Pediatric cardiology: then and now.

It is difficult to date the start of interest in the clinical importance of congenital anomalies of the heart. Sporadic reports certainly appeared from autopsy and dissecting rooms from the seventeenth century onwards. By the eighteenth century, that most entrepreneurial of centuries, the basics of British cardiology were being laid down. Stephen Hales' physiologic researches were running in parallel to the anatomic observations being made in the Covent Garden dissecting rooms of William and John Hunter. I like to attribute the birth of pediatric cardiology to a nephew of the Hunters, Mathew Baillie. Baillie described mirror imagery of the viscera which he called "a strange transposition". When he later described transposition of the great arteries, he did not call it anything, but he understood the hemodynamics. The reason I propose Baillie as the father of the discipline may be because I had an early opportunity, in the twentieth century I hasten to add, to work on transposition. My reason may, nonetheless, be regarded as perfidious and chauvinistic by my French colleagues. They will point to the clinicopathologic correlations of Arthur Fallot and of Henri Roger as the true beginnings of what was to become a recognized speciality throughout the world. Of these two great Frenchmen, my preference is for Henri Roger. He formulated the hypothesis that a particular murmur heard in asymptomatic children was due to a small ventricular septal defect. This he proposed purely on clinical grounds. His colleagues rejected his suggestion; in fact, they were pretty rude about it! But he persisted and soon was able to provide anatomic evidence that he was right. For the next eighty years, knowledge about congenital cardiac malformations continued to be accumulated following much the same pattern as that of Roger. He had added auscultation to the armory of clinical research. Subsequent workers added the chest x-ray, the electrocardiogram, cardiac catheterization and, finally, the methods of direct visualization of the heart. The technology changed dramatically, but the method remained that of clinicopathologic correlation. And we continue in the same mold. The major contribution during these eighty or so years was the systematization of the mass of knowledge being accumulated. Here we owe a great debt to Maude Abbott, Helen Taussig and the neglected James Brown. Brown's textbook, published in 1939, was full of insight, gained not in a great teaching institution but in the Dickensian atmosphere of'Poor Law' hospitals in the north of England during the depression. The first pediatric cardiology text I owned, however, was the first edition of Dr. Nadas' book. Although we have been friends for more than 20 years, I still cannot bring myself to call him Alex. Perhaps because I still remember the respect amounting to terror I felt when we residents were waiting for him to make rounds. The lucidity of his book, based mainly on the experience of his unit in Boston, has rarely been surpassed. In a way, this book marked the coming of age of the speciality.