‘Cardiology Leiden’, the First 40 Years

Abstract

In Internal Medicine, the diagnosis of heart disease has always been regarded as difficult and it requiered highly technical skills. This was especially true at the Leiden University Hospital, because this the place where electrocardiography, developed by Einthoven at the Physiology Laboratory of the University, was first applied in clinical practice. Congenital or valvular disease of the heart is easily detected because of the murmurs and clicks that it causes, but it requires great experience and skill to diagnose the underlying disorder properly by auscultation; a skill that many experienced and highly qualified internists never developed. Arrhythmias of the heart were elusive and practically impossible to diagnose without proper equipment, same was true for angina the diagnosis of which was based solely on the patient’s history. To aid in the diagnosis, clinical electrocardiography and fluoroscopy of the chest was introduced in the thirties; examining patients and interpreting the recordings and images was so difficult that it inevitably became the domain of specialists in cardiology. In this role Dr. Herman Snellen was appointed in 1937 as a consultant in Cardiology at the Department of Internal Medicine by Kuenen, professor of Internal Medicine and in 1934 one of the founders and the first president of the Dutch Society of Cardiology. Snellen’s task was to examine patients on request of the internist, and, in particularly, to study patients using electrocardiography, fluoroscopy and X-ray photography. He passed his thesis in 1939 on X-ray diagnosis of sclerosis of the heart and the aorta.