PRELUDES AND PROGRESS Cardiology in 1885

IT IS IMPOSSIBLE to ignore the dramatic develop-ments that have occurred in the diagnosis and treat-ment of heart disease in recent years. ' Borrowing heav-ily from the physical sciences, new diagnostic instruments have been invented that allow earlier and more precise identification of cardiac disease. Pharma-cologic therapy of angina pectoris, dormant for nearly a century after the discovery that nitrates were effec-tive in relieving this distressing symptom, has blos-somed recently with the introduction of /3-blockers, calcium antagonists, and long-acting nitroglycerin preparations. Surgical approaches to many forms of congenital and acquired heart disease have been devel-oped. Julius Comroe asked, "How many patients who have undergone open heart surgery know of the tre-mendous efforts of many scientists through the years that provided the basic and practical knowledge which was essential for their successful operation?"2 Indeed, how many physicians appreciate the enormous amount of multidisciplinary basic and clinical research neces-sary for the development of the present state of cardi-ology and cardiac surgery? Many of our senior col-leagues remember the practice of cardiology before cardiac catheterization, echocardiography, or nuclear cardiology, and before there was "CPR " or coronary care units. I will describe the practice of cardiology a century ago to emphasize the dramatic advances in this field that have occurred as a result of millions of hours of observation and experiment by countless physicians and basic and clinical scientists. The medical context. The average life expectancy for Americans born in 1885 was about 45 years, and infec-tions were the leading cause of morbidity and mortal-ity. Tuberculosis was responsible for the greatest num-ber of deaths, but other communicable diseases too