Forty years in cardiology.

ELECTION to this lectureship has brought me an honour which I rank highly, in that I am aware of the acknowledged distinction of my predecessors and which laid claim to their appointment to this office. The invitation has also placed upon my shoulders a heavy responsibility, namely to discharge my duty as creditably as they did, and has planted in me a fear lest I fail to do so. I mean, however, to deal faithfully with my subject, attempting to presage what I believe is to be, in the light of what has already been, and within the limits of my own experience. To engage in reminiscence is the prerogative of elders. To recite tales is their just entitlement, for they have tales to tell. This exercise, often wrongly regarded as an expression of garrulity is the cult and very spice of a mature life, for as it recounts the feats of yesterday it places them unashamedly on show to compare them with the claims of our today, and match them with the triumphs that may garland our tomorrow. Cardiology seeped into my blood 40 years ago when I sat at the feet of Sir John Parkinson in the Cardiac Department of the London Hospital, which was the first institute of its kind anywhere to direct its activities exclusively to the study of heart disease. The department had been founded by Parkinson's predecessor, Sir James Mackenzie. To be trained in the right stable gives any horse his best chance in the race he is to run, and I was awarded this good fortune as I graduated in turn to become Parkinson's house physician, registrar, and colleague. Standing at each of these stations I beheld changes in the practice of cardiology which I now mean to recount. FRESH NOMENCLATURE With the march of time it is inevitable that inside any progressive faculty there should be a change of terminology, especially when progress has been profound and swift as in cardiology. In order to understand one another's thoughts we must understand one another's speech. Our conversation needs to be carried out in the same language. Ambiguity in terminology frustrates a true understanding of the subject it purports to portray, and it should not be condoned by any calling which professes to be scientific in its outlook. In my time, many terms have been discarded; most of them deserved this expulsion, but some of them did not, and these have been replaced by less desirous ones. There is need for more weeding, and indeed for more planting, but any change must remain faithful to the principle that the newer version should convey a correct physiological and pathological interpretation. Terms born of conjecture and whims cannot and should not be allowed to survive, for in time they are self-effacing. Before discarding an old term, or accepting a new one, however, there should be good reason for the exercise. Thus, a fashion in terminology should not change just because it is fashionable to change. Certainly, terms should not be cast oneside because they are old, for all that is new is not necessarily virtuous. Neither is it virtuous to