Upon paroxysmal angina pectoris and other forms of cardiac pain : with some remarks on the diagnosis of fatty heart / by George W. Balfour.

  • George William Balfour
Date:
[1881]
Catalogue details

Licence: Public Domain Mark

Credit: Upon paroxysmal angina pectoris and other forms of cardiac pain : with some remarks on the diagnosis of fatty heart / by George W. Balfour. Source: Wellcome Collection.

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    whisky, work, or anything else ; and the next, so to regulate the diet, nature and hours of work and of rest, as to promote the due nutrition of the body, to enable it to live within its income, and to accumulate that margin of health which is our only safeguard from a thousand ailments. We can generally aid the attainment of this end by the exhibition of appropriate tonics; these, however, require to be specialized for eacli case. Along with general remedies, it is often advantageous in such cases to apply sedatives locally to the cutaneous nerves, either by putting a belladonna plaster over the pained part, or by rubbing the side and shoulder with an opiate liniment, and these soothing means are often, in , slight cases, attended with such happy results as to lead to the neglect of the central cause. But whenever we find an accentuated pulmonary second, or an auricular murmur, associated with uneasy or painful sensation in the left breast, we must never forget that we have to do with a cardiac lesion which requires special treatment to cure it quickly and well. Between the slighter forms of mere cardiac uneasiness and the distinctly paroxysmal variety attended by severe precordial pain, shooting in various directions, but most commonly up the chest and down one or both arms, and accom¬ panied by an overwhelming sense of impending dissolution and all the signs of serious nervous shock, there are many intermediate grades of severity. And though we might theoretically desire to exclude from the category cases of tumultuous and forcible heart¬ beat with lancinating pain, as apparently inconsistent with the idea of the subparalytic character of angina, yet this disease may begin in this way. Though I myself would not therefore apply the term angina to cases presenting these symptoms, yet true angina may develop out of them, as the following most interesting case abundantly proves :— Case I.—A. S., a male, aet. 24, admitted to Ward Y. 6th October 1877, complaining of palpitation and pain in the precordial region. The patient stated that he had suffered in this way for fourteen weeks, and that the pain was sometimes a mere uneasiness, and at others more acute. On admission, the patient presented a some¬ what anxious expression, and was found to be well nourished, all his organs being healthy with the exception of the heart, wliich beat rapidly, 120 per minute, and in a somewhat tumultuous manner; the radial pulse was quite regular. On auscultation, the first sound at the apex was impure, the pulmonary second markedly accentuated, and a faint diastolic murmur was audible over the aorta at midsternum. The case was at once recognised as a serious inflammatory affection of the heart or ascending aorta, but whether it was endocarditis, myocarditis, or endarteritis, the symptoms were not distinctive enough to decide. The treatment consisted in the administration of full doses (15 grains) of iodide of potass in a bitter infusion three times a day, with perfect rest in bed, and an unstimulatins diet. Under this treatment his heart quieted