Historical development of pulmonary surgery

Abstract

W HEN in the second haIf of the Iast century a new, important phase in the deveIopment of surgery dawned-when the introduction of anesthesia, of antisepsis and asepsis, new discoveries in anatomy and physioIogy, and deveIopments in pathoIogic anatomy finaIIy ushered in the “golden age of surgery”operative technic was aIready estabIished on a fairIy sound basis. OnIy the endothoracic organs remained an area of which surgeons stiI1 fought shy. True, there are cases reported by surgeons of the MiddIe Ages and the Renaissance in which resection of the puImonary tissue was performed. Back in the thirteenth century RoIando of SaIerno removed the gangrenous part of a Iung that had proIapsed as a resuIt of an injury to the thoracic waI1. In the seventeenth century, under simiIar conditions, Fabricius HiIdanus performed puImonary resection with a red-hot iron. Yet in the numerous descriptions of thoracic and pulmonary injuries contained in the surgica1 Iiterature of the Ancients and of the MiddIe Ages, there is not one mention of pneumothorax and seIdom of subcutaneous emphysema. This is a sign that cIinica1 observation in those days, aIthough we11 advanced in other respects, stiI1 feIl short when it came to studying intrapIeura1 diseases, or else perhaps, was of no practica1 interest for lack of the means to treat such cases. Even the treatment of empyema-one of the outstanding achievements of the Alexandrine schoo1 of surgery-had so fallen into disrepute that Dupuytren (1777-1835), enterprising surgeon though he was, refused to aIIow this operation to be performed on himseIf. thorax, refused to remove the spear point from his breast unti1 he Iearned that the Thebans had won the day. Even in the earIy days of the first World War the ruIe was stiI1 not to intervene in such cases, and the reaIization that it was enough to transform an open pneumothorax into a closed one to remove a11 immediate danger only sIowIy found acceptance. MeanwhiIe the reticence shown toward open thoracotomy gave pIace to an important advancement which fifty years Iater was to become one of the cornerstones of the postoperative treatment of intrathoracic interventions. In 1876 BtiIau, a Hamburg physician, introduced the method of subaqueous drainage into the treatment of empyema. This he was induced to do by the unfavorabIe experiences encountered in performing open thoracotomy in chiIdren. His work shows that he had a cIear conception and understanding of the dangers of the open pneumothorax, and from this time onward surgeons reaIized the need to reduce or eliminate these dangers during and after intrathoracic interventions. The immediate effect of this realization was, admittedIy, to hamper rather than to assist. The dangers of opening the pIeura were grossly overestimated; and although in 1884 KrfinIein, a Swiss surgeon, performed resection of a lung, manv vears went by before others foIIowed suit. It \;a; not until the turn of the century that isoIated cases were reported (by Murphy, Tuffrer, Heidenhain, KBrte, GarrC: and Quincke, Len hartz and others).