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February 18, 1961

Coronary Disease-Reply

JAMA. 1961;175(7):631-632. doi:10.1001/jama.1961.03040070088027

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To the Editor:—  I have read and reread Dr. William Dock's letter, and I find nothing really pertinent to the subject of my study presented in Miami last June. The theme of my paper, namely, that effort and occupation play no apparent role in the precipitation of acute coronary occlusion, is ignored. Only perimeter topics are the target of Dr. Dock's remarks."Acute coronary insufficiency" in my paper was always qualified as "acute coronary insufficiency without occlusion" or "acute coronary insufficiency due to hemorrhage." Many readers who have written to me were, unlike Dr. Dock, able to distinguish this type of acute coronary disease from acute coronary occlusion, the subject of my article. An illustration may emphasize my point. Many years ago a 19-year-old girl suffering from acute ulcerative colitis died following many brisk bowel hemorrhages. At postmortem examination, we found subendocardial infarction without coronary occlusion. In fact, the coronary

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