Psychotherapy / Including the History of the Use of Mental Influence, Directly and Indirectly, in Healing and the Principles for the Application of Energies Derived from the Mind to the Treatment of Disease

by James J. Walsh

Lancisi.—Lancisi was another distinguished clinical observer who made special studies in neurotic heart disturbance. These studies are all the more interesting because he himself was a sufferer from this affection for many years. He was inclined to think that his heart intermittency was due to disturbance in his digestive organs and especially those lying in the upper part of the abdomen. He attributes it himself to sympathy with these and said that it came ex hypochondriorum consensu, as it were a reflex from his hypochondriac regions. As Lancisi lived to a pretty good age in spite of noting this symptom in early middle life, the significance of it will be well understood. It would be perfectly possible to gather a series of such cases from among the distinguished physicians of history, and as for our contemporaries and colleagues, at least one out of four of them will tell you that at some time he has suffered from an affection of this kind and has been much worried [{332}] about it, yet has recovered without incident and without any serious development.

English Opinion.—The role of the stomach in disturbing the heart is only less important than that of the nervous system itself. Of course, individual peculiarities, as I have said, are extremely important. Some people seem to suffer very little cardiac disturbance from a distended stomach, while in others all sorts of heart affections may be simulated as the result of the mechanical interference with the heart action by the pushing up of the diaphragm. Sir William Broadbent in the article on "The Conduct of the Heart in the Face of Difficulties," already quoted from, does not hesitate to say that heart symptoms secondary to gastric disturbance probably cause more suffering than does actual heart disease. Expressions of this kind need to be borne in mind when we reassure patients who have all sorts of queer, uncomfortable, often even painful, conditions in their cardiac region, "Heart disease" has been, perhaps, mentioned casually to them and as a consequence worry is adding a nervous element to hamper a heart already seriously disturbed by gastric distention. Sir William Broadbent's own words are given because they carry so much weight in this matter:

The difficulties arising out of flatulent distention of the stomach or colon or intestinal canal generally, will require some attention, since they are the cause of most of the functional derangements to which the heart is subject, and give rise to the heart complaints which occasion in the aggregate perhaps more suffering than does actual heart disease. The heart often tolerates a considerable degree of upward pressure of the diaphragm, and it is not uncommon to meet with stomach resonance as high as the fifth space, and to find the apex beat displaced upwards and outwards to the fourth space and outside the nipple line, without conspicuous symptoms. But the heart behaves very differently in different subjects in the presence of flatulent distention of the stomach. It partakes of the general constitutional condition of the individual; in the strong, therefore, it is vigorous; in the weak it cannot be anything but weak.

Prognosis.—Nothing sends a young person sooner to a physician than this cardiac unrest and functional disturbance. He comes all a-tremble, as if to hear the worst. Even in middle age and in those whose education might be expected to steady them somewhat in the matter, even in physicians of long experience, there is a tendency so to exaggerate the condition and its possibilities of fatality as a consequence of emotion that inhibitory action on the heart becomes noticeable. It is a rule with very few exceptions that in these cases when the heart is complained of by young persons who have no history of rheumatism, the causative condition will be found in the stomach, or at least in the digestive tract.

I know a number of physicians who have suffered in this way and who have been badly frightened about themselves, yet who have had no serious difficulty once they took reasonable care of their diet, and paid attention above all to regularity of meals and slowness in eating. Indeed, it is rare to find a physician of a nervous temperament who has not had some trouble of this kind, and the demands made on a busy professional man foster this. Some of them are sure that if their cardiac uneasiness does not signify an actual heart lesion, valvular or muscular, at least it portends a premature wearing out of the heart. There are many evidences to show that this is [{333}] not so. I have had a distinguished physician, now well past his seventy-fifth year, tell me of distinct irregularity in his heart action as a young man which had rather alarmed him, and as this had been preceded by an attack of acute articular rheumatism there seemed to be every reason to think that he was a sufferer not from functional but from organic heart disease; yet he has lived well beyond the span of life usually allotted to man, has accomplished an immense amount of work and is now in excellent general health almost at the age of eighty. The case is all the more striking because, while rest and care of the health and regular life and conservation of energy are usually supposed to be essential for these cases, this colleague is noted for having made serious inroads on the hours which should have been devoted to sleep in order to accomplish certain medical literary work while devoting himself to the care of a most exacting practice.

That the good prognosis of these cases which I suggest is not forced and is not over-favorable nor the result of the wish to soothe patients may be judged from recent studies of the heart as well as from the older ones. In discussing extra-systole, MacKenzie in his "Diseases of the Heart," [Footnote 28] says:

[Footnote 28: "Diseases of the Heart," by James MacKenzie, M. D., 1910, Oxford Medical Publications.]

Dyspeptic and neurotic people are often liable [to suffer from them]. That other conditions give rise to extra-systoles, is also evident from the fact that they may occur in young people in whom there is no rheumatic history and no cardiosclerosis and whose after-history reveals no sign of heart trouble.

It is well to note the frequency of such annoying symptoms in those who have gone through rheumatic fever, and where patients have a history of this it is well to be cautious, but even in these cases he says that the trouble is often entirely neurotic and the one important preliminary to any successful treatment is to get the patient's mind off his condition, improve his general nervous state, and above all relieve as far as possible the gastric symptoms that may be present.

He says further: