Peter Fleming, a British cardiologist, has produced a well-written synopsis of the history of heart disease during the past three centuries. He summarizes the main developments in cardiac pathology and physiology and emphasizes how a series of clinical observations, research discoveries, and technological innovations such as the electrocardiograph encouraged some physicians to focus their attention on patients with heart disease early in the twentieth century. To avoid having to deal with “contemporary history” (p. x), the author chose to end his story with 1970.
This small book includes a preface and eighteen chapters, several of which are devoted to categories of illness such as “congenital heart disease,” “ischaemic heart disease,” “rheumatic heart disease,” “infective endocarditis,” and “hypertensive heart disease.” Interspersed with these are six chapters devoted to chronological periods that also emphasize a specific theme, such as “Physical Signs and Physiology: 1819–1860” and “The Arrival of the New Cardiology: 1900–1940.” I especially liked the chapters on the invention and diffusion of auscultation and the early history of angina pectoris. Rather curiously, two chapters are biographical. Of all the possible persons he might have profiled, Fleming chose British physician Peter Mere “Heart” Latham and French physiologist Etienne Jules Marey. The last two chapters, on cardiac catheterization and cardiac surgery, are very short and rather disappointing.
Reviewing hundreds of primary sources, the author does a very admirable job of describing how a better understanding of the pathophysiology of heart disease resulted from a multitude of clinical observations and research findings. He also summarizes the various therapies used to treat patients with known or suspected heart disease. Fleming used an interesting approach to assess what leading British physicians during the second half of the nineteenth century thought aspiring clinicians should know about the heart: he reviewed the cardiological content of the membership examination of the Royal College of Physicians of London from 1859 onward.
Fleming disarms the reviewer by anticipating in his preface a few potential criticisms of this valuable work. He concedes that he paid perhaps too much attention to British contributions, but I found his account on the whole reasonably well-balanced. He acknowledges that he found it rather difficult to avoid writing a history that some would characterize as “Whiggish.” Although his analyses of persons, events, and trends were generally perceptive and reasonable, I thought two of his conclusions were unjustified: that by the early eighteenth century physicians (Raymond Vieussens, Giovanni Maria Lancisi, and Hippolito Francesco Albertini) had produced a “unified concept of heart failure . . . close to that of today” (p. 2), and that by the early nineteenth century “the pathological basis of angina and the concept of myocardial ischaemia” were “firmly established” (p. 24). The title of the first chapter, “Clinical Discipline Emerges: 1680–1760,” [End Page 163] is also problematic: perhaps some seeds were sown then, but by almost any definition, cardiology did not mature into a discipline until the twentieth century.
Although this book does not include illustrations or a bibliography, it contains hundreds of well-chosen references to the primary literature. Between text and notes, I think it is the best available road map to the nineteenth- and early-twentieth-century literature on heart disease. There are also many references to secondary sources. From a careful review of the 747 notes in the body of the book, however, it would appear that Fleming completed his background research by 1990: exclusive of the preface, there are only four references to secondary sources published in the present decade. This is unfortunate, because several useful books and many valuable articles on the history of cardiology have appeared in recent years. Readers seeking a more comprehensive account of the history of cardiology should be aware of Louis Acierno’s 1994 book The History of Cardiology, reviewed in this journal (Bull. Hist. Med., 1995, 69: 323).
Despite these few criticisms, Fleming’s very readable book is a useful guide to the history of heart disease.