British Cardiology in the 20Th Century

British Cardiology in the 20th Century Springer London Berlin Heidelberg New York Barcelona Hong Kong Milan Paris Singapore Tokyo Edited by Mark E Silverman, Peter R Fleming, Arthur Hollman, Desmond G Julian and Dennis M Krikler British Cardiology in the 20th Century With a Foreword by Walter Somerville Springer British Library Cataloguing in Publication Data British cardiology in the 20th century I. Cardiology - Great Britain - History - 20th century I. Silverman, Mark E. 616.1'2'00941 '0904 ISBN-13: 978-1-4471-1199-3 Library of Congress Cataloging-in-Publication Data British cardiology in the 20th century/Mark E. Silverman . .. let a/.J (eds); with a foreword by Walter Somerville. p. ; em. Includes bibliographical references and index. ISBN-I3: 978-1-4471-1199-3 e-ISBN-I3: 978-1-4471-0773-6 001: 10.1007/978-1-4471-0773-6 I. Cardiology-Great Britain-History- 20th century. I. Title: British cardiology in the twentieth century. II. Silverman, Mark E. IDNLM: I. Cardiology-history- Great Britain. 2. History of Medicine, 20th Cent.- Great Britain. WG II FAI B862 2000J RC666.S.B7S 2000 0O-Q36S74 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographie reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. © Springer-Verlag London Limited 2000 Softcover reprint of the hardcover I st edition 2000 The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore free for general use. Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. Typeset by Florence Production Ltd, Stoodleigh, Devon 28/3830-543210 Printed on acid-free paper SPIN 10765440 Foreword I have been accorded the honour of writing a foreword, meaning words said before something more significant that follows. I shall take the prerogative, at my mature age, to look backwards first. As I reflect upon the last century, I realise that our knowledge of cardiology, obscure in 1900, has been like a distant mountain whose magnificent features became more sharply outlined and appreciated as we have travelled through the century. In 1900, the origin of ischaemic chest pain, for example, was a total blur and we did not even know how to diagnose coronary thrombosis. I take great pleasure that certain major disorders which affected so many, so cruelly in the past have been tamed, and in some cases almost eradicated. Among other benefits this century has seen are the dramatic fall in incidence of rheumatic fever; the precise control of coagulation of blood; the discovery of effective treatments for hypertension, syphilis, and endocarditis, and the remarkable develop ments in safe surgery for acquired and congenital heart disease. British cardiology can be justly proud of its many contributions to the clinical understanding and the science of cardiology in the 20th century. The teachings of Mackenzie, Lewis, Parkinson, Wood, Pickering, and many respectfully remembered others from this country spring immediately to my mind. British cardiology has been a discipline that is recognised as one of our strong scientific exports. That this progress has occurred here despite the prolonged havoc and disruption of two world wars is all the more note worthy. As I look forward, however, I wonder if our wisdom will increase as much as our knowledge has in the past. Coronary disease, thought to be uncommon in the early years of this century, has become an increasing menace to our lives despite many advances in diagnosis and treatment. Can molecular biology be a stepping stone to its solution? Will the determina tion of the genetic code help us to eradicate congenital heart disease and cardiomyopathy as we have successfully overcome other problems? What will we do about the care of our ageing and expanding population, tobacco related disease, and the pervasive toxins that threaten our environment and our health? Finally, I wonder whether the stethoscope, the precious tool of the cardiologist, will be replaced by the computer as the symbol of the doctor in the eyes of the patient. This book was not, of course, designed to answer these questions. But it does provide a fine perspective from which to view British contributions v vi British Cardiology in the 20th Century to cardiology and to tell us how far we have come in our 20th century journey to learn about the mountain ... which no longer seems so distant or so mysterious. The editors and authors are to be congratulated and thanked for this important historical document. Walter Somerville Honorary Physician Middlesex Hospital, London President British Cardiac Society, 1976-81 October 1999 Preface British Cardiology in the 20th Century came about through a happy combi nation of circumstances. In May 1998, I came to London from Atlanta, Georgia as a visiting academic at the Wellcome Institute for the History of Medicine to undertake research on Paul Wood. After a lengthy search of archival resources, it became apparent that, with a few notable exceptions, relatively little had been written about British cardiology in this century. Considering the historical importance of British cardiology, beginning with William Harvey and extending through James Mackenzie and Thomas Lewis into modern times, this void was rather surprising. The concept of coediting a multiauthored book devoted to 20th century cardiology was discussed with Peter Fleming, Arthur Hollman, Desmond Julian, and Dennis Krikler - all like minded cardiologist-historians - at an initial meeting at the British Cardiac Society on 21 October 1998. After due consideration of the many obstacles such a book would encounter, the group agreed that the idea was worthy. The purposes of the book were defined, chapter subjects developed, and potential authors selected. Potential publishers were contacted and financial support was obtained. The authors responded with enthusiasm and scholarship and within a year a vivid history of British cardiology in the 20th century has emerged. I am grateful to the Burroughs Well come Fund in Durham, North Carolina and to the Academic Unit and library staff at the Wellcome Institute for the History of Medicine who made it possible for me to partic ipate in this fulfilling project. Mark E Silverman vii Contents Chapter 1 British Cardiology 1900-50 Peter Fleming ............................................ 1 Heart failure .......................................... 1 Cardiac arrhythmias .................................... 7 Conduction defects ..................................... 8 Electrocardiography .................................... 9 Ischaemic heart disease ................................. 10 Angina .............................................. 10 Myocardial infarction ................................... 12 Chronic rheumatic heart disease .......................... 15 Infections of the heart .................................. 18 Hypertensive heart disease . .. 18 Pulmonary heart disease . .. 19 Congenital heart disease . .. 20 Da Costa's syndrome and related conditions .................. 20 The Development of the Speciality Chapter 2 The Second World War and the NHS - the Framework for the Development of Cardiology Geoffrey Rivett ........................................... 27 Hospitals and specialists before the war . .. 27 Planning for district hospitals ............................. 28 Speciality development . .. 29 Development of cardiology and cardiac surgery ............... 30 NHS organisation and specialist services . .. 32 London issues .......................................... 33 Equity, cost, and quality .................................. 34 x British Cardiology in the 20th Century Chapter 3 The Training, Number, and Distribution of Cardiologists Douglas Chamberlain ...................................... 38 Training within the NHS . .. 38 Introduction of formal training ............................ 42 Regulating numbers ..................................... 45 Growth and geographical distribution ....................... 49 The Organisations Involved in the Growth of Cardiology Chapter 4 Societies, Journals, and Books Arthur Hollman .......................................... 52 The Cardiac Club ....................................... 52 The British Cardiac Society ............................... 54 Other British cardiology organisations . .. 62 Journals and books . ... 63. Chapter 5 The British Heart Foundation Desmond G Julian and Brian Pentecost 74 Founding committee . ... 74 Statement of purpose .................................... 75 Fundraising . .. 75 Governance . .. 77 The medical department . .. 77 Research .............................................. 77 Professorial chairs . .. 78 Education ............................................. 78 Cardiac care .......................... ................ 80 Chapter 6 Part I. The National Heart Hospital: The First of its Kind Mark E Silverman . .. 83

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