BOOK REVIEWS

Jauhar is a cardiologist in New York cept of continuous blood circulation still

and is the author of three bestseller eluded him.
books. He narrates with courage and sen- Finally it was William Harvey who
sitivity many of the roles he played: A discovered the mechanism of circulation
high school student, a medical student, a in 1615. He did experiments on the slow
medical intern, a doctor, a father and a beating hearts of fish and frogs. In a
heart patient. There are references to the simple but ingenious experiment tying a
idiosyncrasies of teachers and doctors cloth tourniquet to a human arm, Harvey
and to racism. His work is scholarly giv- inferred that blood drained from artery
ing the details, but just enough, to help through invisible connections to the
us appreciate how we progress. He sup- veins before returning to the heart. We
ports his brief narrations with a liberal call these invisible connections as capil-
list of supplementary reading material. laries today. By simple calculations he
Heart is at the heart of human health. But estimated that liver has to convert 500
what we take for granted today regarding pounds of food into blood every hour if
our knowledge of the heart is known on- blood were the nourishment to the body.
ly recently. And many researchers have He wrote that ‘the pumped blood passes
Heart: A History. Sandeep Jauhar. Pen- taken risks. The heart was a sacred or- through the lungs and also it returns to
guin Viking, India. 2018. 288 pages. gan, beyond the reach of doctors and the heart, the inner temple of the body, to
Price: Rs 599. surgeons. It was not known why it is recover its virtue’. More importantly
there at all. Only poets and philosophers why is it pumped and what is that virtue?
‘He must have had bee pea’, my friend may deal with it. But today we know it is Jauhar reminds us that Harvey could not
declared. ‘What is bee pea?’ was my about plumbing. Surgeons have put a have inferred since the existence of oxy-
confused reaction. This friend is my high tube in it, meddled with it to understand gen was not known yet. That discovery
school classmate and is running a shop in it or repair it, replaced its valves with was a century later. Also, Harvey waited
my small home town after he dropped mechanical or pig’s valves and finally 13 years before publishing his results. He
out from the school. This conversation replaced it altogether with a man-made feared for his safety; challenging Galenic
took place many decades ago when I device. All this is explained here without dogma was considered sacrilegious. It is
visited him and we were discussing expecting readers to know a lot of ana- this kind of simple connectivity and
about a common acquaintance who had tomy or fluid mechanics. This is the suc- details Jauhar provides that contribute to
died a few months ago. ‘It is blood pres- cess of the author. insight and pleasant reading.
sure, if one has it he is certain to die of In the entire book supposed to be on Some of the chapters in the book have
heart attack. And since this death was heart there is no detailed description of titles like Clutch, Dynamo, Pump, Pipes,
sudden it has to be heart attack’, my the ECGs or the familiar pictures of all Nut. The chapter Nut contains very inter-
friend gave his verdict. He seemed to me the events in the heart during one cardiac esting experiments made by dare devil
quite up-to-date. However, if we read the cycle. Jauhar cuts short this temptation doctors on animals, humans and the most
present book by Jauhar we see what is and straight comes to the heart of the kooky of it all, on themselves. It is scary
wrong with my friend’s logic. More im- matter. He has an eye for the logical but comical. A German surgical intern
portantly how much we have progressed development of understanding of the named Forssmann created history in
but still how difficult it is to arrive at heart. 1929 by inserting a catheter first time
correct conclusions. Jauhar narrates why Galen who was into a human heart. And it was his own.
Jauhar in this book makes it clear that the physician of a Roman emperor and Forssmann conspired with a nurse to per-
high blood pressure is only one of the applied rudimentary scientific methods form an experiment on her that would
indicators for heart problems. There are rooted in observation and animal dissec- change the course of medicine. In the
many heart problems and many supposed tion was a towering figure in Western operating room he tied her to a surgical
indicators. We are bound to discover a medicine from the third to the seven- table and immobilized her arm. When
few more in the future. He narrates how teenth century. In his scheme the liver she was waiting for the operation on her-
the famous ‘Framingham Heart Study’ converts food into blood and in the left self he turned around, prepared his left
done in the 1950s in a small town called ventricle of the heart ‘vital spirits’ are arm, sliced open the skin over his elbow
Framingham in the US identified some of added and heat is generated like in a fur- crease, pulled a vein and inserted a 65-
these indicators. Jauhar pictures vividly nace to pump blood through the fleshy centimetre catheter through a hole. He
the mood and fear of heart attacks in the body. We clearly see the difficulties of released the angry nurse and asked her to
US at that time and how the sudden the times. But then a great push to the follow him to the fluoroscopy lab down-
death of the American president by understanding of the heart came due to stairs. Lying down in the lab under the
stroke also contributed to undertake this the Renaissance and its commitment to camera he pushed the catheter in till it
study. He summarizes how it was done investigation and reason and consequent entered the right atrium. If you think his
and what were its findings, very briefly work of Leonardo da Vinci (1452–1519). attempt was chilling, imagine yourself
but self-contained and without jargon. It He dissected pigs, oxen and human attending a lecture by Charles Dotter in
is this quality of the author that has cadavers. He even constructed glass the early 1960s. In the middle of the lec-
enabled him to pack so many stories in models of the aorta and aortic valve to ture he rolled up his shirtsleeve to reveal
his book of only 269 pages. investigate the flow. However, the con- that he had placed a catheter in his own

1788 CURRENT SCIENCE, VOL. 120, NO. 11, 10 JUNE 2021

 BOOK REVIEWS
heart and then he connected himself to an some 200 dogs the first such attempt was In 1959, a study showed that Indian
oscilloscope to measure cardiac pres- in 1954 on a thirteen-month-old boy. His males had four times the rate of prema-
sures. We owe to all these tinkerers and father was the donor whose heart and ture heart disease compared to the Amer-
nuts for our current understanding of the lungs were connected through rubber ican men surveyed in the Framingham
heart. hoses and a milk pump to his son’s car- Heart Study, despite having lower rates
The development of the heart–lung diovascular system. It was a controver- of hypertension, smoking, and high cho-
machine was conceived by John Gibbon, sial procedure risking another person. lesterol and more often consuming a
a Philadelphia surgeon in 1930 but it The success of the heart–lung machine vegetarian diet. Today in South Asia, a
took almost 25 years to develop. Slow around this time brought the curtain large percentage of heart attacks occur in
progress was due to the depression, down for the hypothermia and the cross- men with zero or only one Framingham
World War II and also due to cultural in- circulation methods. risk factor. South Asians will soon make
hibition. How could a man-made ma- The book continues logically to the up over half of the world’s cardiac
chine replace the organ that houses the heart transplants, artificial heart, implan- patients. We need a Framingham-type of
soul? Then we read about surgical hypo- table pacemakers, external and implanta- study to understand the role of South
thermia which was tried in the early ble defibrillators, life saving medicines, Asian genetics and environment.
1950s on dogs, monkeys and subsequent- etc. It is interesting to know that historically
ly on humans. It takes advantage of the Some of the cardiovascular risk factors there was a general resentment towards
fact that metabolic activities come down are likely to be in the ‘psychosocial’ do- any medical meddling with the heart. We
with the temperature and even the brain main, an area which is difficult to han- have come a long way. Jauhar holds our
can survive without permanent damage dle. The book introduces us to a study hand and walks us through with humour
for a few minutes without any oxygen which tells us about ‘chronic arousal’, or and surprises at every stage.
supply. Heart is stopped to facilitate the ‘stress’ with hypertension being a normal
operation on itself. This time window response. The studies on American black MOHAN D. DESHPANDE
was slightly extended by another daring population and immigrant Japanese pop-
if not bizarre attempt by Lillehei using ulations lead to surprising results and Ashok Heights Apts, 204,
the cross-circulation method inspired by should bust some popular myths relating Mahalakshmi Layout,
the circulation of blood between mother a single convenient indicator to every Bengaluru 560 096, India
and foetus. After years of practice on heart disease. e-mail: [email protected]

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