Today is the 142nd birthday of an amazing Canadian researcher and physician– Dr. Maude Abbott. It’s hard to sum up in a few words just how awesome this lady was. Briefly, she was orphaned as a child and was raised by her grandmother. After graduating high school, she joined one of the first groups of women to enroll and graduate from McGill. Although she was tremendously interested in pursuing medicine, she was not admitted to the McGill medical school which at the time was exclusive to men. So instead, she enrolled in Bishop’s where women were admitted, and later pursued her postgraduate studies in Europe.
When Abbott returned to Montreal, as I outline below, she was able to establish herself as an expert in congenital heart disease. For her work she was awarded an honourary medical degree from McGill and became a professor at the very institution that had some three decades earlier refused to consider her application on the basis of her gender. Being a woman researcher and physician, Abbott faced many challenges in a world where science and medicine were considered to be men’s territory. However, she overcame many of these barriers by the excellence in the quality of her work and her strong character, consequently paving the way for many more women to succeed.
The following is not an autobiographical sketch, but rather looks at a particular artifact of medicine that I had the pleasure of seeing at the McGill Medical Museum earlier this year and how it shaped Maude Abbott’s career.
The Holmes Heart
Rise of Pathological Anatomy in Canada
By Marzieh Ghiasi (Mar 2011)
athological anatomy, the study of altered or abnormal anatomy, is a field that in its early stages relied heavily on the collection and study of specimens. The ‘Holmes Heart’ is one of such specimens. Stored today at the McGill Medical Museum, it gave early modern physicians an understanding of the human body and its pathologies.
The basis of pathological anatomy can be found in the seventeenth century publications of Swiss physician Théophile Bonet. In his book Sepulchrtum anatomicum (Anatomical Graveyard, 1679), Bonet carefully categorized known abnormalities and defects in the human body in systematic manner . However, the association between disease and anatomy was not made strong until the nineteenth century when pathological anatomy moved from the peripheries of medicine to the center.
The nineteenth century advent of pathological anatomy came about with two broad scientific trends. The first was tremendous interest in the collection of data and specimens; and the second, empirical study and categorization of objects and phenomenon. Nineteenth century pathological anatomy in particular sought to categorize and classify defects, and make scientific studies of these defects in the context of disease. For example in 1870s, the name of the disease Consumption, describing the state of patients as being ‘internally consumed’, was changed to Pulmonary Tuberculosis, describing the anatomy of the disease in form of tubercles, hard lumps that formed in the lung following infection . Pathological anatomy, then, allowed practitioners to make a scientific study of disease and make diagnoses on a physical foundation.
In early nineteenth century Canada, the rise of medical education occurred through the founding of dedicated schools and teaching hospitals, as well as the procurement of pathological collections as teaching tools. In Montreal, the General Hospital was established in 1822, and the McGill Medical School and Medical Museum, then called the McGill pathological Museum, were established in 1823. The first specimen at the museum was an abnormal heart, the ‘Holmes’ Heart, donated by Dr. Andrew F. Holmes, the first Dean of the Faculty of Medicine at McGill University .
It was not until late nineteenth century, however, that the McGill pathological collection began to be used to as a teaching tool. One of the strong advocates of this mode of teaching, that is combining scientific pathology with descriptive medicine, was Sir William Osler, a renowned professor of medicine at McGill who later moved to the Johns Hopkins School of Medicine. An avid collector of pathological specimens, he contributed many and abnormal specimens to the museum . However, it was not he, but one of his protégés, Maude Abbott who studied the Holmes Heart nearly 75 years after it was acquired.
Maude Abbott, born in 1869 in Quebec, was one of the first generation of women graduating from McGill. As a woman, she was not permitted to enrol in the medical school at McGill, so she pursued her studies at Bishop’s University, receiving her medical doctorate in 1894 and continuing on to post-graduate work in Europe. Abbott returned to Montreal in 1897, where she opened a medical office. However, her true interest was in working in the McGill University Faculty of Medicine.
She therefore pursued an opportunity to work in the Royal Victoria Hospital where she was appointed to work on a study reviewing cardiac murmurs in the hospital records of 2780 patients with cardiac disease. She published her first scientific paper “On So-Called Functional Heart Murmurs” from this study in the Montreal Medical Journal in 1899. Her impressive work led her to be invited to the Montreal Medico-Chirurgical Society, an organization that had until then been restricted to men only . Following this work was appointed as an assistant curator at the McGill Pathological Museum which had at the time fallen to disarray .
As a trained physician familiar with cardiac conditions, Maude Abbott was intrigued by a well-preserved but incorrectly labeled three-chambered heart that she had recovered in the museum. The label was ‘ulcerative endocarditis’, an ulceration of cardiac tissue, but the heart itself was normal with the exception that it had two atriums but only one ventricle instead of two . She contacted William Osler, whom she had acquainted and had been inspired by in an 1898 trip to Baltimore, to inquire if he knew about the specimen. He identified the specimen as one that had been donated by Andrew F. Holmes, though he did not know much more about it. This identification prompted Abbott to begin a search for documentation of the specimen by Holmes, which she found in the 1824 Transactions of the Medico-Chirurgical Society of Edinburgh .
According to records, it was collected in February of 1823 from the cadaver of a patient of Holmes, Isaac N. (age 21), who had suffered from cyanosis, a condition where the skin appears to be bluish due to a lack of proper oxygenation of the blood. In his case report Holmes described the patient’s condition prior to death and results of the autopsy [3, 7]. Following the identification of the heart, Abbott investigated and expanded on the report that had been published by Holmes. She included medical and morphological discussions on the heart, and added a historical review which she published along with the original case report in the Montreal Medical Journal in 1901 .
The mystery of the Holmes Heart sparked in Abbott a tremendous interest in studying congenital pathologies in the heart. In 1905, she was invited by William Osler to write a chapter on congenital heart disease for an upcoming textbook on modern medicine that he was editing. This work compelled Abbott to look at hundreds of other cardiovascular specimens for study . By mid 1930s, she had accumulated analyses of over 1000 specimens that had been sent to her for identification , and in 1936 she published these case studies in an Atlas of Congenital Heart Disease. Though others had published studies describing some of these congenital defects and pathologies, none had ever been so comprehensive. This made Abbott’s Atlas ground-breaking and a foundational and influential work in a new field in medicine.
Today the Holmes Heart remains in a glass container of formalin at the McGill Medical Museum and the condition ‘Holmes Heart’ has become eponymous with the specimen in which it was first studied. Acquisition of the Holmes Heart occurred many years before its pathological anatomy was empirically classified and studied. Nonetheless, it still followed the same trajectory as many other specimens that helped bring about modern medicine. The Holmes Heart, in particular, served two roles two essential roles that have elevated it beyond a regular artefact of medicine. First, it elucidated a new anatomical pathology in a part of the human body that hadn’t been subject of much interest and empirical studied prior. Second it brought forth new questions, ultimately acting as a spring board for a new branch of study in science and medicine.
 Mathias, P., The nineteenth century. 2008, Paris [u.a.]: United Nations Educational, Scientific and Cultural Organization [u.a.].
 Dobell, A.R.C. and R. Van Praagh, The holmes heart: Historic associations and pathologic anatomy. American Heart Journal, 1996. 132(2, Part 1): p. 437-445.
 Abbott, M.E., Osler’s pathological collections and his literary output. Canadian Medical Association Journal 1939.
 Evans, W.N. and M.J. Béland, The paediatric cardiology Hall of Fame: Maude Elizabeth Abbott. Cardiology in the Young, 2010. 20(02): p. 124-132.
 Library and Archives Canada. Maude Abbot: International authority on heart disease. 2000; Available from: http://www.collectionscanada.gc.ca/women/030001-1401-e.html.
 Abbott, M.E. and M.D.R.B.C.o.R.U.M.C.a.t.U.o.C. Stanton A. Friedberg, Atlas of congenital cardiac disease. 1936, New York, N. Y.: The American heart association.
 Fleming, P.R., A short history of cardiology. 1997, Amsterdam [u.a.]: Rodopi.