410 The Philippine Journal of Science 1920 
tom that may be attributed to his heart. If this attitude con- 
tinues for some time, by some sort of autosuggestion he suffers 
from many imaginary symptoms and in time may become a real 
sufferer from the so-called brain storm. 
A typical picture is that of a middle-aged married man, who 
came to see me one midnight, complaining of symptoms sup- 
posed to be of cardiac origin, as he had been told by the physi- 
cians he had previously seen. His symptoms were marked pal- 
pitation, chest oppression, and precordial distress accompanied 
by psychic phenomena of anxiety and fear of sudden death. 
The man was rather nervous and inhaled every once in a while 
from a small bottle containing ether. While in the paroxysm 
of his attack I examined him physically and, to my great sur- 
prise, in spite of all of his symptoms — palpitation, difficulty of 
breathing, chest oppression, and precordial distress — I found 
the heart entirely normal. There was no abnormal pulsation, 
the apex beat was in normal place, the cardiac outline was normal, 
and there were very good cardiac sounds. The pulse was not 
over 60 per minute; it was very regular in rhythm and fairly 
good in tension and in volume. The blood pressure, by the 
Erlanger apparatus, was 120 millimeters of mercury. On 
examining his abdomen I found distinct tenderness in the epi- 
gastrium, in the region of the stomach. In trying to get a 
complete anamnesis, I found the patient had been suffering for 
a long time before he had had any cardiac manifestations. 
There were symptoms referable to the stomach, such as nausea 
and vomiting occasionally in the morning; heaviness and some- 
times pain in the stomach after meals; frequent eructation of 
gas followed by amelioration of the stomach symptoms; and 
later on the cardiac symptoms above referred to. His psychical 
symptoms did not appear until he was told that he was suffering 
from cardiac disease, and ever since his attacks have been grow- 
ing more frequent and worse, for he realized then the supposed 
seriousness of his trouble. 
The examination of his gastric contents disclosed a marked 
hypoacidity, and on X-ray examination there was marked gas- 
troptosis. The lower border of the stomach was about 5 cen- 
timeters below the level of the umbilicus, and at the same time 
it was dilated. The patient was put under ordinary treatment 
for the stomach affection and was assured that his heart was 
entirely normal; he was counseled to take physical exercise. 
After a few weeks of such treatment the patient recovered 
completely. 
