ANGINA PECTORIS. 101 



apparently ails nothing, he looks well, eats well, and were it not for the deadly foe 

 that may attack him at any moment, would be in perfect health. 



Let us now consider the circumstances which are likely to induce a paroxysm. 

 In the man to whom we have referred exertion of any kind would always excite an 

 attack. The act of stooping, as in putting on the stockings, or lacing up the boots, 

 or even washing the face, would be almost sure to induce the pain. A sharp turn 

 up and down the room would bring it on ; but, contrary to rule, walking up-hill or 

 going up-stairs was not more likely to excite it than exertion on level ground. 

 Coughing always brought on the pain, and once, when the patient happened to catch a 

 little cold on his chest, he displayed the greatest anxiety to get rid of it on this 

 account. He remembered only one occasion on which an attack had seized him at 

 night. Excitement of any kind would induce a paroxysm, so that, as the poor 

 fellow said, he was obliged to be good-tempered, he durst not get in a passion. It 

 may be mentioned in connection with this fact that the great comparative anatomist 

 and physiologist, John Hunter, who suffered from this complaint, was deeply 

 sensible of the risk to which he was exposed by an uncontrollable temper, and was 

 accustomed to say that his life was in the hands of any rascal who chose to tease and 

 annoy him. 



In our patient the attacks always came on without warning. They gradually 

 increased in intensity, reached their acme, and then gradually passed off. When 

 the pain seized him he was afraid to move ; if in the streets he stood quite still, 

 supporting himself by the railings, or anything that might be at hand. If sitting 

 or lying down, he would make an effort to stand up, as the pain was less severe 

 when in the upright position. He was always able to speak, even during the most 

 violent paroxysms, but he preferred not to, as it often increased the pain. The 

 average duration of an attack was with him about a quarter of an hour, but it 

 varied from six or seven to twenty minutes. He stated that he had often stood in 

 the street for over twenty minutes, afraid to move a step. During these attacks he 

 suffered from a little shortness of breath, but not enough to cause him any incon- 

 venience. He added that the termination of a paroxysm was always preceded by 

 an attack of palpitation. As soon as the palpitation commenced, the pain decreased 

 in severity, and in a few minutes passed off. During the paroxysms the patient 

 had often been given hot spirits and water by anxious friends and bystanders, but 

 it never cut short the attack. 



So little is positively known about the real cause or nature of angina pectoris, 

 that it is not worth while discussing this subject We may mention, how- 

 ever, that in many cases where death has occurred suddenly during an attack, the 

 heart has been found perfectly healthy. Angina pectoris predominates vastly in 

 men, the disease in women being a rarity. It is rare before the fiftieth year, 

 excessively so before the fortieth, and unknown in infancy and childhood. It is 

 very much more common in the upper classes of society than in the middle or lower. 

 It is said by some writers never to occur among the poor, but this is certainly not 

 true, for we have met with at least half-a-dozen well-marked instances in the wards 

 or out-patient rooms of a metropolitan hospital. 



It is doubtful what part, if any, gout plays in facilitating the occurrence of 



