The roots of modern British cardiology.

The nineteenth century abounds with the names of individual British physicians expert in cardiac disease who wrote of its pathology, diagnosis, and management. As a group, however, they were not cardiologists as we would understand the term today; nor could they have been, when the new techniques available at the start ofthat century-percussion and auscultation-were just being added to the conventional methods-taking the history, inspection, and palpation. British interest in auscultation was immediate. Sir James Clark, who later attended John Keats the poet, acquired a stethoscope in Paris in 1818' and introduced Sir John Forbes to its use. Forbes translated (and modified) Laennec's book.2 While he was still a student, William Stokes of Dublin wrote the first British book on the use of the stethoscope.3 By 1819, stethoscopes were on sale in London,' being mainly used in diseases of the chest. And yet, as the century ended, cardiology was taking on the forms of a subspecialty of general medicine, not yet crystallised but in retrospect already evident. These physicians would not have labelled themselves as heart specialists, and often combined their interest in the heart with an interest in respiratory medicine and indeed even wider activities. Most of the consultant members on the staff of the original National Hospital for the Diseases of the Heart held appointments elsewhere that covered many other aspects of medicine.4 What then might have determined how cardiology developed? This can only be assessed in retrospect by identifying landmarks now known to have been important in leading to new methods ofdiagnosis and treatment. Similar events occurred in parallel in other European countries as well as the United States. It is important to put matters into the perspective ofthe times. The events just mentioned occurred less