PARRY, Caleb Hillier.

An Inquiry into the Symptoms and Causes of the Syncope Anginosa, commonly called Angina Pectoris. [Bound with:] BUTTER, William. A Treatise on the Disease commonly called Angina Pectoris.

Bath; Bath & London: printed by R. Cruttwell; and sold by Cadell and Davies; printed by R. Cruttwell & sold by Cadell and Davies, London, J. Collow, 1799; 1806.

First edition, rare, of this work in which Parry was the first to make the connection between angina and coronary heart disease. “In this important contribution to the understanding of the coronary circulation, Parry … reports on several patients suffering from what he termed ‘syncope anginosa’ and concludes that the condition is caused by disease of the coronary arteries” (Heirs of Hippocrates). He remarked in his case notes that angina most often occurred in obese males over 50 and his autopsies showed calcification in the coronary arteries. He read his paper on the topic before the Gloucester Medical Society in 1788 and it was published in 1799 as the offered work. Parry delayed publication because Edward Jenner had diagnosed John Hunter as having angina pectoris and Parry did not want to alarm his mentor Hunter with the detailed information included in this work; Parry actually treated Hunter for angina – he died in 1793. This is now recognized as Parry’s major contribution to medicine, although it was ignored for more than a hundred years. Parry suggested that to prevent coronary artery disease, his patients should eat and drink in moderation (avoiding ‘flesh meats’) and exercise, but he doubted that his advice would be heeded. Parry’s work reprints (pp. 3-5) a letter from Jenner describing his treatment of some patients with angina pectoris. Parry had met Jenner in grammar school and they remained friends for life. They both became physicians who spoke, wrote or collaborated on some of the same topics, among them, vaccination and cardiology. Jenner dedicated his great work Inquiry into the Causes and Effects of the VariolaeVaccinae (1798) to “C.H. Parry, M.D., at Bath, My Dear Friend.” When Parry died six years after suffering a paralytic stroke, Jenner was one of the pall bearers. The second work in the volume was first published in 1791. It is very rare on the market. ABPC/RBH list only five other copies of the Parry at auction since Norman. All of these except the Friedman copy (Sotheby's New York, November 16, 2001, lot 137, $34,100) were ex-library.

“At the very close of the eighteenth century there was published in Bath a slim volume with the title An inquiry into the symptoms and causes of the syncope anginosa, commonly called angina pectoris; illustrated by dissections (1799). Its author, Caleb Hillier Parry, is known for his sagacity and observational acuity, which among other things led him to produce the first observations on exophthalmic goitre. His is the first volume exclusively devoted to our subject which also deals with the anatomy and pathophysiology of the myocardium. Much influenced by Jenner, whose letter he quotes in the Introduction, Parry is also a strong adherent of the coronary hypothesis. In a ‘dissertation’ which he read in 1788, he states, ‘Angina Pectoris is a disease of the heart, connected with mal-organization of the coronary arteries.’

“Chaper 2 is entitled ‘Cases and Dissections.’ Three cases were described in greater detail, all of them showing a more protracted type of disease, though death, when it occurred eventually, was sudden. The post-mortem findings refer to ossification and partial obstruction of the coronaries, and to gross pathology of the aorta. No morbid changes of the myocardium are reported. However, the description of the clinical features is extraordinarily well-presented.

“Chapter 3 begins with a historical survey. Seneca’s case is mentioned first, but the author regards it rather as a disorder of respiration – a view shared by modern historians. As to Morgagni, Parry found the case discussed in his Epistle 26 (13) the only one bearing a relation to any example of the disease before Heberden’s time. He doubts whether Morgagni’s cases 16 (43) and 17 (17) belong to the angina pectoris group, since they are complicated by other diseases of the pericardium, aorta, and so on …

“Unlike Heberden, Parry, together with Black, Wall and others, found a diminution in the strength of the pulse. In an effort to enlarge the range of the morbid manifestations implied, Parry proposed a new name: ‘syncope anginosa’, thus reviving the notions of the ancients, and at the same time preparing the grounds for the new understanding of myocardial infarction:

‘All the circumstance in the Angina Pectoris preceding the actual syncope are approaches towards it: and in every uncombined and recent case, like those I have described, the patient probably dies with no other symptoms than those which show and irrecoverable diminution of the motion of the heart’ (p. 60).

“It seems that Parry truly grasped the importance of myocardial damage as contrasted with angina pectoris proper.

“To quote him again:

‘the Angina Pectoris is a mere case of Syncope or Fainting, differing from the Common Syncope only in being preceded by an unusual degree of anxiety or pain in the region of the heart, and in being readily excited, during a state of apparent health, by any general exertion of the muscles, more especially that of walking’ (p. 67).

“As already stated, Parry was not able to report anatomical lesions in the myocardium, but he brought the disturbed physiology in the heart muscle to the very centre of his deliberations when he spoke of the causes of the so-called syncope …

“In order to explain the onset of attacks Parry says, ‘and though a quantity of blood may circulate through these arteries, sufficient to nourish the heart … yet there may be probably less than what is requisite for ready and vigorous action’ (p. 113) …

“The etiology of the disease which is now regarded as due to arteriosclerosis was unknown to Parry, but he did speculate upon it when he said ‘It would be an object, valuable in a more important view than that of mere philosophical curiosity, could we discover the cause of that ossification’ (p. 132).

“What we now call myocardial damage in coronary heart disease did not escape Parry’s attention. He devotes the whole of chapter 6 to defining the process which he calls ‘Accidental Symptoms attending the Syncope Anginosa.’ He writes, ‘As induration of the coronary arteries probably depends on causes which may alike operate on every other part of the heart and large vessels, there is no reason why it may not be accompanied with any of those organic injuries which have been described before.’ He supposes that the coronaries may be ‘so obstructed as to intercept the blood, which should be the proper support of the muscular fibres of the heart, that the organ becomes unequal to the task of circulation.’ Parry lists many signs and symptoms due to muscular insufficiency of the heart. Again he comes quite close to the more current estimation of myocardial damage in the disease he describes” (Leibowitz, pp. 97-99).

Of Welsh descent, Caleb Hillier Parry was born in Cirencester on 21 October 1755. Caleb was educated at the local grammar school where Edward Jenner was also a pupil, and despite the difference in their age their friendship developed and continued throughout their adult lives. Parry studied medicine at Edinburgh University, which at that time had the most enlightened and advanced medical school in Britain. Parry also spent some of his undergraduate years in London where he was able to attend lectures and demonstrations given by John and William Hunter. His departure from Edinburgh to London may have been influenced by his older friend Jenner, in whose footsteps he seems to have followed. In 1777, Parry returned to Edinburgh where he graduated M.D. and was held in such high regard that he was elected president of the Edinburgh Medical Society. After qualifying, Parry and his new wife set out on a long tour of northern Europe, returning to England where they lived temporarily in Cirencester with Parry’s widowed mother before establishing their home in Bath.

Bath was then at its height of fashion, attracting rich and famous, impoverished and destitute, some hail and hearty, others sick and ailing. Twenty years earlier, the novelist Tobias Smollett had described the city as the great hospital of the nation. By the time Parry arrived, elegant new buildings designed by John Wood and his son were beginning to spread northwards beyond the walled confines of the old medieval spa town. Visitors far outnumbered residents. Amongst these, a large proportion came for health reasons, providing ample business for doctors. Parry found himself in competition with a multitude of well-established practitioners and his practice was slow to build up. This gave him an opportunity to develop his other interests and to make contact with people of inquiring disposition through the newly founded Bath Philosophical Society, whose membership included William Herschel and Joseph Priestley. By 1786, Parry’s practice was enlarging and his income steadily increasing. In the previous year he had treated his old mentor John Hunter for angina. Parry’s willingness to collaborate with colleagues is illustrated by his involvement in a small medical society which he and Jenner formed so that its members could meet regularly to present papers to each other. The Fleece Medical Society, named after the Gloucestershire inn in which the members met, was one of the earliest English provincial medical societies.

Parry’s health began to decline after his 40th birthday. He suffered from attacks of gout and renal colic. He even published a comprehensive account of his own symptoms entitled Observations on the gravel, written from my own actual feelings … etc. In 1810 he suffered a severe attack of facial erysipelas and never fully recovered his former strength. Six years later, a stroke left him unable to speak and paralysed on his right side. His recovery was slow and incomplete and caused him great frustration and emotional instability, and he ultimately developed epileptic fits. He died on 9 March 1822 and his remains are buried in Bath Abbey. His youngest son was the arctic explorer Admiral Sir Edward Parry.

Parry: ESTC T117585; Garrison-Morton 2888; Heirs of Hippocrates 1127; Osler 3622; Wellcome IV, p. 309; Norman 1646. Butter: Hirsch I, p. 788. Leibowitz, The History of Coronary Heart Disease, 1970.

Two works bound in one vol., 8vo (206 x 132 mm), pp. [6], 167, [1], iii, [1]; [3], 8, [3], 10-62, [2] (a little age-toning and faint occasional spotting, small blue sticker to top corner of p. 54). Contemporary olive half-sheep and marbled boards, green endpapers (a little wear to hinges and spine ends, small shelf label to front pastedown).

Item #5028

Price: $14,500.00