Under this heading we shall first consider the heart troubles of hysteria, neurasthenia, mental strain and worry, and then mention must be made of those occasionally attending true cerebro-spinal disease.
The functional heart troubles occurring under these conditions are well known, and the complaints made by such patients as to their hearts often form a large part of their symptoms. Many of them are convinced that they have "heart disease," and most of the symptoms of organic disease and cardiac failure are faithfully presented. Thus, cardiac pain and oppression, palpitation and shortness of breath are usual complaints. In many there is undoubtedly an attendant cardiac debility, as witnessed by the almost constant great increase in rapidity, on even slight mental or physical exertion, which is so commonly a feature in neurasthenic subjects, but it is obvious that this debility is only part of a general, and not a special, cardiac debility.
In no class of cases has treatment by rest and judiciously increased feeding shown such good results as in these hysterical and neurasthenic patients. In many of them, from nervous debility, unwise management of their lives, fear of getting fat, or fear of dyspepsia, food has been neglected or improperly assimilated, and although many are not wasted, all their symptoms cry out for better nourishment. It would be out of place here to give the details of what is now known as the " Weir-Mitchell " treatment; it will be discussed fully elsewhere. It will be sufficient to say that, under such treatment, the cardiac as well as the other symptoms of the patient gradually disappear. After convalescence these cases must be advised to regulate their lives, and more especially with regard to food, for in this matter they are most likely to err; a nourishing diet and regular life must be insisted upon.
There are but few disordered cardiac states directly connected with organic disease of the brain and spine. The bradycardia of some meningeal cases, is an instance of the connexion, as is also derangement of the heart with some affections of the pneumogastric and sympathetic nerves, but there is nothing to be said as to the dietetic treatment in such cases.
Cardiac failure is a prominent feature in some cases of injury to the skull, brain or spine. The only indication, in these cases, is the great care necessary in the use of alcohol, remembering that, although the heart may show the need for stimulation, such stimulation may do great harm to the cerebral lesion (e.g. haemorrhage).
In locomotor ataxy we have, occasionally, heart crises, but such conditions call for no special dietetic treatment.