The mid-century revolution in thoracic and cardiovascular surgery: Part 5

Abstract

Mitral commissurotomy has, in a way, a war-related prologue. The first consecutive series of successful ‘cardiac’ operations was performed by ‘Captain’ Dwight Harken of the US Army in Europe. This amazing series of 134 operations for removal of shrapnel pieces and other projectiles in and around the heart, right after D-day and the battle on Omaha beach, can certainly be considered as one of the decisive turning points towards modern cardiac surgery. Advances have often been war-related and the fact that the ‘patients’ were young, otherwise healthy soldiers, certainly favored successful results. One can also say that the right man was at the right time in the right place! One had to know the man and his character to comprehend the exceptional performance of this 35-year-old army surgeon. In later years, because of my interest in mitral surgery from 1950 onwards, I came to know Dwight Harken well having spent many hours watching him operate and also being invited to his home, where we developed a friendly relationship and sympathy for each other. He was an outgoing extrovert personality, extremely ambitious and able to develop the best relationship with the surgical leaders of his time—mainly Churchill and Eliott Cuttler in Boston, as well as Tudor Edwards and Norman Barrett in London, men who were extremely helpful for his career. As a medical student at Harvard he was advised by Churchill to make thoracic surgery his career. During his training at Bellevue Hospital, he obtained a traveling fellowship from the New York Academy of Medicine and spent the year of 1938 with Tudor Edwards and Barrett at the Brompton Hospital in London. In 1944, although already in active practice in Boston, he enlisted as an army surgeon when the USA entered the war. He arrived in England on SS ‘Queen Mary’ to take over the 160 Surgical Unit in the small village of Cirencester in the Cotswold Hills. Captain Harken first met with great resistance from his chief, Elliot Cuttler, a convinced general surgeon, when he wanted to set up his unit as a specialized thoracic surgical center. This concept, by the way, had already been implemented by General Churchill, chief in the Mediterranean theater of operations. Fortunately, through the intervention of Tudor Edwards, Harken obtained what he wanted—a thoracic surgical unit. Although, as a resident at Bellevue or later in Boston he did have experience in animal experimentation, especially for cardiac operations, such operations on human beings, American soldiers, were deemed too dangerous to be authorized. This time through the help of his mentor, Elliot Cuttler, Harken was finally authorized to proceed in his cardiac endeavor. As we have seen, with his indomitable determination he created the conditions so as to be ready for his cardiac operations when the first wounded soldiers arrived after Omaha beach and the invasion of France. It is stunning to read a description of these operations under wartime conditions. Once the foreign body was localized and the stay-sutures for temporary hemostasis and final repair were in place, Harken ‘plunged’ an old fashioned Kocher clamp into the heart, grabbed the piece of metal and pulled it out: the gush of blood was luckily, sometimes with difficulty, arrested while the nurses pushed the blood transfusion. The surgeon quite often had to close the heart wound by holding his finger over it, occasionally sewing his rubber glove to the heart! Having gone through these maneuvers at least 50 times during his war experience, no wonder that in his mitral operations some years later he was rarely taken aback by a massive hemorrhage. Dwight Harken was maybe not the type of exceptional surgeon I described when remembering Sweet or Overholt. He seemed always under pressure and was constantly explaining to nurses and visitors how things were going. Nevertheless, he proved by his wartime series and later success that he was a highly determined and competent pioneer and, last but not least, devoted to his patients and... his mission!