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

  • Balfour, George William, 1823-1903.
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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    extent must hold good. And there are many things in pathology which enable us to understand that a depressing cause may at one time act with greater intensity on the sensitive fibres, at another on the motor fibres, and at still another upon both alike. Take for instance an attack of peritonitis ; the action on the heart in such a case is wonderfully analogous to that of angina pectoris, yet in one case we may have excruciating agony and but little depression of the heart’s action, in another the agony and cardiac depression may proceed pari passu, and in still a third case we may have no pain at all, and yet the cardiac depression may prove rapidly fatal. We must never forget that angina is sometimes feigned, and is occasionally of a purely hysterical character. Mrs Chisholm, whose case was formerly commented on,1 was an instance of the former character, and a very clever imposter she was, giving a great deal of trouble before she was detected. Last winter we had in the case of the girl L.2 a well-marked example of the hysterical variety. L. suffered from aortic regurgitation, from which she subse¬ quently died, and the true character of her attacks was not at first suspected; but happening to find her in the fit at visit one day, I at once recognised its hysterical character, and took mea¬ sures to prevent its recurrence, which were happily successful. I have seen several other cases of hysterical angina, but none so well marked as this, and, let me add, never any one in which there was less cause for suspecting hysteria, or more apparent reason for believing the paroxysms to be real. We must never forget that pain in the heart, however caused, is, if not angina, at least very closely allied to it. The infra-mam¬ mary pain of chlorotic girls is almost invariably associated with pain in the heart itself, neurotic in character and depending on mal-nutrition. So also, in all other forms of spanaemia, pain in the heart, often radiating more or less along the nerves after the fashion of true paroxysmal angina, but less severe in character and more constant—less distinctly paroxysmal—is a very common event. I presume it is cases of this kind, probably of an unusually severe character, that Beau has dignified with the name of angina arising from the abuse of tobacco. The tobacco heart, however, as a rule, is simply a spantemic heart, weak, irritable, and somewhat dilated, with an auricular murmur and an accentuated pulmonary second. In all spanaemic cases the pain or uneasiness—for it is seldom more than this—is persistent, with occasional exacerbations following exertion, a distended stomach, or some other exciting cause, and it is readily cured by improving the general health. The first step towards this is, of course, the giving up whatever has deteriorated the health, whether that be excess in tobacco, tea, 1 Balfour On Diseases of the Heart and Aorta, 1876, p. 279. 8 M. L., admitted to Ward XXXIII. on 28th January 1880 ; died from sudden asystole, 31st May 1880.