Evolution in Cardiology: Triumph and Defeat

PERSPECTIVES IN BIOLOGY AND MEDICINE Volume 34 ¦ Number 1 ¦ Autumn 1990 EVOLUTION IN CARDIOLOGY: TRIUMPH AND DEFEAT RICHARD J. BING* Cardiology is only a small cross section of the history of general sciences and medicine. While medicine as an art has remained virtually unchanged over hundreds ofyears, medical science has evolved continuously during the last 100 years. I have often wondered whether scientific evolution is subject to the same law that governs the evolution ofspecies: natural selection. Observing the evolution of scientific ideas and concepts, we perceive an everchanging scene that does not seem to differ from the changing panorama of biological evolution. Can the law that governs evolution also determine history of science? The basis of natural selection is the genetic material with its replications and with the occurrence of mutations, which lead to new variations . It appears to me that the evolution of human thought is also based on the genetic material, because mind is the distillation of soma and thus is determined by natural selection. The thoughts and ideas of a genius represent mutations. They are newly created concepts. In the creation of both species and ideas, natural selection blindly wields its unrelenting scythe. But while natural selection of the species is blind and random, science does have a definite goal, that of finding solutions. In medicine, moreover, applicability and usefulness play an important role. Natural selection of ideas occurs from within: the individual personality, the intellectual capacity, or the innovations of a genius. Natural selection is Talk delivered to the Friends of the Norris Medical Library, University of Southern California, Los Angeles, January 17, 1990. *Department of Experimental Cardiology, Huntington Medical Research Institutes, 100 Congress Street, Pasadena, California 91105.© 1990 by The University of Chicago. All rights reserved. 0031-5982/91/3401-07lO$01.00 Perspectives in Biology and Medicine, 34, 1 ¦ Autumn 1990 \ 1 also influenced from without: the tenure and temper of time and foremost their applicability, in medicine their usefulness. This confers on the history of science and of medicine a personal and often heroic aspect. It is this human element that links science to art. To illustrate this point, I have chosen examples from several fields of the history ofcardiology: catheterization of the heart, coronary arteriography , echocardiography and Doppler flow studies, cardiac surgery, and cardiac pharmacology. This has also presented the opportunity to relate the work of pioneering cardiologists and scientists to their personalities and to their lives. Cardiac Catheterization THE RIGHT TIME, AND RIGHT PERSONALITIES, A NEW IDEA THAT . SURVIVED: CLAUDE BERNARD AND MAREY Claude Bernard had all the attributes of success. He was a genius at experimentation and he lived during a time that recognized his genius. He commenced catheterization of the heart motivated by a physiological problem. The argument had not been settled at the time whether cellular metabolism (heat production) takes place in the lung, as proposed by Lavoisier, or in the tissue, as suggested by Gustaf Magnus. He investigated the problem of the origin of cellular metabolism by an ingenious approach. If the temperature of blood in the cavities of the left heart exceeds that in the right, heat production must have originated in the lungs. Bernard used simultaneous catheterization of the right and left atria, using a catheter made of lead to give it the right curvature, a forerunner of the preformed catheter of today [I]. By finding that the temperatures in the right and left heart were equal, he could discount Lavoisier's thesis that the lung was the site of cellular metabolism and heat production. Bernard was a master of ingenious solutions that went straight to the heart of the problem; he disliked scientific speculations; as he wrote, "the best philosophical system for the working scientist is not to have any at all." Pierre Marey, a contemporary of Bernard, together with Chaveau, published a paper in 1861 on the graphic determination of the relationship between the apex beat and the movement of the atria and ventricles [2]. At that time there was some disagreement about the origin of the apical beat. While some felt that the impact ofthe heart on the chest wall during systole was responsible, others thought that it was the filling...