All in Her Head: The Truth and Lies Early Medicine Taught Us About Women's Bodies and Why It Matters Today

by Elizabeth Comen

But it is also thanks to Osler that cardiac medicine was designed with a male patient in mind, while women presenting with heart complaints were understood to be suffering from neurosis, anxiety, or hysteria. Heart attacks in particular were meant to be understood as linked not just to maleness but to masculinity, particularly tragic in their tendency to cruelly strike down a particular breed of virile, hardworking man in the prime of his adult life: “It is not the delicate neurotic person who is prone to angina,” Osler declared, “but the robust, the vigorous in mind and body, the keen and ambitious man, the indicator of whose engines is always at full speed ahead.” Nearly all the case studies in Osler’s 1897 text on heart disease are male, with the classic angina patient described specifically as “a well ‘set’ man from 45–55 years of age, with a military bearing, iron-gray hair, and a florid complexion.” Women, meanwhile, were said to be afflicted with what Osler termed “pseudo angina”—literally, false angina—which described a collection of neurosis-induced symptoms masquerading as genuine disease. (Ironically, anxiety or emotional stress were still described as serious risk factors for a heart attack—but only in men.)