Abstract
During the early twentieth century, orthodox American medicine incorporated the ideas and the ideology of the natural sciences, marking the beginning of a relationship that has continued to the present day. Medical schools started to devote ever-increasing hours to science, particularly physiology, and physicians began to perceive their task as the application of clinical science.1 In this chapter I explore the historical justification for physicians’ perception of physiology as a natural science valuable to medicine. In so doing I focus on the question: When, and how, did practicing American physicians come to see the physiology of the heart as clinically useful?
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Notes
For a general review, see John Harley Warner, “Physiology,” in The Education of American Physicians, ed. Ronald L. Numbers (Berkeley: Univ. of California Press, 1980). The best work on the history of American medical education is Kenneth Ludmerer, Learning to Heal (New York: Basic, 1985). For a critical evaluation of recent historiography see Daniel M. Fox, “The New Historiography of American Medical Education,” Hist. Educ. Q. 26 (1986): 117–124.
For a representative essay, see Carl J. Wiggers, “The Interrelations of Physiology and Internal Medicine,” J. Am. Med. Assoc. 91 (1928): 270–274. Gerald L. Geison discusses the push for physiology in “Divided We Stand: Physiologists and Clinicians in the American Context,” in The Therapeutic Revolution, ed. Morris J. Vogel and Charles E. Rosenberg ( Philadelphia: Univ. of Pennsylvania Press, 1979 ).
Quoted by Eugene F. DuBois in “Fifty Years of Physiology in America: A Letter to the Editor,” in The Excitement and Fascination of Science (Palo Alto, CA: Annual Reviews, 1965), p. 86. Another noted physiologist, Paul F. Cranefield, was somewhat less certain of physiology’s impact on medicine in “Microscopic Physiology Since 1908, ” Bull. Hist. Med. 33 (1959): 275.
This ideal has been largely defined by the Annales school. See Fernand Braudel, Afterthoughts on Material Civilization and Capitalism (Baltimore, MD: Johns Hopkins Univ. Press, 1977 ).
For a review of recent historical analysis of medical science see Warner, “Science in Medicine,” Osiris 1 (1985): 37–58.
Christopher Lawrence, “Moderns and Ancients: The `New Cardiology’ in Britain 18801930,” Med. Hist. Suppl. 5 (1985): 1–33.
Wiggers, “Pathways of Medical Progress,” in Blood, Heart and Circulation, ed. Forest Ray Moulton ( Washington, DC: Science, 1940 ), pp. 1–9.
Stanley Joel Reiser, Medicine and the Reign of Technology ( Cambridge, UK: Cambridge Univ. Press, 1978 ).
Joel D. Howell, “Early Use of X-ray Machines and Electrocardiographs at the Pennsylvania Hospital: 1897 Through 1927,” J. Am. Med. Assoc. 255 (1986): 2320–2323.
W. B. Cannon, “The Case Method of Teaching Systematic Medicine,” Boston Med. Surg. J. 142 (1900): 31–36;
Thomas Franklin Williams, “Cabot, Peabody, and the Care of the Patient,” Bull. Hist. Med. 24 (1950): 462–465;
Benjamin Castleman and H. Robert Dudley, Jr., Preface to Clinicopathological Conferences of the Massachusetts General Hospital: Selected Medical Cases (Boston, MA: Little, Brown, 1936–1960), pp. vii-ix.
Robert Joy has suggested that the use of machines by life insurance examiners and by physicians who certified aviators can be considered as other indicators of perceived usefulness.
I am not attempting to say anything about the development of cardiology as a specialty (or a subspecialty of internal medicine). There can be little doubt that some relationship exists between clinical cardiology and cardiac physiology. The nature of that relationship, however, awaits further clarification. Also, before the mid-twentieth century, most practicing physicians were general practitioners, not specialists. To define the use of cardiac physiology in terms of specialists’ practice would take us away from the level of ordinary practice and quickly put us into the level of elite, academic researchers.
George E. Burch and Nicholas P. DePasquale, History of Electrocardiography ( Chicago, IL: Yearbook, 1968 );
John Burnett, “The Origins of the Electrocardiograph as a Clinical Instrument,” Med. Hist. Suppl. 5 (1985): 53–76.
For example, C. C. Guthrie, “Twenty Years Progress in Physiology and Pharmacology: Including Present Status and Outlook to the Future,” in Proceedings of the Annual Congress on Medical Education, Medical Licensure, Public Health and Hospitals ( Chicago, IL: American Medical Association, 1925 ), pp. 13–21.
Howell, “Early Perceptions of the Electrocardiogram: From Arrhythmia to Infarction,” Bull. Hist. Med. 58 (1984): 83–98.
W. Bruce Fye, “Ventricular Fibrillation and Defibrillation: Historical Perspectives with Emphasis on the Contributions of John MacWilliam, Carl Wiggers, and William Kouwenhoven,” Circulation 71 (1985): 858–865;
Kouwenhoven and Orthello R. Langworthy, “Cardiopulmonary Resuscitation: An Account of Forty-Five Years of Research,” Johns Hopkins Med. J. 132 (1973): 186–193.
Paul M. Zoll, et al., “Termination of Ventricular Fibrillation in Man by Externally Applied Electric Countershock,” N. Engl. J. Med. 254 (1956): 727–732.
Victor Parsonnet and Marjorie Manhardt, “Permanent Pacing of the Heart: 1952–1976,” Am. J. Cardiol. 39 (1972): 250–256;
Peter C. Hanley, et al., “Two Decades of Cardiac Pacing at the Mayo Clinic (1961 Through 1981),” Mayo Clin. Proc. 59 (1984): 268–274.
R. L. Levy, H. G. Bruenn, and D. Kurtz, “Facts on Diseases of the Coronary Arteries Based on a Survey of the Clinical and Pathological Records of 762 Cases,” Am. J. Med. Sci. 187 (1934): 376–390.
Howell, “Early Use of X-Ray Machines and Electrocardiographs”; and Howell, “Machines and Medicine: Technology Transforms the American Hospital.” In press.
For biographical details, see Paul Dudley White, My Life and Medicine ( Boston, MA: Gambit, 1971 ).
For a general discussion of the history of measuring cardiac pressures and output, see William F. Hamilton and Dickinson W. Richards, “The Output of the Heart,” in Circulation of the Blood: Men and Ideas, ed. Alfred P. Fishman and Richards (New York: Oxford Univ. Press, 1964), pp. 71–126. Also, Stephen Hales, Statistical Essays: Containing Haemastatistics (1733; Reprint ed., New York: Hafner, 1964 ).
Andre Cournand, “Historical Details of Claude Bernard’s Invention of a Technique for Measuring the Temperature and the Pressure of the Blood Within the Cavities of the Heart,” Trans. NYAcad. Sci.,2d ser., 39 (1980): 1–14.
Edward Shapiro, “Adolf Fick-Forgotten Genius of Cardiology,” Am. J. Cardiol. 30 (1972): 662–665;
T. Doby, “History of Cardiovascular Catheterization,” Clio Med. 12 (1977): 185–188.
Fye, “Ernest Henry Starling, His Law and Its Growing Significance in the Practice of Medicine,” Circulation 68 (1983): 1145–1148;
Mark D. Altschule, “Invalidity of Using So-Called Starling Curves in Clinical Medicine,” Perspect. Biol. Med. 26 (1983): 171187.
Wiggers, Reminiscences and Adventures in Circulation Research ( New York: Grune & Stratton, 1958 ).
H. J. C. Swan and William Ganz, “Hemodynamic Monitoring: A Personal and Historical Perspective,” Can. Med. Assoc. 121 (1979): 868–871.
Eugene D. Robin, “The Cult of the Swan-Ganz Catheter: Overuse and Abuse of Pulmonary Flow Catheters,” Ann. Intern. Med. 103 (1985): 445–449.
For a discussion of the many advances needed, as well as an excellent chronology that goes far beyond the dates listed in the title, see Julius H. Comroe, Jr. and Robert D. Dripps, The Top Ten Advances in Cardiovascular-Pulmonary Medicine and Surgery 1945–1975 ( Washington, DC: Government Printing Office, 1977 ).
Fye, “Coronary Arteriography—It Took a Long Time,” Circulation 79 (1984): 781–787.
James Mackenzie, The Study of the Pulse ( Edinburgh: Young J. Pentland, 1902 ).
For example, the National Board of Medical Examiners questions in the Physiology Section of part one (the basic sciences) for February, 1922; September, 1922; and almost every exam thereafter. National Board of Medical Examiners Bulletin No. 8: Examination Questions Parts I and II, 1922–1925.
For example, George R. Hermann, Synopsis of Diseases of the Heart and Arteries (St. Louis, MO: Mosby, 1944 ), p. 68.
A. Werner Theodor Otto Forssmann, “Die Sondierung des Rechten Herzens,” Klin. Wochenschr. 8 (1929): 2085–2087, 2287; and Werner Forssmann, Experiments on Myself: Memoirs of a Surgeon in Germany ( New York: St. Martin’s, 1974 ).
Cournand and Hilmert Albert Ranges, “Catheterization of the Right Auricle in Man,” Proc. Soc. Exp. Biol. Med. 46 (1941): 462–466;
Richards, “The Contributions of Right Heart Catheterization to Physiology and Medicine, with Some Observations on the Pathophysiology of Pulmonary Heart Disease,” Am. Heart J. 54 (1957): 161–171.
Warren describes this event in J. Willis Hurst, “History of Cardiac Catheterization,” in Coronary Arteriography and Angioplasty, ed. Spencer B. King III and John S. Douglas ( New York: McGraw Hill, 1985 ), pp. 1–9.
Fye, “Coronary Arteriography,” 783–784.
Louise B. Russell, Technology in Hospitals: Medical Advances and Their Diffusion (Washington, DC, Brookings Institution, 1979), documents that larger hospitals adopted intensive care units, where such measurements were performed, more rapidly than smaller hospitals.
Hughes W. Day, “History of Coronary Care Units,” Am. J. Cardiol. 30 (172): 405–407.
Russell, Technology in Hospitals,p. 43.
Russell C. Maulitz, “Physician versus Bacteriologist: The Ideology of Science in Clinical Medicine,” in Vogel and Rosenberg, Therapeutic Revolution,pp. 91–108.
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Howell, J.D. (1987). Cardiac Physiology and Clinical Medicine? Two Case Studies. In: Geison, G.L. (eds) Physiology in the American Context 1850–1940. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7528-6_13
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