It brings a unique sense of greatness and gratitude to hear the voice of the father of Interventional cardiology decades after his demise.
Almost 4 decades ago, Andreas Gruentzig described "the ideal catheter" to me. He foresaw the development of FFR, hi-pressure balloons, aspiration catheters, stents, & more. His thoughts on physiologic measurement both during & post-procedure are thought-provoking. #AngioHistorypic.twitter.com/AiBKU6Tjxp
The invention he made has evolved so much. Though, Dr. Gruentzig didn’t live to see any of them, the genius in him predicted most of them. This Interview was recorded a year before his small plane, which he loved next only to his pet balloons, crashed on the Atlantic coast along with his wife. That is history.
This is how the news was reported across US media on October 29th, 1985. (Reconstructed, click over the pic for high resolution)
It was a fact, that he defied the warning and flew in the adverse weather, what many of us were unaware of was, that he wanted to rush to Emory, only to see a patient whom he had done a PTCA, a few days earlier, developed some complication. This makes his death all the more poignant (Ref Dr. H.V. Anderson )
1908, Going back on the time machine, more than 100 years ago, world war I was all set to begin, and the great Titanic was being built in the Belfast shipyard. A parallel histroy is being created in cardiology.
This is a brief story of Dr. James Mackenzie, a general practitioner from a remote Scottish village who ended up with the title of the father of British cardiology. Dr. Harvey might have invented circulation, but it was Mackenzie who taught the science of arterial pulse and wrote a classic on the topic to the new medical world. He was able to decode the secrets of the jugular venous pulse as well and diagnosed various arrhythmias including atrial fibrillation at the bedside. He used the polygraph to record his vast observations in pulse and JVP waveforms which were popularised later by Dr. Paulwood. ECG was just beginning to enter the scene in the 1920s. This makes his work all the more significant, as his treatise on pulse and JVP were based purely on clinical acumen.
Sir James Mackenzie, 1853-1925
Apart from his stupendously successful academic life, it was through his death, that he sent out an extraordinary message to the scientific community. His deep desire to know the truths about coronary atherosclerosis was astonishing. Since he himself was suffering from angina and possibly Infarct, he became his own subject of study. He became case number 28 in his own book on cardiology. When he was on his death bed, as a last wish he Insisted his colleagues do a learning post-mortem and keep his heart in the same hospital he worked. When he died in the early morning of January 25th, 1925, as per his wish, his students Dr. Parkinson,(WPW fame) and another pioneer Dr.Thomas Lewis did an autopsy on his heart.
It is tragic to know about the final days of Dr. Mackenzie’s life and how their beloved students performed the postmortem on their teacher and later published their findings in the British Heart Journal. (BHJ link )It is one of the poignant moments ever recorded in the history of cardiology, a doctor wishing to teach cardiology lessons to the generation next with his dead heart.No surprise, he is being conferred the title of father of British cardiology.
Final message
How could an unassuming GP practicing in a remote rural place reach the pinnacle of scientific glory?
Yes, it is possible. Today’s young (super) specialists must realize, that true scientific minds don’t require exotic research labs, tools, or conflict-ridded funds from Industry for the growth of science. All we require is a passion to teach, and the curiosity to learn. The rest of the things will follow… I think that was the message in the great life of Sir James Mackenzie.
Few individual’s works mattered more than others in the field of cardiology. Here was a man born 1914 in Utah, studied at Rush university trained in Mayo, settled in Seattle as a pediatrician. But his passion drove him to become a specialist cardiac physiologist with an urge to find the answers to all those lingering queries that arise as a practicing clinical cardiologist. He built an exclusive animal lab to study the mechanics and physics of circulation and cardiac pumps in the 1950s
1914-2001
He can be called the new age, Harvey of the 20th century. He seemed to always bother, how is it that the 6 liters of blood traverse from heart to the periphery and comes back going through vast lengthy circulation with variable pressure and little energy loss.? He also made the very pertinent discovery in neural control, the effect of gravity on circulation. His interest in how venous return would have to match cardiac output was phenomenal.
His grasp of cardiovascular physiologic concepts was so powerful and his book on cardiovascular dynamics was so popular. probably the first scientific textbook on circulation. I am sure he had shaped the thought process of so many physicians (I will vouch for myself) and helped create hundreds of cardiologists all over the globe. Dr.Rushmer also did pioneering work on diagnostic ultrasound and doppler. I can recall a video on cardiac embryology edited by him in the 1960s in pre-computer era that probably can not be beaten even today in terms of clarity of content and production value.
Through his thoughts like an engineer and mathematician still, he was able to blend the knowledge together and pass it on to the generation next clinician. No wonder, he was the founder and headed the department of biomedical engineering in the UW. The University of Washington holds an annual Rushmer lecture.
If one person deserves an award for excellence in cardiovascular science for the 20th century, Dr.Rushmer’s name should definitely, come on top. Though he won several accolades, I feel scientific societies have missed an opportunity to felicitate him with the more worthy award. If the Noble prize in medicine is given for a lifetime contribution to cardiovascular physiology wonder why he can’t be considered for it posthumously.
It is heartening to note, at the fag end of his career he moved from core science to philosophical and ethical truths of science and technology. He once said, “We’re confronted with the ethical, political, and technological consequences of our medical triumphs. We have to learn quickly how to deal with these profound problems by looking ahead to recognize and avoid complications of our technical breakthroughs’ How true his observation has turned out to be!
History is rarely kind to the original heroes in the scientific world.The classical Blalock-Taussig shunt,(BT shunt) the term we heard for the first time in the early clinical years of MBBS .We know, it as a dramatic surgery (Palliative though) connecting subclavian artery to the pulmonary artery for the commonest congenital cyanotic heart disease -Tetralogy of Fallot.
Now, half a century later, came to know, there is a gripping story of an oppressed black hero behind this famous cardiac surgery. This post is all about the fascinating life of Vivien Thomas, a humble carpenter’s son from Nashville. While he dreamed to become a doctor, circumstances and fate had some thing different to offer .He could join only as helper in the wards of John Hopkins, Baltimore . His extraordinary hand skills were recognised by then surgeon Alfred Blalock and made him as an assistant in the Hopkins animal lab.He was working on a project to resuscitate traumatic shock victims then. Dr Helen Taussig who was a pediatric cardiologist was wondering whether Dr Blalock could offer some surgical cure for the sick blue babies under her care.
When Dr Blalock was brainstorming the problem , it was Thomas ,who created dog models of hypoxic circulation and helped create the concept and methodology of diverting blood from subclavian artery to pulmonary artery .He single handedly operated on nearly 200 dogs. He literally taught the chief surgeon Blalock the delicate vascular suture tricks .
Come October 24th 1944 , the first blue baby was operated , with Blalock Insisting Thomas to stand beside. History was created -first heart surgery in USA. Which later on became the most famous concept that gave a fresh lease of life to thousands of children with TOF.
It’s painfully emotional to watch the Vivien Thomas standing right behind Dr Blalock,guiding his boss anxiously,with his hands tied just because he is not a qualified doctor. The others in the team included Dr Denton Cooley and Helen Taussig.
No surprise, when this famous work was reported in the media, the entire cardiology community rejoiced as the news broke out over the globe .It was published in JAMA in 1945 (Blalock1945.pdf ) . Did you guess it , yes, the name Thomas was not to be found anywhere though. How can you expect it ? , after all , he is a black lab supervisor working with dogs !
Thomas’ , work was never recognized for the next 30 years until a grand occasion (Lord made?) that happened in the Baltimore in 1971. His dream of becoming doctor became a moment of truth. Baltimore school,of medicine finally recognised his work and conferred a honorary doctor . Unfortunately Dr Blalock was no more by then to attend to his famous pupil. Its 2020 , 80 years after the monumental surgery , the BT shunt has since been renamed as Blalock, Thomas ,Taussig shunt . A new exclusivecenter for congenital heart surgery in Baltimore has come up in their name. What a great end to this black man’s journey in troubled racial times.
Thanks to Hollywood minds who thought this story deserved to be made as movie. “Something Lord made” directed by Joseph Sargent. It was a gripping scientific roller coaster .No surprise it got so many awards including three Emmys.
Every physician,especially the cardiologists should watch this movie. I can vouch, the one and a half hours you are going to spend will enrich professionally and Intellectually. Lucky to find this movie free on you tube.
Great men dream , but they just do not sit idle. They do what they are passionate about .History just follows them or they create it.Here is a brief story of an ordinary man born in a small European country Lithuania in 1921 ,lived much of his life in the east coast of USA ,transformed into a brilliant cardiologist based in Brigham Hospital , Boston.
He is Dr Bernard Lown , best known as a founder of what is used in every coronary care unit and cardiac surgical theaters around the world . Yes, the DC cardioversion was invented by Lown in the year 1961.(Of course, it was an Improvement upon the pioneering work of Zoll’s AC power line for defibrillating the heart which was impractical and caused much injury )
Dr.Bernard Lown (Born 1921) ,With his Invention of DC Cardioversion machine Currently working in Harvard University
He was also the brain behind the conversion of local anesthetic agent Lignocaine to cardiac anesthetic which revolutionized the treatment of ventricular arrhythmia.(What a simple but a path breaking idea to use membrane stabilising action of local anesthesia to sedate the heart when it behaves erratically !)
We can also credit him for rediscovering Digoxin and found the secret that potassium supplementation can largely overcome toxicity of this drug which was otherwise lifesaving in dilated , failing hearts running amok with delirium tremors (Surname for Atrial fibillation in those days !)
While the Invention of DC cardioversion had a dramatic impact all over world , he simultaneously popularized the concept of coronary care units along with Julian in London and Dr Day in Kansas city.
Its said great men’s mind are perennially restless.Accordingly ,he was worried about the impending nuclear war with USSR and other global powers then. He collaborated with Russian cardiologist Dr. Eugene Chazov. It became a hugely popular peace organisation International Physicians for the Prevention of Nuclear War (IPPN) for which he got ultimately the Noble prize for in 1985.
During one of his Noble lectures (Linked to video)
It turned out to be “lovely Irony” for a man who probably should have got a Nobel prize for medicine for inventing DC cardioversion , ended up with Nobel peace prize for his fight against a man made disease called “Nuclear proliferation”.
Its heartening to note he has visited my country(India) and was awarded with Mahatma Gandhi peace prize as well.He is now 95, active in Harvard currently turned his vision towards eradicating Inappropriate medical treatment from the noble profession .I wonder , for a man who fought against a nuclear war, what does this new Initiative mean ? Does he equate the medical profession in its current form and the direction in which travels to something that’s grossly unacceptable ?
Whatever it is , I humbly endorse his views and has since dragged me to his Institute.
I just joined the institute and signed a declaration . I wish every physician who take oath on Hippocrates should strengthen Dr Lown’s Doctrine .
The field of cardiology has seen great men over the centuries. Few women have permanently stamped their presence in that history .Jane Somerville can be termed mother of pediatric cardiology along with Maude Abbott She has a fascinating life history , having worked in Royal Brompton , Imperial and Guys London.She was mentored by pioneers like Paul wood , Blalock and others .She is primarily interested in the pediatric cardiology especially congenital heart surgeries .The classification of pulmonary atresia with VSD goes with her name.
Dr. Jane Somerville : British cardiologist , (b-1933 )
She carries the credit of starting the Pediatric cardiology world congress in 1990 ,is the founder of GUCH (Grown up children with congenital heart disease.) .
Here is a rare interview from he to Dr Robert Califf for Heart.org. For those,who like to have a glimpse of cardiology in its vintage times , don’t miss it.Dr Jane addresses the past treasures , explores specific issues of facing pediatric cardiology and frank expression about the issues of women being a cardiologist in a man’s world.
She has a foundation in her name that helps the children and adults with congenital heart disease.
William I am Harvey first discovered human circulatory system in the year 1628 .Published his work in “De Motu Cordis” (otherwise known as “On the Motion of the Heart and Blood”) as a 72 page booklet in Frankfurt book fair. The world of medicine changed forever , and new system of human circulation was born.
Read this now
Excerpts from Chinese classic of Internal medicine , written 2000 years before William Harvey,
All the blood is under the jurisdiction of the heart .Twelve blood vessels are deeply hidden between the muscles and cannot be seen.Only on the outer ankles are visible because there is nothing to cover. All other blood vessels that are on the surface are veins. The harmful effects of wind and rain enter the system first through the skin , being conveyed to the capillaries. When these are full , the blood goes in and turn empty into the big vessels .The blood current flows continuously in a circle and never stops
Post-amble
Of course , this in no way takes credit away from any body .William Harvey collected every data on circulation available at that time , and came with that classic De Moutu Cordis , the importance of which is undisputed. But ,history time and again tell usthere are silent restless brains pondering over important concepts all over the globe .Whoever has the access to scientific facility , proves the same point , publishes first and gets attention . After all thoughts are never rewarded in human domain ! (God , does it I guess !)
Reference
1.Hume E.H Medicine in china ,old and new,American medical history 1930; 2;272-280
In the early 20th century , Waller invented the ECG machine. Wilson created leads and methods to record it. Eienthoven formulated the concepts the electrical theory behind ECG.
Between 1940-197os one man ruled supreme in the world of electro cardiography . He is Dr Sodi pallares from Mexico. His deep insights revolutionised and helped us understand how the cardiac electricity is generated and propagated in various pathological states that is the beginning new age electrocardiography! It adds much to his credit , as in those days scientists from non American and European countries were hard to come in the global limelight.
Some of his thought processes and Inventions
He laid the foundation for deductive electrocardiography.
Applied vectorocardiographic principles to scalar ECG and helped understand mechanism of ventricular chamber enlargements
He was instrumental to analyse the genesis of current from the myocardium . He tried to reason out the contribution of cell metabolism, hypoxia, electrolytes to the current genesis.
Polarising myocardium with GIK infusion STEMI was proposed by him
Finally he tried to incorporate the laws of thermodynamics into electrocardiography .
Please remember , Sodi pallare’s conscience is still largely unexplored .There are lots of hidden truths .We now know fever can influence qrs voltage and febrile illness can trigger ventricular tachycardia as in of Brugada syndromes.
Today’s youngsters can take a few cues from this great man and enlighten the field of electro-cardiology
Demetrio Sodi Pallares (1913-2003 )
If modern-day cardiologist is able to interpret the ECG by a cursory 3 second scan of strip of waves , we are greatly indebted to the knowledge imbibed by this great man from Mexico !
Sodi-Pallares D,Medrano GA, Bisteni A, Ponce de Leon J:
Deductive and Poly-paramerric Elecrocardiography.Instituton acionalde
Cardiologia de Mexico, Mexico,DF1970,VII,VIII
Sodi-Pallares D, Testelli MR, Fishleder BL, Bisteni A, Medrano GA, Friendland C, De Micheli A. Effects of an intravenous infusion of a potassium-glucose-insulin solution on the electrocardiographic signs of myocardial infarction: a preliminary clinical report. Am J Cardiol. 1962;9:166–181
This man enters your cath lab every morning ! . . . He is Mr Stent !
“
Endo-prothe`ses coronariennes autoexpansives.”
“Endo-prothe`ses coronariennes autoexpansives.” This is the official name given to coronary stents when it was first used in man in 1986 in France . The first stent in human coronary artery was implanted by Puel . Followed by Sigwart ,Puel combine .
Later on , the name Stent came into vogue . Surprisingly stent is not a technical name . It is a name of British dentist. To know more about the historical aspects of coronary stents read the following review from Circulation.
1 .Puel J, Joffre F, Rousseau H; et al. Endo-protheses coronariennes auto-expansives dans le prevention des restenoses apres angioplastie transluminale, Arch Mal Coeur 8 1987 1311-131
2. Sigwart U, Puel J, Mirkovitch V, Joffre F, Kappenberger L. Intravascular stents to prevent occlusion and restenosis after
transluminal angioplasty. N Engl J Med. 1987; 316: 701-706.
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Dr.S.Venkatesan MD 