210 Church Street

April 14/50
Dr. H. Brow,
Physician in Chief,
Royal Victoria Hospital,
Montreal, Quebec

My Dear Doctor Brow: -

The Coronary Arteries have finally caught up with me. I thought you would be interested in hearing of my recent attack in view of what happened sixteen months ago. I had been feeling remarkable well, working hard and taking two hours a week at Y.M.C.A. in a Business Men's gym class. My wind and physical condition apparently not much changed in the last fifteen years. On the afternoon of the 5th of April I had been playing two or three rubbers of bridge at the club, a little late for dinner. I got up from the bridge table and gulped down about a half glass of ginger ale and had the sensation of a lower retro-sternal tightness. This was not severe and I walked out of the club and up the hill toward my car. The Retro-sternal sensation persisted and about half way up the hill I began to notice that both my arms felt numb, my breathing wa comfortable and I continued on to my car. I drove to my father-in-laws for dinner, a matter of a five minute drive. The retro-sternal tightness persisted still and I began to feel nauseated. The sensation in my chest at no time was excruciating. It was just damn annoying. The fact that it persisted and that the sensation in my arms was still there and being nauseated worried me a bit and my wife called Dr. Kennedy. My pulse was slow and full, it was 60 per minute, whereas my average pulse is around 86 to 90. A 1/4 of Morphia plus 1/6 intravenously was given over a period of one hour. I was taken to the hospital as I was anxious to have a tracing done while the distress was still present (I am including the serial Electrocardiogram which I feel shows a definite Posterior Infarction). All in all the tightness lasted 2-3/4 hours and I have had no recurrence since. I was put in oxygen, given Dicumerol and a rather peculiar instance took place the first night. Subsequent to a hypodermic injection of Demerol the room began to fade out on me and I felt my pulse and could not get it. I did not actually lose consciousness but the special nurse I had was certainly alarmed. The syncopal attack lasted about five to six minutes.

At the moment I am on Dicumerol, Fepeverine and a fair slug of Barbituate. My Sed. Rate went up to 1 on the fourth day and my White Count has reached 14,000 and I have been afebrile. Dr. Connoll was in to see me a couple of night ago and seemed satisfied with the way things are going.

The point that intrigues me is this: - Is it possible for sustained sub-clinical autonomic imbalance to produce coronary heart disease? It would seem that there could a fair argument that autonomic imbalance or some neurogenic factor either visceral in origin or psychogenic is the basic forerunner of coronary sclerosis. The viscero-cardiac reflexes are moderately well recognized. What about the psychogenic cardiac reflexes? How do we fit in the fact that the coronary patient in the majority of instances has a definite work and mental pattern. No one can convince me that over-work in itself does anything but make one tired. The important factor, I feel, is the head of steam or tension at which any individual carries out his work. This might explain Paul White's statement that chronic over-indulgence in Alcohol is protection against coronary heart disease. (Perhaps my mistake was going on the wagon). I have a fairly large and varied series of cases demonstrating viscero-cardiac syndrome, in which symptoms of cardiac disease have been improved or completely removed by adequate treatment to some other tissue pathology. I am sure the pieces of the puzzle are before our eyes if we could only fit them tegether.

In my own particular case, I would be interested in hearing your speculation as to the pathogenesis of the present pathology. If you are pressed for time, do not hesitate to delay the discussion until I have a chance to see you personally.

Selye and Brown undoubtedly have a termendous find in their recent research, however, I cannot get over the hunch that there is just as big a lode in the autonomic fields.

Kindest regards,

Yours sincerely,

G. V. Faulkner, M.D.