Saturday, June 13, 2009

Lets begin our voyage with History of Pediatric Cardiology from now on:

What do you think of the earliest reference to the heart? Many have told me about Leonardo da Vinci, few mentioned “Greek physicians”; few had the idea of Egyptians, not to forget our own Charaka and Sushrutha.

The answer lies in the prehistoric times, which probably did not even have a word for Heart!!

About 30,000 years ago even the primitive man was aware of existence of heart, at least in animals. Abbe` Breuil, who is considered as the father of the study of prehistoric art, discovered something fascinating to all of us in AD 1908. The prehistoric figure was sketched in red chalk inside a mammoth (prehistoric animal, larger than the present day African elephant) drawn by Aurignacian man (someone who had firmish jaws) in the cave of a place called Pindal in Northern Spain. It was a 16.75 x 17.5 inch drawing, which had "A broad, almost heart-shaped spot, placed in the middle of the body". Breuil first believed this to indicate the flap of the ear, but the crimson hue was not corroborating. Breuil later described this filling as "A broad red spot covers the place where the heart should be situated". Assumed to be a depiction of the site of the heart located within this huge animal, which the hunter had to aim for. Otherwise probably, it was impossible to hunt for the sheer size and raw power. The Aurignacian drawings also indicate primitive man's knowledge of the vital role of this central organ in sustaining life of the giant animal.

(Ref: Pollak K, Ashworth Underwood E. The healers. The Doctor, then and now. London; Nelson: 1968)

Even if we set aside the hypothesis of prehistoric art, the heart dates back to the origin of great civilizations.

Around the year 700 BC, the Assyrian King Asshurbanipal assembled clay tablets, which were believed to have been passed down from Babylon from the Royal Library of Nineveh. These tablets, which are said to date back to 4000 BC, can be considered as the earliest written records of congenital malformations. This included a list of sixty-two human malformations with their associated prophetic implications. For example, Ectopia cordis, which was included in this list, comes with a description, “when a woman gives birth to an infant ... that has the heart open and that has no skin over it, the country will suffer from calamities”.

(Ref: Brodsky I. Congenital abnormalities, teratology and embryology: Some evidence of primitive man’s knowledge as expressed in art and lore in Oceania. Med. J. Australia 1943;1:417)

The Greeks were to provide further history. Largely because their records are well kept while that of others perished with time.

Aristotle (384-322 BC) ascribed the power of thought to the heart, which he contended also contained the soul. He also is credited with the earliest observations of normal cardiovascular function by describing the fetal pulsations in a chick embryo.

We shall see the development of written account of heart in the next post.

On the personal note, our team had a good week. There was some time to relax at last! Dr Karunakar presented a boy who had all the four valves of the heart involved by Rheumatic disease. Involvement of pulmonary valve is considered as “never possible” in western literature, but often described by Indian physicians and journals. Any inputs?

We had our “Publication meet” with our boss! As usual, few tittered, few were cajoled and few escaped! Kudos to Dr Sunita, who consistently peps us up to do something creative. I can imagine our efforts if she were not push us at all!

Please send in your inputs, especially for the history. Also, if anyone has any data on the knowledge of ancient Indians on heart, please pass on the note and reference to me. After all, Indology is hot nowadays!

We have one more follower, but this time it is a person out of our NH team. Please welcome, Prashanth Mishra. I dont seem to recall any friend by that name. Can you please identify yourself, Sir? Please send me an email if you find it difficult to use comments tool of blog.

Regards

Kiran

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