MISCELLANEOUS PAPERS ON SUBJECTS RELATING TO DISORDERS OF THE HEART.
THE INFLUENCE OF THE MIND OVER THE HEART.
THE object of this paper is twofold: First. To show the powerful influence which the mind can and does exert over the heart, and the manner in which such influence is exerted.
Secondly. The results which may be brought about upon the normal conditions of the heart by such influence; and their value from a medico-legal and therapeutic point of view.
We will first inquire how the mind can affect the heart; or, in other words, through what nerve-channels the intellect, the will, and the emotions can affect that important organ.
The heart is supplied with nerves by the pneumogastric and the sympathetic; but we find it impossible to make satisfactory experiments with the nerves in connection with the purely emotional influences.
We are obliged to depend mainly on negative testimony, viz., the effect produced upon the heart by irritation and by division of these nerves. Even here, unfortunately, we are met by so much contradictory evidence that it really seems hopeless to arrive at any definite conclusion.
Claude Bernard, Weber, Valentine, Schiff, and Lockhart Clark disagree in many essential particulars relating to the effects of division or irritation of the pneumogastrics.
The majority of evidence, however, is in favor of the conclusion that the pneumogastrics, pure and simple, contain motor fibres, and that, through the cardiac branches, they effect the motions of the heart.
The pneumogastric may contain sensory fibres also, and may, therefore, be a compound nerve from its origin.
With regard to the influence of the sympathetic, Carpenter found that pressure on the great cardiac sympathetic nerve checks the heart’s pulsations from four to six beats, causing fearful anxiety and pain; while Weber found that stimuli conveyed through this nerve accelerated the movements of the heart.
These and other facts leave no room to doubt that the sympathetic nerves are also concerned in the motions of the heart.
Now the question is whether the emotions act through them or the pneumogastrics, or both, when accelerating or retarding the movements of the heart.
As to the sympathetic nerves of the heart, Moleschott’s experiments demonstrated that the same phenomena occurred as in the case of the vagi, when excited mildy or strongly by galvanism, and he concludes that these two sets of nerves exercise the same influence upon this viscus.
It appears fair, therefore, to conclude that the emotions act upon the heart both through the vagi and the sympathetic. Their modus operandi now accelerating, now retarding its action would seem to derive illustration from these and similar experiments.
If we were to substitute emotion for the stimulus applied by Moleschott to the nerves proceeding to the heart, we can well understand how the former should produce the various and opposite disturbances of this organ, including spasm and paralysis, with which, we are familiar. First, as a feeble or moderate stimulus of the vagus (whether electric or otherwise) causes a considerable rise in the pulse, so does an emotion which is not excessive in character. Secondly, as an increased stimulus gradually retards the action of the heart, while a very powerful one immediately arrests it from the fatigue which succeeds stimulus, just so, we can well conceive, a violent emotion would act. Thirdly, the fatigue may be gradually recovered from and the heart’s action restored to its normal frequency and force.
The ganglia of the heart appear to act in the way of communicating the condition of one of the four nerves supplying the heart to the other three. In regard to the emotional stimuli, however, it seems impossible to decide whether one is more influenced than another, and in view of Professor Moleschott’s experiments, it is evident that the emotions may act in precisely the same way through either the vagi or sympathetic.
We may be allowed to surmise that the ganglia and the fourfold supply of nerves to this organ are designed to lessen its liability to fatal spasm and paralysis by emotion.
“The heart,” observes Moleschott, “is animated by four very excitable nerves, which may be easily over-excited; these four nerves, two vagi and two sympathetic, have a peculiar consensus, which is no doubt due to the action of the ganglia of the heart, so that the state of irritation or over-excitement of one is conveyed to the other three; but it is impossible to permanently exhaust the other three by the overexcitation of one nerve singly, as stimulants which would be powerful enough to effect this, would soon kill the excited portion of the one nerve, and therefore lose their effect upon the other three; such an effect being only possible as long as the nerve acted upon retains part at least of its excitability.”
This conclusion accords with the opinion of Kirkes and Paget, that the cardiac branches of the pneumogastric are one, through not the sole channel through which the influence of emotion is transmitted to this organ, and with that of Dr. Carpenter, already cited; and it does not contradict the judgment expressed by him elsewhere, that the sympathetic constitutes the channel through which the passions produce palpitation of the heart, or Dr. Baly’s statement, that the disturbed action of the heart during emotion is a remarkable instance of the influence of the passions over movements of organs supplied by the sympathetic.
Since Moleschott’s experiments, those of MM. Cyon and Ludwig indicate the existence of accelerator and depressor nerves of the heart, the former emerging from the cord with the third branch of the inferior cervical ganglion, and the latter arising, in rabbits, from the pneumogastric and superior laryngeal nerves.
Bernard, it is stated, adopted this view, and held that the heart, with this sensory depressor nerve, is able to regulate its volume according to circumstances, by exerting a reflex action on the general circulation.
If the inhibitory view of the pneumogastric nerve be established, we must, in attempting to explain the injurious mode of action of certain emotional states upon the heart, suppose that the normal control which is being constantly exercised by this nerve is, under excessive emotion, so intensified under increased stimulation at its origin in the medulla oblongata, that the pulsations of the organ are partially or wholly arrested. A provision by which the heart is prevented sending more blood to an organ already too vascular from emotional excitement, may thus cause death.
It seems, however, that as long as physiologists differ so widely as to the functions of the nerves supplying the heart, it is impossible to determine the exact manner in which the emotions influence this organ.
The general conclusion is, that it is through the acknowledged sympathetic and probably through the pneumogastric by reflex action, when excited centrally by certain emotional states, just as it is alleged to do from the state of the heart at the periphery, or, if Moleschott’s views be adopted, directly through the motor fibres of this nerve.
In order to be methodical and give a more clear and comprehensive understanding, we will take up the various functions of the mind, as the intellect, the will, and the emotions.
The influence of the intellect upon the heart is similar to that exercised over voluntary muscles.
The direction of thought to the heart has very generally an embarrassing influence on its regular action.
Sir Henry Holland says: “There is cause to believe the action of the heart is often quickened or otherwise disturbed by the mere centering the consciousness on it, without any emotion or anxiety.” On occasions where its beats are audible, observation will give proof of this, or the physician can very often infer it while feeling the pulse; and where there is liability to irregular pulsation such action is seemingly brought on or increased by the effort of attention, even though no obvious emotion be present.
I have observed this phenomenon, in my own practice, in hysterical women, who imagine they have heart disease. In these cases a morbid attention to the action of the heart would bring on palpitation and irregular action. Upon the removal of all anxiety by a decided assertion from me, after a careful physical examination, that the heart was not discussed, it would quickly resume its normal action.
From the same cause medical students, when their thoughts are directed by their studies to this organ, are frequently sufferers from its disturbed action. Anxiety, no doubt, comes in here to aggravate the disorder, and will be referred to again under emotions. Peter Frank himself, even in advanced life, while devoting especially attention to the subject of heart disease, during the preparation of his lectures, was attacked with severe palpitations, accompanied by an intermittent pulse, and felt certain that he was affected with an aneurism. The symptoms did not cease till some time after the completion of his labors, and after he had enjoyed the relaxation and diversion of a journey. In fact, it is quite a common remark that medical men often die from a disease that they have made a special study during life.
The question now naturally arises, is it possible for hysterical or hypochondriac persons to bring on permanent structural disease of the heart by a morbid concentration of the mind on it?
It is the opinion of most medical writers that it is not probable such a result would occur. They admit, however, that it would be likely to aggravate any previous mischief and induce irregular action, and ultimately hypertrophy, or some other disease decidedly organic. The physician should, therefore, in treating such patients, exercise his influence and ingenuity to divert their minds from the heart to some other subject or organ.
Numerous interesting cases are recorded showing the specific effects of the intellect over the heart’s action, as one of a medical student being initiated into the rites of a Masonic society; his eyes were bandaged, a ligature bound around his arm, and the usual preparations made for bleeding. A pretence of opening the vein was made, and a stream of water spurted in a bowl to represent the sound of the flowing blood expected. As a result the student soon became pale and fainted.
Then there is the well-known case of the man being bled by the prick of a pin and warm water running down his arm, who actually died as a result.
The daughter of Sir Charles Lee, at 2 o’clock on a certain morning, saw between the curtains of her bed a little old woman, who told her that at 12 o’clock the next day she would be with her in the next world. She immediately dressed herself very carefully, went into her private closet, and did not come out till 9 o’clock, when she went to her aunt, handed her a letter directed to her father with the request it be sent to him immediately on her death, telling her aunt about the apparition. A physician and a surgeon were sent for, but could discover no disease, but on the urgent solicitation of the aunt bled her slightly. She then took a chair and played on her guitar and sang some favorite pieces, and a few minutes before 12 went to a large arm-chair, sat in it, and at 12 raised her hand toward her heart and was dead.
Another case of a young lady who received a similar warning, only it came a year before the appointed time. She became anaemic, lost flesh and strength; nothing could apparently be done to save life, although no organic or structural disease could be found by the closest examination by skilful physicians. The day before the time set for her death a young physician who had some tact gave her a very heavy anodyne, and she slept under its influence during the entire day of her expected death. When she returned to consciousness the next day, and was making a few final preparations, she was assured that the time had passed for her to die and that the oracle knew nothing of such matters and was andimpostor. She got up from her bed and rapidly regained both flesh and strength.
To be sure these are isolated and exceptional cases, and may by many be accounted for on influences other than intellectual, but in them we cannot help seeing a result comparing with the natural reasoning and with ideas firmly fixed in the minds of the individuals.
Dr. Tuke says: “The direct action of the will upon the heart and nonstriated muscles, if it can ever be exerted, is altogether exceptional, although it may powerfully inlfuence them indirectly by directing the course of the emotions and ideas to them, and i this way it may, and probably does, affect the organic functions.”
A distinguished Fellow of the Royal Society (aet. 79) told him that he could by voluntary effort, increase the frequency of his pulse from ten to twenty beats per minute. At the Doctor’s request the experiment was made. When he sat down his pulse was sixty-two; in the course of about two minutes it increased to eight-two. On being requested to describe the manner of accelerating it, he said it seemed to be partly due to “a sort of impulse,” partly to an internal shiver, and partly to an action on the breathing.
The increase in respiration was not apparent.
It may be that the will did not act directly on the muscular tissue of the heart, but indirectly by concentrating the attention on that particular object, on that particular organ.
The case of Colonel Townsend, in which it is said he possessed the remarkable faculty of throwing himself into a trance at pleasure. The heart ceased apparently to throb at his bidding, respiration seemed at an end, his whole frame assumed the icy rigidity of death, while his face became colorless and shrunk, and his eyes fixed, glazed, and ghastly. He would remain in this state for hours, entirely unconscious, when the signs of life would gradually reappear.
Dr. Darwin says: “There is an instance in the Philosophical Transactions, of a man who could for a time stop the motion of his heart when he pleased.”
The heart may be so affected by the emotions, through the nervous supplying i t, as to produce violent contractions tonic spasms of the organ. This occurring in such a vital organ must of necessity cause death.
It is difficult to decide whether this results from muscular irritability, is caused by the withdrawing of an antagonistic nerve force, or from the direct action of nerve-force upon the muscles; but it is evident that, in cases of death like Hunter’s, a condition of spasmodic contraction of the walls of the heart is produced. Let me refer to the record of his death and post- mortem.
The governors of St. George’s Hospital decided that no person should be admitted as a student without bringing certificates of being educated in the profession.
Hunter advocated, at the board, the admission of two young men inadmissible under the new rule. His biographer, Mr. Palmer, states that, before the meeting, he expressed his apprehensions to a friend, “lest some unpleasant dispute might occur, and his conviction that, if it did, it would certainly prove fatal to him.” Arrived at the hospital he found the board already assembled, and entering the room, presented the memorial of the young men, and proceeded to urge the propriety of their being admitted. In the course of his remarks he made some observations which one of his colleagues thought it necessary instantly and flatly to contradict. Hunter immediately ceased speaking, retired from the table, and struggling to suppress the tumult of his passion, hurried into the adjoining room, which he had scarcely reached when, with a deep groan, he fell lifeless into the arms of Dr. Robertson, one of the physicians of the hospital, who chanced to be present. Various attempts were made for upward of an hour to restore animation, under the hope that the attack might prove to be a fainting fit, such as he had before experienced, but in vain; life had fled and all their efforts proved useless. The post-mortem showed the heart to be badly diseased; it was small, appeared to have wasted, and was strongly contracted. The viscera of the abdomen and head were loaded with blood.
As in such cases death seems to be caused by the severe and persistent spasms or contraction of the heart, it seems to me that the opposite condition of dilatation may also occur from emotional excitement. The organ would, in that case, cease to contract on its contents and become powerless, and death ensue. We see this in voluntary muscles and from emotional causes, as in the hand. In one cases it will be rigidly contracted, in another paralyzed, the only difference in result being that the heart is a vital organ, the hand is not.
Senac gives a case of a person who was witness to a shipwreck, and became so affected by the distress around him and terror that palpitation of the heart was succeeded by suppressed breathing, syncope and death. Upon examination the heart was found enlarged.
Bonnet, Morgagni, Tissot and others assert that dilatation of the heart has been caused by chagrin and anger.
Dr. Richardson says: “I have never met with a case of intermittent pulse in which the disorder was not sequential to some anxiety, shock, fear, sorrow, or their similars.”
From statistics we learn that in the last twenty years deaths from heart disease have increased about twenty-five per cent., and the percentage of the increase is entirely confined to men, and to those between the ages of 21 and 45, which is the time they are subject to the most trying emotional causes.
It is not an uncommon occurrence to meet with syncope produced by emotional excitement, and in the case of a perfectly healthy heart we can readily understand why nothing more serious should supervene, and I think it equally clear that it should succumb when it is already diseased, and of course has less power of resistance.
Here again we find that exactly similar results are produced by the opposite emotions of joy and fear.
Lord Eglinton informed John Hunter “that when two soldiers were condemned to be shot, and one of them to receive a pardon, the event being decided by their throwing dice, the one who proved successful thus securing a retrieve usually fainted, while the other remained calm.”
The American poetess, Lucretia Davidson, who died at 17, often fainted when listening to some of her favorite melodies from Moore, yet notwithstanding this, she would beg to have them repeated.
We often see examples where fear prevents fainting so long as it operates, and immediately it is withdrawn the system yields to the reaction and fainting takes place. A lady sitting up after the rest of the household had gone to bed saw a servant enter the door with a pistol in his hand. She immediately blew out the candle, pushed the bed from the wall, got behind it, and succeeded in evading him and getting out of the door and looking it behind her. She awoke the house and then fainted away.
The case of the doorkeeper of COngress, an aged man, who died suddenly on hearing the news of the capture of Lord Cornwallis’s’ army, is an instance of death from joy, and there can be no doubt that it was the result of cardiac and not cerebral lesion.
Sweetser reports a case of an Irishman, aged 36, of ungovernable passion. Having experienced various misfortunes during the Revolutionary war, at length on the affairs of France assuming a more favorable aspect, received a pension, but which was immediately taken away from him on the death of the patron by whom it had been procured. Immediately on hearing the news he felt a dreadful heavy weight in his chest. His respiration became fatiguing and the action of the heart assumed an irregularity which had no interruption during the two and a half years that he survived his misfortune.
On post-mortem the heart was found pale and flaccid; the parietes of the cavities fell together. There was an astonishing contrast between the flesh of the heart and that of the nest of the body, showing conclusively that it was the diseased organ.
It has been observed by African travellers, among whom are Livingston and Samuel Baker, that when the natives belonging to some of the interior tribes were taken from their homes by force or bribes, that their sufferings from homesickness were intense, and sometimes fatal. Their sufferings were not only mental but physical, for when asked to point out the seat of their evident suffering, they indicated correctly the region of the heart. These same authorities further assert that those who died showed all the evidences of death from cardiac disease.
It is well known that the Swiss soldiers some times die of homesickness, attended with all the symptoms of cardiac failure.
Dr. M. Ward reports a case of death, which is so remarkable I cannot resist the temptation to quote it in brief. Dr. Ward was called on February 17th, 1870, to a Miss H. He found she had been suffering for several days from fever; had been out the day before. She had recently returned from the funeral of a sister who died from typhoid fever. Her symptoms became rapidly worse, and she died before morning.