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Your fascinating piece  about John Warren, the celebrated early nineteenth century Bostonian surgeon, described the breadth of Warren’s surgical interests and practice, but his contribution was yet wider. Cardiologists owe to Warren probably the first description of the relationship between cardiac death and ‘ossification’ of the coronary arteries, noted by Warren on post mortem examination of his own patients. He further drew attention to the poor correlation between the extent of such ossification and the pre-mortem symptoms of angina, to the extent that it is clear that some of his patients had what was later recognised to be silent ischaemia. Fortunately Warren’s descriptions have been immortalised due to their appearance in the first ever number of the New England Journal of Medicine .
1 Cooper DKC. John Collins Warren (1778-1856): An American surgeon in London. BMJ 2012; 345: e8251
2 Warren JC. Remarks on angina pectoris. N Engl J Med Surg 1812;1:1-11.
No competing interests
24 December 2012
Stuart D Rosen
Ealing and Royal Brompton Hospitals
Department of Cardiology, Ealing Hospital, Uxbridge Road, Middlesex UB1 3HW