Licence: In copyright
Credit: Angina pectoris / by G. A. Gibson. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![common to find repeated paroxysms separated by intervals absolutely free from symptoms ; in almost every case, how- ever, the patient has constant uneasiness varied by attacks of greater severity. An important point is that the parox)'-sms are apt to be induced by exertion, whether muscular, intel- lectual, or emotional, as well as by digestive conditions. We must not make too much of this generally recognised fact, however, for many cases are on record, in which the symptoms have been most urgently present during the night. Although a certain amount of weight must be allowed to the commonly accepted belief that the incidence of an anginous attack after effort of any kind is significant of the graver varieties of the affection, there are, nevertheless, so many exceptions that any rule based on such a conception would be as unwise as it would be misleading. Many other subjective sensations attend the painful feelings, such as faintness and giddiness, tightness and breathlessness, weakness and unsteadiness. The prospect of impending death has been recognised since the early days of our knowledge of angina pectoris, and certainly it is often met wu'th. Many of these sensations can be modified, or even removed, by change of posture and by deep inspiration, but at times the influence of the subjective disturbance is so over- whelming as to prevent any efforts of either kind for fear of increasing the distress. It is generally found that, when the sufferer takes his courage in both hands and alters his position, or draws some deep breaths, he to some extent relieves his symptoms. Patients occasionally complain of weakness of the muscles on the affected side, and this weakness is necessarily found chiefly in the muscles of the upper extremity ; they] further complain occasionally of tenderness over the areas to which subjective pain is referred. To both of these points further reference wull be made. Turning to the objective aspect of angina pectoris, it may be said that the general appearance of the patient may present the widest variation. From deathly pallor to intense cyanosis showing an attitude of statuesque immobility, or contortion.‘ of intolerable agony; with the skin dry and shrivelled, o' with the surface bedewed with drops of perspiration ; having an expression w^hich may betoken lively curiosity or gloom]« apprehension—patients manifesting all these appearances hav 50l per <u](https://iiif.wellcomecollection.org/image/b2168909x_0006.jp2/full/800%2C/0/default.jpg)
