Friday, June 19, 2009

Lets continue our voyage with History of Pediatric Cardiology.

In the last post we saw some fantastic facts. Lets see few more now.

Herophilus of Chalcedon (BC 280)

One of the most famous Roman authors of an encyclopedic natural history, Pliny, considers Herophilus of Chalcedon as “the first physician who searched into the causes of disease". The diagnostic value of the pulse, which is relevant even today, was the most important contribution of Herophilus' to clinical medicine. He lived in a period when measurement of time depended on movement of Sun and Moon/planets. Precision time measurement could be in hours, forget minutes and seconds.
Herophilus used his innovation to count pulse, using the water clock. He made subtle analyses of pulse rate and rhythm. As per the norms of time, a gentleman had to attach music for almost everything! Herophilus was no different. Aristoxenus of Tarentum, who was famed for his musical theories of the period, had his influence on Herophilus to build the famous rhythmical pulse lore that continued in medicine until late 19th century.
Herophilus described the pulse as not just an innate faculty of the arteries, but that it also derived from the heart itself, a concept that is groundbreaking in present standards. He was not the one to just count the pulse and feel the rhythm, but he also linked them to palpitations, tremors and spasms, which are indeed muscular in origin. Unfortunately, for the rest of the world, this pulse doctrine was based on too much musical tenants. It got sequentially more complicated for each subsequent generation, that only a skilled musician could possibly understand it in later centuries! The theory failed to gain ground, thanks to its complexity and failure of the future “Gentlemen” to bank on as much music as their predecessors!

Erasistratos of Iulis (BC 250)

Erasistratos of Iulis was another celebrated figure of his times. He elaborated the view of the pneuma. This theory said that the inspired air passed to the left side of the heart and to the arteries of the body to cause the heartbeat. The theory explained the absence of any fluids in arteries postmortem. This erroneous view was maintained for almost four centuries, with each generation cutting open the arteries of dead animals to show the emptiness and praise Erasistratos for this!

(Ref: Osler W. The evolution of modern medicine. Yale; Yale University Press:1921)

Claudius Galenus (AD 129-201)

It took almost 400 years for Erasistratos to get disproved. Claudius Galenus (popularly known as Galen), who was considered as the “Genius of the era” used several experiments to prove that the arteries carried blood and not air.
Galen studied the actions of the heart, its valves and the pulse. He noted the structural differences between arteries and veins, wondered why they were different, but fell short to realise that blood circulated. He hypothesized that blood was produced by liver and sent to the periphery of the body to form flesh. He not only noticed, but also attempted to explain the function of the arterial duct and the foramen ovale, probably for the first time in human history. Galen strongly believed in the relationship between food, blood and air. He was so prolific and accurate for his times, that medical and church authorities considered Galen’s work could not happen without divine inspiration, thereby calling him Divinus Galenus. Galen’s extraordinary brilliance provided more recognition to Divinity, but his hypotheses got sustained for ages, as the church solidly backed him up and bashed anyone who dared question him, for almost 13 centuries after his death!

(Ref: Osler W. The evolution of modern medicine. Yale; Yale University Press:1921 and Thiene G. The discovery of cirulation and the origin of modern medicine during the Italian Renaissance.Cardiol Young 1996;6:109-119)

We shall see how the knowledge of these brilliant Greeks led to further unfolding of secrets of heart in next post.

On the personal note, Dr Sunita and yours sincerely had a publication in the current issue of Annals in Pediatric Cardiology. The article is an invited one under “Point of view” and titled, “Cardiac Care for the Economically Challenged: What are the options?” It is freely available from For anyone interested, please see issue 1, Volume 2, 2009, page 91-94.

The wonderful surgical team of our institute did very well this week. They not only saved a couple of infracardiac obstructed TAPVCs by urgent surgeries, they also did a stage one Norwood for HLHS newborn successfully. None of them had enough finances to cover their surgical expenses, but it did not come in the way of surgery. Bravo!

How common is Ebstein’s anomaly of Tricuspid valve with bicuspid aortic valve and coarctation of aorta in the same child? We came across one this week. I shall map progress of this next time.

Please send in your inputs. Let me hear something about the history if any particular aspect is to be dealt with.



1 comment:

  1. Dr Sunita MaheshwariAugust 6, 2009 at 7:52 AM

    After much laughter and discussion on the 'blog' I am finally following it! Great stuff and have now marked it as my opening page on internet explorer!!