_ CHAPTER XVI. THE WILL AND THE HEART
"For what I will, I will, and there an end."
Two Gentlemen of Verona.
The heart is the
primum movens, the first tissue of the body that moves of itself in the animal organism, doing so rhythmically and of course continuously before the nervous system develops in the embryo. This spontaneous activity would seem to place it quite beyond the control of the will, as of course it is, so far as the continuance of its essential activity goes, but there is probably no organ that is so much influenced by the emotions and comes indirectly under the influence of the will as the heart. There are a series of expressions in practically all languages which chronicle this fact. We talk about the encouragement and discouragement or in Saxon terms that are exactly equivalent to the French words, heartening and disheartening of the individual. At moments of panic the heart can be felt to be depressed, while at times when resolve is high there is a sense of well-being in connection with the firm action of the heart that flows over into the organism and makes everything seem easy of accomplishment.
There are a number of heart conditions that depend for their existence and continuance on a sense of discouragement, that is oversolicitude with regard to the heart. If something calls attention to that organ, the fact that it is so important for life and health and that anything the matter with it may easily prove serious, will sometimes precipitate a feeling of panic that is reflected in the heart and adds to the symptoms noted. The original disturbing heart sensation may be due to nothing more than some slight distention of the stomach by gas, or by a rather heavy meal, but once the dread of the presence of a heart condition of some kind comes over the individual, all the subjective feelings in the cardiac region are emphasized and the discouragement that results further disturbs both heart and patient.
Palpitation of the heart is scarcely more than a solicitous noting of the fact that the heart is beating. In certain cases, under the stress of emotion, the heart beat-rate may be faster than normal, but in a number of people who complain of palpitation, no rapid heart action is noted. What has happened is that something having called particular attention to the heart, the beating of the organ gets above the threshold of consciousness and then continues to be noted whenever attention is given it. This is of itself quite sufficient to cause a sense of discomfort in the heart region and there may be, owing to the solicitude about the organ, a great deal of complaint.
Just one thing is absolutely necessary in the treatment of these cases, once it is found that there is no organic condition present. The patient's will must be stimulated to divert the attention from the heart and to keep solicitude from disturbing both that organ and the patient himself. It is not always easy to accomplish this, but where the patient has confidence in the diagnosis and the assurance that nothing serious is the matter, a contrary habit that will overcome the worry with regard to the heart can be formed. For it must not be forgotten that in these cases a series of acts of solicitous attention has been performed which has created a habit that can only be overcome by the opposite habit. It is surprising how much discomfort this simple affection, due to a functional disturbance of the heart and overattention to it, may produce and how much it may interfere with the usual occupation. It is a case, however, simply of willing to be better, and nothing else will accomplish the desired result. At times the mistake is made of giving such patients a heart remedy, perhaps digitalis, but this only emphasizes the unfavorable suggestion and besides, by stimulating heart action, sometimes brings it more into the sphere of consciousness than before and actually does harm.
There is a form of this functional disturbance of the heart which reaches a climax of power to disturb and then is sometimes spoken of as spurious
angina pectoris. In these cases the patient complains not only of a sense of discomfort but of actual pain over the heart region and this pain is sometimes spoken of as excruciating. Occasionally the pain will be reflected down the left arm which used to be considered the pathognomic sign of true
angina pectoris but is not. Sometimes the pain is reflected in the neck on the left side or at times is noted at the angle of the scapula behind. When these symptoms occur in young persons and particularly in young women, there is no reason to think for a moment of their being due to true
angina pectoris, which is a spasm of the heart muscle consequent upon the degeneration of the coronary arteries, the blood vessels which feed the heart itself, and occurs almost exclusively in the old, and much more commonly in old men.
The pain of true
angina pectoris is often said to be perhaps the worst torture that humanity has to bear. As a rule, however, it is very prostrating and so genuine sufferers from it are not loud in their complaints. Their suffering is more evident in their faces than in their voices. Indeed, it has come to be looked upon as a rule by the English clinicians and heart experts that the more fuss there is made, the less likelihood there is of the affection being true
angina pectoris. When there is pain in the heart region then, especially in young or comparatively young women, of which great complaint is made, it is almost surely to be considered spurious
angina, even though there may be reflex pain down the arm as well as the impending sense of death which used to be considered distinctive of the genuine
angina pectoris.
The treatment of true
angina depends to some extent on inspiring the patient with courage, for it is needed to carry him through the very serious condition to which he is subjected. The psychic element is important, though the drug treatment by the nitrites and especially amyl nitrite is often very effective. In spurious
angina, the will is the all-important element. There is some irritation of the heart muscle but it is mainly fright that exaggerates the pain and then concentration of attention on it makes it seem very serious. The one thing that is all important is to relieve patients from the solicitude which comes upon them with regard to their hearts and which prevents them from suppressing their feelings and diverting their minds to other things. Sometimes the will is needed to bring about such a change in the habits of the individual as will furnish proper nutrition for the heart. Very often these patients are under weight, not infrequently they have been staying a great deal in the house, and both of these bad habits of living need to be corrected. Good habits of eating and exercise are above all important for the relief of the condition.
For functional heart trouble, gentle exercise in the open air generally must be taken, for it acts as a tonic stimulant to the heart muscle. Almost as a rule, when patients suffer from symptoms from their hearts, they are inclined to consider them a signal that they must rest and above all must not exercise to such an extent as to make the heart go faster. Rest, if indulged in to too great an extent, has a very unfavorable effect upon the heart, for the heart, like all muscles, needs exercise to keep it in good condition. One of the most important developments of heart therapeutics in our generation was the Nauheim treatment. In this, exercise is an important feature. The exercise is graduated and is pushed so as to make a definite call upon the heart's muscular power. Nauheim is situated in a little cup-shaped valley and patients are directed to walk a certain distance on one of the various roads, distances being marked by signposts every quarter of a mile or so. The walk outward, when the patient is fresh, is slightly uphill, and the return home is always downhill, which saves the patient from any undue strain.
The experience at Nauheim was so favorable that many physicians took up the practice of having their heart patients exercise regularly and found that it was decidedly to their benefit. If this is true for organic heart conditions, it is even more valuable for neurotic heart cases, though it often requires a good deal of exercise of will on the part of patients suffering from these affections to control their feelings and take such exercise as is needed. In men, it will often be found that the discomfort in the heart region, particularly in muscular, well-built men who have no organic condition, is due more to lack of exercise than to any other factor. This is particularly true whenever the men have taken considerable vigorous exercise when they were young and then tried to settle down to the inactive habits of a sedentary life. Athletes who have been on the teams at college, self-made men who have been hard manual laborers when they were young, even sons of farmers who take up city life are likely to suffer in this way. Their successful treatment depends more on getting exercise in the open back into their lives than on anything else, and for this a call upon the individual's will power for the establishment of the needed new habits is the essential.
Former athletes who try to settle down to a very inactive life are almost sure to have uncomfortable feelings in their heart region. At times it will be hard to persuade them that they have not some serious affection consequent upon some overstrain at athletics. In a few cases, this will be found to be true, but in the great majority the root of the trouble is that the heart craves exercise. A good many functional heart cases, like the neurotic indigestions, so called--are due to the fact that the heart and the stomach are not given enough to do. The renewal of exercise in the daily life--and it should be the daily life as a rule and not merely once or twice a week--will do more than anything else to relieve these cases and restore the patient's confidence. We saw during the war that a number of young men, officers even more than privates--that is, the better educated more than the less educated--suffered from shell shock so called. A good many university men may suffer from what might be termed heart shock if they find any reason to be solicitous about their hearts. These neurotic conditions can only be relieved by the will and diversion of attention.
A certain number of people who suffer from missed beats of their hearts become very much perturbed about the condition of that organ. Irregular heart action, and especially what has been called the irregularly irregular heart, may prove to be a serious condition. There are a number of regular irregularities of heart action, however, consisting particularly of the missed beat at shorter or longer intervals, which may have almost no significance at all. I know two physicians, both athletes when they were at college, who have suffered from a missed heartbeat since their early twenties. In one case it has lasted now for thirty-five years and the physician is still vigorous and hearty, capable even of running up an elevated stairway after a train without any inconvenience. Some twenty years ago there was question of his taking out a twenty-year life insurance policy and the insurance company's physician at first hesitated to accept the risk because of the missed beat. An examination made by three physicians at the home office was followed by his acceptance and he has outlived the maturity of the policy in good health and been given a renewal of it, in spite of the fact that his missed beat still persists.
There is often likely to be a good deal of solicitude as to the eventual prognosis in these cases, that is as to what the prospect of prolonged life is. The regularly irregular heart does not seem to make for an unfavorable prognosis. Young patients particularly who have learned that they have a missed heartbeat need to have this fact emphasized. We have the story of an important official of an American university in whom a missed beat was discovered when he was under forty. This was many years ago, and the prognosis of his condition was considered to be rather serious. The patient actually lived, however, for a little more than fifty years after the discovery of his missed beat. It is easy to understand what a favorable effect on a patient solicitous about a missed beat such a story as this will have. It heartens a patient and gives him the will power to throw off his anxieties and to keep from watching his heart and thus further interfering with its activities. There is even a possibility of life to the eighties or, as I have known at least one case, to the nineties, where the irregular heart was first noted under thirty.
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 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 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. _