has come on suddenly, and seems to be on the

increase.

After this state has endured for some time, or sometimes without this premonitory stage, the marked symptoms of oppression from plethora come on. The person feels heavy and listless, indisposed to exertion, seeks for sedentary occupations, is inclined to sleep, or rather to doze away many hours; complains of weight and fulness in the head, of being fatigued by continuous mental exertion, of the sight being tired, and the eyes feeling strained by long reading or writing. The sleep is heavy, but unrefreshing; the appetite is not urgent, but the food is greatly enjoyed, and highly seasoned dishes are sought for; the countenance often looks florid and healthy, and the limbs plump; the breathing is difficult and oppressed, especially when going up stairs, ascending a hill, or attempting to move quickly; the pulse is large and full, although not quickened; there is every appearance of health and strength, yet the individual complains of feebleness and moves about heavily and difficultly: in a word, the vascular system is overloaded, and oppresses the whole organisation. No time should be lost in restoring it to its natural condition, by abstaining from all stimulants; by diminishing the quantity of food; by active but not exciting exercise

and exertion; by promoting evacuations by the bowels, skin, and kidneys; and perhaps by the abstraction of blood, or by the employment of such medicines as science and experience may point out as needful. But in all this, let the individual proceed with great caution, and travel not but with safe and sure guidance. There is not in the whole range of practical medicine more difficult questions to determine, than those which concern the abstraction of blood or the use of depressing agencies in the plethoric condition of the aged.

CHAPTER IX.

DISEASES OF THE HEART AND ARTERIES.

ORGANIC diseases of the heart and arteries are amongst the most important affections to which age is liable. They consist in changes of structure, few if any of which are remediable; and the entire attention of both the physician and patient must, therefore, be directed to prevent their progress and obviate their ill effects. It would be useless here to give a description of the diseases of the heart, or of their treatment. I shall merely sketch the nature of the changes which may take place, and point out the patient's proper line of conduct, as far as diet and regimen are concerned.

The heart is a hollow vessel, consisting of four chambers acting alternately on their contents by the muscular power of its walls, and thus alternately receiving and propelling the blood. Now it is manifest that this organ must be subject to all the diseases to which muscular substance is liable; it may waste, it may increase in size. Its walls may, therefore, become thicker or thinner; its cavities may

become dilated, and perhaps narrowed in capacity. The circulation may go on regularly, the stream of blood passing from the veins to the heart, from the heart to the arteries, and, within the heart itself, from auricle to ventricle, without let or hinderance; or the circulation may be impeded by obstacles which affect its due course. At the entrance of the ventricles, at the entrance to the great arteries, nature has placed valves to regulate and divide the waves of blood, and prevent regurgitation. These valves may be, and often are, the seats of disease; their structure may be altered. Depositions of earthy or bony matter may occur in their substance, preventing the due performance of their duties, or rendering them all but useless.

Derangements may occur in one or more of the valves. They may vary in intensity; but, be they greater or less, they manifestly cannot exist without seriously affecting the circulation; without compelling the muscular coat of the heart to such irregular and violent exertions as must occasion diseased changes in its structure; without often producing the most distressing symptoms of anxiety about the chest, restlessness, faintness, palpitations, intermissions, and irregularities of pulse, all the symptoms so well known as angina pectoris, and sometimes even sudden death; whilst, if the disease go on gradually increasing, and

the circulation become more and more irregular and oppressed, dropsy in some one or other of its forms. will be the inevitable result.

This is a dreadful picture, and it is rendered more so by remembering that these diseases are very common, that they commence soon after middle age, and often go on so insidiously for some time, that they occasionally produce sudden and fatal results, when there was not the most remote suspicion of their existence. The man apparently healthy and robust, in the full enjoyment of his faculties, and in the active pursuit of the affairs of life, may suddenly drop down dead, as though a bullet had passed through his brain, and, on examining the body after death, disease of the substance of the heart, or of its valves, or of its bloodvessels, is for the first time discovered. Yet this dreadful malady might have been known,-its nature and its extent might have been ascertained. The happy invention of the stethoscope has enabled us to learn, with almost unerring certainty, in fact to feel, the actual condition of the heart. But too often the early symptoms are neglected; they are regarded as too trifling to deserve attention; they perhaps only occur in any slight excitement to the circulation, and then pass off quickly. This very transient character, which would excite suspicion in the physician, lulls the