Hearts Out Of Order
( Originally Published 1921 )
WHAT WE CAN LEARN FROM THE SENSATIONS THAT PEOPLE EXPERIENCE WHEN THEIR HEARTS ARE OUT OF ORDER
There are few things more interesting than the attempt to interpret the meaning of the descriptions that sick people give of their sensations and sufferings. The young child has no power of speech, but the experienced mother can distinguish the cry of hunger from the cry of pain, or the cry of anger. As people grow older they are able, according to their powers of observation, their intellect, and their experience, to describe their sensations in a more definite way than the young child. At the same time, however, they have developed imagination, often a habit of exaggeration, and perhaps unconscious motives for deception. The child, when he cries, is at least attempting to tell the truth. The older person's complaint is modified by many side influences. The intention to deceive, however, among sick people is not common.
When a sick person is trying his best to describe his sensations, according to his ability of observation and description, he is talking a language that is known to the physician to a degree depending on his training and experience. If it were necessary to have a rating of physicians according to their true worth in dealing with heart trouble, that rating could be made according to their ability to question the sufferer and extract the true description of his sensations, and then interpret them. A knowledge of this language that is spoken by patients is lacking in the young doctor. It is acquired only in after years. Sick people feel this, and when they go to an older man they are conscious that be understands what they say much better than a young man. It is because the older man has learned their language and the younger man has not. So the young man is much more de-pendent on his physical examination, on what he can discover by the use of instruments and by listening to the heart.
That we can learn very much from what people feel when their hearts are out of order is true, but it must never be forgotten that heart disease as a rule does not cause sensations. The sensations ordinarily come only when complications have set in. However, we can by questioning find out whether the person is conscious of the heart beat or has palpitation; or we can go further than that and often find out what kind of irregular heart he has by the interpretation of a description of the attacks.
When a person feels the rapid heart, he can himself tell whether it is regular or irregular; whether it began to beat suddenly or stop suddenly; also whether he notices it more when he keeps quiet or when he moves about.
A person may not be able to describe his sensations perfectly when questioned at first, but if he is taught what to look for,, the next time the thing happens he can tell you more about it. This is important, because many heart attacks come so suddenly and are so quickly over that the physician has no opportunity to observe them. Sometimes there is a trace left of the attacks in the heart's action which will tell what they were, but often we have no clue except what we can discover by questioning.
Another thing that can be told only by what the person feels is the presence or absence of pain. The first principle in the understanding of the meaning of pain is that it often means trouble somewhere else rather than where it is felt. Every one has struck the point of the elbow and felt pain in the fingers. In the same way, pain over the heart may have its origin in trouble with the stomach or gall bladder. But pain over the heart that traverses up the left shoulder and down the left arm almost always means serious weakness of the heart's muscles.
Much misunderstanding of the relation of pain to serious heart conditions has been due to the kindness of physicians, who have attempted to conceal from people the fact that their hearts are at fault. So it has come about that the only pains in the heart that are called angina pectoris are those that are so severe that everyone is compelled to acknowledge their true nature. But it is not generally known that almost any heart is capable of giving pain if put under strain. It is true of all young children who get a "stitch" in the side when they run too hard.
If older people would understand that pain in the heart is often felt when heart conditions are not serious, it would be easier for them to believe that this pain is actually from the heart. Thus, pain may be felt when the heart is supplied with the wrong kind of food, or when a person exerts himself beyond the point justified by his physical condition. And yet it has been so much the custom to blame the stomach for all these pains that it is hard to get even the profession to accept the truth that pain having its origin in the heart is a common thing.
The slightest pain caused by a temporary weakness of the heart and the most severe pains of angina pectoris all come about through the same machinery. (This machinery consists of nerves that run from the heart to the spinal cord, and of the nerves that run from the brain to the surface of the body. When the heart gets into trouble it sends a message to the spinal cord, and the spinal cord speaks through the nerves of sensation that go to the surface of the body, which are the medium of forwarding the complaint. That is the reason that the nerve to the little finger of the left hand is so often the spokesman of serious heart trouble.