Ischaemic heart disease, aortic aneurysms, and atherosclerosis in the City of London, 1868-1982.

The rarity of thrombotic complications and overt clinical disease are possibly the only features that distinguish atherosclerosis in animals from the same condition in man. Yet the reason (or reasons) why a comparatively bland vascular disorder now presents as a lethal myocardial disease of high prevalence in modern western man is still largely unknown. A historical approach to the problem has received little attention, and apart from the classic study by Morris,' few historical surveys, based on post-mortem reports, of ischaemic heart disease and its relationship to atherosclerosis have been attempted. To redress the balance in part, a fresh survey, based on autopsy reports dating back to 1868 at St Bartholomew's Hospital in the City of London and supplemented by records on autopsies performed at the City mortuary on the direction of the Coroner, is presented. In October 1867, two registers, one of medical and the other of surgical post-mortem reports, were initiated at St Bartholomew's Hospital. The medical register continued, apart from an unexplained hiatus in the handwritten reports from May 1869 to March 1870, until it was combined with the surgical register into a single post-mortem register with typed reports on 1 January 1937. The surgical register started with a flourish in October 1867, but within six months the reporting had become desultory, and by December 1868 it expired. The register restarted on 1 January 1884, and continued without interruption until being integrated with the medical register in 1937. The post mortems, with few exceptions, were performed by aspiring consultant physicians or surgeons until the early 1930s. The introduction of a printed systemized anatomical pro forma on alternate pages of the medical register in the 1880s and of the surgical register some thirty years later significantly improved the quality of the reports. The pro forma lapsed with the typing of the records in 1937. During the Second World War, the hospital remained open for acute cases, but no post mortems were carried out during September-December 1939, and autopsy reports for 1940-44 were succinct. The immediate postwar years showed a gradual reopening of wards and the construction of new wards. Although a few clinical units were not transferred back to St Bartholomew's from the "war-time" sector hospital at Hill End, St Albans, until 1961, the related autopsy reports, carrying the prefix