A British Medical Association Lecture on Angina Minor
Authors: J. Hay
Journal: BMJ (1926)

ANGINA MINOR -is a copditiou: of some practical importance, and I trust that its consideration wyill help to crystallin.e our ideas; for there is still, in spite of much writing.and talking& a certain haziness as to the significance of some of the pains and discomforts located in the precordial and substernal r egions.Up to Deciember 31st, 1925, I have -careful notes of 472 patients suffering from angina (309 up to July 31st, 1925, and 163 to December, 1925), mostly private patients;and it is on a careful scrutiny of these records that I base my remarks.*One outstanding feature of the study of medicine to-day is the much greater attention paid to symptoms than to the physical; signs of disease.In the latter part of tile nineteenth century it was the physical signs of heaft disease which occupied the minds of the professioR, and the aim was to correlate.thephysical signs with the gross pathological changes -present.This attitude dominated clinical investigation.Now with the swing of the pendulum the cross-examination of a patient is often -considered even more importantthan the-physical examination, and both are made with the object of obtaining a -clear .conception of the functioning power of the organ at fault, whether that oirgan be the heart, the kidneys, the pancreas, the liver, or any other viscus.For an organ may be gravely inadequate and yet present few, if any, objective signs of disease.It is here, in the assessing of the functioning power of the kidneys and pancreas, to give but tw3 instanices, that biochemistry has come into its own.EARLY SYMPTOMS.Symptoms are the earliest manifestations of disease more often than physical signs.There is some subjective deviation from the normal, such as discomfort, pain, exhaustion, or lassitude.The elucidation of the meaning of such deviations from the normal and their prognostic significance was the aim underlying all the work of the late Sir James Mackenzie.He, more than any other man, focused the attention of the world of medicine on the subjective aspect of disease.Of all subjective sensations- pain is the most arresting, and is of the nature of a protective reflex.We are saved from destruction by the pain which we deplore.This is true even if we may have to admit that on occasions the anguish proves too great for the human mechanism, and becomes, in fact, the lethal factor precipitating the end which it is its function to avert.Peculiarly is this the case in patients suffering from angina pectoris, and it is essential that we should be familiar with the earliest manifestations of this condition or symptom complex, in order that our patients may have the benefit of a correct and early diagnosis, so that their lives may be ordered aright and their days lengthened." By angina pectoris I have in mind an arresting form of cardiac pain, substernal rather than submammary, in which the patient is conscious of a sense of oppression, or constriction, which may reach a bigh grade of intensity, even a condition of intolerable anguish.his pasin has certain well recognized lines of radiation and is often ilnduced by effort or emotion.There are in addition characteristic associated symptoms not invariably present-notably the sense of impending death, and indescribable anguish of mind accompanied by varying vasomotor disorders, such as cold sweats and deathly pallorn" (Bradshaw Lecture,