engravings and 4 full-page colored plates. Cloth, $4.00, net; leather, $5.00, net; half morocco, $5.50, net. Lea Brothers & Co., Publishers, Philadelphia and New York, 1904.

This is the most convenient, comprehensive, trustworthy and by far the most widely used work on Therapeutics ever published, requires no introduction to the medical profession or the student world. The demand which has necessitated in a little more than a decade, ten editions and three times as many printings is readily understood upon an examination of the volume.

Every new edition means a complete revision, which in the present issue has been so thorough that the entire work has been reset in new type. Every discovery of worth, every really useful new remedy or method of treatment is clearly set down with telling illustrations wherever needed. Hare's Practical Therapeutics has come to be synonymous with up-to-date knowledge of treatment, medicinal or otherwise.

THE PRINCIPLES AND PRACTICE OF GYNECOLOGY for students and practitioners, by E. C. Dudley, A. M., M. D., Fourth edition, revised. With 419 illustrations and monochrone of which 18 are full page plates. Lea Bros. & Co., Philadelphia, Publishers. 1904.

The author in his preface to the fourth edition, says, "that he has endeavored to make a thoroughgoing revision which does not include the recent advances in Gynecology and in doing so he has rewritten and rearranged and condensed many chapters and in this way has found considerable space for new matter without enlarging the volume." The sections relating to General Diagnosis, Local Treatment, Major _Operations, Drainage, Urethritis, Cystitis, Ovarian Tumers, Embryology, Malformations, and the Treatment of Salpingitis, Ovaritis and Pelvic Peritonitis have been subjected to special revision and to a great extent have been rewritten with practical additions. The most noticeable improvements in the book are the illustrations. Most of these are new and of his own drawings, especially made for the book. All the minor and major manipulations and operations have been illustrated to show the several procedures as they take place step by step, each operation being set forth in a series of drawings; for example, 12 drawings describe the steps of hyeteromyomectomy and 32 explain perineal lacerations and the steps of perineorrhaphy.

DWIGHT'S EPITOME OF TOXICOLOGY.

A Manual for Students.

and Practitioners. By E. W. Dwight, M. D., Instructor in Legal Medicine, Harvard University. In one 12mo volume

of 298 pages. Cloth, $1.00, net. Lea's Series of Medical Epitomes. Edited by V. C. Pedersen, M. D. Lea Brothers & Co., Publishers, Philadelphia and New York, 1904.

This little volume is an epitome covering the essentials of toxicology. Some idea of the thoroughness with which the subject is covered may be obtained from the following brief of contents. After a section on the general principles of toxicology the subjects are taken up as follows: Irritant Poisons; Specific Irritants; Poisonous Foods; Cerebral Neurotics; Spinal and Cerebro-spinal Neurotics;. Depressants; Asthenics; Ptomains. etc.

A COMPEND OF MEDICAL LATIN, designed expressly for elementary training of medical students, by W. T. St. Clair, A. M., professor of the Latin language and literature in the Male High School of Louisville, Ky.; Author of Caesar for Beginners, etc. Second edition, revised. P. Blakiston's Son & Co., Philadelphia, Pa. 1904.

The author's aim in publishing this little book, is to present to the student of medicine, in a plain and practical way, the fundamental principles upon which the medical language is built. Students will find it of considerable help and convenience in their work.

APPENDICITIS AND OTHER DISEASES ABOUT THE APPENDIX, by Bayard Holmes, B. S., M. D., Professor of Surgery in the University of Illinois, Professor of Clinical Surgery in the American Medical Missionary College, Chicago, Attending Surgeon at the Chicago Baptist Hospital. Publishers, D. Appleton & Co., New York City, N. Y. 1904.

This is a very interesting and useful book. The author presents a careful scientific study of the appendix. In chapter II. he discusses the Historic Notes; Definition; Terminology; Appendicitis as an Entity; The Retention Cyst. Anatomic Consideration; Clinical Consideration; Neglected Appendicitis; The Spread of Infection. In chapter III. he discusses Obscure Forms of Appendicitis. Chapted IV. the Symptomatology; Chapter V., Course and So-called Complications; Chapted VI., Diagnosis and Differential Diagnosis; Chapter VII., Treatment. Other subjects treated of are Peritonitis, Intussusception, Perforated Typhoid Ulcer and Carcinoma of the Intestinal Tract. The physician will find it very interesting reading.

THE COLUMBUS MEDICAL JOURNAL.

VOL. XXIX.

FEBRUARY, 1905.

"ANGINA PECTORIS."*

HENSON M. HAZELTON, M. D., LANCASTER, OHIO.

No. 2.

Angina pectoris, in its typical form, is a very rare disease. Pseudo-angina, or what resembles it at times, cardiac asthma, is not infrequent. It does not fall to the lot of many physicians to witness an attack of true angina pectoris, and when it does the agony and the mental suffering of his patient can scarcely be forgotten by him. There are two chief elements that go to mak up the symptomatology of the paroxysm. First, the pain, and second, the indescribable feeling of anguish and sense of imminent dissolution. The resources of the language have been taxed to describe the pain of this disease. Patients speak of it as though the heart was in the grasp of a mailed hand and having it gradually tightened around it. Others describe the sensation as though some enormous weight was pressing the breast bone against the spine, or as though the whole chest was in the grip of some monster vise. Others speak of the breast pang as that of a stabbing character and describe the pains as though the heart was transfixed by some sharp instrument. In true angina the pain is very characteristic and marked by great intensity. When a true anginal attack occurs if the patient be walking or exercising in any manner, he stops immediately, holds himself as quiet as possible and grasps the nearest object that will give him support. So great is his distress at times during the attack that the muscles of respiration scarcely move, and indeed breathing comes almost to a standstill for a while at least. The ocality of the pain in true angina. is of much significance. Most frequently it is situated over * Read before the Tenth District Medical Association, November 15, 1904, at Columbus, Ohio.

the precardial region. Oftentimes it is felt in the upper part of the chest or again it may radiate through the chest and be even felt in the back or in the left shoulder joint. At times the radiation of the pain extends to the left arm and can also be felt in the forearm and the ring and little fingers of the left hand. No matter where the radiation of true angina may extend or in what region of the chest it may be felt or how active the imagination of the patient in describing it, we know it is of a frightful sort and quite unlike anything with which we are familiar. The mental anguish these patients suffer is almost indescribable. Latham, who was the first to distinguish this mental element,

"The suffering is as sharp as anything that can be conceived in the nature of pain and that it includes moreover something which is beyond the nature of pain-a sense of dying." During the attack the patient's countenance has that gray, ashy, ghastly and drawn look which once seen leaves an indelible impression upon him who observes it. Together with this pallor there is extreme weakness and a faint feeling which soon overwhelms the individual who is attacked. The pulse is small, feeble and irregular, as though the poorly acting heart could not send the blood to the extremities. During the attack when it is severe, perspiration will flow almost constantly from the patient. His face, neck and hands may be covered with it. It is cold and clammy and lends additional significance to the gravity of the other symptoms. He looks haggard and exhausted and as though every moment would be his last, and indeed it is a trying time for the vital powers to sustain the spark of life that still survives in his body. Frequently an attack terminates by a sudden explosion of gas from the stomach or an intense desire to urinate. The duration of an attack of true angina is very short, so much so that when we are called to see a patient suffering with it he is over it oftentimes before we arrive on the scene. Other cases are more prolonged and may last several hours and almost end the patient's existence before they cease. Among the causes which act efficiently in bringing on the phenomenon of attack are primarily exertion, and any exertion whether accompanied with little or great effort is liable to bring it about. They who are affected with this disease are eized while walking and especially when it is up hill or against a cold cutting wind. Even an attempt to

move in bed or assume the sitting posture, or such slight exertion as stooping to lace the shoes, according to Osler, has been known to produce a paroxysm. In subjects predisposed to this disease, any muscular exertion which calls for increased heart action is liable to bring on an attack of angina pectoris. Mental emotion is another well known exciting cause of this phenomena. This has never been better described than by the renowned John Hunter, who himself was a sufferer from angina. He says his life was in the hands of any rascal who chose to annoy or tease him. Cold is another frequent exciting cause, particularly in the vaso-motor form, the mere sitting by an open window on a cold day or the retiring between cold sheets at bedtime are oftentimes sufficient cause in these patients to precipitate an attack. The conditions of the heart associated with angina pectoris and which enter largely into its causation are varied. We sometimes find it with affections of the aortic valve. An adherent pericardium associated with aortic valvular trouble is sometimes the dominant factor in the causation of angina. Fatty degeneration of the heart structure with an accompanying aortitis and diseased corinary arteries is often the condition found postmortem in angina subjects. The autopsy often reveals a fibrous myocarditis, and so frequently is this found in these cases of angina that Gibson says it is a surprise not to find it. Another concurrent condition with angina is an arterial degeneration especially in the nature of an arterio-sclerosis. During life the arteries are stiff and thick. and after death we find the coronaries almost calcified. The most important factor in the causation of angina is the fact that too great stress is put upon the heart to which it is unequal for the moment, and the main cause of this stress is resistance of peripheral circulation or habitual high arterial tension. The question of diagnosis of angina is sometimes not an easy task. It may be simulated by various paroxysms of pain that are not of the heart and that are not attended with any danger whatever. Age, sex, appearance of the patient and circumstances under which the early attacks come on are the chief helps that throw light upon the diagnosis of this affection. Rarely do we have true angina before forty-five years of age unless there be some great myocardial changes. So rare is it before this age. that Belfour classifies it among the senile affections of the heart.