When one of my principal mentors, Lewis Dexter, retired, he passed on to a number of his closest colleagues, medical texts that he had acquired during his long and illustrious career. I was delighted when Dr Dexter (I never could get used to calling him Lew, even when I became a professor myself!) gave me a number of classic texts written during the early and mid 1900s. Among these texts was the second edition of Paul Wood’s important textbook, Diseases of the Heart and Circulation. This text was one of the bibles of cardiology during the 1950s and 1960s, alongside Charles Friedberg’s text, Diseases of the Heart. Most cardiologists today have never heard of either Paul Wood or Charles Friedberg, despite the fact that these 2 physicians were among the giants of cardiology in the mid 20th century.
Wood was an Australian who went to medical school in Melbourne but eventually landed a position in the London Heart Hospital, where his talent was recognized. He eventually worked for much of his career at the distinguished Hammersmith Hospital, and it was there that he wrote his famous book in 1950, with subsequent revised editions in 1952 and 1956. He was a superb bedside teacher described by colleagues as a showman with a commanding personality that could be caustic, sarcastic, and combative at different times. Unfortunately, he was a heavy smoker, which undoubtedly led to his premature death at age 54 years from an acute myocardial infarction. When I was in training at the Peter Bent Brigham Hospital in the 1970s, there were a number of senior cardiologists on the staff who had spent time rounding at the Hammersmith with Wood. They all agreed that he was a remarkable clinician, teacher, and scholar. Charles Friedberg was Wood’s American counterpart who had a long and distinguished career at New York’s Mount Sinai Hospital.
What was particularly unique about these 2 books and their authors was that they were written entirely by Woods and Friedberg alone. This is remarkable and very different from today’s texts in which most of the chapters are written by a large number of experts in the field, with multiple editors responsible for different sections of the book. During my academic career I have personally participated in the writing and editing of a number of textbooks alongside a long list of colleagues. To think that one individual could write an entire book encompassing such a vast quantity of material is almost unthinkable today given the “hyperspecialization” of all branches of medicine together with the logarithmic growth in the medical literature during the last 50 years.
When I have a few moments of free time during my usually hectic workday, I enjoy perusing Wood’s and Friedberg’s texts to see what was known about a particular cardiac topic more than 50 years ago. I have observed that the detailed sections on history and physical examination could be profitably studied by a medical student or resident today. This is, of course, not true about material on specific cardiac conditions. For example, Paul Wood suggests that patients suffering from angina pectoris should limit cigarette smoking to “10 to 15 per day.” He suggests that cigarette smoking be given up entirely if it precipitates attacks of angina! With respect to therapy for acute myocardial infarction, Wood suggests 3 to 6 weeks or longer of bed rest according to the severity of the illness. Patients should be semi-starved for the first few days after the onset of the infarction. The most beneficial drug to be given is morphine, particularly when given intravenously to relieve pain and “distress.” Anticoagulation with heparin and warfarin is also discussed and recommended, but not for milder cases. Wood also states that supplemental inspiratory oxygen is not used routinely in Britain.
Wood’s recommendations seem quaint in light of the current approach to patients with acute myocardial infarction who are often discharged within 2 to 3 days after the onset of an ST-segment elevation myocardial infarction following successful reperfusion of the occluded coronary artery in the catheterization laboratory. Of course, today’s remarkable successes with patients suffering from acute myocardial infarction are the result of decades of groundbreaking basic science and clinical investigation that has occurred since Paul Wood’s death. During my long career as a cardiologist, I have been privileged to witness these developments and the clinical successes that have resulted from them. Yes, the history of the management of acute myocardial infarction and the breakthrough therapy for human immunodeficiency virus, are, in my opinion, 2 of the greatest stories of biomedical success during the last 50 years. My library of classic texts contains almost exclusively cardiology books. However, I am sure that experienced specialists in other areas could recount histories about their fields that are similar to what I have written about here.
I often wonder what will be the most dramatically successful therapy or therapies that will be developed over the next 50 years.
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-Joseph S. Alpert, MD (Editor in Chief, The American Journal of Medicine)
This article originally appeared in the June 2016 issue of The American Journal of Medicine.
