98 PRACTICE OF MEDICINE. 



Others there has been a softness of the heart ; in others disease of 

 the valves or of the aorta ; and in several ossification of the coronary 

 artery^ a change which would, of course, greatly interfere with the 

 proper nourishment of the heart. 



Symptoms. — These seem to be of the nature of a cramp., or 

 spasm of the hearty combined with inability to propel its contents 

 properly. The patient, in walking briskly, especially if he does so 

 after a meal, is seized with a peculiar pain in the region of the 

 heart. It is a pain of an alarming nature to the patient, who often 

 feels that he must stop and support himself, and as if another step 

 would be fatal. The pain goes through to the back, and often shoots 

 down to the elbow of the left arm. The pulse sometimes stops during 

 the paroxysm. When it has lasted some seconds, it goes off. 



The attacks, generally, as the disease advances, become more and 

 more frequent and violent, and more easily induced. 



Treatment. — This may be comprised in the word quiet. The 

 patient should be warned of his danger ; and the means which have 

 been before spoken of should be employed to allay irritation of the 

 diseased organ, taking care neither to weaken the patient too much 

 on the one hand, nor on the other to let his veins become too full, or 

 the liver and kidneys inactive. 



OF PARTICULAR HEMORRHAGES. 

 EPiSTAxis {^Bleeding from the Nose). 



There is no part of the body more disposed to hemorrhage than 

 the pituitary membrane, and none in which the recurrence of the 

 discharge is productive of so little injury, as respects either the 

 structure or the constitution. The blood effused from this membrane 

 may be discharged either by the nostrils or by the mouth, after 

 having passed into the posterior fauces. 



Causes. — In its idiopathic states, epistaxis occurs most frequently 

 in children and young persons. In the more mature periods of life, 

 it is most frequently symp)tomatic., or dependent upon disease of the 

 heart, of the liver, spleen, or of some other viscus, or consequent 

 upon the disappearance of some sanguineous or other evacuation. 

 The e:^Ve/^^a/ causes are, injuries, irritants, exposure of the face to 

 fires or to the sun's rays. The internal causes are, whatever in- 

 creases the flow of blood to the head, as mental excitement ; sneez- 

 ing ; catarrh, &c., &c. 



Symptoms. — The sthenic form is ushered in by pain of the head, 

 vertigo, or somnolency ; with increased pulsation in the temporal 

 arteries. The sthenic epistaxis is often symptomatic or critical of 

 several acute diseases ; especially the more inflammatory kinds of 

 fever, and inflammations of the brain, or of the lungs, &c. The 

 passive forms are frequently symptomatic of several cachectic 



