Photographing medicine: image and power in Britain and America since 1840

spectacular successes of investigators who evolved surgical techniques to obviate or eliminate the dire effects of mitral stenosis and rheumatic aortic insufficiency. The work of Denny and colleagues is a classic of cardiology by any definition; but it is not to be found anywhere in Classics of cardiology. Yet another relatively unsung classic is 'The pharmacological actions of polymethylene bis-trimethyl ammonium salts' (Paton and Zaimis: Br. J. Pharmacol., 1949, 4: 381-400) which ushered in the first effective treatment (but not cure) of essential hypertension, even in its dreaded malignant phase. It also reduced the effect of hypertension as a risk factor in accelerating the march of arteriovascular disease. The drug (hexamethonium), brought to the fore by Paton and his colleagues, was not to be the last word in the treatment of essential hypertension; but the drug treatment of essential hypertension has extended the life spans and vastly improved the quality of life for countless thousands of sufferers from the disease. The identification of so-called risk factors in the development of arteriosclerotic heart disease, including obstruction to coronary arterial blood flow, very properly receives attention in part 2 of volume 4. Ancel Keys's perceptive statement of 1953 (part 2, pp. 693-701) is still amazingly current, although no one is as yet able to say precisely why the morbidity of, and mortality from, coronary arterial disease are today on the decline in the western world. As things now stand, the investigator who devotes an entire career to such worthy efforts is taking an immense gamble with regard to personal recognition for his efforts during his lifetime. But no other research project seems at present as likely as the studies of Keys and his co-workers to yield a reasonable synthesis of the pathogenesis of arteriosclerotic disease in general, and coronary arterial disease in particular. Deficiencies notwithstanding, the fourth volume of Classics of cardiology is a useful and courageous undertaking, the chief criticism being that the author-compilers seem to have defined cardiac classics too narrowly. But the question what is a classic? is once again raised by the inclusion of cardiac transplantation, while excluding immensely valuable but less dramatic items such as the prevention of rheumatic fever and effective treatment of essential hypertension. Cardiac transplantation, however spectacular and daring, seems to have created more problems than it is capable of solving; the question of donors is one such; the cost in money and professional …