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found in man than woman. The disposition seems also to be transmitted by inheritance; possibly through the gouty diathesis, syphilis, etc. Other causes may act, such as toxic agencies, but would have a special action on the cell vitality of the part of the anatomy involved in this disease-the coronary arteries, the root of aorta and the myocardium-which is involved in the process of sclerosis in every instance of true angina pectoris. Osler states that without exception the subjects of true angina have arterosclerosis, either general or localized at the root of the aorta, in the coronary arteries or in the myocardium. Gothair and Huchard observed in seventy autopsies changes in the coronaries thirtyeight times, changes in the aorta seventeen times; changes in the myocardium four times. While Wilde found atheroma of the coronaries in every one of six cases which ended in sudden death.3 It is fair to conclude, considering the other evidence, that as all the seventy cases of Gothair and Huchard had atheromathous changes in the heart and coronaries, except eleven, that this number had some inter-current disease associated with pseudo angina which helped them off, and that all cases of true angina are dependent on arterosclerosis of the heart and associated arteries.

Clinical Manifestations.-An attack is generally brought on by excitement, muscular effort, or by exposure to cold. The patient is seized with a pain in the regions of the heart; with a sense of suffocation; the pain extends down to the arm, following the course of the nerves, and up the side of the neck of the left side. The face is pale, and is usually covered with cold sweat; the patient is motionless; the face has an expression of great anxiety and impending death; the pulse is, as a rule, not materially interefered with, except by an increase in tension. The attack usually lasts only a few minutes, after which the patient feels fairly well, in some cases, and in others the patient feels much exhausted for several days after. The sufferer may die in the first or second attack, and in other cases the attacks may extend over a period of years. There is thought to be a condition of transient anemia in the heart muscle associated with spasm when the attack is on, brought about by the extra demand for nutrition of the heart muscle, on account of the muscular or mental effort on the part of the patient and the inability on the part of the associated arteries of the heart to furnish the needed nutrition because of their involvement in sclerosis. A diagnosis is not easy in many cases, as we have several grades

4Osler, Practice of Medicine.

Twentieth Century Practice of Medicine.

of the disease and may have the true and the pseudo angina associated in the same patient. From what I have said under clinical manifestations, one would have a pretty good idea of the disease, and would be able to recognize it in most cases. However, it might be well to contrast the symptoms of the two diseases to get a more definite idea:

TRUE ANGINA.

Most common between the ages of 40 and 50 years.
Most common in men. Attacks brought on by exertion.
Attacks rarely periodical or nocturnal.

Not associated with other symptoms.

Vaso-motor form are rare. Agonizing pain and sensation of compression by a vice.

Pain of short duration. Attitude: Silence, immobility.
Lesions: Sclerosis of coronary artery.

Prognosis grave, often fatal.

Arterial medication.

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Pain last one or two hours. Agitation and activity.
Neuralgia of nerves of cardioplexus.

Never fatal.

Antineuralgic medication."

Now I think that it is very necessary to make a differential diagnosis, as the pathology of the two diseases is essentially different; one is sclerosis and other neurosis. After coming to a diagnosis it is easy to see that the treatment for one might be decidedly contra-indicated for the other. It would be well to say something with regard to the treatment of both, in order that we might not become confused as to the treatment of either.

In true angina we would use alteratives, eliminatives and vasodilators. As alterative, the salts of iodine; vasodilators, the nitrites, eliminatives, alkaline mineral waters and diuretics; while in pseudo angina we would give stimulants, anodynes and recon

Osler, Practice of Medicine.

structives, such as would be indicated in cases of neurasthenia associated with pain. I shall not enumerate a great list of remedies, as I think it sufficient to mention the class from which they are to be chosen, and allow the physician to choose the drug to be used in each individual case.

It will be seen at once that stimulants would have to be used with great care, and possibly not at all, in true angina; while drugs producing destructive metamorphosis of tissue would not be indicated in such diseases as pseudo angina, where we would only expect results from reconstructive agents.

A NOTABLE PRIZE ESSAY.-We have before mentioned Dr. S. A. Knopf's prize essay on tuberculous disease, but the recent appearance of a fourth edition (New York, 1907) makes it only due to the distinguished author that we should call attention anew to the extraordinary degree to which he has impressed the medical profession and the world. It may well be a matter of pride with us that this New York physician has met with such great success in enlisting general sympathy in the campaign against consumption. The prize was awarded by the International Congress to Combat Tuberculosis as a Disease of the Masses, which held its session in Berlin in May, 1899.

Dr. Knopf's masterly essay was written in German, and has been translated (by himself) into English (with an edition, by Dr. J. M. Barbour, adapted to British use), Arabic, Portuguese, Bulgarian, Dutch, Finnish, French, Hebrew, Hungarian, Icelandic, Italian (two translations), Japanese, Spanish (with an additional translation for Mexico), Polish, Russian (two translations), Servian, Swedish, and Turkish. If there are any other medical essays that have met with such widespread appreciation in recent years, we have yet to hear of them. Dr. Knopf had something tangible to say, and he said it in plain and simple words. He dealt with the problems of tuberculous disease from the common sense point of view. Those, as it seems to us, are the reasons why his essay has been so universally acclaimed.

Dr. Knopf-and this is in the highest degree to his credit-has not been content to enjoy the honors brought to him by his prize essay; he has continually bestirred himself in the interest of the consumptives by addresses, journal articles, and personal work.New York Medical Journal.

EDITORIAL DEPARTMENT.

CENSORSHIP OF THE MEDICAL PRESS.

CZAR METHODS OF THE OCTOPUS.

Amongst the "Regulations Regarding Exhibits" at this year's meeting of the A. M. A. is the following:

"No medical journal or publication can be exhibited that contains advertisements of drug, chemical or similar preparation used in the treatment of disease, which does not conform to the rules of the Council on Pharmacy and Chemistry of the American Medical Association."

The enforcement of this ukase will exclude practically every medical journal published in America and Canada, excepting the "State" journals, those wearing the collar of the octopus and bearing the union stamp,-and it will, or should, include the California tentacle also.

Are we living in America, or in darkest Russia? Is this the fourteenth or the twentieth century? Are we freemen, or serfs? Have we as owners and publishers of legitimate medical journals -any rights whatever, that the machine is bound to respect? Have we the right to think and speak our sentiments-or are we to be controlled, in both, by the monstrous machine which would dictate to us, and “muzzle the press," under the denunciation of being "unclean," "infectious" and unworthy of support by the profession? Shall we not be permitted "to differ with Brother Paul”— as to the respectability of a pharmacal preparation? Who gave this council the right to dictate what the press shall and shall not advertise? This is the most insolent, high-handed and outrageous act, of all the brazen acts, of the political machine that controls the A. M. A. and its "organ." Will the effrontery an arbitrary exercise of a self-assumed authority, on the part of the Octopus, stop here? Hardly. If this is submitted to by the American medical editors-those who do not wear the collar and the union stamp-we may look, next, to see an inspector with the A. M. A. union badge, stationed at each door at future meetings, to search our persons to see if any one has concealed about him a copy of any of the "infectious" and "unclean" publications (as Chase and Jonesey call the independent journals). We may look to see such person arrested, caught in the act of smuggling contraband publications, and arraigned on a charge of treason to the autocrat.

the czar of all the "schools" of medicine. Shall we, like Socrates, for "corrupting the youth of Athens," be made to quaff the hemlock for corrupting the morals of the younger men of medicine by insisting that there is virtue in pharmacy by the large as well as per the obsolete prescription compounding, and that thousands of the most experienced use, and find useful,-hosts of the preparations advertised in the medical press? Will our editorial utterances be censored next?

The Association of American Medical Editors will meet at Atlantic City, June 4th, simultaneously, with the A. M. A. We will see what they will do about this monstrous assumption of authority. If they tamely submit to the thraldom-submit to being put in irons, as it were, and exhibited in the pillory as "unclean and infectious" and unfit to be represented in the A. M. A., they may next expect to be bodily kicked out, and they would deserve to be. These editors are all members of the A. M. A., and pay tribute to Cæsar. I reproduce the following from the Texas tentacle of the Octopus:

66 **

A careful perusal of the reading pages of most of these journals will demonstrate a bitter, prejudicial, carping, vindictive and antagonistic spirit on many vital subjects affecting modern progress. These journals might do a useful work; we wish them well, but they must clean house or be labeled 'infectious,' and be shunned by the profession."-Abstract from an editorial in the Texas State Journal of Medicine, March, 1907.

["Modern progress" is good. Progress, backward, like the crab. It is a new name for degeneracy.-D.]

I will say for myself, I am not a member of the A. M. A., having drawn out fifteen years ago, although I have been solicited-by Simmons-many times, to become a member. I am not in accord with the policy of the clique who control the Texas State Medical Association; who have played that splendid body into the hands of the Octopus, and who would now out-Herod Herod! I am "bitter and antagonistic" only to the trickery which has enabled certain pliant and complaisant members to get control of the Association, and to gag and tie the majority. I am fighting for the Association, to free it from this thraldom; and because I love the Association and grieve to see it so debased. I have, always, for twenty odd years, stood for, advocated, championed, and defended the best interests of the body of the Association, as against those who would degrade it, and who, by the forcing down our throats of that absurd Joseph's coat of many colors the absurd mixed board-have degraded it. Two of our most distinguished leaders, and ex-Presidents, de

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