Surgery

The emergence of heart surgery in the twentieth century defied earlier beliefs that the heart was inviolate and untouchable. Contemporary surgeons replace hearts in heart transplant operations, create new pathways for the blood using tissue from other parts of the body in coronary bypass operations, and clear out the blood vessels of the heart using special tools in coronary angioplasty. But the story of the development of heart surgery makes clear the high cost in human lives of medical advancement in this area.

As early as 1882, the German physician M.H. Block wrote of his successful suturing of rabbit hearts and suggested that human hearts could also be sutured. Surgeons in the early twentieth century who attempted surgery on heart valves found limited success. A 1928 survey of the 12 known cases of surgery on heart valves reported that 83% of those who received the procedure had died.

Due to overwhelming death rates, heart valve surgery waned until the 1940s and 1950s, when the procedure was reintroduced and surgeons could take advantage of several research advances. These included procedures which enabled surgeons to maintain circulation during surgery and to slow the beating of the heart. In 1950, the first electric pacemaker was developed. The race to add new ways to preserve the precious heart intensified.

In 1967, the first successful human heart transplant was performed by South African surgeon Christian Barnard. Although the patient died in 18 days, Barnard was celebrated internationally for his surgical skill. The thrill of transplanting hearts, and the great potential for saving lives, encouraged surgeons around the world to try the operation. The results were disappointing, as patient after patient died in a number of days or, sometimes, months. Most died after their bodies rejected the donated organ. Enthusiasm for the operation faded. While 99 transplants had been conducted in 1968, nine were performed in 1971.

As a small number of surgeons continued performing transplants, success rates for the operation improved. In addition, effective drugs to fight organ rejection were developed. By the early 1980s, heart transplants had regained popularity and in 1984, about 300 heart transplants were performed in the United States. In 1994, a total of 83% of individuals receiving heart transplants were expected to survive one or more years, making the surgery far safer than life with a failing heart.

A more common, and safer, procedure for individuals whose hearts are weak but not in need of complete replacement is the coronary artery bypass, a procedure developed in the late 1960s. The procedure takes tissue from elsewhere in the body to form new, clear pathways for blood to flow through the heart. A total of 309,000 coronary artery bypass grafts were performed in the United States in 1992. The procedure is not without risk, and the death rate linked to bypass surgery is from one to two individuals out of 100. Yet the prospect of a limited life without the surgery makes coronary bypass a common procedure.

One vivid measure of the extent to which surgery has become routine is the high number of babies born using caesarian section, the surgical delivery of a baby. In 1992, a total of 921,000 caesarian sections were performed, making the procedure the most common type of major inpatient surgery. The procedure is used when labor fails to progress, when a child being born is in distress, and in other situations where normal birth is considered unwise or dangerous. The frequency of the procedure is controversial, with many critics saying that cesareans are used too frequently, placing mothers at risk and adding to the high cost of health care.

Many contemporary experts challenge the long-told story that cesarean birth was named after the birth of Roman statesman Julius Caesar. They say that had Caesar been delivered using caesarian section, his mother probably would have died, due to the high risk of infection. Historical evidence suggests that she survived the birth of her son. Cesarean sections were mentioned in ancient Indian medical texts, although the outcomes are unclear. In the modern era, the first cesarean births in which mother and child were expected to survive were performed in the early 1800s. Death due to infection still occurred frequently following the surgery. Cesarean births did not become popular until the late 1920s and they did not approach their current popularity until recently.