102 THE TREATMENT OF DISEASES. 



angina. The disease of necessity often occurs in gouty people, because gouty, like 

 anginal sufferers, are usually elderly men of the well-to-do classes. It has been 

 supposed that in some cases the excessive use of tobacco has promoted the develop- 

 ment of the disease, but this, to say the least of it, is problematic. 



There is, unfortunately, no difficulty in recognising the occurrence of angina 

 pectoris ; its symptoms are only too well marked to admit of any doubt as to their 

 nature. The intensity and situation of the pain, and the attendant dread of im- 

 pending death, at once declare the character of the disease. Asthma is almost the 

 only other complaint which comes on in such sudden paroxysms, and for this it 

 could hardly be mistaken. Sometimes over-eating, indigestion, and flatulent dis- 

 tension of the stomach may simulate angina, but there is never that frightful fear of 

 sudden death which is so essentially a symptom of the real disease. Moreover, 

 these symptoms often occur in people under forty years of age, in whom, as we have 

 seen, true angina is rare. 



Respecting the duration of the disease the greatest diversity occurs. Life may 

 be prolonged for years after the first seizure, in spite of more or less frequent recur- 

 rence. In the generality of instances, the complaint undoubtedly runs a somewhat 

 protracted course. At the same time, it is only right that we should say, and say 

 most distinctly, that the life of a man who has had an unmistakable attack of angina 

 pectoris is not insurably safe for a single hour ; he may live for twenty years, or 

 he may die to-morrow. He should recognise the possibility of a sudden cessation of 

 his troubles, and should put his worldly affairs in order. People often procrastinate 

 in the matter of making their wills, but a man with angina pectoris must never 

 put it off even for a day. The cardinal fact of the disease is its uncertainty. Death 

 may occur with startling suddenness. Such was the end of John Hunter. The 

 mode of its occurrence is well known, and there is reason to think that it was 

 almost foreseen by him. A dispute of a painful nature had embittered his relations 

 with the governors of St. George's Hospital. On the 10th of October, 1793, he 

 determined to be present at a meeting, at which, however, he apprehended a personal 

 dispute. He expressed to a friend his fear that such an encounter might be fatal to 

 him ; but went nevertheless. Something that he said in the board-room was noticed 

 and flatly contradicted. He stopped, left the room in silent rage, and had just time 

 to reach an adjacent apartment, when he gave a deep groan and fell down dead. 



Have we any remedy for this fearful affection 1 Yes ; during the last ten years 

 a remedy has been discovered which is almost a specific, and that remedy is nitrite 

 of amyl. It is a pale straw-coloured liquid, having an odour which is likened to that 

 of pine-apple, or more commonly to pear-drops. It is used as an inhalation. A few 

 drops are poured on a piece of lint or pocket-handkerchief, or even into the palm of 

 the hand, placed under the nose, and the vapour inhaled. It causes flushing of the 

 face, and almost immediately the pain ceases. It really acts like a charm. At first, 

 a little caution will have to be employed in regulating the quantity, but the sufferer 

 soon becomes accustomed to its use, and may be safely trusted with the bottle. We 

 know three or four sufferers from angina who always carry a small bottle in the 

 waistcoat pocket. The carman to whom we have so frequently referred has now 

 done so for nearly three years. Although he still suffers from his attacks he has 



