Angina Pectoris

When a robust man suddenly drops dead and the newspapers report "heart failure," the probability is that he died during an attack of angina pectoris. If he had gone to his doctor the day before, the doctor would probably have slapped him on the back and told him that his heart was as sound as a dollar. The underlying conditions which bring on an attack of angina pectoris usually exist in the arteries of the heart muscle. Yet the physician may not be able to detect them with a cardiograph or x-rays. In general, honest doctors admit that angina pectoris and its causes baffle them, that all they can do is to stand off Death for a while.

On the presumption that the cause of angina pectoris lies somewhere in the heart, physiologists have studied that organ painstakingly. The first offshoots of the mighty aorta are two small twining arteries, called the coronaries, which feed blood to the hardworking heart muscle. If the bore of the coronary arteries is narrowed by disease or if cardiac circulation is otherwise interfered with, the cells of the heart muscle suffocate. The heart will stand for such maltreatment just so long. Then suddenly the heart "utters a piercing cry of distress." That cry is angina pectoris.

The pain of angina pectoris is the most agonizing that a human being ever feels. It usually begins at the upper part of the breastbone, shoots to the left shoulder, and down the left arm. The victim has a terrifying sense of being about to drop dead. And he looks very much as he feels. Many victims do die during their first attack of angina pectoris. But for most victims the first attack is the heart's warning that it will cease working if its brain, soul and body do not instantly change to a calmer way of life.

Angina pectoris attacks men more often than women,"Jews more often than other groups, business and professional men more often than mechanics and laborers,' indoor workers more than outdoor workers. It is the doctor's occupational disease. And it is increasing in the U. S.

Last week, to marshal Medicine's best weapons against this troublesome ailment, the New York Academy of Medicine summoned the best available authorities to a special symposium. Dr. Emanuel Libman, 63, of Manhattan, famed among medical scholars for his discoveries in all kinds of heart and visceral diseases, explained the causes of coronary disease and angina pectoris. Dr. Henry Harlow Brooks, 64, of Manhattan, famed diagnostician, explained the best medical treatment. Dr. Harold Myers Marvin, 41, a rising Yale scholar, evaluated treatment by surgery.

Dr. Libman's first point was that angina pectoris does not always indicate actual heart disease. A diaphragm pushed up by a distended stomach may cause the pain. A poorly functioning gall bladder or colon may cause it. So may disturbed ovaries. One of the subtlest causes is focal infection, which may lower the resistance of the heart or sensitize it to pain.

An extraordinarily simple and efficacious treatment for coronary disease has developed from Dr. Libman's conceptions of the physiology of the internal organs. The Libman treatment: a dose of calomel, a saline purge, enemas of carbonate of soda, instillations of colon bacilli in the large bowel and bicarbonate of soda night and morning. The carbonate and bicarbonate of soda tend to alkalize the system; the colon bacilli prevent putrefaction and toxemia; calomel and purge clean out the gall bladder and bowels.

Shrewdest aspect of the Libman treatment is his attention to the gall bladder, Gall bladder troubles affect the heart through sympathetic nerves. They also lead to gout. The heart can become as gouty as the big toe and can be as thoroughly cleared of gout by adequate attention to the gall bladder.

Dr. Brooks, a handsome, comforting physician, is more concerned with the coronary patient's emotions than is Dr. Libman. "Anger, love, fear, hate, surprise more strikingly influence the heart rhythm than any physical factor that we know of," said he. Relaxation, music, diversions, congenial conversation are good for heart cases, prevent anginal attacks. Climate ''is another important consideration. The tropics are good for such patients, also Spain and Egypt. Altitudes may also be advantageously employed, especially as regards wind and air pressure. When the barometer falls, patients invariably come in. Sunshine is a good aid."

The drugs which Dr. Brooks prefers in attacks of angina pectoris are amyl nitrate or nitroglycerin. He also uses chloral hydrate, paraldehyde and barbiturates.

He lets his patients who like alcohol drink it moderately, for its soothing and relaxing effects. Dr. Brooks thinks that the tendency to suffer angina pectoris is hereditary. Said he: "It would not be wise to advise marrying among individuals with angina pectoris."

Surgery is practically useless in controlling angina pectoris, declared Dr. Marvin. A few years ago surgeons, without knowing precisely why, cut certain nerves near the neck, which carry messages to and from the heart. All that this did was to keep the patient from being aware of the agonizing pain and in some instances prevent spasms from contracting the coronary arteries. But such operations did not attack the underlying causes of the spasms or pain. Besides, many patients died during the operations. So now few surgeons perform them.

Some surgeons inject alcohol into those nerves. The alcohol paralyzes the nerves and makes them as useless as though they were severed. But few surgeons are adept at hitting the quarter of a square inch under the collar bone for which they must aim their hypodermic needles. Dr. Marvin thinks little of the procedure, but said it is the only sensible thing surgery has done for angina pectoris or coronary disease.

He scoffed at total excision of the thyroid. The theory is that the thyroid drives the heart more than the heart can stand and that without the thyroid's slave-driving the heart can take its own time and method of pumping blood through the coronary arteries. Thyroidectomy does relieve drive on the heart and does prevent angina. But it does not cure the source of trouble and, except for lifelong dosing with the thyroid hormone, makes an idiot of the coronary patient.

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