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The patient, a woman of about forty-five, came into the study with every appearance of intense physical suffering. That she was making heroic efforts for self-control was evident. She spoke in gasps, between paroxysms of intense pain, under her left shoulder blade, explaining that these pains were preceded by sharp, shooting pains up and down her left arm. As these arm and shoulder pains became more severe, they were followed by heart seizures.
She explained, between the periods of pain and exhaustion, that the suffering was well-nigh unbearable. For it seemed that some giant hand grasped her heart, squeezing it again and again until it was drained dry of blood, and then released the hand; this over and over again, until the agony seemed to be suffocating. She had endured this for several days and nights, before seeking aid. Indeed, she had delayed her coming until a queer looking rash appeared on the left breast, a condition that filled her with alarm.
The rash was very red and angry looking, but the most noticeable looking thing about it was the shape. Instead of being loosely scattered about, as such outbreaks usually appear, the affected area was covered with a brilliant eruption, shaped like the heart which is seen on a playing card, the top curving toward the center, but unclosed.
That Mrs. Flavell was under a heavy mental and emotional strain was evident. As I watched her struggle for some degree of composure, she seemed to me like one who had looked death in the face, and bade him retreat for a while, until the amenities of living had been met and the traditions of her race preserved.
Gently I put a leading question or two, that we might establish the conditions of the family constellation. Whatever her case might indicate, we knew in advance that it must be considered in relation to her family, and the conditions existing in her home. For the patient does not stand alone; he is subject to the influence of the actions and reactions of every member of the family