Encyclopaedia Britannica, or, a Dictionary of arts, sciences, and miscellaneous literature : enlarged and improved. Illustrated with nearly six hundred engravings > Volume 13, MAT-MIC

Appendix. d. L iJ 1
Angin_a
peiSoris.
u^v—' A P P E
ANGINA PECTORIS.
Dr Heberden was the firft who deferibed this dif-
eafe, though it is an extremely dangerous, and, by his
aceount, not very rare affeilion. It feizes thofe who
are fubjedl to it when they are walking, and particu¬
larly when they walk foon after eating, with a molt
difagreeable and painful fenfation in the bread, which
feems to threaten immediate deftrudlion : but the mo¬
ment they Hand dill, all the unealinefs vanifhes. In all
other refpetfs the patients at the beginning of this dif-
order are well, and have no fhortnefs of breath ; from
which the angina pectoris is totally different. After it
has continued fome months, the fits will not ceafe in-
ftantaneoufly on Handing ftill ; and it will come on not
only when the patients are walking, but when they are
lying down, and oblige them to rile up out of bed every
night for many months together. In one or two very
inveterate cafes, it has been brought on by the motion
of a horfe or carriage, and even by fwallowing, cough-
ing, going to ffool, fpeaking, or by any diiturbance of
mind. The perfons affected were all men, almoft all
of whom were above 50 years of age, and molt of them
with a Ihort neck and inclining to be fat. Something
like it, however, was obferved in one woman, who was
paralytic •, and one or two young men complained of it
in a flight degree. Other practitioners hare obferved
it in very young perfons.
When a fit of this fort comes on by walking, its du¬
ration is very Ihort, as it goes off almoft immediately
upon flopping. If it comes on in the night, it will laft
an hour or two. Dr Heberden met with one in whom
it once continued for feveral days ; during all which
time the patient feemed to be in imminent danger
of death. Moft of thofe attacked with the diftemper
died fuddenly : though this rule was not without excep¬
tions 5 and Dr Heberden obferved one who funk under
a lingering illnefs of a different nature.
The os Jterni is ufually pointed to as the feat of this
malady. It feems as if it wras under the lower part of
that bone, and at other times under the middle or up¬
per part, but always" inclining more to the left fide j
and in many cafes there is joined with it a pain about
the middle of the left arm, which appears to be feated
in the biceps mufcle.
The appearance of Dr Heberden’s paper in the Me¬
dical Tranfadftions very foon raifed the attention of the
faculty, and produced other obfervations from phy-
ficians of eminence j particularly Dr Fothergill, Dr
Wall of Worcefter, Dr Haygarth of Chefter, and Dr
Percival of Manchefter. It alfo induced an unknown
fufferer under the difeafe to write Dr Heberden a very
fenfible letter, deferibing his feelings in the moft na¬
tural manner; which, unfortunately, in three weeks
after the date of this anonymous epiftle, terminated
in a fudden death, as the writer himfelf had appre-
henrled.
The youngeft fubjeCt that Dr Fothergill ever faw
afflicted with this diforder was about 30 years of age j
C I N E. 45 <
Angina
Pedlori?.
N D I X.
and this perfon was cured. The method that fticceed-
ed with him wras a courfe of pills, compofed of the maf$
of gum pill, foap, and native cinnabar ; with a light
chalybeate bitter : this vTas continued for fome months,
after which he went to Bath feveral fucceflive feafons,
and acquired his ufual health : he was ordered to be
very [paring in his diet j to keep the bowels open 5 and
to ufe moderate exercife on horfcback, but not to take
long or fatiguing Avalks.
The only fymptom in this patient that is mentioned,
was a ftriClure about the cheft, which came on if he
was walking up hill or a little fafter than ordinary, or
if he was riding at a very brilk trot; for moderate ex¬
ercife of any kind did not affeCI him : and this uneafy
fenfation always obliged him to flop, as he felt himfelf
threatened with immediate death if he had been obliged
to go forward.
It is the tbarp conftriCtive pain acrofs the cheft which
(according to Dr Fothergill’s obfervation) particularly
marks this lingular difeafe 5 and which is apt to fuper-
vene upon a certain degree of mufcular motion, or what¬
ever agitates the nervous fyftem.
In fuch cafes as fell under the infpeCtion of Dr Fo¬
thergill, he very feldom met with one that was not at¬
tended vTith an irregular and intermitting pulfe 5 not
only during the exacerbations, but often when the pa¬
tient was free from pain and at reft : but Dr Heber¬
den obferves, that the pulfe is, at leaft fometimes, not
difturbed j and mentions his having once had an op¬
portunity of being convinced of this circumftance, by
feeling the pulfe during the paroxyfm.
But no doubt thefe varieties, as well as many other
little circumftances, will occur in this difeafe, as they
do in every other, on account of the diverfity of the hu¬
man frame ; and if thofe which in general are found
to predominate and give the diftinguilhing chara&er
be prefent, they will always authorife us in giving the
name to the difeafe : thus, when we find the conftric-
tory pain acrofs the cheft, accompanied with a fenfe
of ftrangling or fuffocation *, and ftill more, if this pain
fhould ftrike acrofs the breaft into one or both arms ;
we (hould not hefitate to pronounce the cafe an angina
pectoris.
As to the nature of this difeafe, it appears to be
purely fpafmodic : and this opinion null readily prefent
itfelf to any one who confiders the fudden manner of
its coming on and going off-, the long intervals of per-
fett ejle 5 the relief afforded by wine and fpirituous
cordials the influence which paflionate affettions of
the mind has over it -, the eafe which comes from
varying the pofture of the head and {boulders, or from
remaining quite motionlefs 5 the number of years for
which it will continue, without otherwife difordering
health-, its bearing fo well the motion of a horfe or
carriage, which circumftance often diftinguifh.es fpaf¬
modic pains from thofe which arife from ulcers : and,
laftly, its coming on for the moft part after a full meal,
and in certain patients at night, juft after the firft fleep,
at which time the incubus, convulfive althma, and
other difeafes, juftly attributed to the difordered func-
3 M 2 lion’s