1872.] The Physiological Position of Tobacco. 487 
A physician of 52 was afflicted with similar disagreeable 
symptoms, and was also cured by abstinence. Habit had 
become so strong that he could not resist at times the 
temptation to slight indulgence. Finding that these returns 
to tobacco were immediately followed by his old painful 
attacks he renounced it for ever. 
The circulatory system presents in chronic nicotism 
similar symptoms to those found in acute poisoning. ‘The 
most noticeable of these is the intermittent pulse, of which 
many cases have been collected by Decaisne and others. 
Decaisne speaks of narcotism of the heart, but Blatin 
does not consider the action to be dire¢tly upon that organ, 
but considers the effects described to result from an irregular 
relaxation of the ganglia cf the great sympathetic nerve. 
When a person suffering from intermittent pulse was 
carefully examined, Blatin found the stoppage in the heart’s 
beat followed a series of apparently normal movements. 
The systole and diastole succeeded in due regularity, and 
nothing in the play of the central organ indicated trouble, 
when the heart suddenly stopped in diastole, sometimes for 
the space of three arterial pulsations. When it awakens from 
this syncope its action is abnormally quick, as if it wished 
to make up for the lost time, and force the mass of blood 
across the organs at one stroke. But, with force insufficient 
for this purpose, it is exhausted in fruitless efforts, hesitates, 
wavers, acquires fresh power, commences again, now violent, 
now feeble, and fulfils very imperfectly the duties which it 
should perform. Gradually it calms; a foreign element 
seems to appease the tumult, the heart again becomes 
regular. The explanation appears to be that the irritation 
of the sympathetic nerve stops short the movements of the 
heart, and thus causes the intermittence; then the suscepti- 
bility of the nerve is lessened or paralysed, and the cardiac 
functions are left to the sole direction of the auto-motor 
ganglia; hence the disordered beats, which decrease as 
the nervous force coming afresh from the pneumogastric 
moderates and regularises it. 
From intermittent pulse to angina pectoris the distance 
isnot far. That tobacco may produce all the usual symptoms 
of that painful disease has been abundantly shown by Beau. 
To the cases which he has cited may be added an epidemic 
of this nature noted by M. Gelineau, with which a great 
part of the crew of the Embuscade were struck. ‘The 
patients were all great smokers. It is worthy of notice that 
this disease is much more common amongst men than 
women. 
