The 100-year anniversary of World War I this year is uncovering new truths. One surprise concerns the origins of heart surgery. To put the breakthrough in context, one should know that in 1896, the standard textbook “Surgery of the Chest” declared: “Surgery of the heart has probably reached the limits set by nature; no new methods and no new discovery can overcome the natural difficulties that attend a wound of the heart.” The leading surgeon in the world at that time, Theodore Billroth from Germany, had gone so far as to declare, “The surgeon who operates on the heart will lose the respect of his colleagues.”
The Supposed Beginnings of Heart Surgery
During my training, we were taught that surgery on the heart began with a few operations in the 1920s when a couple of daring surgeons tried to stretch mitral valves that had been critically narrowed by the after-effects of rheumatic fever. Then common, this infection is now easily treated with penicillin (and is rare today in developed countries). The few operations were ignored.
In World War II, an American surgeon, Dwight Harken, had unprecedented success (and not a single death) removing shrapnel from the hearts of wounded soldiers. This drove early heart surgery onward, supported by anesthesia, transfusion, antibiotics, imaging, intensive care units and a host of medical improvements.
New Evidence of Earlier Heart Surgeries Discovered
Wounded in the Battle of Cambrai
Now, however, new evidence of the earliest history of heart surgery has emerged. One British soldier in the World Ward I Battle of Cambrai (1917) was shot by a machine-gun bullet from 500 yards. The bullet pierced the pocket of his tunic, his chest and then travelled into his heart. X-rays, a new technology in a base hospital, showed the bullet moving with every beat of the heart. Without the benefit of antibiotics, a blood bank or proper lighting, and only ether for anesthesia (dripped onto a gauze mask), George Grey Turner (later an eminent British surgeon) exposed the heart with an incision in the left chest, and found the spot where the bullet had entered, but he could not feel the bullet.
Finally, in desperation, Dr. Turner rotated the heart and felt the bullet in the middle of the heart, lodged in the wall between the left and right ventricles. The heart stopped, and somehow without pacemaker or defibrillator (not yet invented) the surgical team got the heart restarted, and, wisely, abandoned the operation and closed the incision. The patient survived another 25 years!
Detective Work Reveals Successful WWI Surgery
Another World War I patient, it turns out, actually had a bullet removed from the right ventricle. Details were forgotten until recently when a British surgeon was giving a public lecture about heart surgery. A woman in the audience insisted that family tradition said her great uncle had survived heart surgery in WWI. The surgeon said this was impossible, but after she insisted, he tracked down the records, including the operation note.
The woman was correct! While on horseback on his 21st birthday in November 1917, her relative, a British soldier, was shot by a Bulgarian. The soldier rode several miles to an aid post, where he was patched up and then transferred, by hospital ship, to Malta. At the base hospital, doctors believed he would not survive without removal of the bullet, and they performed this operation successfully. Unfortunately, the young man died of an infection 2 months after surgery. By coincidence, the modern British surgeon who did the detective work was born in Malta, and when he was next on the island, he located the grave of the young soldier and paid his respects.
Modern Heart Surgery Indebted to Wartime Innovation
Wars have repeatedly driven surgeons to daring innovation, and the military doctors and their patients have propelled surgical progress. We modern heart surgeons, and our patients, owe a debt to the brave doctors and patients of those bygone days.
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