460 DISEASES OF THE CIRCULATORY SYSTEM. 



The symptoms of nervous palpitations are the violence of the 

 precordial impulse (in some patients it shakes the thorax or the 

 whole body, and is extended some distance); the acceleration of 

 the circulation and of the respiration, the small irregular pulse;, 

 restlessness, anxiety, sweating-spells. Auscultation determines the 

 intensity of the sounds, which are sometimes not very distinct, the 

 augmentation in force of the cardiac systole is perceptible upon the 

 abdominal aorta when the ear is placed upon the dorsal region 

 opposite this bloodvessel ; we have also observed a venous pulse 

 and visible pulsations upon the carotids (Milanese). We may 

 observe true attacks, during which the animals frequently expel 

 excrements and stretch themselves as if to urinate. In some iso- 

 lated cases the disease ends with paralysis of the heart or cerebral 

 apoplexy ; in most of these a cure is produced after a variable time, 

 but the attacks may be repeated. The synchronism of the thoracis 

 shaking with the beatings of the heart is a very important diag- 

 nostic symptom. 



2. JDiaphragmatic spasms produce phenomena which are similar 

 to palpitations, with which they have often been confounded by 

 authors. They have also been designated under the name of ab- 

 dominal pulsations. They are produced by various causes. Catarrh 

 and inflammation of the stomach or intestine may cause them in a 

 reflex way or through the propagation of the inflammation to the 

 diaphragmatic partition. Bril has seen them appear after vomit- 

 ing ; Berghuis observed them in cases of overloading of the stom- 

 ach ; Oreste, in gastric disturbances, in colics, and after heavy 

 meals; Grosswendt, in enteritis; Leblanc, Worz, and others, im- 

 mediately after the imbibition of cold water ; Boiteau, after the 

 ingestion of mouldy hay — that is to say, as the expression of a 

 poisoning ; Cartwright, after the administration of aloes pills. It 

 is possible that the cardiac palpitations are accompanied by morbid 

 contractions of the diaphragm — that the diaphragmatic nerve, pass- 

 ing below the base of the heart, is irritated by the violent move- 

 ments of this organ (Haubner-Siedamgrotzky). 



The diaphragmatic spasm, designated very appropriately under 

 the name of chorea of the diaphragm, is accompanied by particular 

 symptoms which are very remarkable. We observe in the left 

 costal region and in the corresponding flank, shocks which at times 

 shake the whole body ; they are usually accompanied by a short, 

 jerking expiration (Boiteau, Hering), and by a dull sound which is 



