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

Heart disease killed more Americans than any other disease in the 20^th century. Its rising prevalence, inadequate medical treatments, and the public’s fear of sudden death from heart attacks stimulated significant medical research and therapeutic innovation. Indeed, during this century, remarkable new drugs and technologies have successfully turned the tide on the war on heart disease. Today, it is a more manageable disease due to improvements in treatment and prevention strategies. Cardiologist-historian Bruce Fye traces the dramatic changes in the care of heart patients during this period, applauding the medical pioneers who developed and introduced many life-saving cardiac technologies and procedures, yet he ends his book by emphasizing that prevention is the best course of action.

In the first section of the book, Fye describes the creation of the Mayo Clinic, the world’s oldest and largest multi-specialty group practice, based in Rochester, Minnesota. This institution was built around patient care, not a medical school or research university, supporting clinical investigation and training specialists in the various disciplines. Fye discusses the late 19^th-century origins of the Mayo Clinic, arguing that three things came together to allow for its success: a family of ambitious doctors, an order of Catholic sisters, and hospital-based antiseptic surgery (3). It forged a new concept of group practice and later turned into a major academic medical centre with its affiliation with the University of Minnesota. I enjoyed reading about Canadian Leonard Rowntree, a 1905 gold medalist from Western University’s medical school, who was hired in 1920 to launch a clinical research program. According to Fye, Rowntree was “Mayo’s most ambitious internist-investigator” (95). Rowntree established clinical investigation at the Mayo Clinic, adding to its academic standing, but he also came into personal conflict with Will Mayo. Feeling marginalized and frustrated, Rowntree left the Mayo Clinic after twelve years to continue his work at the Philadelphia Institute for Medical Research. During this time, the Mayo Clinic created a new cardiology section and soon gained national recognition for its programs in disorders of the cardiovascular system and heart disease.

In the second section of the book, Fye outlines developments in the diagnosis and treatment of heart disease, emphasizing cardiac catheterization and open-heart surgery. At mid-century, the challenges of treating heart failure and hypertension were significant, as Fye offers in a fascinating account of US President Franklin Roosevelt’s hidden battle with hypertension. Just weeks before the 1944 presidential election, there was a “whispering campaign” about Roosevelt’s health. Secrecy was paramount; the cover-up of Roosevelt’s heart problems was seen to be required in order to win the election. Mayo Clinic cardiologists Arlie Barnes and Howard Odel were interviewed by FBI agents, who attempted to substantiate comments of Roosevelt’s poor health. None of this made the news. Fye argues that had voters known how sick Roosevelt was at this time, Thomas Dewey would most likely have become president (157). However, the heart disease battles of many other public figures, such as Lyndon Johnson, Dwight Eisenhower, Jackie Robinson, and Clark Gable, were well known. These news stories contributed to the public’s fear and anxiety regarding heart disease as well as to greater federal funding for cardiac research and treatment innovations.

In the third and final section of the book, Fye identifies key technologies that transformed heart care and introduced sub-specialization. In the early 1960s, specialty-trained nurses and physicians, working in new coronary care units, used life-saving technologies and techniques on patients suffering acute myocardial infarction with rising success. Coronary angiograms, soon to become the gold standard for evaluating coronary artery disease, became a common clinical tool during this period. In the thrombolytic era of the 1980s, the concept of dissolving dangerous clots in blood vessels to improve blood flow and prevent damage to tissues, had taken hold. Minutes counted in stopping impending damage, and...