The History of Coronary Heart Disease

The cardiologist tends to envisage the history of coronary heart disease in terms of anatomy, physiology, pathology and clinical features, whereas the historian approaches it chronologically as Dr. Leibowitz has done, but by passing backwards and forwards in time in the text, he has succeeded in presenting a pleasantly readable account of the growth of our knowledge of arterial disease, angina pectoris and cardiac infarction. Until Harvey described the third and separate coronary circulation (1649), and recognized the nutritive function of the arteries as opposed to veins, no conception of coronary disease was possible, and until Heberden identified angina pectoris over a century later, there was no reason to suspect its symptoms. Nevertheless, coronary disease existed before their time and the author takes a panoramic sweep through the medical texts of antiquity in search of symptoms suggestive of cardiac pain and heart disease. Starting in Pharaonic times, he passes to Hippocrates, Galen and the middle ages, seeking to build up some picture of heart disease in antiquity. One difficulty encountered was the meaning of the term Morbus Cardiacus applied both to cardiac and gastric symptoms, and this diagnostic difficulty has persisted until quite recent times when Huchard described a pseudo-gastralgic form of angina pectoris, and even in my time cases of acute cardiac infarction were often admitted to surgical wards as acute abdominal emergencies. In the earliest treatises on heart disease appearing in the seventeenth century, palpitation and syncope or lipothymia were the recognized symptoms and sudden death was vaguely associated with cardialgia. Dr. Leibowitz's painstaking search of the primary sources of medical knowledge, however speculative some of his conclusions must be, makes a valuable contribution to cardiological history. Historians, we are told, have been puzzled by the belated recognition of cardiac infarction, yet the reasons are not far to seek. Pathologists were at fault in not distinguishing acute infarction from fatty degeneration and softening, until Ziegler and others recognized myomalacia cordis at the end of the nineteenth century. Though angina pectoris was quickly linked with ossified coronary arteries by Jenner and Parry, rival theories soon started a controversy which lasted for 150 years and the author underestimates the strong opposition to the coronary theory which held up progress. The neuralgic or neuritic theory supported by Jurine, Desportes and later by Laennec, Bouillaud, Peter and Von Dusch on the continent soon spread to this country where Sir John Forbes regarded …