Licence: Public Domain Mark
Credit: Discussion on the surgical treatment of angina pectoris. Source: Wellcome Collection.
![= . ok Ba Sectional . 4 © ee foi ais cecal page 15 Proceedings of the Royal Society of Medicine pina JOINT DISCUSSION No. 2. Section of Medicine and Section of Surgery _Chairman—Srir Maurice Cassrpy, K.C.V.O., M.D. (President of the Section of Medicine) en [February 27, 1940] DISCUSSION ON THE SURGICAL TREATMENT OF ANGINA PECTORIS i | | | Dr. Geoffrey Bourne: In no other branch of clinical medicine is diagnosis more | often difficult than in patients suffering from cardiac pain. Here is an account of | 4 three patients I have seen. hee A man aged 54 suffered from severe pain in the chest which was of two types, acute attacks lasting for a comparatively brief period, and a constant pain which might last for hours at a time. The pain was increased after exertion and after emotion. He was told that he was suffering from “ angina pectoris”’. Since that time, three years ago, he had done no work. On examining him at St. Bartholomew’s Hospital I found that the pain was left-sided, that it was so severe that he was afraid to walk, and his limit seemed to be about 100 yards ; but on careful questioning it was evident that the pain did not vary with the degree of exertion, nor did it diminish when the exertion ceased. It might last for some hours subsequently. My opinion that the pain was of the functional type was borne out by a full clinical, electro- cardiographic, and radiological examination. I then sent him to a psychiatrist. Within a month the pain had disappeared. He has since resumed full work as a parquet floor layer, at which he has continued for a period of two years up to the present time. The second case was a man aged 58. I had seen him two years previously, and had come to the conclusion—again after full examination—that the pain was functional and not of coronary origin. At the time of the second admission to St. Bartholomew’s he was treated by alcohol injection, and his previous pain became worse. When I myself saw him subsequently it was still clear that the pain was not coronary in type. yf! The third case was similar ; he had been treated by sympathectomy. I refused ie | to consider the question of thyroidectomy, which was the point at issue. A oe ts psychologist found an advanced degree of obsessional neurosis. In a ten-years’ follow-up investigation of cardiac pain I have met with a number of similar cases. Since diagnosis may thus be difficult for physicians of experience, it is clear that no surgeon should consider treating patients with severe cardiac pain, trusting in his own powers of diagnosis. Statistics of results are not worth publication unless the original diagnosis has been made with extreme care. No case should be regarded as being suitable investigative material unless classical angina of effort is present. In this condition the pain is strictly quantitative to the degree of exertion undergone. It is increased during exercise, and diminishes as JunE—Joint Dis. No. 2—1 rae ite pot arent ta nes Pe ee el te](https://iiif.wellcomecollection.org/image/b33449417_0001.jp2/full/800%2C/0/default.jpg)
