In his autobiography, Sir Fred Bowerbank, the hospital's first cardiologist, wrote: "When I was a medical student .... if a heart murmur was heard on auscultation a diagnosis of V.D.H. (valvular disease of the heart) was made..."
Diagnoses of valve disease do not figure highly in the discharge diagnoses during Bowerbank's time, but one sees a significant increase in diagnoses of AF and of hypertension. Popular diagnoses in that era were myocardial insufficiency and myocarditis. It is not clear what these patients were suffering from, though one suspects that many had congestive cardiac failure. There were very few patients diagnosed as having a myocardial infarction or coronary occlusion.
Charles Burns replaced Bowerbank as cardiologist in 1939. In the Burns era one sees a major increase in the diagnosis of heart failure but there were none with myocardial insufficiency and very few with myocarditis. This is likely to reflect a change in terminology. The emergence of coronary thrombosis and coronary insufficiency reflects a new appreciation of these conditions. There are notable increases in admissions for AF and for hypertension, but with the exception of mitral stenosis, valve disease is still infrequently diagnosed as a primary disorder in inpatients.
It should be noted that the discharge diagnoses presented are for the hospital as a whole, and not just for patients of the cardiologist.
in-patient diagnoses at discharge or death
primary diagnosis | 1924 | 1935 | 1942 | 1952 |
atrial fibrillation | 7 | 61 | 77 | 107 |
tachycardia | 1 | 6 | 9 | 4 |
heart block | 3 | 0 | 1 | 6 |
angina | 5 | 10 | 29 | 10 |
coronary insufficiency | 0 | 0 | 0 | 74 |
coronary thrombosis | 0 | 6 | 79 | 241 |
coronary sclerosis | 0 | 14 | 8 | 0 |
myocardial insufficiency | 29 | 69 | 0 | 0 |
cardiac failure | 5 | 10 | 70 | 288 |
myocarditis | 21 | 58 | 7 | 0 |
hypertension | 1 | 70 | 131 | 186 |
aortic stenosis | 2 | 1 | 0 | 6 |
aortic insufficiency | 4 | 3 | 3 | 8 |
mitral stenosis | 1 | 9 | 23 | 40 |
mitral insufficiency | 0 | 1 | 2 | 6 |
endocarditis | 5 | 7 | 7 | 5 |
pericarditis | 2 | 5 | 6 | 7 |
aortic aneurysm | 8 | 9 | 4 | 0 |
total admissions | 95 | 440 | 466 | 988 |
Note: these are the primary diagnosis recorded
Source: Classified Diseases Records, Wellington Hospital archives