But it is well recognized that close concentration of attention on the heart will hamper its action. It has been demonstrated that it is possible by will power to cause the missing of heartbeats and while only those who have [{238}] practised the phenomenon can demonstrate it, there are a number of well-authenticated examples of it. There is no doubt, however, that anxiety about the heart will quicken or slow the pulse rate. When a patient comes to be examined for suspected heart trouble the pulse rate is almost sure to be higher than normal, even though there may be nothing the matter with the heart; the increase or decrease of the pulse beat is due to the anxiety lest some heart lesion should be discovered. This makes it necessary as a rule not to take too seriously the pulse rate that is discovered on a first consultation and makes it always advisable to wait until the patient has been reassured to some extent before the pulse rate is definitely taken.
It is easy to see, then, what a large place there is for the will in heart therapeutics. Courage is an extremely important element in keeping the heart from being disturbed and maintaining it properly under control. Scares of various kinds with regard to this all-important organ are prone to get hold of people and then to disturb it. Many a heart that is actually interfered with in its activities by drugs of various kinds would respond to the awakening of the will of the patient [{239}] so as to control solicitudes, anxieties, dreads and the like that are acting as disturbing factors on the heart. When taken in conjunction with the will to eat and to exercise properly so often necessary in these cases, the will becomes the therapeutic agent whose power must never be forgotten, because it can always be an adjuvant even when it is not curative and can produce excellent auxiliary effects for every form of heart treatment that we have.
CHAPTER XVII
THE WILL IN SO-CALLED CHRONIC RHEUMATISM
|
"I should do it With much more ease; for my good will is to it." |
| The Tempest |
In popular estimation, rheumatism is one of the commonest of affections. When a physician asks a patient, especially if the patient is over forty years of age, "Have you ever suffered from rheumatism?" the almost invariable response is, "Yes", though but little further inquiry is needed to show that what the patient means is that he has suffered from some painful conditions in the neighborhood of his joints, or that his muscles have been sore or inclined to ache in rainy weather, or that he has undergone some other vague discomforts connected with dampness. Chronic rheumatism is a term that includes a great many of the most varied conditions. True rheumatism, that is, acute articular rheumatism, is now recognized as an infectious disease which runs a definite course, usually with [{241}] fever, for some ten days to ten weeks, and requires confinement to bed usually for a month or more. Very rarely will any connection be found between this affection, which presents always Galen's four classic symptoms of inflammation, swelling, redness, heat and pain (tumor, rubor, color, et dolor), and the usual conditions which are broadly characterized as rheumatism. Just as soon as patients are asked if their rheumatism included these symptoms there is denial, yet the idea of their having had rheumatism remains.
As a matter of fact, there are a number of sore and painful conditions in connection with muscles and particularly in and around joints that have, without any scientific justification at least, been called chronic rheumatism. Any painful condition that is worse in rainy weather is sure to be so named. As old dislocations, sprains and wrenches of joints, broken bones, as well as muscular conditions of all kinds, including flat foot and other yielding of joints, all produce this effect, it is easy to understand that there is an immense jumble of all sorts of painful conditions included under the term "chronic rheumatism." Some of them, particularly in older people, produce lameness or at least inability to walk [{242}] distances without showing the disability; a great many of them produce distinct painful conditions during the night following the use of muscles and often disturb patients very much, because they arouse the dread that they are going to be crippled as they grow older.
Indeed, one of the most serious effects of these recurring painful conditions is the dread produced lest they should cause such progressive affections in and around joints as would eventually make the patients bed-ridden. There are a certain number of cases of so-called rheumatoid arthritis which produce very serious changes in joints with inevitable crippling and quite beyond all possibility of repair. These cases are often spoken of as chronic rheumatism and it is the solicitude produced by the dread of them that makes the worst part of the discomfort in many a so-called chronic rheumatic case. If their affection is to be progressive, then the patients foresee a prolonged confinement to bed in the midst of severe pain, hopeless of ultimate cure. It may be said at once that these cases of rheumatoid arthritis have nothing to do with rheumatism, represent a special acute infection, are never a sequela of any of the rheumatic conditions and are [{243}] fortunately very rare. This assurance of itself is quite sufficient to make ever so much better a great many patients who feel that they suffer from rheumatism.
The painful conditions that are described under the term chronic rheumatism would seem to be quite beyond any power of the will to affect. They are at least supposed to represent very definite changes in the tissues, usually of chronic character and therefore not amenable to any remedies except those of physical influence. Besides, they are so frequent that surely if there were any question of the will being able to control them or bring relief for them, most sufferers would discover this fact for themselves and apply the remedy from within. It is not to be expected that a very great many people would suffer pains and aches that are worse in rainy weather if all that was needed was the exertion of their will power either to throw off the affection or to perform such exercises and activities as would gradually make their conditions better. In general it is felt that painful conditions of this kind cannot be affected by the will and that distinctly material and not psychic therapeutics must be looked to for their relief.
Now it so happens that the best illustration [{244}] of the power of the will to "cure" people, that is, to relieve them completely of their affections and start them afresh in life with the feeling that they are no longer handicapped by disease, is to be found exactly in the group of cases that have almost from time immemorial been called chronic rheumatisms. We have had more "cures" of various kinds announced for these—chemical, electrical, physical, hydriatic, movement therapy and so forth—than for almost any other group of diseases. More irregular practitioners of medicine all down the ages have made a reputation by curing these affections than have won renown by treating any other set of ills to which humanity is heir. Like the poor, these ills are still with us, in spite of all the "cures" and probably nowhere is the expression of the old French physician that "the therapeutics of any generation is always absurd to the second succeeding generation" better illustrated than in regard to them. These cases serve to emphasize very clearly, however, the fact that the pains and aches of mankind are largely under the control of the will.