A Cardiologist Remembers

A CARDIOLOGIST REMEMBERS DAVID SCHERF* Why Scherf? Others who have contributed more to cardiology might better pre-empt this page than I. But the accident ofassociation with great cardiologists shortly after World War I conveys an obligation to record the essential character oftheir achievements against the background ofthe time. Without this documentation, delightful facets oftheir presence become lost, the full significance oftheir contribution palls, and the assessment ofone's own work is incomplete. I was born and grew up in a modest merchant family in eastern Austria, which was colonized with Germans by EmperorJoseph II. There I went to the gymnasium and remember vividly one day in December, 1916, when, just as the mathematics teacher was writing on the blackboard the formula cos (alpha + beta) = . . . , the school bell rang and cannon firewas heard. Shortly afterward the Russians took the town. The Austrians reoccupied it six weeks later, but when a new Russian offensive threatened my mother took my sister and me on a strenuous trip over the Carpathian mountain passes to Hungary, whence we traveled to Vienna. This was a wise move, because when the Russians again took the town all men between sixteen and sixty who could eventually serve in the army were transported to Siberia. In Vienna I finished the gymnasium and graduated from the medical faculty ofthe university in 1922. "The great possession ofany university is its great names" [1]. Vienna, the proud possessor of Wenckebach, Winterberg, and Rothberger, fulfilled Osier's definition and became in the ten years following World War I a world center of cardiology. The work of these men represented fundamental discoveries which were not only universally accepted but remain undisputed today. Now their names are familiar principally to those interested in the history of cardiology. Only Wenckebach is * Present address: 55 East 86th Street, New York, New York 10028. 615 widely known to the present generation, because a particular disturbance ofthe cardiac rhythm which he discovered is named after him. K. F. Wenckebach, as professor ofmedicine, occupied one ofthe three chairs ofmedicine at the medical school ofthe University ofVienna. The other two professors were Chvostek, an unusually gifted lecturer, and Ortner, known for his work on differential diagnosis ofinternal diseases and for his brilliant description ofabdominal angina. H. Winterberg, an associate of Wenckebach, headed the cardiac ward of his institution, the first medical clinic. CJ. Rothberger was chiefofthe Institute for Experimental Pathology. Wenckebach, who was of Dutch origin, had studied medicine at the University ofUtrecht, where he learned physiology under Engelmann. As a student, he soon discovered that he was color blind, a fact which he mentioned only to his friends and to pupils who were close to him. This defect forced him to abandon his favorite subjects ofembryology and hematology . When, after marriage, economic reasons led him into practice, he cared for inmates ofa home for the aged, who, ofcourse, presented many disturbances ofheart rhythm. One day, while listening to the heart sounds ofan old lady, he heard an irregularity ofthe heart rhythm which fascinated him so much that he listened motionless for about twenty minutes. Because at that time direct auscultation was used with the ear directly on the chest ofthepatients, the oldlady was sure that the good-looking young doctor had fallen asleep on her bosom. The rhythm which he heard reminded him of the frog experiments which he had so often seen in the laboratory ofEngelmann, who had formulated the laws ofcompensatory pauses by stimulating the frog heart with electrical shocks. After registering the radial pulse tracings of this patient, Wenckebach found that the intervals corresponded with those found after extrasystoles in the frog heart. In this manner, in 1899, Wenckebach demonstrated that the intermittent pulse known as an ominous sign for centuries could result from extrasystoles resembling those extra beats known to Marrey in his investigations on the refractory phase. Cushny made the same discovery simultaneously, and several years later, with the aid ofthejugular venous pulse, Mackenzie showed that extrasystoles may arise in both the atria and the ventricles. This discovery led to the realization that extrasystoles were not invariably a sign of serious heart disease and that the "intermittent pulse" may often be seen in the...