566 HEART (DISEASES OF TUB) ten say that the heart seems to rise into the throat, or it seems to be struggling to get out of the chest. Frequent interinittency of the heart's action is another form ; the patient is sensible of the intermissions, and feels as if there was danger at any instant of the heart ceasing to act. In some cases the heart acts regularly, but with more or less rapidity. Pa- tients sometimes describe a sensation of flut- tering in the chest. A strong beat followed by a feeble beat, the latter sometimes not giv- ing rise to a pulsation at the wrist, and this al- ternation going on regularly for hours, days, or weeks, is a curious form of disorder ; and want of unison in the action of the right and the left ventricle, causing reduplication of the sounds of the heart, is another equally curious. In most instances functional disorder occasions great anxiety and apprehension, patients think- ing that there must be organic disease of the heart, and that they are in danger of sudden death. It is often very difficult to convince them that they have only a functional disorder, which, however distressing, is devoid of dan- ger. The mental uneasiness caused by a func- tional disorder in general far exceeds that felt in cases of serious organic disease. From the sympathetic relations between the mind and the heart, functional disorder of the latter is frequently due to mental excitement and de- pression, and the disorder is apt to be increased or perpetuated in consequence of the attention becoming concentrated on the heart's action as represented by the beats and the pulse. Other causes which produce and keep up functional disorder are the immoderate use of tobacco, dyspeptic derangement, and abuse of the sex- ual function. Gouty persons are liable to it. It is especially apt to occur in connection with impoverishment of the blood (anaemia). There is a constitutional tendency to disorder of the heart's action in some persons, who may be said to have irritable hearts. These persons are often subject to it more or less during their lives. It is vastly important to discriminate between functional disorder and organic dis- ease of the heart, inasmuch as the former is unattended with danger, and has little or no tendency to eventuate in the latter ; and this assurance by the physician not only relieves needless anxiety on the part of the patient, but often does much toward effecting a cure. In determining that an affection of the heart is purely functional, a physical examination by means of auscultation and percussion must be made, and a positive conclusion can only be based on the result of this examination. If the result be negative, that is, if none of the signs of structural lesions be found, the infer- ence is that the affection is functional. In or- der to reach this conclusion with positiveness, of course the physician must be confident in his ability to recognize the signs of organic dis- eases, and, therefore, to exclude them by find- ing no physical evidence of their existence. In severe attacks of functional disorder, re- HEART'S CONTENT lief is obtained by the use of narcotic remedies, such as belladonna or opium ; and if persistent, cardiac sedatives, especially aconite, are useful as palliatives. An alcoholic stimulant some- times affords temporary relief and also the so- called antispasmodic remedies, such as valerian, asafoetida, and the ethers. With a view to per- manent relief or the prevention of paroxysms, the causes which have been named are to be removed whenever these are ascertained ; de- rangements of the digestive system, if present, are to be remedied if practicable ; and if the patient be anemic, it is important to restore the normal condition of the blood. A re- markable affection consists in a persistent fre- quency of the heart's action, associated with enlargements of the thyroid gland (goitre), and in some cases with a notable projection of the eyeballs. This affection has received different names. It is often called " Graves's disease," from the fact that the connection between the functional affection of the heart and the goitre was pointed out by the late Dr. Graves of Dublin in 1835. The German writers desig- nate it Basedow's disease, after a German ob- server who described it in 1840. Other names are exophthalmic goitre, exophthalmic ca- chexia, and anaemic protrusion of the eyeballs. A rapid action of the heart, the pulse ranging in different cases from 100 to 140 per minute, may continue uninterruptedly for many years. The goitre rarely progresses to a great extent. The projection of the eyeballs varies in differ- ent cases, being sometimes so great that the eyelids are unable to cover them, and giving to the face a strikingly ferocious expression. In most cases anaemia exists in a marked degree, and there is usually much nervous irritabili- ty. The pathology of the affection is obscure, but the disorder of the heart always precedes the goitre and the protrusion of the eyeballs. With our present knowledge, it is very little under therapeutic control. Sedative remedies to moderate the frequency of the heart's ac- tion, and measures having reference to the im- poverished condition of the blood, are indica- ted, together with hygienic treatment to invig- orate the system. Complete recovery is in general not to be expected; but the affection does not tend to destroy life, and may be tol- erated for many years. The long persisting frequency of the heart's action may lead at length to enlargement of the organ. More- over, the affection tends to impair the ability to resist any important disease which may be- come developed. HEART'S CONTENT, a seaport of the district of Trinity, Newfoundland, on an inlet of the E. shore of Trinity bay, 37 m. N. W. of St. John's ; lat. 47 50' N., Ion. 53 20' W. ; pop. about 900. It has a fine harbor, and the sur- rounding scenery is picturesque. The inhabi- tants are chiefly engaged in fishing, but farm- ing and ship building are pursued to some ex- tent. The Atlantic telegraph cables have their western terminus here.
