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Landmarks In Cardiac Surgery, by Cecil Bosher, Stephen Westaby
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This text, published in the profession's centenary year, traces the history of cardiac surgery from ancient times to the present, detailing clinical developments with facsimilies of the original articles, consent forms from the first heart transplant, newspaper articles, and correspondence. The text follows a set pattern, describing the historical background to each new procedure, facsimilies of the original articles, bibliography of the main clinicians, and a commentary putting each development into its historical context.
- Sales Rank: #2069887 in Books
- Published on: 1998-02-01
- Original language: English
- Number of items: 1
- Dimensions: 11.25" h x 9.00" w x 1.75" l, 5.85 pounds
- Binding: Hardcover
- 712 pages
From The New England Journal of Medicine
The development of extracorporeal circulation and the ability to perform surgery on the human heart is one of the greatest achievements of medical science in the 20th century. The extraordinary efforts related to the development of these highest forms of technology that we now enjoy are detailed in this book about the history of cardiac surgery by one of the leading cardiac surgeons in the United Kingdom. The book is interesting, and its approach differs somewhat from the usual historical treatments of medical topics. The method of presentation is personal and in many instances constitutes a behind-the-scenes approach filled with inside information and material conveyed in a somewhat spicy and controversial atmosphere, such as the description of the acrimonious details of the artificial heart saga that took place in Houston in 1968.
The book is unusual in its editorial organization. The first half consists of eight chapters that deal with separate aspects of the history of cardiac surgery. The first is an overview, beginning with the emergence of the idea of actually operating on the human heart and bringing us to the present, highly developed state of technology. The wonderment and forbidden nature of the heart throughout the ages are beautifully catalogued. Subsequent chapters describe the history of valve surgery, coronary bypass surgery, cardiac transplantation, mechanical circulatory support, surgery for thoracic aortic disease, and surgical treatment of congenital heart disease. The author pays a bit more attention to the areas he is interested in, and thus, less information is provided on valve surgery, particularly aortic-valve surgery, but a great deal of information is provided on mechanical circulatory support, an area in which the author is an acknowledged expert.
The second half of the book contains facsimiles of seminal articles on cardiac surgery, such as the report of the first valve operation by Cutler and Levine in 1923 at Peter Bent Brigham Hospital in Boston, and biographies of a select group of pioneers in cardiac surgery. Thus, half the book is text, and half consists of reproduced articles and biographies. There are also biographies in the text half of the book of other physicians who were instrumental in the development of specific areas of cardiac surgery.
The book is slanted toward the author's experience with physicians whom he has worked with and obviously admires, including John Kirklin, Denton Cooley, and Russell Brock, all of whom have had long and illustrious careers in cardiac surgery. But by and large, Westaby does incorporate most of the essential aspects of the history of cardiac surgery in the 300 pages of text.
It is a readable book, nicely organized and packaged. There are some errors in pagination in the table of contents and the subject and name indexes are incomplete. This entertaining book is a personal history of cardiac surgery. It offers a reasonably accurate, colorful account of one of the greatest advances in health care technology in the 20th century.
Reviewed by Lawrence H. Cohn, M.D.
Copyright � 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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0 of 0 people found the following review helpful.
A very useful encyclopedic collection of history
By George Lewis Mikhael
The artificial heart implantation and the open heart surgery is one of the greatest achievements in medical sciences in the 20th century. It is a fight against the highest cause of death in the 20th century in which cardiologists and many other specialists achieved great innovations and efforts to treat. In this interesting book, Stephen Westaby is tracing the progress and the history of cardiovascular surgery from the discovery of circulation to state of technology artificial heart implantation in topical and chronological order. The book covers technical historical details concerning discovery of anatomy and physiology of the heart, discovery of cardiac diseases, the progress of treatment methods, the progress of technological methods and innovations of assistive devices for cardiac support. The book traces both technical and humanistic stories behind this progress. Stephen Westaby is a leading practicing cardiac surgeon in United Kingdom who and his team implanted an artificial assist to the longest living person with an electric heart pump.
To understand a little bit the purpose of the author in writing this book and the methods he used, we need to examine his history and biography. Professor Stephen Westaby (born in 1948) is a heart surgeon at John Radcliffe Hospital, Oxford, England. He won the award of Midlander of the Year in 2002. Westaby and his team performed Peter Houghton's heart operation in June 2000, implanting a Jarvik 7 artificial left ventricular assist device, a turbine pump. Peter Houghton (1938 - 2007) became the longest living person with an electric heart pump in the world (Wikipedia). From this biography, we can see that Dr. Westaby is not a specialized historian, but a clever and significant figure in surgery. This gives us an impression of the reason of writing this book in this broad encyclopedic way as a reference in cardiac history. He didn't mention explicitly his purpose in writing the book which is a weakness but it is probably that as a cardiologist he wants to show the impact of his career on humanity and pride this progress as part of it. He may also stimulate his colleagues and students to follow the leaders in that field and to be part of the discoveries and inventions.
The book is exploring in all directions the progress in cardiology in all its branches. It is centered on inventions and discoveries by category, tracing the history of each. It doesn't concentrate on one aspect or field but shows a broad view of the history in a pure technical aspect. The book chapters are arranged topically then chronologically. Therefore the chapters are not sharply arranged in one aspect but a rough combination of both, starting with the topical arrangement. The book is divided into 8 chapters topically. Each chapter describes the history of one major part of cardiac surgery; cardiopulmonary bypass, congenital heart defects, valve heart diseases, thoracic aorta, cardiac transplantation, mechanical circulatory support and the first chapter is a special introduction about ancient discoveries of the circulatory system and some other general topics related to cardiac surgery. At the end of each chapter, the author mentions a dozen of biographies related to the chapter topic. The other half of the book contains the original copies of articles and journals about cardiac surgery as well as more biographies and names index.
The book is very suitable for all professionals in the field as it requires prior knowledge in cardiology and its terms and it gives them the encouraging history about their profession. It is a good reference for surgeons, cardiologists, physicians, medicine students or biomedical engineers. It is very technically written, and therefore the unspecialized readers like historians will need to search for many uncommon medical terms and might be able to progress in reading without understanding cardiology deeply. It might have been possible to add a list of definitions to broaden the range of readers to include unspecialized readers may be historians or cardiac patients who are probably interested in this research or engineers who may be interested in studying this significant progress in technology and its effect on humanity.
Generally speaking, the author's writing style is divergent between literary style and technical scientific style and story narration including narration of the lives and deaths of patients who participated in the discoveries of cardiovascular diseases and treatment. Here are some key features of his writing in this book.
The author writes in story narration style with lots of interesting behind the scenes stories and humanistic stories of patients not just operations and discoveries. In chapter 5, "Surgery for coronary artery disease", he starts by narrating the story of confusion of diagnosis of angina and the lost relation between angina pain and the coronary artery disease and the confusion between aortic diseases and coronary artery diseases. He mentions the patients' names who participated in the discoveries of the relation between angina and coronary artery disease and their death stories and dissecting their bodies.
The author inserts some non scientific literary style to the text to give it some soft touch. In chapter 7, "The beginnings of cardiac transplantation", he didn't start directly with the traditional first heart transplantation trials, but instead he started with a verse from the bible about the Lord changing ones heart from stony heart to a heart of flesh. A symbolic verse but he wonders if it is prophetic about heart transplantation and the stony coronary and valve calcification! He then mentions a legend about a Chinese doctor who swapped a number of internal organs of 2 soldiers who awoke 3 days later. And he spoke about Cosmos and Damian, the patron saints of surgery, who replaced a cancerous leg of a white man with another black one found in a cemetery. He also talked about the heart as the seat of soul and emotions and intellect according to Aristotle and the ethical issues concerning the transplantation.
The author gets related topics from the far history not just the 20th century related topics. In the first chapter, he started by narrating the mysteries behind the discoveries of the heart anatomy and physiology and the historical mistakes and the liver being believed as the natural spirits and the heart as the seat of the soul.
Regarding methodology, the author didn't mention clearly his research methods and reasons which is another historical weakness but it is clear that he collects data from historical archival journals and scientific articles and keeps a copy of each of these sources in the second half of the book. Most of the book is written in the author's own words more than referencing. His use of references is not uniform and do not follow a defined way. References are not shown inside text; instead they are mentioned in the second part of the book by chapter which is a little bit confusing and sometime you don't find the source of information clearly.
The book uses different methods of development.
1. Narration: The author narrates the stories of cardiovascular progress history. He narrates events concerning: discovery of cardiovascular diseases, progress of diagnosis; the relation between diseases and causes , progress in noninvasive treatment, progress in surgery
2. Description: The book is full of illustrative elements: (a)diagrams of historical anatomy, (b)photos of surgeons and cardiologists, (c)photos of patients who where a key factor in discovering and testing new treatment methods, (d)copies of original pages from journals and scientific articles, (e)photos of related ancient paintings, (f)photos of tools and devices and historical equipments that were the pioneers of their type.
3. Quotation: inside the text the author inserts significant quotations of famous cardiologists and physicians and sometimes philosophical sayings and verses from the bible.
4. Original copies: of journals and scientific articles which are very useful and interesting for the reader because some of them are very old and significant.
There are many points that make the book interesting and attractive to choose. The book title "Landmarks" is an attractive expression rather than "History" or "Progress" despite the word cardiac isn't very suitable and should be cardiovascular to include vascular diseases. The book starts with ancient history of discovering cardiac anatomy and physiology rather than just the common start from the twentieth century which gives the book a deep historical taste with many rare anatomical diagrams from ancient eras. The text is not boring and quite readable due to the diverging collection of interesting historical quotations, photos, diagrams and biographies that are inserted in an interesting manner between small portions of text. The author writing style is also attractive due to his divergence between literary style and technical style and narration style as mentioned before. Also the addition of copies of the original articles is not common and adds an interesting material to the book to further read in addition to the main text which is characterized by wealth of information.
Though the many interesting points in the book, it has some weaknesses. References to the historical data and biographies are not clear. For example in chapter one, the author describes the history of discovery of cardiovascular anatomy and physiology and mentions clearly the dates and names but without a footnote or endnote reference. The endnote references for chapter one do not mention these historical data. As there is a divergent and wealthy amount of data, I think there is a need to add a graphical timeline depicting all landmarks collectively by date in the book introduction or in each chapter to show the big historical picture more clearly and to summarize the dates and events in one diagram. The table of contents needs more structuring or adding hierarchal numbering of subtopics to give the reader a big view of the subtopics inside each chapter instead of searching manually or inside the alphabetical index for a certain subtopic. The subtopics in chapter one are not consistent; "Between the great wars", "Antibiotics", "Progress in closed cardiac surgery". There is a need for clear organization of the subtopics either topically or chronologically or a clear combination of both. And sometimes you feel that because the divergent nature of the book, it is little bit confusing specially that the author did not mention a systematic way of gathering information from references and articles.
How does the book contribute to the history of cardiovascular surgery?
When searching in amazon.com, I didn't find a similar book that discussed thoroughly the history of cardiac surgery in this broad view. There are some books which discuss the history of one part or may be the twentieth century technology starting in the fifties. This book is distinctive in its careful tracing of as old events as it can trace through rare articles information. This book is also distinctive in providing the original articles "as it is", which is very interesting to read the cardiologists papers from the beginning of the century and how they thought about it. I think this book is an important and interesting addition to everyone who is interested in the big picture of cardiac history but it is not a deep or specialized explanation of a certain field history. The book did not add something new to the history but it is a well organized collection of articles in the author's words.
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