In 1912, the Chicago physician James Herrick published a seminal paper on the diagnosis of coronary heart disease—following up on the work of two Russian clinicians in Kiev—but only after Herrick used the newly invented electrocardiogram in 1918 to augment the diagnosis was his work taken seriously. This helped launch cardiology as a medical specialty, and it blossomed in the 1920s. White and other practitioners may have mistaken the new understanding of coronary heart disease for the emergence of the disease itself. “Medical diagnosis depends, in large measure, on fashion,” observed the New York heart specialist R. L. Levy in 1932. Between 1920 and 1930, Levy reported, physicians at New York’s Presbyterian Hospital increased their diagnosis of coronary disease by 400 percent, whereas the hospital’s pathology records indicated that the disease incidence remained constant during that period. “It was after the publication of the papers of Herrick,” Levy observed, that “clinicians became more alert in recognizing the disturbances in the coronary circulation and recorded them more frequently.”

Over the next thirty years, recorded cases of coronary-heart-disease fatalities increased dramatically, but this rise—the alleged epidemic—had little to do with increasing incidence of disease. By the 1950s, premature deaths from infectious diseases and nutritional deficiencies had been all but eliminated in the United States, which left more Americans living long enough to die of chronic diseases—in particular, cancer and heart disease. According to the Bureau of the Census, in 1910, out of every thousand men born in America 250 would die of cardiovascular disease, compared with 110 from degenerative diseases, including diabetes and nephritis; 102 from influenza, pneumonia, and bronchitis; 75 from tuberculosis; and 73 from infections and parasites. Cancer was eighth on the list. By 1950, infectious diseases had been subdued, largely thanks to the discovery of antibiotics: male deaths from pneumonia, influenza, and bronchitis had dropped to 33 per thousand; tuberculosis deaths accounted for only 21; infections and parasites 12. Now cancer was second on the list, accounting for 133 deaths per thousand. Cardiovascular disease accounted for 560 per thousand.

Fortune magazine drew the proper conclusion in a 1950 article: “The conquering of infectious diseases has so spectacularly lengthened the life of Western man—from an average life expectancy of only forty-eight years in 1900 to sixty-seven years today—that more people are living longer to succumb to the deeper-seated degenerative or malignant diseases, such as heart disease and cancer….” Sir Maurice Cassidy made a similar point in 1946 about the rising tide of heart-disease deaths in Britain: the number of persons over sixty-five, he explained, the ones most likely to have a heart attack, more than doubled between 1900 and 1937. That heart-attack deaths would more than double with them would be expected.