ANGINA PECTORIS 495 in Neustria, now Normandy, died Feb. 18, 814. He studied under Alcuin with Charlemagne ; received Bertha, the daughter of that prince, in marriage ; was appointed prime minister of Pepin, king of Italy; and after returning to France was intrusted with a portion of the gov- ernment, and became secretary and minister to Charlemagne. With the consent of his wife he entered in 790 the monastery of Centule or St. Riquier, of which he became abbot in 794. He often left his retreat to attend to interests of state or to ecclesiastical affairs, and made four journeys to Rome, in the last of which he accompanied Charlemagne and saw him crown- ed emperor of the West. Angilbert was a cor- respondent of Alcuin, and was called the Ho- mer of his time. His poems and a history of the abbey of Centule are marked by much elegance. ANGINA PECTORIS (Lat. anger e, to suffocate), a disease so named from a sense of suffocating contraction or tightening of the chest, over the sternum, causing anguish and fear of sudden death. A sudden attack of severe pain in the lower part of the chest, commonly inclining to the left side and extending down the left arm, is the most prominent symptom of the disease. The pain sometimes affects the right arm, and is often attended with palpitation of the heart and a sensation of fainting ; but the latter symptoms are not constant. The pulse is com- monly accelerated, though otherwise very slightly affected. The countenance is pal- lid, and the expression anxious and depress- ed. There is no regular interval between the paroxysms nor distinct warnings of return. They come on suddenly and unexpectedly, from slight causes, and often when no immediate cause can be assigned, and last from a few min- utes to half an hour or more. The health is often tolerably good between- the intervals when first the disease comes on, but by degrees it fails, and various uneasy sensations distress the patient in the intervals of paroxysms. The respiration becomes labored and digestion difficult. The nature of this disease is still in- volved in some obscurity. It seems to be mainly an affection of the nerves, complicated with symptoms of a rheumatic or a gouty na- ture, and often also with disease of the vessels. The morbid appearances which are found after death are most frequently ossification of the small vessels that supply the heart itself, com- monly called coronary arteries ; ossification of the valves of the heart ; excessive accumulation of fat on its external surface ; enlargement of its cavities, and change of structure in its muscu- lar substance, which becomes soft and flabby, thin, and easily torn. Although the hardening of the coronary arteries and the valves of the heart has been generally called ossification, the term is a misnomer ; for there is no real ossification, but a hardening and thickening of the parts by earthy deposits, such as are ob- served in the blood vessels and in the joints of certain rheumatic and gouty constitutions. The degenerations and morbid appearances of the vessels, valves, and tissues of the heart are therefore often quite analogous to those ob- served in other parts of the body, in patients suffering from gout and rheumatism and certain kinds of aneurisms, with morbid deposits in the distended and thickened walls of the arteries. Still, these symptoms are not constant, and cases are not infrequent in which the patients have suffered much during life from attacks of angina pectoris, and yet in which no morbid changes whatever have been found after death, either in the heart or blood vessels. Much has been done to ascertain the primary seat and the nature of this disease, but physicians are not as yet unanimous in their opinions. The majority believe it to be primarily a nervous affection, the nerves at fault being those which supply the lungs and the heart. It differs from neuralgia properly so called in several most important features, although the sudden violent shooting pains are not unlike those of tic dou- loureux and other forms of severe neuralgia. In so far as the latter disease may be chiefly caused by swelling and inflammation of the sheaths of the nerves, there is a strong analogy; but careful observation suggests that the gouty or rheumatic diathesis, whatever be the nature and the cause of that peculiar cachexia, lies at the bottom of the disease of the heart known as angina pectoris; and that the neuralgic pains are no more violent and sudden in the paroxysms of this disease than they are in gout and certain forms of rheumatism. The seat of the disease, however, renders the same parox- ysms more alarming. There are undoubted instances on record in which angina pectoris has been completely cured, the paroxysms growing- more moderate in character and less frequent in their recurrence, and finally passing off altogether, leaving the patient in a state of sound health. On the whole, however, the malady is a dangerous one, having a tendency to become worse rather than better, the pa- tient's health gradually deteriorating, and death finally taking place, either from syncope during one of the paroxysms, or from one of the compli- cations mentioned above, by which the disease is so frequently accompanied. Angina pectoria seldom affect* young people. It most fre- quently occurs in the meridian of life or in the descending phase of existence. It is much more frequent in the male than in the female. Sir John Forbes and M. Lartigue found that out of 155 cases 140 were males and only 15 females. The following list of 64 cases by M. Lartigue shows its comparative frequency -at different ages : At 17 years, 1 ; 21, 1 ; 29, 1 ; 30 to 35, 6 ; 40, 2 ; 41 to 50, 11 ; 51 to 60, 25 ; 61 to 70, 13 ; 71 to 77, 4. When the disease is far advanced, paroxysms are easily brought on by mental or moral emotions. Absolute rest of body and tranquillity of mind are necessary while the paroxysm lasts. The head and chest should be raised, and the body seated in an easy chair ; and where the disease is far ad- vanced, the patient should sleep in this position.
