100 THE TREATMENT OP DISEASES. 



or in the face of a strong wind, and then usually ceases immediately on standing 

 still. It is instinctively associated in the mind of the sufferer with the idea of a 

 particularly severe form of oppression or suffocation, or rather with some indefinite 

 sense of impending danger, which is simply indescribable. The patient is not 

 merely suffering, but he feels that the very springs of life are implicated, and that 

 under a prolongation or increase of the pain the whole fabric of life must give way. 

 It is from this sense of impending dissolution, and from the fact that death may 

 occur at any moment, that the disease derives its fearful distinctiveness. 



The pain of angina pectoris is quite distinct from the fear of impending death to 

 which we have alluded, although they are nearly always associated. Its character 

 will be gathered from a short description of a case which recently came under our 

 care. The patient was thirty-seven years of age, and was a carman by occupation. 

 He was, to the best of his belief, in perfect health until he met with an accident, 

 and was thrown from his van, falling on the left arm. He was not seriously hurt, 

 but was unable to use the limb for nine weeks. At the expiration of that time he 

 resumed his work, and then first experienced the symptoms we are about to describe. 

 He suffered from a severe pain in the chest, which came on in fits, and seized him 

 on the slightest exertion. He could only describe it as " a heavy, dull pain, like a 

 great weight ;" and it was often so severe as to make him cry out with anguish. It 

 was always first felt about the middle of the breastbone, extending on either side as 

 far as the nipple. In a second it would seize his shoulders, which he said seemed 

 as if they were being squeezed with a grasp of iron. It then ran down to the 

 elbows, where it usually ceased ; but sometimes extended to the hands and even to 

 the tips of the fingers. The pain was equal in severity in the two limbs, and was 

 never confined to one side. It was more severe in the shoulders and elbows than 

 in any other part of the arms. It always began in the chest, and its direction was 

 never reversed. It never passed through the chest to the back, and never extended 

 to the head and neck or to the legs. During a paroxysm of pain, the arms felt dead 

 and heavy, and the patient had a difficulty in raising them, the hands at the same 

 time becoming white and shrunken. Such is the usual character of the pain in 

 angina pectoris. 



The sensation of impending death to which we have referred is, from its very 

 nature, almost indescribable. Sometimes for the want of a better term it is 

 likened to suffocation; but it is something quite distinct from that. It is this 

 even more than the pain which renders an attack so terribly awful. 



These two symptoms coming on in paroxysms, may be said together to constitute 

 angina pectoris. There are other symptoms, but they are of less constant occur- 

 rence. Usually the face is deadly pale during an attack, but sometimes we have 

 seen it quite red, so that the sufferer looked just as if he had been inhaling nitrite 

 of amyl. In the case of the man of whom we have been speaking, the face was 

 always flushed at the commencement of an attack, but became deadly pale as the 

 pain increased in severity. The pulse is usually slow and feeble, the breathing 

 short and hurried, and veiy often the surface of the body is covered with a cold 

 clammy sweat, the intellect remains unimpaired, and even to the last the patient 'is 

 keenly alive to his frightfully critical condition. In the intervals of the seizures he 



