Dr. Cardiology

Paul Dudley White's start as a practicing physician 60 years ago coincided with the hesitant, unheralded beginnings of a new medical specialty: cardiology. Dr. White nurtured and grew with it: for almost half a century his name was synonymous with the study, treatment and prevention of heart disease. Last week, as the American Heart Association was preparing to add to White's endless string of awards, death--from complications following a stroke--robbed him of what would have been a most appropriate honor.

White was to have received the James B. Herrick award, named for the Chicago physician (1861-1954) who in 1912 first accurately described a coronary-artery shutdown in a living patient and in effect added the term coronary thrombosis to the language. Previously, doctors had assumed that no one could survive a heart attack. They had viewed the post-mortem finding of a coronary thrombosis merely as an interesting item of pathology, and no particular significance was attached to Herrick's report, which he admitted "fell like a dud." But it was eventually to have great impact on Paul White (M.D., Harvard, 1911), who was then switching from pediatrics to heart disease because a sister had died from the aftereffects of rheumatic fever. After White's internship, Harvard financed a trip to London, where he bought a newfangled invention, the electrocardiograph. White took the instrument back to Massachusetts General Hospital, where he set it up in a closet in the basement of a Bulfinch building. There he began taking and studying the ECGs of Americans, men, women and children, eventually compiling records of tens of thousands of patients.

Survival Regimen. Although tuberculosis and pneumonia had long been the leading causes of death in the U.S., heart disease was fast overtaking them. White suggested that a special cardiology service be set up. As he later recalled: "My former teachers and the hospital chiefs warned me that I was entering an insignificant, special field and would never be heard from again." Undaunted, White expanded his service and research. From detailed studies of patients, he learned that a man could survive a heart attack not only for weeks or months but for a quarter-century--if he followed the White regimen of weight control using a prudent diet, no smoking and programmed exercise.

In 1924 White helped to found the American Heart Association and thereafter became Dr. Cardiology to half a dozen federal health services--and eventually to a large segment of the American public. When President Eisenhower had his first heart attack in 1955, his personal physicians turned naturally to White as a consultant. Describing the President's recovery to the press, he spoke freely of the patient's bowel movements. To many, this was shocking, but White, a sage and proper Yankee, was speaking with a purpose: he was getting across to a mass audience the value of normal body functions as a sign of a cardiac patient's recovery. White was often accused of sensationalism and publicity seeking, but this candor was his way of promoting the cause of preventive cardiology.

Always thin as a bean pole, White inveighed relentlessly against sloth of mind or body. He advocated walking and, better yet, bicycling as a means of stimulating circulation to the brain as well as the heart. Well into his 80s, he practiced what he preached. Not until he was 84 did he suffer a minor heart attack. He recovered and went back to work and even kept on bicycling. Late last May he had a stroke and was hospitalized in Massachusetts General. There he was told that one of his patients had arrived from Florida expecting treatment, unaware that White was ill. Dr. White got out of bed and held the desired consultation in his bathrobe.

The hospital's neurological service had recently acquired a supersophisticated X-ray brain scanner. A researcher to the last, White was glad to have it used on him to locate a blood clot, which was surgically removed. But a second stroke last month proved more than he could withstand. White once said: "It would be desirable for everyone to die suddenly in his sleep at the age of 90." He came close to achieving that goal.

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