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GEN. II.

α

SPEC. III.
C. Palpi-

tatio cordis.
Palpitation
of the heart.

6 C. Palpitatio arte

riosa.

of the arte

ries.

Existence of topical irritability

in an artery easy to be conceived from analo

gous facts.

Yet some

times capa

ble of full

proof, as in phlegmo

thor, with a spontaneous términation equally as favoura ble. M. Laennec's ingenious method of MEDIATE ausCULTATION by the stethoscope, as we have already explained, will often be found of great importance in the different forms of this species of disease *.

The same alternating spasmodic motion into which the muscular substance of the heart is occasionally thrown Palpitation by one or other of the causes thus glanced at, seems, at times, to take place in some of the LARGER ARTERIES, and extends to a greater or less length in proportion to the nature of the cause or the extent of the morbid irritability by which they are affected, producing the SECOND VARIETY before us. That a morbid irritability may exist in a part of an artery while the rest is free from any such condition is easy to be conceived, since a like partial irritability is often found to exist in organs in which we are capable of tracing it in the most manifest manner. Yet even in arteries themselves we can sometimes ascertain the same to the conviction of our senses; as for example in the case of phlegmonous inflammation; in which, also, we find it accompanied with the throb or alternating spasm and relaxation which constitutes what is meant by In an ordi- palpitation. In a healthy and ordinary flow of the blood through the arteries it is very well known that there is no sensible series of contractions and dilatations whatever; and we have already observed in the Physiological Proem to the third class that there is no actual change of bulk of in the latter. any kind, and that it is the pressure of the finger or of some other substance against the side of an artery that In phleg- alone produces a feeling of pulsation. In a phlegmonous monous inflammation inflammation, however, every one is sensible of a considerable change in this respect; for there is often a very manifest by smart and vibratory pulsation while the affected part is in perfect freedom, and no finger is applied to it: and that this is a pulsation unconnected with the regular derived from pulsation of the heart is perfectly clear, because it is fre

nous inflammation.

nary flow of the blood

through the

arteries no alternate

change of the diameter

such alter

nate change

the throb

bing: which cannot be

the action of the heart.

* See Vol. 1. Cl. ш. Ord. iv. Gen. 111. Spec. v.

GEN. II.

SPEC. III.

tatio arteri

quently less uniform, rarely, if ever, synchronous with it,
and, in most instances, twice as rapid. We have here, & C. Palpi-
therefore, a full proof of a local excess of irritability in an
arterial tube, and of a palpitation, or alternating spasm Palpitation
and relaxation, as its effect.

Yet inflammation is but one cause of such subsultory action, or of the irritability which gives rise to it. With other causes we are not much acquainted; but we have reason to believe them very numerous, and wherever they exist, the artery operated upon will evince the same kind of vibratory throb, though, in general, the stroke will not be found quite so smart as that which takes place in the pulse of a phlegmon. It may appear singular that this abnormal action, whether of the heart or arteries, should evince so much punctuality in its vibration; but there is often a wonderful tendency to punctuality in all intermissive affections whatever. We see it in hemorrhoidal discharges, in gout, and above all, in intermitting fevers: and till the cause of such punctuality is explained in this last instance, it will be in vain to expect an explanation in the case before us.

In very irritable habits, or, perhaps, where there is a morbid sensibility through the whole of the sanguiferous system, the palpitation will not unfrequently shoot from one artery to another; and one or two cases are given in the Ephemerides of Natural Curiosities*, in which it appears to have been universal. It was so, indeed, in the very irritable organization of that singularly constituted character J. J. Rousseau, if we may credit the account he gives of himself in relation to this subject: for he tells us that, after a peculiar paroxysm of high corporeal excitement, he became, all of a sudden, sensible of a pulsation in every part of his body, which from this time accompanied him without intermission: and he adds, somewhat extravagantly, that the throbbing was so distinct and strong, that he was often capable of hearing as well as feeling it.

* Eph. Nat. Cur. Dec. 1. Ann. vI-VII,

osa.

of the arte-
ries.

Inflammation only one

cause of this,
subsultory
action:
others nu-
as active.

merous and

The punctuality of

this abnor

whence

mal action

derived.

sometimes

Palpitation shoots from artery to

artery :

been found

and has universal. How far exemplified in

J. J. Rous

seau.

GEN. II.

SPEC. III. B C. Palpitatio arteri

osa.

Palpitation of the arte

ries. Palpitation

or throbbing of the temporal arte

ries, and the

carotid.

Chain of

The temporal arteries are peculiarly apt to concur in this migratory throbbing, and occasionally the carotid; and the throbbing of both is sometimes synchronous with that of the heart, and sometimes successive to it. Mr. Dundas has observed that this affection of the carotids is most common to persons in the prime of life; and that, on dissection, the heart is often found enlarged in its size, but without any increase of muscular power; an assertion collaterally supported by the case of the young lady described under the preceding variety. We here also, sometimes meet with polypous concretions, and very generally adhesions to the pericardium.

And it is highly curious and interesting to notice the morbid acramifying chain of morbid action of which the heart sometion often singular. times forms the first link. I had lately a lady under my Illustrated. care, of delicate constitution and highly nervous habit, in the third month of pregnancy, who had for several weeks past been uniformly attacked in the evening with a violent palpitation in the heart, that continued for nearly an hour or upwards; it was then transferred to the temples, which throbbed with as much violence and for as long a period of time; vertigo followed with a tendency to deliquium, immediately after which there was a general reaction in the system; the skin became heated and at first very dry; but the driness at length yielded to a gentle diaphoresis, which concluded the morbid series; for the patient, at that time becoming tranquil, dropped into a sound and refreshing sleep, and woke free from all these symptoms in the morning.

Palpitation in the epigastric region.

In this case, also, there was a considerable tendency to that universal subsultus or alternating spasm of the arterial system to which we have just adverted: for all the arteries of the extremities pulsated or palpitated whenever accidentally pressed upon by any substance, though it required this additional stimulus to excite the spasmodic action.

Arterial palpitation, however, is to be found, though not more frequently, still far more alarmingly in the epigastric region than in the head; and appears to proceed

GEN. II.

SPEC. III.

from some particular excitement of the aorta, the superior mesenteric, or some branch of the cœliac artery. Its beat has here some resemblance to that of an aneurism tatio arteri

& C. Palpi

osa.

Sometimes

an aneurism.

Illustrated

from Baillie.

Often inde pendent of

of these vessels, and has often been pronounced to be such Palpitation without the slightest foundation, to the great terror of of the artethe patient, and consequently to a considerable exacerba- ries. tion of the disease. It may, for the most part, be easily resembling distinguished from an aneurism by being destitute of any circumscribed pulsatory tumour, that can be ascertained How distinguishable. by a pressure of the finger; by a smarter vibration in the arterial stroke; and by that degree of irregularity in the return of the stroke by which palpitation is distinguished from pulsation. In some cases, indeed, the line of the affected artery can be distinctly felt and followed up to a considerable length; and the vibration has occasionally been so strong as to be visible to the eye, even at some distance, when the surface of the epigastric region has been exposed to view. "From a good deal of experience upon this subject," says Dr. Baillie, "I am enabled to say that the increased pulsation of the aorta in the epigastric region, very rarely depends upon any disease of the aorta itself, or of its large branches in that place; and that this occurrence is almost constantly of very little importance."* This distinguished physiologist tells us, further, that he has had an opportunity of examining the state of the arteries in the epigastric region after death, in two persons who had this pulsation very strongly marked, and who died from other diseases. In both cases all the arteries were perfectly free from every appearance of diseased structure. He was, also, some years ago, consulted by an old man upon a paralytic affection; who afterwards spoke to him incidentally concerning a palpitatation of the kind before us, to which he had been subject for upwards of twenty-five years. The throb, on examination, was distinctly to be felt; and on the patient's first perceiving it, and applying to Sir Cæsar Hawkins, Mr. Bromfield, and Dr. Hunter, the two former had declared

Med. Trans. IV. XIX.

any disease whatever in the aorta.

GEN. II.

SPEC. III. B C. Palpitatio arteri

osa.

Palpitation

of the arte

ries.

Hence the cause often difficult to be ascertained: but mostly con

nected with dyspepsy. Advantage of the stethoscope.

y C. Palpitatio com

plicata.

Mostly pro

such organs

to the heart or large trunks of arteries: Sometimes

it to be an aneurism, while the latter, more modestly, confessed that he did not know what it was.

Dr. Baillie, in the article now alluded to, has imitated the modesty of Dr. Hunter." It is, perhaps, difficult”, says he, "to ascertain, in many instances, the causes of this increased pulsation of the aorta in the epigastric region but in most cases it will be found to be connected with an imperfect digestion, and an irritable constitution." And hence, whatever may improve the digestion, and render the constitution less irritable, will be of use in mitigating the complaint: and, above all, it will be found. highly serviceable to remove the patient's anxiety on the subject, whenever it can fairly be done. It is here that M. Laennec's stethoscope may be employed as a valuable diagnostic, and will often enable us, better than any other means, to ascertain the real nature of the malady; for an account of which the reader may turn to the remarks on phthisis*.

But the throbbing or pulsatory motion is often communicated to other organs than the sanguiferous vessels, Complicated and forms that variety of affection to which we have given palpitation. the name of COMPLICATED PALPITATION. This is clearly duced by the dependent, in many cases, upon the vicinity or close convicinity of nexion of such organs with the heart or arteries that form the seat of disease; and it may also in other cases be produced, as ingeniously conjectured by Dr. Young, by an accumulation of fluid in the pericardium or thorax, which transmits a pulsatory motion from the heart itself to whatever other organ or surface of a cavity such fluid may reach; in the same manner as the fluctuation produced by a slight blow given to one side of the abdomen, when distended with water, is distinctly propagated to the opposite side. In the case of a middleof the heart aged woman, of a rheumatic habit, labouring under symptoms of general dropsy †, "a palpitation", he tells us, from Young. "was observed in the right hypochondriac region, and on the right side of the neck, which exhibited a vibratory

perhaps by the fluctua

tion of a fluid

accumulated in cavities operated

upon by a palpitation

or arteries.

Illustrated

* Vol. I. Cl. III. Ord. Iv. Gen. ш. Spec. v.

† Med. Trans. Vol, v. Art. xvii.

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