Kitabı oku: «Health Through Will Power», sayfa 11

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.

CHAPTER XVII
THE WILL IN SO-CALLED CHRONIC RHEUMATISM

 
"I should do it
With much more ease; for my good will is to it."
 

The Tempest

In popular estimation, rheumatism is one of the commonest of affections. When a physician asks a patient, especially if the patient is over forty years of age, "Have you ever suffered from rheumatism?" the almost invariable response is, "Yes", though but little further inquiry is needed to show that what the patient means is that he has suffered from some painful conditions in the neighborhood of his joints, or that his muscles have been sore or inclined to ache in rainy weather, or that he has undergone some other vague discomforts connected with dampness. Chronic rheumatism is a term that includes a great many of the most varied conditions. True rheumatism, that is, acute articular rheumatism, is now recognized as an infectious disease which runs a definite course, usually with fever, for some ten days to ten weeks, and requires confinement to bed usually for a month or more. Very rarely will any connection be found between this affection, which presents always Galen's four classic symptoms of inflammation, swelling, redness, heat and pain (tumor, rubor, color, et dolor), and the usual conditions which are broadly characterized as rheumatism. Just as soon as patients are asked if their rheumatism included these symptoms there is denial, yet the idea of their having had rheumatism remains.

As a matter of fact, there are a number of sore and painful conditions in connection with muscles and particularly in and around joints that have, without any scientific justification at least, been called chronic rheumatism. Any painful condition that is worse in rainy weather is sure to be so named. As old dislocations, sprains and wrenches of joints, broken bones, as well as muscular conditions of all kinds, including flat foot and other yielding of joints, all produce this effect, it is easy to understand that there is an immense jumble of all sorts of painful conditions included under the term "chronic rheumatism." Some of them, particularly in older people, produce lameness or at least inability to walk distances without showing the disability; a great many of them produce distinct painful conditions during the night following the use of muscles and often disturb patients very much, because they arouse the dread that they are going to be crippled as they grow older.

Indeed, one of the most serious effects of these recurring painful conditions is the dread produced lest they should cause such progressive affections in and around joints as would eventually make the patients bed-ridden. There are a certain number of cases of so-called rheumatoid arthritis which produce very serious changes in joints with inevitable crippling and quite beyond all possibility of repair. These cases are often spoken of as chronic rheumatism and it is the solicitude produced by the dread of them that makes the worst part of the discomfort in many a so-called chronic rheumatic case. If their affection is to be progressive, then the patients foresee a prolonged confinement to bed in the midst of severe pain, hopeless of ultimate cure. It may be said at once that these cases of rheumatoid arthritis have nothing to do with rheumatism, represent a special acute infection, are never a sequela of any of the rheumatic conditions and are fortunately very rare. This assurance of itself is quite sufficient to make ever so much better a great many patients who feel that they suffer from rheumatism.

The painful conditions that are described under the term chronic rheumatism would seem to be quite beyond any power of the will to affect. They are at least supposed to represent very definite changes in the tissues, usually of chronic character and therefore not amenable to any remedies except those of physical influence. Besides, they are so frequent that surely if there were any question of the will being able to control them or bring relief for them, most sufferers would discover this fact for themselves and apply the remedy from within. It is not to be expected that a very great many people would suffer pains and aches that are worse in rainy weather if all that was needed was the exertion of their will power either to throw off the affection or to perform such exercises and activities as would gradually make their conditions better. In general it is felt that painful conditions of this kind cannot be affected by the will and that distinctly material and not psychic therapeutics must be looked to for their relief.

Now it so happens that the best illustration of the power of the will to "cure" people, that is, to relieve them completely of their affections and start them afresh in life with the feeling that they are no longer handicapped by disease, is to be found exactly in the group of cases that have almost from time immemorial been called chronic rheumatisms. We have had more "cures" of various kinds announced for these—chemical, electrical, physical, hydriatic, movement therapy and so forth—than for almost any other group of diseases. More irregular practitioners of medicine all down the ages have made a reputation by curing these affections than have won renown by treating any other set of ills to which humanity is heir. Like the poor, these ills are still with us, in spite of all the "cures" and probably nowhere is the expression of the old French physician that "the therapeutics of any generation is always absurd to the second succeeding generation" better illustrated than in regard to them. These cases serve to emphasize very clearly, however, the fact that the pains and aches of mankind are largely under the control of the will.

The more one studies these cases of so-called chronic rheumatism the easier it is to understand how they become the signal "cures" which attract attention to the quacks and charlatans who promise much, but do nothing in particular, though they may give medicines or treatment of some kind or another. They only arouse the patient's will to be better and the determination to use his will with confidence, now that the much praised treatment is doing something which will surely make him better. Cases of this kind have constituted a goodly part of the clientele of the great historic impostors who succeeded in making large sums of money out of curing people by methods that in themselves had no curative power. A review of some of the chapters of that very interesting department of human history, the history of quackery, is extremely suggestive in that regard. The only way to get a good idea of the basic significance of these cases is to realize by what they were cured and by whom they were cured.

One of the most interesting illustrations of that phase of human credulity is the story of Greatrakes, the Irish adventurer who had been a soldier in Flanders, and who when his campaigns were over set up to be a healer of mankind. He chose his opportunity during the time while Cromwell, as Lord Protector of Great Britain, had refused to continue the practice of touching the ailing which the Kings of England had pursued for hundreds of years since the Confessor's time. Cromwell did not impugn the efficacy of the Royal Touch but he refused to have anything to do with it himself. Greatrakes found it an opportune moment to announce that for three nights in succession he had been told in a dream by the Holy Spirit that in the absence of the King he was to touch people and cure them.

One might possibly think that with no better credentials than this and no testimony except his own claim in the matter Greatrakes would receive but scant attention. Any one who thinks so, however, does not understand human nature. It was not long before some of the people who had been sufferers for longer or shorter periods went to Greatrakes and allowed him to try his hand at healing them. They argued that at least if it did them no good it could do them no harm, and it was not long before some of them declared that they had been benefited by his ministrations. Very soon then he was able to furnish what seemed to be abundant evidence of Divine Mission in the cures that were worked by his more than magic touch. Above all, people who had been sufferers for prolonged periods, who had gone the rounds of physicians, who had tried all sorts of popular remedies, and some of whom had been declared incurable were healed of their ills after a series of visits to Greatrakes. No wonder then that patients came more and more frequently, until his name went abroad in all the country and in spite of the difficulties of travel people came from long distances just to be treated by him.

All that he did was to ask the patient to expose the affected part and then Greatrakes would stroke it with his hand, assure the patient that a wonderful new vitality would go into them because of his Mission from on High and promise them that they would surely get better, explaining of course that betterment would be progressive and that it would start from this very moment. The stroking was the important part of the cure and so he is known in history as "Greatrakes the Stroker." It may be said in passing that while those who were touched by the English kings in the exercise of the prerogative of the Royal Touch were usually presented with a gold coin which had been particularly coined for that purpose as a memorial, a corresponding gold piece, a sovereign as a rule, in Greatrakes' method of treatment passed from the patient to the healer. It was a case of metallotherapy with extraction of the precious metal from the patient, as is always the case under such circumstances.

Here in America we had a similar experience, though ours had science as the basis of the superstition in the case instead of religion. The interest aroused by Galvani's experience with the twitching of frogs' legs when exposed nerve and muscle were touched by different metals led Doctor Elisha Perkins to invent a pair of tractors which would presumedly apply Galvani's discovery to therapeutics. These were just plain pieces of metal four or five inches long, shaped more or less like a lead pencil and tapering to a blunt point. With these, as Thatcher, one of our earlier historians of medicine, tells us, Perkins succeeded in curing all sorts of ailments, but particularly many different kinds of painful conditions. He was most successful in the treatment of "pains in the head, face, teeth, breast, side, stomach, back, rheumatism and so forth." In a word, he cured the neuralgias and the rheumatic pains and the chronic rheumatisms which are the source of so much trouble—and especially complaint—for the old, and which so often physicians, in any time of the world's history, have been unable to cure.

For a time his success was supposed to be due to some curious electrical power that he was using. Learned pamphlets were issued to show that animal magnetism or animal electricity or Galvanism was at work. Professors at no less than three universities in America gave attestations in favor of its efficacy. Time has of course shown that there was absolutely no physical influence of any kind at work. The only appeal was to the mind. Elisha Perkins was a Yale man of education and impressive personality, "possessing by nature uncommon endowments both bodily and mental ", and he succeeded in impressing on his patients the idea that they would surely be cured; he thus overcame the dreads, released the will power, gave new hope and a tonic stimulus to appetite, created a desire for exercise, and then the will kept this up and before long the patient was cured.

When animal magnetism, as it was called about the middle of the nineteenth century, was practised without apparatus, one of its most important claims to the consideration of physicians was founded on its power to heal chronic painful affections which had previously resisted all therapeutic efforts. The power of neuro-hypnotism, as it came to be designated, to accomplish this, will be best appreciated from the fact that this state was being used as a mode of anaesthesia for surgical operations. When the news of the use of ether to produce narcosis for surgical purposes at the Massachusetts General Hospital first came to England, it did not attract so much attention as would otherwise have been the case, because English physicians and surgeons were just then preoccupied with the discussion of neuro-hypnotic anaesthesia, and those who believed in it thought that ether would not be necessary, while those who refused to believe thought the report with regard to ether just another of these curious self-delusions to which physicians seemed to be so liable.

Perkins' declarations of the curative value of his tractors were, after all, only a succeeding phase of what Mesmer had called to the attention of the medical profession and the public in Paris not quite a generation before. Mesmer seated his patients around a tub containing bottles filled with metallic materials out of which wires were conducted and placed in the hands of patients seated in a circle around it. Mesmer called this apparatus a baquet or battery and it was thought to have some wonderful electric properties. A great many people who received the treatment were cured of chronic pains and aches that had sometimes lasted for years. So many prominent people were involved that the Government finally ordered an investigation to be made by French scientists with whom, because he was the Minister from the colonies at the time, our own Benjamin Franklin was associated. They declared that there was not a trace of electricity or any other physical force in Mesmer's apparatus. He was forbidden to continue the treatment and there was a great scandal about the affair, because a large number of people felt that he was doing a great deal of good.

When hypnotism came in vogue again at the end of the nineteenth century, it was a case of chronic rheumatism that gave it its first impetus in scientific circles. Professor Bernheim of Nancy had tried in vain all of his remedies in the treatment of a patient suffering from lumbago. The patient disappeared for a time and when Bernheim next saw him, he was cured. Bernheim had treated him futilely for months and was curious to know how he had been cured. The patient told him that he had been cured by hypnotism as practised by Liebault. This brought Bernheim to investigate Liebault's method of hypnotism and made him a convert to its practice. It was the interest of the school of Nancy in the subject that finally aroused Charcot's attention and gave us the phase of interest in hypnotism which attracted so much public attention some thirty years ago. Many other cases of those very refractory affections—lumbago and sciatica—have been cured by hypnotism when they have resisted the best directed treatment of other kinds over very long periods.

It is these chronic rheumatisms, so called, the chronic pains and aches in muscles in the neighborhood of joints, that were cured by the Viennese astronomer, Father Maximilian Höll, in the eighteenth century. He simply applied the magnet and saw the result, and felt sure that there must be some physical effect, though there was none. His work was taken up by Pfarrer Gassner of Elwangen who, after using the magnets for a time, found that there was no need of their application, provided the patients could by prayer and other religious means be brought into a state of mind where they were sure that they were going to get better. They then proceeded to use their muscles properly in spite of the pain that might result for a time, and as a result it was not long before they were cured of their affections. The Church forbade his further practise because of his expressed idea that pain came from the power of evil and dropped from men when they turned to God, which was the eighteenth-century anticipation of Eddyism. Dowie's cures were largely of similar affections, and patients sometimes dropped their crutches and walked straight who could not walk before.