MATTHEW BAILLIE GAIRDNER,THE ROYAL MEDICAL SOCIETY AND THE PROBLEM OF THE SECOND HEART SOUND

1 Balfour GW. On the evolution of cardiac diagnosis from Harvey’s days till now. Edin Med J 1887; 32:1065-81. The Harveian Discourse was delivered annually by the President of the Edinburgh Harveian Society. From 1884, the Society held its annual Festival in the Royal College of Physicians of Edinburgh, of which Balfour was President from 1882 to 1884. See: Craig WS. History of the Royal College of Physicians of Edinburgh. Oxford: Blackwell Scientific; 1976; 953, 1076. For biographical details of Balfour (1823–1903), see: Anon. George William Balfour, MD, FRCPE. BMJ 1903; 2:439-40.

2 Weatherall DJ JGG Ledingham DA Warrell , editors. Oxford textbook of medicine. 3rd ed. Oxford: Oxford University Press; 1996; 2153.

3 Acierno LJ. The history of cardiology. London and New York: Parthenon; 1994; 511.

4 Duffin J. To see with a better eye: A life of R.T.H. Laennec. Princeton: Princeton University Press; 1998; 200. Idem: The cardiology of R.T.H. Laennec. Med Hist 1989; 33:42-71; Fleming P. A short history of cardiology. Amsterdam: Rodopi; 1997; 92-3.

5 Bedford E. Cardiology in the days of Laennec: the story of auscultation of the heart. Brit Heart J 1972; 34:1193-8.

6It is acknowledged that the term ‘cardiology’ is employed with some danger of anachronism in this context. The use of the word can be traced back only as far as 1847. See: Lawrence C. Moderns and ancients: the ‘new cardiology’ in Britain 1880–1930. In: Bynum WF, Lawrence C, Nutton V, editors. The emergence of modern cardiology. London: Wellcome Institute; 1985; 1-33. The beginnings of cardiology as a discrete clinical specialty characterised by distinctive expertise and training are much later still.

7It is not a coincidence that the first English translation of De Motu Cordis to be published since the seventeenth century appeared in 1832: Ryan M. Dr Harvey on the motion of the heart and the blood. Lond Med Surg J 1832; 1:556-9; 590-4; 649-52; 685-7; 810-12; 1833; 2:42-5; 102-5; 197-9; 230-2; 259-60; 684-6.

8Some impression of the character of this debate may be gained from the pages of the Lancet and, especially, the London Medical Gazette between 1830 and 1840. Clendinning J. Experiments on the motions and sounds of the heart. Lond Med Gaz 1840; (new series) 1:104-8; 152-6; 186-91; 267-70 is a good place to start.

9Duffin, op. cit. ref. 4, 12.

10The revisiting of particular matters of dispute did not end with the nineteenth century. As late as 1949, CJ Wiggers argued that the semilunar valves closed noiselessly and that the second sound occurred after these valves had closed. See: Acierno, op. cit. ref. 3, 511.

11Birth Certificate Entry: Gardner (sic), 7 Sept 1808, Old Parish Records, Glasgow and Lanark, in the National Archives of Scotland. According to his obituarist, Gairdner was named after the famous Scottish physician/anatomist Matthew Baillie (1761–1823), but we have not been able to identify any direct link. See: Anon. Dr Matthew Baillie Gairdner of Crieff. Edin Med J 1888; 33:1150-1. Nor, as far as we can ascertain, was Matthew Baillie Gairdner related to the medical dynasty of John Gairdner (1790–1876), President of the Royal College of Surgeons of Edinburgh, and Sir William Tennant Gairdner (1824–1907), Professor of Medicine at the University of Glasgow.

12 Bell B. The life, character and writings of Benjamin Bell. Edinburgh: Edmonston and Douglas; 1868. Bell, Russell and Co. was founded by the Edinburgh surgeons Benjamin Bell (1749–1806) and James Russell, probably in the 1780s. Bell’s son George (1777–1832) joined the firm in 1798 and eventually took it over.

13 Gray J. History of the Royal Medical Society. Edinburgh: Edinburgh University Press; 1952. See also: Rosner L. Medical education in the age of improvement: Edinburgh students and apprentices. Edinburgh: Edinburgh University Press; 1991; 126. Rosner estimates that membership of the RMS did not exceed 13% of the Edinburgh medical student body.

14 Hall TS. Ideas of life and matter: Studies in the history of general physiology, 600 BC–1900 AD. Chicago: Chicago University Press; 1969; 257-9. This gives an outline of the Cartesian explanation of the actions of the heart.

15 Cournand A. Cardiac catheterization: development of the technique, its contribution to experimental medicine, and its application to man. Acta Medica Scand 1975; 579(Suppl):1-32.

16 Corrigan D. On the motions and sounds of the heart. Dublin Med Trans 1830; 1:151-203. Idem: On permanent patency of the mouth of the aorta. Edin Med Surg J 1832; 37:225-45. For Corrigan, see: Agnew RAL. The achievement of Dominic John Corrigan. Med Hist 1965; 9:230-40.

17 Stokes W. and Hart J. Observations on the actions of the heart. Edin Med Surg J 1830; 34:269-73.

18 Hope J. On the organic diseases of the heart. RMS Dissertations. Edinburgh: Library of the Royal Medical Society; 1824-5; 134-84.

19 Waterhouse T. On the causes of the impulse and sounds of the heart. RMS Dissertations. Edinburgh: Library of the Royal Medical Society; 1830-1; 632-50.

20Ibid. p. 646. The argument was substantially resolved in 1861 when the invention of the technique of closed thorax catherisation allowed recording of the changes of pressure within the heart on a rotating drum. See: Chauveau A, Marey EJ. Détermination graphique du rapports du choc du coeur avec les mouvements des oreillettes et des ventricles: Expérience faite à l’aide à un appareil enregistreur sphygmographe. Compte rend des Scéances Acad Sci 1861; 53:622. Also: Cournand. op. cit. ref. 15.

21 Stokes W. An introduction to the use of the stethoscope with its application to the diagnosis in diseases of the thoracic viscera. Edinburgh: MacLachlan and Stewart; 1825.

22The leading Laennec scholar, Jacalyn Duffin, (see reference 4) has pointed out that Laennec was familiar with Harvey’s work and has followed Stokes in arguing that the contradiction between Laennec and Harvey may be more apparent than real. Atrial contraction follows as well as precedes ventricular contraction, albeit after an interval. The present authors are not however convinced by this argument. Even if Laennec’s first sound was synchronous with the apex beat, the time interval between the first sound (ventricular systole to Laennec) and the second sound (auricular systole to Laennec) would still be greater than the time interval between the second sound and the next first sound. In other words, Laennec’s explanation of the sounds must imply that he imagined the cycle of the heart to be ventricular systole, auricular systole, long pause, ventricular systole, etc., whereas to Harvey it was auricular systole, ventricular systole, long pause, etc. It should be noted that Harvey and Laennec approached the phenomena of the heart from differing investigative perspectives, Harvey via vivisection, Laennec via auscultation and post-mortem dissection. Harmonising the two modes of understanding the action of the heart turned out to be an inherently problematic matter.

23Anon. On auscultation and percussion. Glas Med J 1828; 1:59-77. The authors are grateful to James Beaton, Librarian of the Royal College of Physicians and Surgeons of Glasgow, for bringing this essay to our attention.

24 Nicolson M. The introduction of percussion and stethoscopy to early nineteenth-century Edinburgh. In: Bynum WF, Porter R, editors. The five senses in medicine. Cambridge: Cambridge University Press; 1992; 134-53.

25 Huard P Grmek M. Les élèves étrangers de Laennec. Revue d’histoire de sciences 1973; 26:315-37.

26 Hope J. Dissertio medica inauguralis de aortae aneurismate. Unpublished MD thesis from the University of Edinburgh, 1825. Hope later published a translated and somewhat enlarged version of this work, On the diagnosis of aneurisms of the aorta by general and stethoscope signs. Lond Med Gaz 1829; 4:353-8,

391-4 417-24 For Hope 449-53 , see: Flaxman N. The Hope of cardiology: James Hope (1801–1841). Bull Inst Hist Med 1938; 6:1-21.

27 Turner JW. Observations on the causes of the sound produced by the action of the heart. Edin Med-Chir Trans 1828; 3:205-29. Turner had been President of the RMS in 1807 and was elevated to the University’s Chair of Systematic Surgery in 1831. Although Turner was well aware of the experimental investigations of Harvey, Haller, Lancisi and so on, his own experience of vivisection had been, he admitted, ‘limited’. His arguments, where original, are chiefly based upon clinical observations, especially of pulsations of the jugular vein.

28Ibid. p. 221.

29Ibid. p. 224.

30As late as 1832 David Badham, a Glasgow physician, defended in its entirety, on clinical grounds, Laennec’s interpretation of the heart sounds. Badham D. The second sound of the heart not ventricular. Lond Med Gaz 1832; 10:82-4.

31 Bynum WF. Science and the Practice of Medicine in the Nineteenth Century. Cambridge: Cambridge University Press; 1994; 50.

32 Gairdner MB. On the impulse and sounds of the heart. RMS Dissertations. Edinburgh: Library of the Royal Medical Society; 1829-30; 406-27.

33In this aspect of his study of the heart, Gairdner would doubtless have found the excellent library of the RMS a valuable resource. See: Anon. List of Members, Laws and Library Catalogue of the Medical Society of Edinburgh. Edinburgh: Aitken; 1820.

34Gairdner, op. cit. ref. 32, 415-6.

35For Laennec as a physiologist, see: Duffin, op.cit. ref. 4; chapters 4 and 12.

36Ibid. p. 411. Gairdner seems to have undertaken relatively crude experiments with a dead heart, the provenance of which is not specified.

37Ibid. p. 406.

38Ibid. p. 412-3.

39Ibid. p. 411.

40 Williams D. On the sounds produced by the action of the heart. Edin Med Surg J 1829; 32:297-305. Williams’s views were extensively discussed in: Williams CJB. The pathology and diagnosis of diseases of the chest. 3rd ed. London: Churchill; 1835. See also: Schott A. Historical notes on the mechanism of closure of the atrioventricular valves. Med Hist 1980; 24:163-84.

41Gairdner, op. cit. ref. 32, 410. It is possible that this description of the action of the heart was derived, at least partially, from an uncredited literary source. To compare with Harvey’s account, see: Harvey W. An anatomical disputation concerning the movement of the heart and blood in living creatures. Whitteridge G, translator. Oxford: Blackwell; 1976; 32-7.

42Gairdner, op. cit. ref. 32, 417.

43Ibid. p. 428.

44Fleming, op. cit. ref. 4, 33-4, 76.

45 Burns A. Observations of some of the most frequent and important diseases of the heart. Edinburgh: Bryce; 1809; 119-29. This text was, like most of the books referred to by Gairdner, in the Library of the RMS, see: Anon, op. cit. ref. 33. Burns, like Gairdner, based his argument for arterial contractility upon anatomico-clinical observation. He noted that some patients could function quite effectively with severe pathological deformities of the heart muscle, as revealed by later postmortem investigation. The circulation was maintained by the major arteries, Burns argued. For Burns, see: Herrick JB. Allan Burns: 1781-1813, anatomist, surgeon and cardiologist. Bull Soc Med Hist 1935; 4:457-83.

46Gairdner, op. cit. ref. 32, 415.

47Ibid. p. 425-6.

48Ibid. p. 426.

49Ibid. p. 418.

50Ibid. p. 422.

51Ibid. p. 423. Gairdner quotes: Bertin RJ. Traite des maladies du coeur et des gros vaisseaux. Paris: Bailliere; 1824; 356, as his authority on this point.

52Gairdner, op. cit. ref. 32, 423.

53Ibid. p. 424.

54 Alison WP. Outlines of human physiology. 3rd ed. Edinburgh: Blackwood; 1839; 49-50. Alison cites Gairdner in the context of refuting the claim, made shortly before by the French physiologist, François Magendie, that the source of the ‘cardiac’ sounds lay outside of the heart itself. The attribution to Gairdner’s discovery to Elliot was, however, repeated: O’Farrell PT. A famous cardiac controversy: Hope v. Williams. Irish J Med Sci 1957; 378:278-85. For Magendie’s views, see: Magendie F. Lectures on the physical conditions of the human body, XVI. Lancet 1835; 1:633-9.

55Williams, op. cit. ref. 39, 170.

56 Billings A. Causes of the sounds of the heart. Lond Med Gaz 1840; 2:64-7. Idem. On the auscultation and treatment of affections of the heart. Lancet 1832; 1:198-201.

57O’Farrell, op. cit. ref. 54.

58For Robert Dundas, see: Omond GWT. The Arniston memoirs: Three centuries of a Scottish house. Edinburgh: Douglas; 1887; xxxi.

59Op. cit. ref. 11.

60Marriage Certificate Entry: Matthew Baillie Gairdner, physician, Crieff (36 yrs) and Elizabeth Campbell Orr, Largs (18 yrs, soon to be 19 yrs). 14 April 1845, Old Parish Records, Crieff, in National Archives of Scotland.

61Op. cit. ref. 11.

62Syme was Professor of Surgery in Edinburgh University 1833–

69.See: Miles A. The Edinburgh school of surgery before Lister. London; 1918.

63Benjamin Bell was the nephew of George Bell and the grandson of Benjamin Bell. See note 12 above.

64 Grierson JM. Records of the Scottish volunteer force, 1859–1908. Edinburgh: Blackwood; 1909; 247. Jewitt L. Rifle and volunteer rifle corps: Their constitution, arms, drill laws and uniform. London: Ward and Lock;1860.

65Gairdner is listed in: Vernon R. A narrative of the Royal Scottish volunteer review in Holyrood Park on the seventh August 1860. Printed pamphlet, no publisher given, in Library of Edinburgh Castle.

66Extract: Registered Trust Disposition and Deed of Settlement of Dr Matthew B. Gairdner. 10 Sept 1885, Court Books of the Commisseriat of Perth, National Archives of Scotland.

67Medical Records of the Royal Edinburgh Asylum, Logbook 1886, pp. 427-8. Lothian Health Board Archive: Edinburgh University Library; 1886.

68Death Certificate Entry: Matthew Baillie Gairdner, Medical Practitioner, etc., 18 May 1888. National Archives of Scotland.

69Confirmation of Matthew Baillie Gairdner, MD, etc., Court Books of the Commissariat of Perth, 18 August 1888. National Archives of Scotland.

70Op. cit. ref. 11.

71For much valuable insight into the role and status of original inquiry in the academic medical culture of the early nineteenth century Edinburgh Medical School, see: Jacyna LS. Philosophic whigs: Medicine, science and citizenship in Edinburgh, 1789–1848. London and New York: Routledge; 1994; see especially 115-29. Also: Lawrence C. The Edinburgh Medical School and the end of the ‘old thing’, 1790–1830. Hist of Universities 1988; 7:259-86. Barfoot M. Brunonianism under the bed: an alternative to university medicine in Edinburgh in the 1780s. In: Bynum WF, Porter R, editors. Brunonianism in Britain and Europe. Med Hist 1988; 8(Suppl):22-45. It is evident, moreover, that the RMS enjoyed the patronage and encouragement of many of the leading medical professors of the time. The Society was, in other words, integrated within Edinburgh’s academic medical culture. See: Stroud W. History of the Medical Society of Edinburgh. In: Gairdner, op. cit. ref. 32, iii-ci; Gray, op. cit. ref. 13.

72 Stroud W. In Anon. op.cit. ref. 32, iii-ci; Gray, op. cit. ref. 13.

73 Barlow N , editor. The autobiography of Charles Darwin, 1809–1882. London: Collins; 1958; 51. Darwin did, however, acknowledge that some of the presentations to the Society were of good quality. He had, moreover, already become disillusioned with the study of medicine by this time. Janet Browne, in her authoritative recent biography of Darwin, notes the high standard of the work accomplished by the student members of the other Edinburgh society that Darwin joined, the Plinian, which sponsored natural history and antiquarian researches. Browne J. Charles Darwin: Voyaging. London: Cape; 1995; 76.

74Gray, op. cit. ref. 13.

75Ibid. p. 134.

76Ibid. p. 125.

77Ibid. p. 132. See also: Rosner L. Eighteenth-century medical education and the didactic model of experiment. In Dear P, editor. The literary structure of scientific argument. Philadelphia: Pennsylvania University Press; 1991; 182-94.

78Miles, op. cit. ref. 62, 32.

79Anon. Dissertations by eminent members of the Royal Medical Society. Edinburgh: Douglas; 1892.

80Burns, op. cit. ref. 45.

81 Newbigging PSK. On the causes of the impulse and sounds attending the action of the heart in its normal state. RMS Dissertations. Edinburgh: Library of the Royal Medical Society; 1833; 441-65.

82Ibid. p. 441.

83Ibid. p. 454.

84Ibid. p. 454-5.

85Gray, op. cit. ref. 13, 62.

86 Hastings C. What is the state of the blood vessels in inflammation? RMS Dissertations. Edinburgh: Library of the Royal Medical Society; 1815, 201-35. Sir Charles Hastings was a founder of the Provincial Medical and Surgical Association, later the British Medical Association. See: Gray, op. cit. ref. 13, 117. Medical microscopy was not taught in Edinburgh as part of the formal curriculum until the appointment of John Hughes Bennett to the Chair of the Institutes of Medicine in 1848. See also: Jacyna S. John Hughes Bennett and the origins of medical microscopy in Edinburgh: Lilliputian wonders. Proc Royal Coll Phys Edinb 1997; 2(Suppl 3):12-21.

87 Hall M. On the dispersive and refractory powers of the human eye and on some notions of the iris. In: Anon, op. cit. ref. 79, 84-94.

88Gray, op. cit. ref 13, 119.

89 Jewson N. The disappearance of the sick man from medical cosmology. Sociology 1976; 10:225-44.

90 Nicolson M. The art of diagnosis: Medicine and the five senses. In: Bynum WF, Porter R, editors. Companion encyclopedia of the history of medicine. London: Routledge; 1993; 2:801-23.

91For the Paris school, see: Ackernecht EH. Medicine at the Paris School, 1794–1848. Baltimore: Johns Hopkins University Press; 1967; Foucault M. The birth of the clinic: An archaeology of medical perception. London: Tavistock; 1973; and for its impact in Britain, Maulitz R. Morbid appearances: the anatomy of pathology in the early nineteenth century. Cambridge: Cambridge University Press; 1987.

92Lawrence and Jacyna (op. cit. ref. 71) discuss the impact of the French clinico-pathological style of research on Edinburgh; also, Jacyna S. Robert Carswell and William Thompson at the Hôtel-Dieu of Lyons: Scottish views of French medicine. In: French R, Wear A, editors. British medicine in the age of reform. London and New York: Routledge; 1991; 110-35.

93See, for instance, the remarks on the stethoscope in: Seagram WB. On sundry organic diseases of the heart. RMS Dissertations. Edinburgh: Library of the Royal Medical Society; 1827-8; 80-102.

94 Bernard C. An introduction to the study of experimental medicine. Green HC, translator. New York: Dover; 1957; 108. See also note 20 above.

95 Balfour GW. Clinical lectures on diseases of the heart and aorta. London: Churchill; 1876; 243; see also: Acierno, op. cit. ref. 3, 119.

96See note 6 above.

97For Skoda’s influence, see: Lesky E. The Vienna Medical School of the nineteenth century. William L, Levij IS, translators. Baltimore: Johns Hopkins University Press; 1976. See also: Sakula A. Joseph Skoda 1805–81: a centenary tribute to a pioneer of thoracic medicine. Thorax 1981; 36:404-41; Neuberger M. British medicine and the Vienna school. London: Heinemann; 1943.

98For the importance of horsemanship to the rural medical practitioner, see: Loudon I. Medical care and the general practitioner. Oxford: Claredon; 1986; 117-25. It has also been pointed out that the landed gentry often chose their physicians as much for their social graces and their sporting abilities as their medical acumen. See: Lawrence C. Incommunicable knowledge: Science, technology and the clinical art in Britain, 1850–1914. J Contemp Hist 1985; 20:503-20. Gairdner, we may presume, possessed all three sets of qualities – the medical, the social and the sporting.