Allan Burns was a brilliant anatomist and demonstrator from Scotland and published the first book on heart disease in the English language in 1809. He did not have a medical degree and got his medical education while he was working with his brother as demonstrator of anatomy. Similarly, his clinical experience was based on his collaboration with his brother.
Burns' outstanding book is divided into 12 sections and covers a broad spectrum of topics.
In the section on valvular diseases, Burns indicated that "the auricular valves are more rarely affected than the arterial ones, and those on the right side, are less subject to disease than those on the left."
In his monograph, he described three cases of mitral stenosis. He also gave an account of a case with double mitral and aortic valve disease. He provided a detailed description of clinical symptoms and correlated them with autopsy findings.
He described clearly the most important clinical symptoms of valvular obstruction: dyspnea, palpitation, hemoptysis and chest pain. He also mentioned that the principal cause of death in these patients was "dropsy" (congestive heart failure). He also explained that the obstruction of the left-sided orifices was accompanied by the dilatation of the right chambers, pulmonary congestion and the risk of rupture of pulmonary capillaries ("minute branches").
Allan Burns in the postmortem examination of the case one wrote:
"...the mitral valve was much thickened and contracted; the chordae tendineae, were very short and almost as thick as crow quills; and the columnae carneae [papillary muscles] were uncommonly large, though diminished in length; the passage from the auricle to the ventricle was very much contracted; the projecting columnae carneae forming there a close network." He stressed that the right ventricle was not only dilated but also hypertrophic.
Allan Burns also reported the first observation on the existence of a large left atrial thrombus in the setting of mitral valve stenosis. In one of his cases, he remarked:
"...the left auricle contained a concretion larger than a pigeon's egg; this substance was of an irregular round form, it appeared as if it had been composed of several portions forcibly pressed together; it was of firm consistence, but somewhat friable, and of granular structure; it was covered by a distinct membrane, and adhered firmly to the side of the cavity, which was everywhere lined with lymphatic incrustation, and in many places ossified."
He also described a case of mitral valve disease in which valve regurgitation was predominant.
On physical examination, Allan Burns noted: "...there was a jarring when the ventricles contracted; and when the hand was laid on the side, it resembled the feel of a varicose aneurism; his expectoration, when he used exercise was bloody; he had unusual palpitation, jarring sensation, and hissing noise, as of several currents meeting; the sound was frequently audible, as in the varicose aneurism; the pulse did not correspond with the action of the heart, it was feeble, yet the contraction of the artery was made with rapidity."
He then reported the following statement from Dr Rutherford's clinical observation on the same patient:
"There seemed to be an opening left between the auricle and ventricle, during the contraction of the latter. Thus on each contraction, the blood flowed in part into the aorta, in part into the left auricle [atrium], producing regurgitation along the pulmonary veins, and obstruction to this circulation."
From this observation, Burns postulated that " the regurgitation of the blood from the ventricle into the auricle, must have produced both the jarring sensation, and also, the hissing noise as of several currents meeting. In all probability, it is something of this kind which is described as audible palpitation, in some diseases of the heart."
It does appear from this description that Burns recognized the thrill or "bruissement" reported first by Corvisart and probably understood the mechanism of production of a cardiac murmur.
Finally, in this chapter Burns described the case of a young patient who presented with aortic valve stenosis and regurgitation. She died suddenly at effort. Burns then made these astonishing comments:
"...blood must very often have been driven back into the ventricle. It must have gained on that cavity, producing an irregularity in the action of the heart, which would soon induce a state of deep syncope. Here, I would observe, that death is at first, probably only apparent, and I would wish to impress on your minds, an idea, that by due perseverance in the means of resuscitation, life may in some instances be restored. And I would also wish you to understand, that by procrastination in employing these means, the apparent death is in a time, which, a priori, cannot be specified, exchanged for real death. If therefore, you are to make any attempt to restore animation, you will do well to commence your operations as soon as you can reach the place where the patient is laid; and here, as in every case of asphyxia, you will probably be obliged to persist in the use of necessary means, for a considerable length of time, before you can be certain of either succeeding or failing."
In this paragraph, Burns explained the risk of sudden death and the concept of cardiopulmonary resuscitation. He also stressed that the latter should be initiated as soon as possible. Burns' proposal was simply more than a century in advance of his time.
The entire chapter of Burns' monograph on valvular heart disease is displayed here.
In his monograph, Burns also reported several cases of aortic disease including a case of aortic dissection with hemopericardium.Furthermore, he wrote about obstructive coronary disease as the main cause of angina pectoris.
Allan Burns, a brilliant anatomist and an outstanding physician, died at the age 31 from appendicitis complicated with peritonitis.
Herrick JB. Allan Burns: 1781-1813. Anatomist, surgeon, and cardiologist. Bull Soc Section Med Hist Chicago,1935
Fye WB. Profiles in cardiology: Allan Burns. Clin Cardiol 1990;13:301-302