William Heberden Research Articles

Poxes great and small: The stories behind their names.

The word "pox" indicated, during the late 15th century, a disease characterized by eruptive sores. When an outbreak of syphilis began in Europe during that time, it was called by many names, including the French term "la grosse verole" ("the great pox"), to distinguish it from smallpox, which was termed "la petite verole" ("the small pox"). Chickenpox was initially confused with smallpox until 1767, when the English physician William Heberden (1710-1801) provided a detailed description of chickenpox, differentiating it from smallpox. The cowpox virus was used by Edward Jenner (1749-1823) to develop a successful vaccine against smallpox. He devised the term "variolae vaccinae" ("smallpox of the cow") to denote cowpox. Jenner's pioneering work on a smallpox vaccine has led to the eradication of this disease and opened the way to preventing other infectious diseases, such as monkeypox, a poxvirus that is closely related to smallpox and that is currently infecting persons around the world. This contribution tells the stories behind the names of the various "poxes" that have infected humans: the great pox (syphilis), smallpox, chickenpox, cowpox, and monkeypox. These infectious diseases not only share a common "pox" nomenclature, but are also closely interconnected in medical history.

Dermatographism in popular culture.

Dermatographism was first described by William Heberden (1710-1801) more than 250 years ago as a type of urticaria brought on by rubbing or scratching the skin. In 1859, William Gull (1816-1890) gave it the name factitious urticaria, distinguishing dermatographism from chronic urticaria, in which the skin lesions appear spontaneously. During the 1870s French physicians at the Salpetriere Hospital in Paris became impressed by their ability to write words on the bodies of patients admitted with hysteria and other psychiatric disorders, who also exhibited dermatographism. At first, they described this phenomenon as "autographisme," but by 1890 it became known as "dermographisme," the forerunner of the current term "dermatographism." At the Salpetriere and elsewhere in the world, it became fashionable to photograph patients with dermatographism, to capture the striking urticarial writing on their skin. These photographs were used in atlases and to illustrate dermatology texts and medical journals as well as popular magazines. This contribution presents several vintage photographs of dermatographism from the late 19th century to the early 20th century. Dermatographism has also become featured in popular culture including film, comic books, poetry, and body art, examples of which are provided in this contribution with the assistance of two of our authors, Ariana Page Russell and Jeannine Hall Gailey, who have embraced their dermatographism and have used their artistic and poetic talents to educate and inspire patients about this common skin condition.

Overview of Diagnostic Criteria and Epidemiology of Acute Kidney Injury and Acute Kidney Disease in the Critically Ill Patient.

Since the description ischuria renalis by William Heberden (1), AKI has remained a prominent complication of critical illness. Beyond KRT, treatment has been limited by the capacity to phenotype this condition. Here, we chronicle the evolution of attempts to classify AKI, including the adoption of consensus definitions, the expansion of diagnosis and prognosis with novel biomarkers, and emerging tools such as artificial intelligence (AI).

William Heberden.

The son of an innkeeper, William Heberden was educated at a charitable parish school in south London, where the emphasis was firmly on the classics. It was an interest he maintained for his entire life. In his 1782 preface to Commentaries on the History and Cure of Diseases, which he wrote in Latin, Heberden reached back to ancient Rome. “Plutarch says that the life of a vestal virgin was divided into three portions; in the first of which she learned the duties of her profession, in the second she practiced them, and in the third she taught them to others”, he noted. “This is no bad model for the life of a physician: and, as I have now passed through the two first of these times, I am willing to employ the remainder of my days in teaching.”

Angina: contemporary diagnosis and management

### Learning objectives Ischaemic heart disease (IHD) remains the leading global cause of death and lost life years in adults, notably in younger (<55 years) women.1 Angina pectoris (derived from...

William Heberden Senior

William Heberden Senior

Stable Coronary Syndromes: The Case for Consolidating the Nomenclature of Stable Ischemic Heart Disease

Angina pectoris, first described by William Heberden in the Royal College of Physicians, London, in 1768, is chest pain of cardiac origin. Despite being a symptom, angina is a disease-based diagnosis ( International Classification of Diseases , I20). Practice guidelines use somewhat different terms. The nomenclature of the American guidelines includes chronic stable angina (2002) and stable ischemic heart disease (2012), whereas the guidelines of the European Society of Cardiology (2013) refer to stable coronary artery disease. Thus, there are multiple terms and abbreviations for stable ischemic heart disease and cohesion is lacking. By contrast, acute coronary syndrome is a unifying hierarchical term that subtends the distinct subgroups of unstable angina and myocardial infarction and is used consistently worldwide. The established diagnostic pathways for patients with suspected angina have been appropriately developed to identify obstructive coronary artery disease (CAD) with a view to evidence-based treatment. In recent years, however, multiple clinical studies have disclosed that more than one-third of symptomatic patients do not have obstructive CAD.1 Furthermore, ischemia may be substantial in this subgroup, and the prognosis is not benign.2 Exclusion of obstructive CAD in a patient with angina presents a conundrum. Angina without obstructive CAD may be frustrating for the patient and the clinician, and, in the absence of a unifying diagnosis, treatment becomes empirical and potentially suboptimal. The lack of evidence from randomized controlled clinical trials in this …

Mental stress-induced myocardial ischaemia

### Learning objectives The management of angina is determined by symptoms and cardiovascular risk, together guiding further assessment in order to detect significant underlying coronary artery disease (CAD). The current...

William Heberden and reverse translation.

Beginning with the 18th-century physician-scientist William Heberden, the elder, Science Translational Medicine introduces a new article series about historical figures whose transformational contributions to science, medicine, and society remain relevant today.

A History of Geology and Medicine by Christopher J. Duffin, Richard T.J. Moody, and Christopher Gardner-Thorpe, eds

78 BOOK REVIEWS Christopher J. Duffin, Richard T.J. Moody, and Christopher GardnerThorpe , eds, A History of Geology and Medicine, Special Publication # 375 (London: The Geological Society, 2013). ISBN 978-1-86239356 -1 (HC). Illustrations, vi + 490 pp. There are numerous historical links between geology and medicine. These linkages have given rise to the modern science of medical geology, which deals with relationships between geological factors and health. Today, there are various textbooks on the subject, reflecting the wide interest in this area but A History of Geology and Medicine represents the first book to describe the history of this field. Three senior editors have championed the present work. Christopher J. Duffin from The Natural History Museum in London has teamed up with Richard T.J. Moody from Kingston University in London and world-renowned medical historian Christopher Gardner-Thorpe at the University of Exeter Medical School to bring to fruition a quite remarkable historical compendium of individual historical papers on the subject. A History of Geology and Medicine is presented as a large hardback publication. The front cover features a drawing of geopharmaceuticals used by William Heberden (1710–1801), an English physician, to illustrate his annual course of lectures at Cambridge on materia medica in the second half of the eighteenth century. The chapters of the book are many, varied, and colourful, ranging from ‘Lithotherapeutical Research Sources from Antiquity to the Mid-Eighteenth Century’ to ‘Dr Arthur Conan Doyle’s Contribution to the Popularity of Pterodactyls’. The colourful names of the chapters indicate the diversity and authenticity of the subject matter covered. The first chapter is basically an introduction to the chapters presented in this work, which are very much individuallyresearched works, largely from medical historians, but also from geoscientists. Each chapter is well-referenced, and once you get past the myriad challenging words with geological overtones, each chapter draws you into the particular world that is painted by each of the chapter contributors. The second chapter, for example on lithotherapeutical research, describes a number of medical treatments which have their origin in rocks and minerals or from the earth more broadly. The use of pumice stone, especially in treating gum disease (p. 12) and wound healing (p. 27) is not that far removed from modern medicine. Although many of these treatments have largely disappeared, some, such as the Health & History ● 17/2 ● 2015 79 use of baked clays for treatment (p. 69–70) in Chapter 4, continue to be used to the present day in human and veterinary medicine. Kaolin, for example, is a type of clay rich in the clay mineral kaolinite, which when made in the laboratory is still widely used for treating diarrhoea and dysentery. Found amongst the middle pages of A History of Geology and Medicine are a number of most interesting chapters. For example, the chapter on the ‘Sunday Stone: An Enduring Metaphor of Mining Diseases and Underground Mining Conditions’ immediately sparked my occupational health interest. This is an easy reading chapter written with the modern context in mind by two of the book’s most senior medical historians, John Pearn and Christopher GardnerThorpe , also one of the book’s editors. Sunday stones are basically calcareous deposits often taken from pipes that drain water from collieries, and the carbonate of lime deposits often had a striped appearance. The dark layers came from more active mining periods, where the coal dust blacked the water, and lighter layers formed during periods when the mines were not active and the water was cleaner. It exemplified what miners were exposed to in these mines and we are well-aware of myriad mining diseases that have afflicted workers through the centuries. As a reader with a public health background I was also drawn to the sixteenth chapter—‘The Influence of Geology in the Development of Public Health’. While some advances in geology and public health are more obvious, such as the recent understanding of trace element deficiency diseases (p. 279) (for example, goitre), others, such as environmental contamination of air and ground water, took centuries to understand by many of the well-known pioneers of public health, including John Snow, among others. Hippocrates’ (circa 400 BC) observations concerning...

History of Angina

Ladies and gentlemen, Angina Pectoris was first brought to the notice of the medical profession by William Heberden in 1772, although references to pain in the breast and arm in relation to disease affecting the heart and occurring on exercise are found in ancient Egyptian and Roman literature, and more particularly in the 17th and early 18th centuries. It was not until 1768, however, when Heberden read his paper entitled, “Some Account of the Disorder of the Breast”, before the Royal College of Physicians in London, that the condition was given the name of “Angina Pectoris”. Heberden’s observations were based on a study of twenty cases and by the time he had incorporated the description in his book, “Commentaries on the History and Cure of Diseases”, this number had grown to one hundred of which three were women, one was a boy twelve years old, and the rest were men of fifty years of age or over. In one or two of the patients mentioned original pain lasted for some hours; in one case the first attack continuing all night. Some died suddenly but these were more probably cases of myocardial infarction; in fact he mentioned that if the disease goes on to its height, the patients suddenly fall down and perish almost immediately.

Some early eighteenth century geological Materia Medica

Abstract The transition from the late seventeenth to the early eighteenth century represented an interesting time in the development of the Materia Medica, with the traditional ‘Galenical’ approach being progressively replaced by the ‘Chymical’ approach, a necessary precursor to modern pharmacology. Four surviving complete and partial Materia Medica cabinets belonging to Sir Hans Sloane, John Vigani, John Addenbrooke and William Heberden form the focus for a consideration of changing practices in the medicinal use of geological materials over this period. The working and teaching cabinets contain both processed and unprocessed specimens of geological simples. Of these, some were waning in popularity (e.g. nephrite jade, Irish slate, pyrite and garnets, jet and cannel coal), others were hardly ever used (e.g. belemnites, echinoid spines, Goa Stone, hematite and aetites), whilst others still continued to be popular, either in raw or processed form (e.g. amber, cinnabar, selenite and Terra Sigillata ). The collections, considered in the context of contemporary literature, provide a unique insight into this dynamic period in the history of pharmacy.

Exercise Physiology in the Catheterization Laboratory

Writing on the topic of pectoris dolor: With respect to the treatment of this complaint, I have little or nothing to advance: nor indeed is it to be expected we should have made much progress in the cure of a disease, which has hitherto hardly had a place, or a name in medical books… Opium taken at bed-time will prevent the attacks at night. I know one who set himself a task of sawing wood for half an hour every day, and was nearly cured. —William Heberden1 The salient observation defining the clinical syndrome of warm-up angina, namely that anginal symptoms may be reduced with repeated episodes of work, was initially made >200 years ago by the London physician William Heberden. Consistent with his original description, contemporary demonstrations of warm-up angina either involves greater time to ischemic signs or symptoms (ie, ST-segment depression or chest pain) or a reduction in ischemic manifestations at equivalent workload in patients with coronary artery disease undergoing repeated bouts of exercise. Multiple theories have been proposed to explain this physiological phenomenon, ranging from changes in myocardial signaling to increased collateral recruitment and ischemic preconditioning.2–4 Greater appreciation of physiological adaptations occurring with exercise vis-a-vis ventricular vascular coupling combined with novel methodologic approaches has provided a fresh mechanistic insights and advanced our understanding of this clinical entity.5–7 Article see p 2565 At its most basic level, warm-up angina implies a favorable modulation of the myocardial supply–demand equation whereby the oxygen supply is enhanced or demand is reduced after an initial bout of exercise. To address this complex question, Lockie …

A story of heartache: the understanding of angina pectoris in the pre-surgical period

This paper traces the understanding of angina pectoris over two centuries from its first description by William Heberden, emphasising the Scottish dimension in this process. Such a retrospect is appropriate at a time when natural disasters in several parts of the world are drawing attention to their effect in increasing the incidence of heart attacks.

The French paradox and other ecological fallacies

The Ecological Fallacy and the complexity of the appropriate weightings to apply for aggregated vs individual data, has recently been subjected to scrutiny in this journal. In 1981, three Frenchmen, Ducimetiere, Cambien and Richard, coined the term The French Paradox, after having compared levels of heart disease with fat intake data provided by The Organisation for Economic Cooperation and Development. Consumption of animal fat in France was high despite the fact that mortality data showed age-standardized male mortality rates (35–64 years of age) lying just above Greece and Japan. In fact, the classic risk factors did not explain the 4-fold gradient in ischaemic heart disease later observed between Toulouse and Belfast. Ecological Fallacies typically arise when disease differences identified between countries are assumed to be caused by factors that are found to also differ—in reality the differences may be due to unknown factors. The French Paradox is an unusual example in that it compares the large differences in ischaemic heart disease between France and other countries, finds that major risk factors do not differ, and infers that the differences must be caused by unknown factors. In any case, the comparison of heart disease between France and elsewhere is far from new. A difference in the prevalence of angina pectoris between Ireland and France had been noted by Samuel Black as early as 1819. It was William Heberden who coined the term Angina Pectoris, thereby drawing attention to the condition, in 1768. Black was born in 1763–64 near Dromore, County Down, attended Edinburgh University from 1782 to 1786, and graduated with an MD. He entered practice in Newry, County Down in 1788 and published the first of four cases of angina pectoris in 1795; he died in 1832. In his book Clinical and Pathological Reports published in Newry in 1819 it appeared to him ‘that the Physician who ascertains half a dozen of important facts, performs a more valuable, though a less splendid achievement, than he who invents a dazzling theory’. Yet, Black did truly help develop a dazzling theory—the ischaemic hypothesis of angina pectoris. A most remarkable feature of Black’s work was that he adopted an epidemiological stance in asking how individuals with angina pectoris differed from those without it. He put it more eloquently: ‘Is our knowledge of the remote causes of this disease such as to enable us to classify the liable and the exempt?’ He feared not, but continued:

John Bostock's first description of hayfever

John Bostock's first description of hayfever

A Quarter-Millenium of Cardiovascular Epidemiology

According to George Rosen the roots of Epidemiology lie in the mid 17 th century, although Hippocrates was aware of some of its methods. Cardiovascular Epidemiology can be traced back to the mid 18 th century to the pioneering contribution of William Heberden (who coined the term 'angina pectoris') and John Fothergill. Proudfit in 1983 cited Jenner, Parry, Burns and Black as the originators of the ischaemic theory of angina pectoris. Of these four, Samuel Black's observations displayed a particularly epidemiological bent and he was the first to notice 'the French Paradox'. The description of myocardial infarction in living patients was not made until the late 19 th century. It was Sir James Mackenzie's community studies of disease in Scotland which ushered in modern Cardiovascular Epidemiology. His work influenced Paul Dudley White who was instrumental in the Framingham Study, where the term 'Risk Factor' was first ap- plied to cardiovascular disease, and involved at the inception of the Seven Counties study. Over the second half of the 20 th century the number and types of epidemiological studies mushroomed, but it is beyond the scope of this review to cover them exhaustively. We are now in the era of genomics and witnessing an 'Epidemiologi- cal Transition.' GENERAL BACKGROUND

It Is All in Your Hands

Named after William Heberden (1710-1801), Heberden's nodes are bony, hard nodules or swellings that develop around the distal interphalangeal joints.1 The second (index) and third (middle) fingers are affected most often (Figure). They are produced by calcific spurs of the articular cartilage at the base of the terminal phalanges. They are more common in women. The onset, which is usually in middle life, can be insidious or abrupt with pain, redness, and warmth. The initial inflammatory phase eventually subsides, leaving the patient with an angulation articular deformity (skewing the fingertip sideways), limitation of motion, and loss of manual dexterity.

Henoch–Schönlein purpura

Henoch–Schonlein purpura (HSP) is the commonest vasculitis of childhood. The first description of this disorder was probably that of a young boy with “bloody points” over the shins of his...

Frontiers in Nephrology

“Intestinal appendix! Kidney!” he said to himself, “It's not a question of the appendix, not a question of the kidney, but a question of life and…death.” —Leo Tolstoy, The Death of Ivan Ilyitch Angina pectoris was first described by William Heberden in 1772, but the pathology of the