PATHOLOGY OF ANGINA PECTORIS. 191 



during the night, generally between midnight and 3 a.m., was 

 accompanied by little or no feeling of dyspnoea, and was some- 

 what relieved by the patient's sitting up. It generally came on 

 every third night at first, but latterly every night, and was 

 worse when the patient had used much exertion during the day. 

 It was not relieved by tincture of aconite, tincture of lobelia 

 inflata, brandy, or dry cupping over the cardiac region. It was 

 made worse rather than better by tincture of digitalis. It was 

 temporarily relieved by chloroform, but whenever the stupefy- 

 ing effect passed off the pain was as bad as before. It was 

 somewhat relieved by warm poultices to the chest, and was 

 generally absent for one night after a small bleeding, either 

 from the arm or by cupping the chest. Under the use of iodide 

 of potassium the attacks became less frequent, but purpuric 

 spots appeared on the limbs, and each attack was at once re- 

 lieved by the inhalation of nitrite of amyl. During an attack 

 of rheu.matic fever it disappeared completely, again returning 

 with the departure of the rheumatic pains. 



Angina pectoris is defined by Dr. Walshe as a paroxysmal 

 neurosis, in which the heart is essentially concerned, and he 

 divides it into pseudo and true angina, which differ mainly in 

 the intensity of the symptoms. Friedreich and others divide it 

 into functional and organic, according as it is accompanied by 

 cardiac lesion or not. From the absence of a sense of impend- 

 ing death, the present case might be reckoned as one of pseudo- 

 angina, but in the intensity of the pain and the manner of its 

 radiation it more closely resembles true angina. As a cardiac 

 lesion was present, it belongs to the class organic angina. 



Various opinions have been advanced as to the pathology of 

 this disease, some saying it is a mere brachio-thoracic neuralgia, 

 but most holding that it is a neuralgic affection of the cardiac 

 plexus. Some are of opinion that it is associated with cramp 

 of the heart, others with weakness of that organ. 



Eichwald* thinks that there is not only weakness of the 

 heart, but a mechanical impediment to its action, produced by 

 irritation of its regulating nerves, and that the pain is caused 



* Wiirzlurg. med. Zeitschr., vol. iv, 249; Chit. f. mcd. Wiss., rol. i, 877. 



