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 Forty
years after he died at the tragically early age of 54,
the reputation of Dr Paul Wood as a showman and con-summate
physician, so dazzling in his ability to diagnose that
he is recognized as one of the greatest diagnosticians
ever, still serves as a reminder of what he means to contemporary
cardiology. These diagnostic skills, combined with his
quantitative approach to examination and clinical data,
meticulously recorded on voluminous data cards, led to
studies that have become the foundation of current clinical
understand-ing of septal defects, pulmonic stenosis, mitral
stenosis, aortic stenosis, Eisenmenger syndrome, constrictive
pericarditis, and surgery for congenital and acquired
heart disease.
Driving himself relentlessly in his investigative work
and expecting perfection from himself and his colleagues,
he inject-ed energy, enthusiasm, and an enormous capacity
for work into everything that he did, according to Mark
Silverman, MD, Pro-fessor of Medicine at Emory University,
Atlanta, Georgia. As an historian, Silverman chronicled
the brilliant career of the British physician whose reputation
in Europe and the United States in the 1950s established
him as a legend in the field of rheumat- Paul Wood, MD
ic and congenital heart disease.1 According to Silverman’s
research, Wood introduced physiology to the bedside, brought
accuracy to the preoperative assessment of cardiac disease,
and bridged the gap between early 20th century and modern
cardiology.1
Wood’s commanding personality—ranging from caustic and
sarcastic to combative—often intimidated students and
offend-ed colleagues as he openly argued with himself
and others to arrive at the correct diagnosis. His 1950
textbook, Diseases of the Heart and Circulation, still
stands as a landmark in the cardiovascular literature
and the Wood Unit, the value for vas-cular resistance,
still reminds 21st century clinicians of his stature in
the field. As early as the 1950s, Wood echoed the concerns
of some latter day clinicians when he warned that bedside
medicine was being replaced by an overreliance on technology:
“Yet there is already plenty of evidence to show that
we are in danger of losing our clinical heritage and of
pinning too much faith in figures thrown up by machines.
Medicine must suffer if this tendency is not checked,”
he said.
Practicing in London during an era when echocardiography
had yet to appear and when cardiac catheterization still
meant right-heart catheterization, Wood made important
observations on Da Costa’s syndrome, the electrocardiogram
in pulmonary heart disease, pulmonary vasoconstriction,
and anticoagulation for coronary insufficiency. His major
influence was his extraordinary bedside teaching during
the days of unoperated upon and often advanced valvular
and congenital heart disease. A bedside diagnosis was
critical because a decision to operate hinged on clinical
findings. Wood’s method of teaching emphasized a gathering
of 10 to 20 colleagues, residents, students, and clinical
assistants around the bedside as he revealed his logic
in arriving at a diagnosis and challenged them to offer
their opinions.
Refusing resuscitation because he said he preferred to
die rather than risk surviving without his full mental
capabilities, Wood died of a myocardial infarction in
July 1962, about a month after a speaking tour of the
U.S. During that tour he met with J. Willis Hurst, Emeritus
Chairman of Medicine at Emory. Hurst later credited his
conversation with Wood as providing a major stimulus for
Hurst and his colleagues to create the landmark text,
The Heart, in 1966.
There was another side to Wood. Silverman reports that
he was kind and considerate to each patient, and most
seemed thrilled to be at the center of attention of a
master physician. After his examination, he would explain
his findings and prognosis to the patient, expressing
concern about his or her welfare but at the same time
speaking bluntly and honestly.1 Most of his graduate students,
how-ever, were cowed, awed and inspired by his dazzling
ability to think and teach. Many used him as a role model
and remained disciples to his teaching for the rest of
their careers. In that sense, all who studied under or
were influenced by him can be considered keepers of the
flame of Paul Wood.
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