The resolution of the Heberden-Parry controversy.

INTRODUCTION During the last 200 years there has been no significant improvement upon William Heberden's original description of the symptoms of angina pectoris.' Although he was unaware of the aetiology of the condition, so relatively quickly did his account become established that C. H. Parry's controversial attempt, thirty years later, to point out " . . . the mistakes of some of my medical brethren, in their nosological judgement of this disease .. .", did not find its proper place.3 Moreover, Parry's important concept of the syncope anginosa became progressively misinterpreted, neglected and finally forgotten. Indeed, the syncope anginosa is not thought to be relevant to medical practice today and Parry's work in this field is used as a reference only because it describes Jenner's original discovery of obstructive coronary arterial disease. However, as a result of personal observations made using radiotelemetric electrocardiography' and atrial-pacing coronary-sinus lactate studies5 in the investigation of patients with ischaemic heart disease, an explanation can be put forward which not only underlines the importance of Parry's work but also resolves the Heberden-Parry controversy. We can now show that, in the light of present-day knowledge, both Heberden and Parry described conditions which are at the opposite ends of the clinical spectrum of ischaemic heart disease. Furthermore, we can understand not only how Parry's concept gradually became neglected but also how the Heberden-Parry controversy could have been resolved by earlier reference to the symptoms of their famous contemporary. John Hunter had both the angina pectoris of William Heberden and the syncope anginosa of Caleb Hillier Parry.