Caring for the Heart: Mayo Clinic and the Rise of Specialization by Bruce W. Fye (review)

Caring for the Heart is an important book. It sets an ambitious mission from the outset, seeking to explain “how and why the care of patients with heart disease changed so dramatically during the twentieth century” (p. xvii). It pursues this goal by interweaving three stories: the history of heart disease and cardiac therapeutics, the history of the Mayo Clinic, and the history of specialization and medical technology. Each of these is significant. Heart disease remains the leading cause of death, cardiac therapeutics has become a leading sector of the health care economy, and the Mayo Clinic has been the most respected health care institution in the world for over a century. Fye is the ideal author for this book. A historian and cardiologist at Mayo, he has led both the American College of Cardiology and the American Association for the History of Medicine. He draws on his personal experiences in the field, his relevant prior scholarship, and his analysis of over fifteen thousand written sources, including archives at the Mayo Clinic that other historians have not examined. The ensuing text is daunting—640 pages of text and notes—but Fye designed it so that individual chapters function well as standalone case studies.

The book rewards its readers in many ways. The opening chapters track the development of the Mayo Clinic from its founding until the 1940s, alongside the history of cardiology, both nationally and at Mayo. I was initially worried by the frequency of “marvel,” “genius,” and “brilliant,” but Caring is not institutional hagiography. Fye highlights Mayo’s rare fumbles and provides nuanced analyses of an impressive institution. The book then proceeds through many case studies including four chapters on cardiac surgery, three on diagnostic technology (e.g., catheterization, angiography, and echocardiography), and others about coronary care units and nurses, angioplasty, electrophysiology, and heart failure (including transplants). Many of the vignettes are unexpected and interesting. I was intrigued by the clinic’s key role in World War II aviation medicine (researchers spun Charles Lindbergh in the country’s first human centrifuge and then rendered him unconscious in a low pressure chamber), and by the clinic’s initial refusal to accept NIH grants, for fear of government inspection and control. Though focused on Mayo, Fye traces key developments at the University of Minnesota (e.g., early open heart surgery) and the Cleveland Clinic (e.g., coronary angiography and surgery).

Such a broad project requires compromises. Since the book is arranged by topic, not chronology, the chapters slide back and forth through time. Lyndon Johnson dies in one chapter, only to reappear later on. Fye acknowledges that many of his chapter-length case studies deserve book-length analyses. For instance, even though he provides the best account yet of Mason Sones and the development of selective coronary angiography, his history of coronary artery surgery leaves out important early developments in New York, Houston, and Leningrad. Caring for the Heart is not a comprehensive history of the Mayo Clinic, or medical specialization, or heart disease, or cardiology. Instead, it is a fascinating slice through many of the key developments in each of those histories that reveals important strategies and obstacles for physicians, departments, and hospitals that seek to achieve excellence in health care.

My one regret (though other readers might value this) is Fye’s gentle touch with argument and critique. He documents the cover-up of FDR’s hypertension during the 1944 campaign, but stops short of arguing that the public’s right to know trumps a patient-president’s right to privacy. He argues that Mayo succeeded, in part, by allowing specialization while demanding cooperation, but tensions flared, for instance between radiology and cardiology over control of cardiac catheterization. And while the clinic fostered a culture of research and innovation, it demanded so much clinical work from its physicians that their research suffered and Mayo lost early leads in...