This complaint is found to attack men much more frequently than women, particularly those who have short necks, who are inclined to be corpulent, and who, at the same time, lead an inactive or sedentary life. In most instances the attacks are sudden, and occur in those who have previously enjoyed good health. In a few cases spasms of the stomach, indigestion, and pains in the limbs are not unusual at the commencement of the disease.

The fit usually comes on suddenly. The patient may be in his usual health, but, on walking up hill, or going up stairs, or walking at a quick pace after a hearty meal, he is suddenly seized with an acute pain in the breast, a kind of spasm; the pain extending into the arm, accompanied by a sense of suffocation, great anxiety, and a feeling that if he attempted to move the act would be fatal. These effects usually go off after a short time on the patient's standing still. But, as the disease advances, the paroxysms do not so easily subside, and in some cases they attack the patient while sitting or standing, without any previous exertion or obvious cause. They are sometimes brought on by passions of the mind, by repletion of the stomach, by walking or riding on horseback, or by sneezing, coughing, speaking, or straining at stool. They sometimes make their attack at night. During the fit the pulse sinks and becomes irregular, but not always so; the face and extremities are pale, and bathed in a cold sweat, and sometimes the patient is, for a time, deprived of the powers of sense and motion.

The pain will sometimes shoot backwards towards the spine, or across the chest. Frequently it extends, accompanied by a sort of numbness, to the left shoulder, and down the left arm, stopping short sometimes, at the elbow or at the wrist. Sometimes, however, it runs down to the very extremities of the fingers. Occasionally, similar pains affect the right side and arm, and, now and then, all the four extremities at once. Sir John Forbes states, as the result of his inquiries, that out of 88 cases, 8 only, or one in eleven, occurred in women; and of 84, seventy-two were above fifty years of age. The total number of instances collected by him, in which the body was examined after death, was forty-five. Of this number disease was found in the liver in only two instances: organic disease of the heart or the great vessels, in forty-three.

This disorder may continue to recur for months, or even for years; but it is frequently fatal within a much shorter period. The following case was described by Dr. Latham. A gentleman, about fifty years old, was recovering from the influenza, of which nothing remained but a slight cough, that troubled him at night. It was to relieve this that Dr. Latham was consulted. The gentleman looked perfectly well. After Dr. Latham had prescribed for this little ailment, the patient begged to see him the next day, to talk over with him, he said, a very strange affection he had. Accordingly he then described a paroxysm of Angina Pectoris in terms that could not be mistaken; dwelling particularly upon the precordial pain, the sensation down the left arm, the feeling of approaching dissolution, and then the perfect recovery. This gentleman had, during the previous summer, performed a walking-tour through Switzerland, and returned home in excellent health. The first notice of his Angina was less than a month past, when he was walking up Hampstead Hill. It was then that he had his first paroxysm. In the short period which had elapsed, the attacks had rapidly increased in severity and frequency: occurring now every two or three days, or every day, or several times a day, with or without an obvious exciting cause. Dr. Latham made a careful examination of the chest, and found the sounds healthy. The only thing that particularly attracted his notice, was the exceeding feebleness of its impulse. In the afternoon of the next day Dr. Latham visited him again, when he described a paroxysm he had suffered in the course of the morning, of much greater severity than any he had hitherto experienced. Dr. Latham saw enough to convince him that his patient's existence was very precarious; and as he had previously been a stranger to him, he inquired about his friends, and took down the address of a brother, intending to call and apprise him of what he feared. On reaching his own home, two hours afterwards, a messenger met him, announcing that his patient had fallen into another paroxysm, soon after he left the house, and was dead. The body was carefully examined by a thorough anatomist, Mr. Stanley. There was no disease of the aorta, or of the heart generally; but the coronary arteries resembled tubes of coral, being completely ossified as far as they could be traced.

The patient may expire in the first or second paroxysm. This happened in the case of Dr. Arnold, the well known master of Rugby school.

Occasionally cases do occur, where the patient makes a complete and permanent recovery; but these are rare.

The preventive measures are plain and simple. The patient must be cautioned to avoid the exciting causes of the paroxysm; walking up hill; or against the wind, which has also often been known to produce it. Whatever is likely to hurry the circulation, and therefore, among the rest all mental emotion and anxiety, should be guarded against as much as possible. The celebrated John Hunter died of Angina Pectoris: and the fatal seizure was brought on by a fit of anger.

Care should be taken to keep the bowels in a proper state; as, as in other diseases of the heart, they are often attended and aggravated by flatulence of the stomach and bowels.

Treatment

In the paroxysm itself, bleeding has been fairly tried, but, it has seldom been followed by any benefit, and sometimes it appears to have done harm; and cordials, stimulants, and antispasmodics, are found to be of service. For the pain, when it is lasting and severe, the best remedy is Opium or Chloral. Dr. Elliottson thought Prussic Acid the best thing you could administer. Dr. Davies had more faith in Belladonna Plaisters than in most other things. Dr. Copland advised stimulant liniments externally and warm carminative or aperient medicines, as the circumstances might require, internally. All may be tried. The following may be taken as directed, and a Belladonna Plaister may be applied over the seat of pain; or one of the liniments given below may be rubbed in freely, for half an hour at a time with a glove on the hand, or with a piece of soft flannel.

Paregoric....................................One Ounce.

Compound Tincture of Cardamoms__One Ounce.

Infusion of Wild Cherry Bark..........Half a Pint.

Syrup..........................................One Ounce.

Two tablespoonfuls may be taken every three or four hours.

When the pain is severe the following may be taken, two tablespoonfuls for a dose, which may be repeated in two or three hours, if necessary:

Hydrate of Chloral..............................One Dram.

Tincture of Orange Peel......................One Ounce.

Water sufficient to make.....................Four Ounces.

The following may be used as a liniment:

Camphor in fine Powder.......................Two Drams.

Opodeldoc..................................Three Ounces.

Tincture of Opium..............................One Ounce.

Tincture of Arnioa...............................One Ounce.

In many cases, the administration of Wine or Brandy may he necessary.