Section 1 -

The Maude Abbott Collection of Congenital Heart Disease Rick Fraser McGill University Montreal

The story of the McGill Maude Abbott Collection of Congenital Heart Disease is closely linked to the history of the McGill Medical Museum , of which Abbott was curator between 1898 and 1922, and to the Atlas on Congenital Cardiac Disease, which she published in 1936. Medical Museums were considered by many to be an important adjunct to medical education in the late 19th and early 20th centuries. In a sense, they could be considered to represent an intermediate step between the autopsy room, in which the answers to specific clinical questions were often forthcoming, and the hospital ward or classroom in which medical students were lectured. In this respect the key part of the museum was the specimen, which was meant to illustrate in a concrete and readily accessible visual fashion a particular facet of disease. The hearts which Abbott collected and carefully preserved were meant for such teaching. Abbott's involvement in the study of congenital heart disease can be traced to her "discovery" of the Holmes heart in 1899. Following her appointment as Assistant Curator of the McGill Medical Museum in 1898, she began reviewing and classifying specimens in the collection. She came across an unusual heart labeled "ulcerative endocarditis" for which she could find no additional clinical or pathological information. She directed an enquiry to William Osler, who informed her that the heart had been given to the McGill Museum by Andrew Holmes, one of the four founders of the McGill Medical School in 1823 and the first Dean of its Medical Faculty. The case history and pathologic description of the heart had been reported by Holmes in the Transactions of the Medico-Chirurgical Society of Edinburgh in 1824. Abbott republished the case in the Montreal Medical Journal in 1901, expanding the morphological discussion and adding a historical review. This work was an important "seed" that stimulated her life-long interest in congenital cardiovascular disease. Abbott's plan for the Medical Museum overall was to group specimens according to what she called the "Osler" (or Descriptive) Catalogue", in which material displayed in the Museum would be organized according to organ system and associated with clinical information. Specimen descriptions as well as the corresponding case histories and medical discussions were to be published in a series of books which students would use as a guide for study in the Museum. Abbott first worked on the catalogue of the circulatory system and sent a draft of its endocardial section to Osler in 1905. He was clearly impressed with the work and invited her to contribute a chapter on congenital heart disease to his 1908 edition of the Principles and Practice of Medicine. Following Olser's advice to treat the subject "statistically", she undertook a review of the literature. Beginning with the Transactions of the Pathological Society of London she summarized all the clinical and pathological information related to cardiac anomalies, eventually documenting over 400 cases. During the subsequent 30 years, Abbott collected many specimens illustrating cardiovascular anomalies: most were from McGill teaching hospitals and some from colleagues around the world. In 1931, she organized a series of diagrams, photographs and drawings of some of these specimens and the clinical material associated with them for display at a meeting of the New York Academy of Medicine. The following year, she sent much of this graphic material along with 50 corresponding museum specimens as an exhibit to the Centenary Meeting of the British Medical Association in London , England . Following her return from London, David Seecof of the Jewish General Hospital in Montreal suggested that the exhibit material might form the basis for an Atlas. Her original idea was to reproduce the exhibit exactly as it had appeared in London and a dummy atlas was prepared on this basis. However, the reduction in size of the diagrams that would have been necessary with this format was felt to be inadequate. The material from the London Exhibit posters was thus dissembled and re-organized in a series of 25 Plates which, together with additional case material, formed the Atlas. The Atlas was published by the American Heart Association in 1936 and proved to be a critical success. A second printing was undertaken in 1954, prompted by "numerous requests" to the Heart Association for additional copies. Abbott's work, as exemplified in the Atlas, lay the groundwork for understanding the morphology and pathogenesis of congenital cardiac abnormalities and, ultimately, for their treatment in the latter part of the 20th century. It is likely that she foresaw some of these developments, since she had plans for the Atlas to be followed by a more extensive textbook which would include information on prognosis ("duration of life"), the effects of pregnancy and lactation, the incidence of endocarditis and other complications, and the indications for surgical intervention. She hoped to begin the project in January 1941 and complete it by September 1942. However, in July 1940, before she could begin serious work, she suffered a cerebral hemorrhage from which she eventually died in September of the same year. The exact number of specimens exemplifying congenital cardiovascular disease that remained in the McGill Medical Museum following Abbott's death is unclear. However, in the mid-1940's, these were transferred from the Strathcona Medical Building (the site of Abbott's Medical Museum) to the Pathology Museum located in the nearby Pathological Institute. In the 1960s, the 80 remaining specimens were placed in a display cabinet along with those specimens that constituted the Osler collection. In addition to numerous hearts that show a variety of valvular, septal, endocardial and myocardial anomalies, the collection includes 11 fish/reptilian hearts that Abbott used in her publications related to comparative anatomy, a series of 12 fetal/neonatal hearts that illustrate the normal structure/function of the ductus arteriosus, 1 specimen related to experimental hypertension, and 3 specimens illustrating disease of the aorta. Most specimens were contributed by Montreal physicians, among the most prominent of whom were William Osler, Wyatt Johnston, John McCrea and George Adami. Digital images were taken of the entire Abbott collection in 2003-2004 and subsequently enhanced by digitally "removing" their glass cases as well as the accumulated sediment and debris within the preservative fluid. The Atlas itself, as well as a selection of re-mastered images from the Abbott collection, was republished in 2006 to commemorate the 100th anniversary of the founding of the International Association of Medical Museums (now the International Academy of Pathology). Seventeen of the specimens in the collection are specifically referred to in the Atlas.