WORK OF YOUR HEART: JOURNEY TO THE CENTRE OF THE HEART
One of the most important dates in the early history of heart surgery is 9 September 1896, for it was on that day that a 22-year-old man, Wilhelm Justus, was operated on by Ludwig Rehn. Rehn, a German surgeon, successfully stitched up a wound in Justus’ heart which went on to heal perfectly, thus demonstrating beyond all doubt that the human heart could actually be handled while a person was alive – and the patient could live to tell the tale to his or her grandchildren. The touch of the scalpel, the intrusion of the suturing needle, the probing of the doctor’s finger – none of these could any longer be dismissed as rash or foolhardy attempts to tamper with nature to the detriment of the patient. At last surgeons were beginning to take their rightful place in the struggle to fight diseases of the heart.
Rehn’s success produced a fresh note of optimism among surgeons. Up to that time the vast majority of surgical interventions had been purely experimental. Animals such as dogs had been used in the study of, for example, the action of the heart’s very special valves, or rabbits in the testing out of the effects of suturing wounds.
Audacious surgeons
And so it was in the wake of Rehn’s operation on Herr Justus. Papers were written in medical journals suggesting that surgery could be the answer for diseases that had previously been virtually untreatable. In 1897 one Dr. Tuffier successfully treated a case of cardiac arrest (when the heart-pump just stops) by applying massage, while elsewhere there was talk of surgically correcting defects in the heart’s valve mechanisms. Sir Lauder Brunton, a leading surgeon of his day, wrote to the medical journal, The Lancet, suggesting that it might be possible to widen a narrowed valve-opening by surgical means, and pointing out that he had come to this opinion after experimenting with cats in the laboratory. A week later he was verbally chastised for being the champion of such a dangerous procedure – cats or no cats – while others wondered if the valve-opening would stay open after surgery, or revert to its unhealthy constriction. But for all the initial opposition the tide was undoubtedly on the turn.
Over the next ten years or so enthusiasm for heart surgery, especially in connection with the relief of valve blockages, built up steadily. In those pioneering days, from the turn of the century to around the outbreak of the First World War in 1914, this enthusiasm was primarily directed towards animal experiments. In Europe and the USA medical researchers used laboratory animals to try out various techniques for correcting valve deformities; these, though far from perfect, helped to spread the notion that soon such operations might safely be performed on humans.
War wounds
In the event, however, things did not speed ahead quite so rapidly as one might have anticipated. There was a bit of a hiatus with the coming of the First World War, when surgeons were preoccupied not so much with furthering the experimental measures initiated in peacetime as with coping with the wounds to the heart incurred on the battlefield. However, the very fact that doctors were forced to operate on so many heart wounds was both highly instructive and encouraging for the future. It became obvious that the heart was indeed a rugged organ which would tolerate far more manipulation and ‘interference’ than most people had realized. Although many of the medical records of those war years have been lost, the documents that survive show that the success rate among heart-wound operations was very high. After the war, this fact gave even greater impetus to experimental work on the development of cardiac surgery for the disorders of peacetime.
The first great landmark in the post-war phase was in May 1923 when Cutler, Levine and Beck operated on an 11-year-old girl whose life was threatened by a defective heart valve. Having delicately worked their way in through the heart chamber known as the left ventricle, they managed, using a special surgical knife, to enlarge the valve-opening by separating the flaps or cusps which had become fused as a result of inflammation. As it happens, the patient, although surviving the operation and indeed going on to live for a further four-and-a-half years, did not show a marked improvement in her condition after the operation. Cutler and his team tried to improve matters during four more operations over the next two years, but with little success. However, we should not undervalue their efforts. After centuries of mystery, the heart, that terra incognita of the human body, had at last been penetrated by the scalpel, had continued to function, and had even been revisited by the surgeon for later attempts to improve its performance.
*2/353/5*
