angina pectoris usually comes on with a sudden seizure of pain, felt
at first over the region of the heart, but radiating through the chest
in various directions, and frequently extending down the left arm.
A feeling of constriction and of suffocation accompanies the pain,
although there is seldom actual difficulty in breathing. When the
attack comes on, as it often does, in the course of some bodily
exertion, the sufferer is at once brought to rest, and during the
continuance of the paroxysm experiences the most intense agony. The
countenance becomes pale, the surface of the body cold, the pulse
feeble, and death appears to be imminent, when suddenly the attack
subsides and complete relief is obtained. The duration of a paroxysm
rarely exceeds two or three minutes, but it may last for a longer
period. The attacks are apt to recur on slight exertion, and even in
aggravated cases without any such exciting cause. Occasionally the
first seizure proves fatal; but more commonly death takes place as the
result of repeated attacks. Angina pectoris is extremely rare under
middle life, and is much more common in males than in females. It
must always be regarded as a disorder of a very serious nature. In the
treatment of the paroxysm, nitrite of amyl has now replaced all other
remedies. It can be carried by the patient in the form of nitrite
of amyl pearls, each pearl containing the dose prescribed by the
physician. Kept in this way the drug does not lose strength. As soon
as the pain begins the patient crushes a pearl in his handkerchief
and holds it to his mouth and nose. The relief given in this way is
marvellous and usually takes place within a very few seconds. In the
rare cases where this drug does not relieve, hypodermic injections
of morphia are used. But on account of the well-known dangers of this
drug, it should only be administered by a medical man. To prevent
recurrence of the attacks something may be done by scrupulous
attention to the general health, and by the avoidance of mental and