The Dawn of Open Heart Surgery

For many years, doctors had assumed the heart was too Important to Interfere with and too fragile to be operated on. In those days, cardiac problems often meant death. During the last fifty years, however, our understanding of the complicated cardiac system has increased greatly, and doctors now routinely perform surgeries that were once beyond the furthest reaches of medical imagination.

The Early Days

The development of major surgery was retarded for centuries by a lack of knowledge and technology. Significantly, general anesthetics like ether and chloroform weren't developed until the middle of the nineteenth century. They made major surgical operations possible, which led to an interest in repairing wounds to the heart, and the first simple heart operations were soon reported in the medical literature.

On July 10, 1893, Dr. Daniel Hale Williams, an African-American surgeon from Chicago, successfully operated on a twenty-four-year-old man who had been stabbed in the heart during a fight. The patient was admitted to Chicago's

Provident Hospital on July 9 at 7:30 p.m. The stab wound was slightly to the left of the breast bone (sternum) and dead center over the heart. Initially, the wound was thought to be superficial, but during the night there was persistent bleeding, pain, and pronounced symptoms of shock. Williams decided to operate. He opened the patient's chest and tied off an artery and a vein that had been injured inside the chest wall, possibly causing the blood loss. Then he noticed a tear in the pericardium (sack around the heart) and a puncture wound of the heart "about one-tenth of an inch in length."

The wound itself, in the right ventricle, was not bleeding, so Williams did not place a stitch through the heart wound. He did, however, stitch closed the hole in the pericardium. The patient recovered. Williams went on to report this case in a medical journal four years later. This is the first successful operation involving a documented stab wound to the heart.

At the time, Williams' surgery was considered bold and daring, but he never received the credit he deserved, probably because he did not actually place a stitch through the wound in the heart. Yet his treatment seems to have been appropriate

Daniel Hale Williams

Daniel Hale Williams

under the circumstances and most likely saved that patient's life.

The first stitch closure of a human heart wound was performed by Dr. Ansel Cappelen in Norway on a twenty-four-year-old man stabbed in the left chest. Upon arrival at the hospital, the victim was unconscious, pale, and pulseless. The operation began at 1:30 a.m. on September 5, 1894. A tear of the ventricle was closed with catgut stitches. Unfortunately, the patient's condition remained poor, and he died four days later.

Two years later, Dr. Ludwig Rehn, a surgeon in Frankfurt, Germany, performed what many consider the first successful heart operation. On September 7, 1896, a twenty-two-year-old man was stabbed in the heart and collapsed. The police found him pale, covered with cold sweat, and extremely short of breath. His pulse was irregular, and his clothes were soaked with blood. On September 9, his condition was worsening.

With his patient in profound shock and near death, Rehn opened the chest and found blood and a blood clot inside the pericardium, in addition to a wound in the right ventricle that was actively bleeding (it probably started to bleed again when Rehn removed the blood clot). Rehn placed three silk stitches through the heart wound, and the bleeding stopped. The patient made a full recovery.

In his official report to a medical journal, Rehn wrote, "Today the patient is cured. He looks very good. His heart action is regular This proves the feasibility of cardiac suture repair without a doubt. I hope this will lead to more investigations regarding surgery of the heart. This may save many lives." Ten years after Rehn's initial heart repair, he had accumulated a series of 124 patients who had undergone suture repair of heart wounds with a survival rate of 40 percent.

On September 14, 1902, the first successful stitching of a human heart in America happened under circumstances that would be hard to comprehend by modern day heart surgeons. Henry Myrick, a thirteen-year-old boy, was stabbed by another youth earlier that day. The boy was already in profound shock when the local country doctor arrived. The doctor remembered that Dr. Luther Hill from nearby Montgomery, Alabama, had spoken on the repair of cardiac wounds at a medical society meeting. Hill was sent for and arrived sometime after midnight with his brother, who was also a physician, and five other physicians.

The surgery took place on the patient's kitchen table in a run-down shack. Since it was night, the doctors borrowed two kerosene lamps from a neighbor. One of the doctors administered chloroform anesthesia, and Luther Hill located the stab wound in the left ventricle. About forty-five minutes later, they had stitched the heart wound shut with two catgut stitches.

Although the early postoperative course was stormy, Henry made a complete recovery. He eventually moved to Chicago, where, in 1942 at the age of fifty-three, he got into a heated argument and was stabbed in the heart again, very close to the original stab wound. This time, Henry was not so lucky and died from the wound.

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