The Holmes Heart: Still Beating Two Centuries Later

Abstract

This is a wide-ranging article tracing the saga of the Holmes Heart, autopsied in 1823 by Andrew Holmes, MD, at McGill University in Montreal. The patient was a 22 year-old male named Isaac, for whom Holmes had cared for since birth.  His unusual congenital heart defect included a univentricular heart. The paper regarding the case was presented in Edinburgh not long after the autopsy but date discrepancies present unresolved conundrums. Holmes predicted ante-mortem pathophysiology was remarkably prescient. The sundered heart was rediscovered in 1900 by Maude Abbott, MD, in the McGill Medical Museum. She contacted William Osler who had studied the heart and presented it to students. He directed her to Holmes's 1824 paper.  This heart was the springboard that catapulted  Abbott's remarkable career as she became the world authority on congenital heart disease (CHD). Her Atlas of Congenital  Cardiac Disease has been reprinted twice. The issue of the univentricular heart recapitulates the issue of embryological arrest of the human heart  at the  reptilian univentricular stage in the evolution of the heart. The alligator is imbued with remarkable adaptations including the Foramen  of Panizza connecting the dual aortae, and a cogwheel valve shutting down the pulmonary circulation during dives. The author obtained two alligator hearts and dissected them to find this unique foramen. At the Maude Abbott Medical Museum Conference held at McGill University in 2022, a unique feminist perspective on Maude Abbot was presented which is encapsulated in this paper. A historical exploration of univentricular hearts and cardiac evolution is included.  This article tells an intriguing story.