The mental symptoms of heart disease / by T. Duncan Greenlees.

  • Greenlees, T. Duncan.
Date:
[1903]
Catalogue details

Licence: In copyright

Credit: The mental symptoms of heart disease / by T. Duncan Greenlees. Source: Wellcome Collection.

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    applicable to other diseases as well as to the insanities, but that it explains satisfactorily the mode of origin of most of the forms of mental disease is very much open to question. What may be termed the “sane mental symptoms” of a case of heart disease is well known to every practitioner; impatience of control or interference, fits of depression, alternating with periods of irritability, amounting in some cases almost to violence, and even hallucinations of the senses, or delusions, may be found in a cardiac case not considered insane! As Clouston says, it is only when the mental reaction is quite out of proportion to the cause—physical or otherwise—we conclude that the person is suffering from insanity. I have a patient under my care at present suffering from a “double aortic,” who is otherwise perfectly sane, and yet he complains of a peculiar metallic taste in his mouth, and that his room is full of electric batteries and wires that “ play ” upon him during the night. These mental phenomena only appear when he is very ill and suffering from an attack of cardiac dyspnoea, to which he is liable; at other times, although the cardiac condition is permanent, he is quite free from abnormal mental symptoms. In this case, there can be no doubt that these psychic phenomena are the result of the heart disease, and are produced, partly, at all events, through the agency of the sympathetic system of nerves. The governing centre for the heart is, as is well known, localised in the medulla oblongata, and is, as has been recently pointed out by Ferrier,1 in a more or less continuous state of so-called automatic activity, which is capable of being modified by impulses proceeding from the heart itself and blood-vessels, as well as from the higher regions of thought and feeling. While I have shown how morbid conditions of the circula¬ tory apparatus may give rise to abnormal mental manifestations, it is just as important to recollect that abnormal mental pro¬ cesses may so act upon the circulatory mechanism as to induce temporary and functional disorders of the circulation. Ferrier has shown that influences of a mental or emotional character may modify or disturb the circulation in a perfectly sane individual, as is seen in blushing the result of modesty, and pallor consequent upon a fright. Such mental or emotional influences upon the circulation 1 Harveian Oration, British Medical Journal, 25tli October, 1902, p. 1337,