An Address ON THE RELATION OF ANGINA PECTORIS AND ALLIED CONDITIONS TO AN ARTERIO-CARDIAC REFLEX HAVING ITS ORIGIN IN THE ABDOMEN: Read before the Edinburgh Medico-Chirurgical Society on December 6th, 1905
Authors: W. Russell
Journal: BMJ (1906)

ANGINA PECTOR11S has attracted the attention, and at times rivetted the tllought, of manmy greatclinicians during the past 130 years.Tllat it should exercise the same influence over the clinicians of to-day neednot, therefore, cause surprise.Gibson' of Edinburgh, Oliver2 of Newcastle-upon-Tyne, and Mackenzie3 of Burnley have all tilree shown quite recently tllat they were the victims of the fascination or attractiveness of the subject.It requires no special courage to avow oneself a fellow- victim, however much courage it may require to attempt the elucidation of a subject whiell Ilas been dealt with by so many able plhysicians of the present and the past.Were apologynecessary for so doing, I would say that I have found the view which I am to submit of much practical value; tilat, instead of conflicting with past observations, this view interprets them, and that it gives theclue for the disentaiiglenxent of the confused mass of opinion on the subject.My views have emerged from tile special attention wlichl I lhave long given to cardiac anid vascular disturbances, and more recently from a fuller knowledge of tile processes of primary and secondary digestion, of niutrition, and of elimination.My indebted- ness to the work of Pawlow,4 Herter,' Chittenden, 6 and others I gratefully acknowledge.The relations between gastro-intestinal conditions and vasculo-cardiac dis- turbances and the influenice of dietetic substainces uponi the vasculo-cardiac system have recently been more and more impressed upon me, and this communication contains the conclusions at whlichi I have arrived and indicates tlhe path by whichl I have reaclied them.HISTORICAL AND CRZITICAL.Heberden to Trousseau, 1768Trousseau, -1862. .We do niot require to go further back in our historical retrospect than the date when the term " angina pectoris " was introduced into medical nomenclature.Those wllo wish to examine the earliest records of tile symptoms called by this name will find the references in several of the older autllors, particularly in Parry's monograpli.Angina pectoris was the namne given by William Heberden7 in the year 1768 to a disorder of the breast, which he thus described: " Those who are affected with it are seized while they are walking, and more particularly when they walk soon after eating, with a painful and most disagreeable sensation in the breast, which seems as if it would take their life away if it were to increase or to continue."" The seat of it and sense of strangling and anxiety with which it is attended may make it not improperly be called angina pectoris."As regards the nature of the disease to which lie gave this name, he says that "'the opinion of its being a convulsion of the part affected will readily present itself to any one " (p. 64).In a later paper, of date 1785, containing the account of the post-mortem examination on the historical "unknown," he reports that there was no lesion fotund ; and in his comments on treatment he advocated the use of medicines whiell " relieve and quiet convulsive motions " (vol.iii, p. 10).Here at the fountaimi-head is found the idea of the nervous nature of the clinical phenomena of angina pectoris, a concep- tion of the condition shared by many subsequient writers.The next step worthy of note was made by Dr. Ca.leb Hillier Parry,8 a physician in Bath, who pulblished in 1799 a mnono- -graph entitled An Inquiry into the Symnptoms and Causes of the Syncope Anginosa, comnmonly called Angina Pectoris.This work is characterized by remarkable clinical acumen, and '3arry's views, it seems to me, have not always been accurately presented by suibsequent writers.Some of the clinical poInts dealt with by him are to be specially noted.He 3 points out, for instance, that the first symptom is "an uneasy sensation (described variously as a stricture, an anxiety, or a pain) about the middle of the sternum, across the left breast, and in certain stages of the disorder usually stretching into the left arm " (p. 42),also that the pain occurs in paroxysms, andthat early seizures seldom occurred without apparenit cause (p.43).He also insists, " we shall always find it (the pulse) become inore or less feeble according to the violence of the paroxysm " (p.45).Here wehave an early recognition of great differences in the degree of severity in the leading symiptoin.The pathology of the condition was held by him, and by his friend Jenner, to be disease of the coronary arteries interfering with the blood supply to the heart.His induction was that a heart witlh such coronary arteries couldnot bear any extra strain putupon it, that if subjected to extra strain it became suircharged with blood, that its action became enfeebled, and inight cease.The extra strain could be induced bymenital emotion, by physical effort, and by gastro-iintestinal conditions.As the heart condiition advanced, even slightereauses than these might produce paroxysmiis.Thus heart failure and its organic cause formed the central, and to him the essential, factors, in determining the gravity of the condition.According to Cullen's nosology this was assuiredly a syncope.'Themnotion of the heart