also a common result of chronic, nicotism. A very distinguished Parisian physician had hands which shook so much that he could not write. Whenever he remained without tobacco for any length of time, these tremblings disappeared. Another case mentioned by Blatin is noteworthy. A man of forty-five years consulted him respecting violent and numerous attacks of vertigo. When he felt one of them approaching, he was obliged to lie down wherever he might be, in order to avoid falling. In the country, where he had plenty of exercise, they were less frequent than in the town, where his occupation was sedentary. Cessation from tobacco and a tonic regimen quickly restored him.
A physician of fifty-two was afflicted with similar disagreeable symptom's, and was also cured by abstinence. Habit had become so strong that he could not resist at times the temptation to slight indulgence. Finding that these returns to tobacco were immediately followed by his old painful attacks, he renounced it forever.
The circulatory system presents in chronic nicotism similar symptoms to those found in acute poisoning. The most noticeable of these is the intermittent pulse, of which many cases have been collected by Decaisne and others.
Decaisne speaks of narcotism of the heart, but Blatin does not consider the action to be directly upon that organ, but considers the effects described to result from an irregular relaxation of the ganglia of the great sympathetic nerve.
When a person suffering from intermittent pulse was carefully examined, Blatin found the stoppage in the heart's beat followed a series of apparently normal movements. The systole and diastole succeeded in due regularity, and nothing in the play of the central organ indicated trouble, when the heart suddenly stopped in diastole, sometimes for the space of three arterial pulsations. When it awakens from this syncope its action is abnormally quick, as if it wished to make up for the lost time, and force the mass of blood across the organs at one stroke. But, with force insufficient for this purpose, it is exhausted in fruitless efforts, hesitates, wavers, acquires fresh power, commences again, now violent, now feeble, and fulfills very imperfectly the duties which it should perform. Gradually it calms; a foreign element seems to appease the tumult, the heart again becomes regular. The explanation appears to be that the irritation of the sympathetic nerve stops short the movements of the heart, and thus causes the intermittence; then the susceptibility of the nerve is lessened or paralyzed, and the cardiac functions are left to the sole direction of the auto-motor ganglia; hence the disordered beats, which decrease as the nervous force coming afresh from the pneumogastric moderates and regularizes it.
From intermittent pulse to angina pectoris the distance is not far. That tobacco may produce all the usual symptoms of that painful disease has been abundantly shown by Beau. To the cases which he has
