the presence of this agent 

 which makes the difference. "We conclude that palpitation is due merely to stomach 

 disorder when it occurs occasionally only, when the action of the heart is perfectly 

 regular in the intervals, and when there are no other symptoms of heart disease. 



In the following table the more prominent characters of the palpitation 

 depending on organic disease of the heart are contrasted with those of palpitation 

 arising from other causes : 

 Palpitation depending on Disease of the Heart. Palpitation arising from other causes. 



1. More common in men than in women. 1. More common in women than in men. 



2. Usually comes on slowly and gradually. 2. Usually sets in suddenly. 



3. Constant, though more marked at one time 3. Not constant, having perfect intermissions. 



than another. 



4. Often not much complained of "by the patient, 4. Usually much complained of by the patient ; 



occasionally attended by severe pain ex- readily induced by mental emotion; and 



tending to the shoulders. frequently accompanied by pain in the left 



side. 



5. Beat against the chest usually stronger than 5. Beat neither heaving nor prolonged ; often 



natural ; sometimes remarkably increased, abrupt, or knocking, and accompanied by 



heaving and prolonged ; at others irregular fluttering sensation at the pit of the 



and unequal stomach. 



6. Lips and cheeks often blue ; countenance 6. Lips and cheeks never livid ; countenance 



congested ; dropsy of the lower extremities often pale ; dropsy absent, except in ex- 



common, treme cases. 



7. Palpitation increased by stimulants and 7. Palpitation increased by sedentary occupa- 



tonics, but relieved by rest. tions, relieved by moderate exercise, and 



by stimulants and tonics. 



