Our Changing Cardiovascular Attitudes Toward Major Surgery

A Review—Attitudes and Aspects Often in the practice of medicine the internist or cardiologist may be called upon to support or share with the surgeon the evaluation of the preoperative cardiac fitness of the patient undergoing an indicated surgical procedure. No doubt, following such medical clearance, the internist has at times indulged in self-interrogation concerning the patient's chances of survival. Does the internist's responsibility hold for the period of the actual surgery, or 4, 12, or 24 hours, or a week, or a month after operation? Were the conclusions for clearance based on clinical experience inexpressible by words or on criteria of a standard text, or were they based on what may be designated as applied science of medicine, using tools—blood pressure apparatus, electrocardiograph, ballistocardiograph, etc.? Frequently, in the course of history taking to evaluate the functional capacity of the heart, the patient would be asked how far he