Heberden's account of angina pectoris

The pain came on during a walk, especially soon after a meal. It sat under the breastbone, always leaning to the left, sometimes with a pain about the middle of the left arm, and felt as if it would take the patient's life if it grew or lasted. The moment the patient stood still, it was gone. William Heberden described these attacks in a paper read at the College of Physicians in London on 21 July 1768. He called the disorder angina pectoris, for its seat in the chest and the sense of strangling and anxiety that came with it, and wrote that he could recall no mention of it by medical authors.

At first the patients were otherwise well, with no shortness of breath. After some months the attacks came at night as well, forcing people out of bed every night for months, and in one or two long-standing cases the motion of a horse or carriage, swallowing, coughing or an upset of mind could set them off. Heberden had seen something similar in one paralysed woman and heard mild complaints from one or two young men. The rest, at least twenty, were men, nearly all past fifty, most short-necked and inclined to be fat.

An experienced physician he consulted had known several such patients, and all had died suddenly; six of Heberden's own had died the same way. He suspected a strong cramp, perhaps with an ulcer. Because the pulse, when he felt it during an attack, was at least sometimes undisturbed, he concluded that the heart was not affected. He had never seen a patient opened after death, since most were buried before he heard they had died. Bleeding and other evacuations did no good. Wine at bedtime weakened the night attacks, and 10 to 20 drops of tincture of opium let patients stay in bed until morning.

The College printed the paper in the second volume of its Medical Transactions in 1772. Heberden went on collecting cases. In his Commentaries, published in London in 1802, the year after his death, he counted nearly a hundred patients, among them three women and a boy of twelve. He also reported a post-mortem: a skilled anatomist opened a patient who had died suddenly of it and found no fault in the heart, the valves, the arteries or the neighbouring veins, apart from small beginnings of bone in the aorta. One patient who set himself to saw wood for half an hour every day was, Heberden wrote, nearly cured.