Clin. Cardiol. 13, 301-302 (1990)
This section edited
by
J . Willis Hurst, M.D.
Allan Bums w. B. FYE.M.D. Marshfield Clinic, Marshfield, Wisconsin, USA
Allan Bums was bom in Glasgow, Scotland on September 18, 1781.1.2His father, John Bums, was a minister, and his older brother John would become a leading anatomist and surgeon at the University of Glasgow. When he was fourteen, Allan began studying medicine and soon was serving as demonstrator of anatomy for his brother. By 20, Allan Bums was acknowledged as a skilled anatomist and demonstrator. Although he never received a university degree in medicine, Bums gained clinical experience through attending patients with his brother. Young Bums kept careful records on the clinical features of these cases and attempted to explain the signs and symptoms observed during life by detailed pathological examination. Indeed, he attempted to anticipate the pathological findings from the symptoms and physical findings noted during life. His pupil and associate Granville Sharp Pattison recalled that Bums was an unusually skilled and patient dissector. In 1804, Bums was considering entering the medical service of the army, when he was presented with an unusual opportunity. Russia, under the rule of Alexander I and Catherine, sought greater influence in the affairs of Western Europe which was becoming increasingly unstable in the face of Napoleon’s aggression. Catherine established a hospital in St. Petersburg which she wanted organized along the lines of British hospitals. A British surgeon was, therefore, sought as its director, and Bums was offered the position despite his lack of formal training and limited experience. Bums missed his native Scot-
Adapted from an essay prepared for the Classics of Cardiology Library, Gryphon Edition, Birmingham. Address for reprints: W . Bruce Fye Department of Cardiology Marshfield Clinic lo00 North Oak Avenue Marshfield. WI 54449-5777, USA
Received: November 29. 1988 Accepted: November 6, 1989
land, however, and remained in St. Petersburg for only six months. He returned to Glasgow to assume his brother’s lecturing duties at the university. Diseases of the heart were of special interest to Bums, and when he was 27, he began writing his classic monograph, Observations on Some of the Most Frequent and Important Diseases of the Heart, which was published in 1809.3This volume on cardiovascular disease is notable not only because it is the first monograph on heart disease in the English language; it contains several important observations on the pathophysiology of congenital and acquired cardiac disorders. Bums was familiar with the writings of the leading anatomists, pathologists, and practitioners of the eighteenth century. In his book he refers frequently to the works of John Hunter, John Bell, Joseph Lieutaud, Jean Baptiste Senac, and Giovanni Baptiste Morgagni, among others. Bums’s interest in, and familiarity with, the natural history of disease as well as his thorough knowledge of cardiac anatomy and pathology are apparent in his book. It consists of twelve chapters devoted to such subjects as cardiac enlargement, chronic inflammation of the heart, coronary artery disease, valvular heart disease, anomalies and acquired disorders of the great vessels, and congenital heart disease. It is important to recognize that this monograph was written prior to the introduction of mediate auscultation. Observation and palpitation were employed, but percussion had not yet been widely accepted. Laennec would not publish his treatise on auscultation for another decade. Bums reported cases in which audible murmurs were heard without placing the ear on the chest and denoted this “audible palpation.” The pathological findings of cardiac dilatation and hypertrophy were of interest to Bums, who believed that hypertrophy was generally more “dangerous” than dilatation. Bums found the right ventricle dilated more often than the left, probably reflecting the greater prevalence of congenital and rheumatic heart disease in this era when the average life span was short and ischemic heart disease relatively less common. Among the congenital abnormalities Bums described in his book are patent ductus arteriosus, patent foramen ovale, and ventricular septa1 defect.
302
Clin. Cardiol. Vol. 13. April 1990
Bums acknowledged the limitations of contemporary approaches to the treatment of cardiac disorders. Dietary measures were felt to be important in cases of heart disease because they assured proper digestion and elimination. Digitalis had been introduced into medical practice a quarter of a century earlier by William Withering, and Bums advocated its use in a variety of cardiac conditions. He also suggested that tincture of opium, squill, ginger, castor oil. and mercury were efficacious in certain cases of heart disease. Reflecting the therapeutic philosophy of the time, Bums advocated bleeding and the application of blisters for some patients. From the standpoint of therapy, Bums recognized the limitations of medicine in his era. In discussing mitral stenosis, for example, he characterized it as “a defect, which it is beyond the power of medicine to remove. To attempt to cure this disease is futile. As I have already stated, we are in most diseases of the heart, called upon rather to prevent positive evil, than to remove what is already present.” Bums’ book appeared in an era when there was great He was familiar with the writinterest in angina pectori~.~ ings of William Heberden, Edwad Jenner, and Caleb Parry on this subject. Bums believed that angina was due to “some organic lesions of the nutrient vessels of the heart.” Indeed, he drew an analogy between coronary artery disease and the ligation of a peripheral artery in order to explain his interpretation of the pathophysiology of angina pectoris. It would be nearly a century before major advances were made in our understanding of what we now term ischemic heart disease, however.s Cardiac resuscitation was described by the Scottish anatomist in the context of the treatment of patients with angina pectoris. If syncope accompanied an attack of angina, Bums advocated applying cold water to the forehead and breast and forcing the patient to inhale ammonia. In cases where “the cessation of vital action is very complete, and continues long, we ought to inflate the lungs, and pass electric shocks through the chest; the practitioner ought never, if the death has been sudden, and the person not very advanced in life, to despair of success, till he has unequivocal signs of real death.” Bums advised that resuscitative efforts should begin “as soon as you can reach the place where the patient is laid; and here, as in every case of asphyxia, you will probably be obligated to persist in the use of the necessary means, for a considerable length of time, before you can be certain of either succeeding or failing.” This approach to sudden death preceded the development of modem cardiopulmonary resuscitation by 150 years! Bums claimed that it was occasionally successful. Bum’s book reveals his advanced understanding of the pathophysiology of the formation of intracardiac thrombi. He explained that in some cardiac disorders “the blood stagnates longer in the heart than it usually does, or ought to do, while here it undergoes changes by the reciprocal action of the blood on the heart, and of the heart, on the
blood; new organized matter is deposited, and adheres to the parieties of the cavity in which it is lodged. This concretion slowly increases, the first particle acting as the exciting cause for the deposition of the second, and son on.” It was Bums’s belief that the formation of a thrombus within the heart implied a more serious underlying disease of that organ. It is apparent that Bums had unusual insight into many aspects of the structure and function of the heart in health and disease. This knowledge was not gained from long years of clinical experience or with the aid of diagnostic instruments; it was derived from Bums’s thorough knowledge of the medical literature, from his extensive pathological experience, and from a keen mind. He was aggressive and innovative and declared, somewhat condescendingly, “that a young practitioner seldom ventures to deviate from what he has read in books, or heart at lectures.” Bums was not afraid to venture beyond the limits of contemporary knowledge. Although the Scottish anatomist was not always right in his interpretation of the pathophysiology of the heart and circulation, his monograph is a sophisticated summary of contemporary knowledge and includes several important original observations on congenital and acquired cardiac disorders. Bums was only 28 when he published his valuable monograph on the heart. He was soon preparing his work on the surgical anatomy of the head and neck which included important observations on the anatomy of the great vessels. He soon became ill, however, and for the final three years of his short life he was in declining health. His career as an anatomist, pathologist, teacher, and author was cut short by recurrent gastrointestinal ailments complicated by abscess formation and fatal sepsis, vividly described by his colleague Pattison. Bums died at the age of 31 in 1813 but left the world a great classic of cardiology.
References I . Pattison GS: A short account of the life of the author. In Observutions O N the Surgical Anutorny of the Head and Neck, IIlustrated by Cases und Engraving. F. Lucas, Jr., Baltimore, (1823) vii-xxix 2. Henick JB: Allan Bums: 1781-1813. Anatomist, surgeon. and cardiologist. Bull Soc Section Med Hist Chicago 4 . 4 5 1 ( 1935) 3 . Bums A: Observations on Some of the Most Frequent and Important Diseuses of the Heurt; on Aneurysm of the Thoracic Aorta; on Preternatural Pulsation in the Epigastric Region; and on the Unusual Origin and Distribution of Some of the Large Arteries of the Human Body. Illustruted by Cases. Thomas Bryce, Edinburgh ( I 809) 4. Leibowitz JO: 711e History of Coronary Heurt Diseuse. Wellcome Institute of the History of Medicine, London (1970) 5. Fye WB: The delayed diagnosis of myocardial infarction: It took half a century! Circulation 72, 262 (1985) 6 . Fye WB: Ventricular fibrillation and defibrillation: Historical perspectives with emphasis on the contributions of John MacWilliam, Carl Wiggers, and William Kouwenhoven. Circulution 7 I,858 (1985)
This section edited
by
J . Willis Hurst, M.D.
Allan Bums w. B. FYE.M.D. Marshfield Clinic, Marshfield, Wisconsin, USA
Allan Bums was bom in Glasgow, Scotland on September 18, 1781.1.2His father, John Bums, was a minister, and his older brother John would become a leading anatomist and surgeon at the University of Glasgow. When he was fourteen, Allan began studying medicine and soon was serving as demonstrator of anatomy for his brother. By 20, Allan Bums was acknowledged as a skilled anatomist and demonstrator. Although he never received a university degree in medicine, Bums gained clinical experience through attending patients with his brother. Young Bums kept careful records on the clinical features of these cases and attempted to explain the signs and symptoms observed during life by detailed pathological examination. Indeed, he attempted to anticipate the pathological findings from the symptoms and physical findings noted during life. His pupil and associate Granville Sharp Pattison recalled that Bums was an unusually skilled and patient dissector. In 1804, Bums was considering entering the medical service of the army, when he was presented with an unusual opportunity. Russia, under the rule of Alexander I and Catherine, sought greater influence in the affairs of Western Europe which was becoming increasingly unstable in the face of Napoleon’s aggression. Catherine established a hospital in St. Petersburg which she wanted organized along the lines of British hospitals. A British surgeon was, therefore, sought as its director, and Bums was offered the position despite his lack of formal training and limited experience. Bums missed his native Scot-
Adapted from an essay prepared for the Classics of Cardiology Library, Gryphon Edition, Birmingham. Address for reprints: W . Bruce Fye Department of Cardiology Marshfield Clinic lo00 North Oak Avenue Marshfield. WI 54449-5777, USA
Received: November 29. 1988 Accepted: November 6, 1989
land, however, and remained in St. Petersburg for only six months. He returned to Glasgow to assume his brother’s lecturing duties at the university. Diseases of the heart were of special interest to Bums, and when he was 27, he began writing his classic monograph, Observations on Some of the Most Frequent and Important Diseases of the Heart, which was published in 1809.3This volume on cardiovascular disease is notable not only because it is the first monograph on heart disease in the English language; it contains several important observations on the pathophysiology of congenital and acquired cardiac disorders. Bums was familiar with the writings of the leading anatomists, pathologists, and practitioners of the eighteenth century. In his book he refers frequently to the works of John Hunter, John Bell, Joseph Lieutaud, Jean Baptiste Senac, and Giovanni Baptiste Morgagni, among others. Bums’s interest in, and familiarity with, the natural history of disease as well as his thorough knowledge of cardiac anatomy and pathology are apparent in his book. It consists of twelve chapters devoted to such subjects as cardiac enlargement, chronic inflammation of the heart, coronary artery disease, valvular heart disease, anomalies and acquired disorders of the great vessels, and congenital heart disease. It is important to recognize that this monograph was written prior to the introduction of mediate auscultation. Observation and palpitation were employed, but percussion had not yet been widely accepted. Laennec would not publish his treatise on auscultation for another decade. Bums reported cases in which audible murmurs were heard without placing the ear on the chest and denoted this “audible palpation.” The pathological findings of cardiac dilatation and hypertrophy were of interest to Bums, who believed that hypertrophy was generally more “dangerous” than dilatation. Bums found the right ventricle dilated more often than the left, probably reflecting the greater prevalence of congenital and rheumatic heart disease in this era when the average life span was short and ischemic heart disease relatively less common. Among the congenital abnormalities Bums described in his book are patent ductus arteriosus, patent foramen ovale, and ventricular septa1 defect.
302
Clin. Cardiol. Vol. 13. April 1990
Bums acknowledged the limitations of contemporary approaches to the treatment of cardiac disorders. Dietary measures were felt to be important in cases of heart disease because they assured proper digestion and elimination. Digitalis had been introduced into medical practice a quarter of a century earlier by William Withering, and Bums advocated its use in a variety of cardiac conditions. He also suggested that tincture of opium, squill, ginger, castor oil. and mercury were efficacious in certain cases of heart disease. Reflecting the therapeutic philosophy of the time, Bums advocated bleeding and the application of blisters for some patients. From the standpoint of therapy, Bums recognized the limitations of medicine in his era. In discussing mitral stenosis, for example, he characterized it as “a defect, which it is beyond the power of medicine to remove. To attempt to cure this disease is futile. As I have already stated, we are in most diseases of the heart, called upon rather to prevent positive evil, than to remove what is already present.” Bums’ book appeared in an era when there was great He was familiar with the writinterest in angina pectori~.~ ings of William Heberden, Edwad Jenner, and Caleb Parry on this subject. Bums believed that angina was due to “some organic lesions of the nutrient vessels of the heart.” Indeed, he drew an analogy between coronary artery disease and the ligation of a peripheral artery in order to explain his interpretation of the pathophysiology of angina pectoris. It would be nearly a century before major advances were made in our understanding of what we now term ischemic heart disease, however.s Cardiac resuscitation was described by the Scottish anatomist in the context of the treatment of patients with angina pectoris. If syncope accompanied an attack of angina, Bums advocated applying cold water to the forehead and breast and forcing the patient to inhale ammonia. In cases where “the cessation of vital action is very complete, and continues long, we ought to inflate the lungs, and pass electric shocks through the chest; the practitioner ought never, if the death has been sudden, and the person not very advanced in life, to despair of success, till he has unequivocal signs of real death.” Bums advised that resuscitative efforts should begin “as soon as you can reach the place where the patient is laid; and here, as in every case of asphyxia, you will probably be obligated to persist in the use of the necessary means, for a considerable length of time, before you can be certain of either succeeding or failing.” This approach to sudden death preceded the development of modem cardiopulmonary resuscitation by 150 years! Bums claimed that it was occasionally successful. Bum’s book reveals his advanced understanding of the pathophysiology of the formation of intracardiac thrombi. He explained that in some cardiac disorders “the blood stagnates longer in the heart than it usually does, or ought to do, while here it undergoes changes by the reciprocal action of the blood on the heart, and of the heart, on the
blood; new organized matter is deposited, and adheres to the parieties of the cavity in which it is lodged. This concretion slowly increases, the first particle acting as the exciting cause for the deposition of the second, and son on.” It was Bums’s belief that the formation of a thrombus within the heart implied a more serious underlying disease of that organ. It is apparent that Bums had unusual insight into many aspects of the structure and function of the heart in health and disease. This knowledge was not gained from long years of clinical experience or with the aid of diagnostic instruments; it was derived from Bums’s thorough knowledge of the medical literature, from his extensive pathological experience, and from a keen mind. He was aggressive and innovative and declared, somewhat condescendingly, “that a young practitioner seldom ventures to deviate from what he has read in books, or heart at lectures.” Bums was not afraid to venture beyond the limits of contemporary knowledge. Although the Scottish anatomist was not always right in his interpretation of the pathophysiology of the heart and circulation, his monograph is a sophisticated summary of contemporary knowledge and includes several important original observations on congenital and acquired cardiac disorders. Bums was only 28 when he published his valuable monograph on the heart. He was soon preparing his work on the surgical anatomy of the head and neck which included important observations on the anatomy of the great vessels. He soon became ill, however, and for the final three years of his short life he was in declining health. His career as an anatomist, pathologist, teacher, and author was cut short by recurrent gastrointestinal ailments complicated by abscess formation and fatal sepsis, vividly described by his colleague Pattison. Bums died at the age of 31 in 1813 but left the world a great classic of cardiology.
References I . Pattison GS: A short account of the life of the author. In Observutions O N the Surgical Anutorny of the Head and Neck, IIlustrated by Cases und Engraving. F. Lucas, Jr., Baltimore, (1823) vii-xxix 2. Henick JB: Allan Bums: 1781-1813. Anatomist, surgeon. and cardiologist. Bull Soc Section Med Hist Chicago 4 . 4 5 1 ( 1935) 3 . Bums A: Observations on Some of the Most Frequent and Important Diseuses of the Heurt; on Aneurysm of the Thoracic Aorta; on Preternatural Pulsation in the Epigastric Region; and on the Unusual Origin and Distribution of Some of the Large Arteries of the Human Body. Illustruted by Cases. Thomas Bryce, Edinburgh ( I 809) 4. Leibowitz JO: 711e History of Coronary Heurt Diseuse. Wellcome Institute of the History of Medicine, London (1970) 5. Fye WB: The delayed diagnosis of myocardial infarction: It took half a century! Circulation 72, 262 (1985) 6 . Fye WB: Ventricular fibrillation and defibrillation: Historical perspectives with emphasis on the contributions of John MacWilliam, Carl Wiggers, and William Kouwenhoven. Circulution 7 I,858 (1985)
