GEN. H. SPEC. III. templates palpitation as dependent on a diseased action of the heart alone, or of the larger arteries alone, or of Clonus the one or the other associating with some organ more Palpitatio. or less remote: and hence lays a foundation for the three following varieties: a Cordis. Palpitation of the heart. Palpitation. B Arteriosa. 7 Complicata. Palpitation of the arteries. tation. tatio cordis. Throbbing: Both producible by two systole harsh and causes : unpliant: The vibratory and irregular action, which we denomi- « C. Palpinate PALPITATION OF THE HEART, is sometimes sharp and Palpitation strong, in which case it is called a THROBBING OF THE of the heart. HEART, and sometimes soft and feeble, when it is called a fluttering. FLUTTERING of this organ. Both may possibly proceed from two distinct causes; the one a morbid irritability of its muscular fibres, or some sudden stimulus applied to it, either external or internal, by which its systole becomes harsh and unpliant, and evinces a tendency to a spastic fixation; and the other an irregular motion of the entire organ of the heart in the pericardium, by which it literally strikes against the chest: the cause of which we do not always know, though we see it very frequently occasioned by a sudden and violent emotion of the mind, and have reason to believe that it is often a result of the spastic systole or contraction of the heart which we have just noticed. When, however, the substance of the heart is thus irregularly acted upon, and jerked backward and forward from a cause extrinsic to itself, the palpitation is confined to the pericardium, and the pulse does not partake of the abnormity. and an irregular motion of the organ of the heart in the pericardium: by Dr. W. The last is, perhaps, the most common proximate as first cause of the palpitation of this organ, and we are in- pointed out debted to Dr. William Hunter for having first pointed it Hunter. out to us. The heart, in its natural state, lies loose and Illustrated. pendulous in the pericardium: and when the blood which it receives is, from an irritation of any kind, thrown with a peculiar jirk into the aorta, the moment it reaches the curvature of this trunk it encounters so strong a resistance as to produce a very powerful rebound in conse GEN. II. SPEC. III. ❝ C. Palpitatio cordis. Palpitation of the heart. Rebound sometimes so strong as quence of the aorta being the first point against the spine: the influence of the heart's own action is now, therefore, thrown back upon itself, and this organ, as a result of its being loose and pendulous, is tilted forward against the inside of the chest, between the fifth and sixth ribs. on the left *. The rebound of so strong a muscle as the heart against the inside of the chest must depend for its violence upon to be heard, the violence of the jerk with which the blood is spasmodically thrown into the aorta; and this has often been so powerful as to be distinctly heard by by-standers †. Castellus has given an example of this sonorous effect: and Mr. Dundas has observed it in various cases. "The the bedclothes. Has sometimes dislocated or and agitate action of the heart", says the latter," is sometimes so very strong as to be distinctly heard, and to agitate the bed the patient is in so violently, that his pulse has been counted by looking at the motions of the curtain of the bed ". I have already observed, under the genus PAROPSIS, that the point of a knife when introduced into the cornea, for the extraction of a cataract, has occasionally been broken off by a spasm of the muscles of the eye. And we shall hence hear with less wonder that the heart has sometimes palpitated with a force so violent as to dislocate § or break the ribs, for both are stated to have occurred on respectable authorities, and, in one instance, to rupture its own ventricles T. Upon the wonderful power of the soft parts, or rather of the muscles over the bones, when thrown into vehement spasmodic action, we had occasion to observe in the Physiological Proem to the present order: and it is hence that we have sometimes had examples of the humerus, and other long bones, being broken by a convulsion-fit. A contrac fractured the ruptured its ribs; and own ven tricles. * See J. Hunter on Blood, p. 146. note. Trans. Medico-Chirurg. Soc. 1. 27. Thoracis. Tr. 1x. Toloso. Horstii 11. 137–139. tion of the left aurico-ventricular opening is sometimes found to produce the phænomenon of a double pulse *. GEN. II. SPEC. III. a C. Palpi tatio cordis, of the heart. Palpitation I have said that we are not always acquainted with the remote or exciting causes of the palpitation of the heart. Violent emotion of the mind, as already observed, is a frequent excitement, and one or two others have been already indicated. The first of these is perhaps the most frequent cause; and hence we can readily admit with M. Corvisart that palpitation, together with many other diseases of the heart, have been far more frequent in France, since the commencement of its late horrible revolution. M. Portal has, indeed, proved this fact by Striking exvarious interesting examples; from which the following first ample of the may be selected as it is short. A young lady who had suddenly learned that her husband had been cruelly murered by a band of the popular ruffians, was instantly seized with a violent palpitation that terminated in a syncope so extreme that she was supposed to be dead. This apprehension, however, was erroneous. She recovered; but the palpitation continued for many years: and she at length died of water in her chest †. structure of The remote causes are rarely to be discovered till after Remote death, and for the most part seem to consist in a morbid causes; chiefly constructure of the heart itself, or the pericardium, by which sist in a last the muscular walls of the heart have either been ob- morbid structed in their play, or have had too much liberty of the heart. action. The heart has sometimes been found ossified in Exemplified. its general substance, as in the case of Pope Urban the VIIIth; and more frequently in its valvules or its connexion with the aorta. It has sometimes been thickened and has grown to an enormous size, which change of structure has lately been distinguished by the name of hypertrophy, and has been found in one instance of a weight of not less than fourteen pounds ‡. A case occurred to Hodgson on the Diseases of Arteries and Veins. † Mémoires sur la Nature et le Traitement de plusieurs Maladies. Tom. IV. 8vo. Paris 1819. Eph. Nat. Cur. Dec. III. Ann. ш. Obs. 166. GEN. II. SPEC. III. C. Palpi tatio cordis. Palpitation of the heart. Other causes occasionally to be met with. Organic injury. Yet often se vere lesion the present author not long ago in a young lady of fourteen, in whom it reached half this weight, and was the cause of a most distressing palpitation, as well as of a general dropsy. By close confinement and quiet, and the use of elaterium and scarification to carry off the water, she recovered an apparently good share of health; but the exercise of dancing, a few months afterwards, produced a recurrence of all the symptoms in a more violent and obstinate degree, and she gradually fell a sacrifice to them. In other cases the heart has been peculiarly small and contracted, chiefly, perhaps, in the disease of tabes, or marasmus; and consequently there has not been a sufficient capacity for the regular influx of venous blood. The space of the pericardium has often been morbidly diminished by inflammation, or an undue growth of fat; and hence, again, the heart has been impeded in its proper action; while occasionally it seems to have been filled, or nearly so, with a dropsical fluid. Organic injury from external violence is also a frequent cause of palpitation. Yet it is singular to observe the severity of lesion the heart and its appendages will sometimes yield to, when the constitution is sound, without affecting the life. M. Latour who, during the French Exemplified. war, was first physician to the Grand Duke of Berg, at without af fecting the life. tended a soldier who laboured under a tremendous hemorrhage from the breast, produced by a wound from a musket that had penetrated this organ. The hemorrhage, however, ceased on the third day, the patient's strength gradually recruited, and suppuration proceeded kindly. It was nevertheless necessary to cut several pieces of fractured rib away; yet the wound cicatrized at the end of three months, and the only inconvenience that remained was a very troublesome palpitation of the breast that annoyed him for three years. Six years after the accident he died of a complaint totally unconnected with the wound. His body, however, was opened by M. Mausion, chief surgeon of the hospital at Orleans: and the ball which had entered his breast was found lodging in the right ventricle of the heart, covered over in a great measure by the pericardium, and resting on the septum medium*. To these causes may be added a scirrhous or other morbid structure of the lungs, and, perhaps, of the spleen, liver, stomach, or intestinal canal; for it is a frequent accompaniment upon most species of parabysma: and in these cases appears as a symptomatic affection alone. For reasons already assigned it is also an occasional symptom in hydrothorax: during which it shows itself in a very violent degree upon mental agitation, especially that produced by fright or vehement rage. cause often the disease Exemplified We should not, however, be hasty in deciding upon The real any structural affection of the heart, or of any of the misunderlarger organs that closely associate with it, nor in reality stood: and upon any incurable cause whatever. For it has not un- recovered frequently happened that a palpitation of long standing, from unexpectedly. and which has been regarded as of a dangerous kind, has gradually gone away of its own accord, and left us altogether in the dark. Dr. Cullen gives a confirmation of from Cullen. this remark in the following very instructive case: "A gentleman pretty well advanced in life, was frequently attacked with palpitations of his heart, which, by degrees, increased both in frequency and violence, and thus continued for two or three years. As the patient was a man of the profession he was visited by many physicians, who were very unanimously of opinion that the disease depended upon an organic affection of the heart, and considered it as absolutely incurable. The disease, however, after some years, gradually abated both in its frequency and violence, and at length ceased altogether; and since that time, for the space of seven or eight years, the gentleman has remained in perfect health, without the slightest symptom of his former complaint."+ A case precisely Confirmed similar, and in a professional gentleman somewhat beyond thor's prae. the middle of life also, has occurred to the present au- tice. * Dict. des Sciences Médicales, Art. Cas. Rares. by the au |