Heated spells, if prolonged, always cause an increased mortality in such patients, because heat is relaxant and this leads to exhaustion. Patients who have been nursed faithfully through a severe winter will sometimes succumb to the first few successive days of hot weather that are likely to come at the end of May or the beginning of June. The deaths that occur during the hot spells of July and August are more looked for and accordingly prove not so unexpected. The warning symptom in heart disease that the patient is giving out is the development of irregularity and rapidity of the pulse. On the other hand, when a pulse has been running rapidly for weeks and then drops to below the regular rate, to 50 or 60, a fatal termination may be looked for at almost any time, though, of course, the patient may rally. The prognosis of heart cases is extremely difficult. Confined to bed and evidently seriously ill, they may continue in reasonably good condition for months, and then some indiscretion in diet, which causes a dilation of the stomach with gas, pushes the diaphragm up against the heart, adds a mechanical impediment to the physical difficulties the organ is already labouring under, and a sudden termination may ensue. As a rule, lingering heart cases terminate suddenly and often with little warning of the approach of death. An interesting set of heart symptoms, for the physician as well as the clergyman, are those which occur in what is called angina pectoris, heart pang, or heart anguish. Serious angina pectoris occurs in elderly people whose arteries are degenerate. Its main symptom is a feeling of discomfort which develops in the praecordia,--the region over the heart. {142} This discomfort may often increase to positive cutting pain. The pain is often referred to the shoulder, and runs down the left arm. This set of symptoms is accompanied by an intense sense of impending death. When the patient's arteries are degenerated, this train of symptoms must always be considered of ominous significance. A readily visible sign of arterial degeneration can sometimes be noted in the tortuous prominent temporal artery just above the temple.