In Matters of the Heart, Fay Bound Alberti focuses on one organ—the heart—to explore the mind-body relationship in Great Britain over a longue durée, the eighteenth century to the twentieth century. Alberti successfully demonstrates that in order to understand the heart's emotional status we cannot merely study it alone: “Rather it needs to be understood in situ as an aspect of the human body, and its relationship with the emotions, the mind, and the soul” (161–62). Despite the changing medical theories for heart disease, Alberti sees physicians and patients in practice as frequently understanding the heart within a holistic body—at least until the twentieth century when medical specialties developed.
Descartes is usually blamed for the mind-body split, but Alberti traces a much more complex process. She looks first at the eighteenth century, with its emergence of several competing models of the body. In addition to the humoral body, there were also mechanical, nervous, and electrical models, all of which treated the mind-body relationship slightly differently. For Alberti, the late eighteenth century marks a key turning point in the treatment of heart disease, with the newly established disease category of angina pectoris. This, she argues, was a product of old and new discourses. According to the old discourse, angina pectoris was caused by emotional, psychological, and environmental factors; the new discourse, however, treated the heart as an organ of science—a physical object that could be measured and analyzed.
A growing interest in heart disease emerged during the nineteenth century, with greater specificity in diagnosis and classification, as well as new technologies that could objectively measure living hearts. Not only did physicians divide heart disease into functional and structural, but they classified it according to age and gender. Functional heart disease meant that there were no lesions on the heart and that it posed no real danger to the patient. Structural heart disease had lesions on the heart (such as ossified arteries) and would, inevitably, prove fatal. Men were most at risk between the ages of fifty-five and sixty, and their (structural) heart disease was caused by gout, strain, alcohol, or syphilis. Women and young men, however, developed (functional) problems triggered by excessive emotions; their heart disease was, literally, all in their head.
It was not until the twentieth century that the mind-body split was completed as part of the process of modernization. Medical theories by this time had shifted to cranio-centric models, emphasizing the thinking being. Human emotions were no longer seated in the heart but in the head. A body might feel or reveal emotions, but the emotions had been processed by the brain. At the same time, medical treatment had become ever more specialized, resulting in a body that was studied in bits rather than holistically.
Along the way, Alberti offers “slices of the heart, severed up at various points”: chapters in which she examines specific cases to support her larger narrative (160). The death and autopsy of the often angry John Hunter embodies the late eighteenth-century ideas about angina pectoris, while the nineteenth-century case study of Thomas Arnold reveals the treatment and lay understanding of a patient's hereditary heart condition. The chapter on Harriet Martineau examines the gendering of heart disease as female, something caused by excessive emotion, and Martineau's use of her diagnosis to bolster her literary cachet. Another chapter focuses on the medical casebooks of Peter Mare Latham to consider a nineteenth-century heart specialist's medical practice. Although Latham knew and contributed to the medical theories of the day, he treated patients using much older ideas in which heart disease was seen within a social and emotional framework.
My criticisms of the book are minor. For example, Alberti's occasional comparisons between Western and Chinese medicine are underdeveloped and, as they stand, add nothing to her analysis. On pages 113–14, where she discusses the importance of looking at the tongue to assess health in the nineteenth century, she then notes that “[t]here was and is a long Chinese tradition of understanding the tongue as symptomatic of the body's condition.” Perhaps a better comparison would have been to consider the early modern significance of checking the tongue, particularly because the chapter examined continuities between Galenic and nineteenth-century medicine.
Alberti does, however, tell a fascinating story. Her account of the wider medical changes would be useful and accessible undergraduate reading, while her analysis of the mind-body relationship should be required reading for anyone working on minds, emotions, or bodies. Alberti rightly notes that historians have perpetuated the twentieth-century scientific boundaries between mind and body, meaning “that the history of neuroscience need not be connected with the history of cardiology” (141). Alberti's thought-provoking study makes not only a compelling case for scholarly reintegration of the mind and body but also highlights the research riches that it provides.
