Nature Of The Disorders Of The Heart Beat
( Originally Published 1921 )
EVERY science is advanced by periods of activity, after which a long time may elapse be-fore any great thing is done. It happened that, in the advancement of the knowledge of heart disease, about ten years ago a renaissance began and continued actively until the 'World War temporarily put an end to investigation. The great change that took place then in the study of the heart was that people began for the first time to realise the nature of the disorders of the heart beat. For many years it has been the custom, for a person who complained of his heart, to ask if he had organic heart disease or if his trouble was functional. The organic heart disease was supposed to be serious, and the functional disease was .regarded lightly. In the last ten years +we have learned the great relative importance of the functional disorders. When functional disorders are overcome and the action of the heart is like that of the average healthy person, a patient may live comfortably in spite of organic trouble that formerly caused much worry.
In the history of medicine there have been many wise men who have known very much about the heart. Among these there arose, about thirty years ago, a man who was wiser than the rest, because he realised what he did not know. He realized that all the popular explanations of palpitation of the heart, or great slowness, or great irregularity, were not satisfactory, and he made it his life work to find the true explanation of these divergences from normal.
First he decided that what was needed was a definite record of how the heart was really misbehaving. To this end he made use of an almost forgotten discovery, namely, that the beat of the auricle of the heart caused small waves to travel up the jugular vein into the neck, while the activity of the ventricle, or great bulk of the heart, caused waves throughout the body, creating the pulse as usually observed. The auricles are that portion which originates the heart beat and are at the top of the heart.
There was no good instrument in existence for these observations, so Dr. (now Sir) James Mackenzie 1 invented one, and had it made by his village watchmaker. By means of this instrument, Dr. Mackensie, as the basis of his future study, made many thousands of these tracings, showing exactly what was happening while the hearts of people were beating from day to day. His work was noised abroad in the place where he lived, and nearly all the people of that country who had irregularity of the heart submitted to these examinations and furnished these records. After he had obtained many hundreds of these records, he began to classify them according to what they showed, and he divided them into certain groups. He said, wisely, "I am not able to interpret these things, but these records are permanent, and some one may be able to do so in the future." However, he was too modest, for no one ever interpreted them better than he did.
This work constituted the beginning of modem cardiology, and became known to the world about twelve years ago, when Dr. Mackenzie published his great work on the heart. Since then many workers in all parts of the world have taken up the subject, and wonderful new instruments have been invented.
It was discovered that each muscle of the heart, as it contracted, generated electricity, and by passing these currents through a moving film machine, a photograph of the heart beat could be made. I have such an instrument in daily use, and will tell about it in another part of the book.
There is nothing more inspiring than the work of a great scientist who is at the same time a great physician. His methods are simple. First he accumulates facts, discards everything that is untrue pertaining to these facts, and retains everything that is proved to be correct; then he projects his imagination to form theories to explain what he has discovered, tests these theories, and discards most of them as untrue, until finally he is rewarded by some really great discovery.
The birth of modern knowledge of the heart is one of the splendid and important examples of true scientific work in the past hundred years; yet it has been done so quietly that few people in the world at large know about it, and the medical profession itself has not yet entirely realised its importance.