Medicine: Surgeons’ College

On the platform of Philadelphia’s Irvine Auditorium one night last week stood two eminent U. S. surgeons. Dr. Donald Church Balfour of Rochester, Minn., husband of the elder daughter of the elder Mayo Brother, was wearing cap & gown. Dr. Eugene Hillhouse Pool of Manhattan stood in evening dress. Suddenly with a great grin, Dr. Balfour took off his mortarboard, clapped it on the thin grey thatch of Dr. Pool. Thus playfully did Dr. Balfour symbolize the fact that he was passing on to Dr. Pool the presidency of the American College of Surgeons, convened before them for its annual meeting.*

50-50 Chance-This scene of medical levity was sombrely interrupted when Dr. Claude Shaeffer Beck, skillful Cleveland surgeon whose preferred operative area is the heart, rumbled: “The death rate from sclerosis of the coronary arteries is appalling. Of the physicians who died during the first half of this year 14.6% were given a diagnosis of coronary thrombosis, coronary sclerosis or angina pectoris. . . .”

Lights in the auditorium were dimmed. The photograph of a very sick man flashed on a screen. Continued Dr. Beck: “This man [on the screen] is a surgeon, a fellow of this College, who came to me because he knew of my work and had confidence in it. He had diabetes and other complications which made him a bad risk. But he said, ‘You get me off the table and I’ll do the rest.’ ”

Dr. Beck did get his doctor-patient off the operating table, has managed to keep him alive for months. Like all muscles, the heart requires the nourishment of blood. It gets this blood through two coronary arteries which tap off from the aorta just after it springs from the hollows of the heart. If a coronary artery is clogged by a blood clot (thrombus), or is narrowed by hardening, the heart cannot get enough blood to survive. Before it dies, it causes the terrifying signal of pain called angina pectoris.

Dr. Beck told his colleagues at Philadelphia that a patient who came to him for an operation to relieve hardening of a coronary artery had a 50-50 chance to survive. Taking the chance, Surgeon Beck opened the man’s chest, detached a length of pectoral muscle, made a hole in the sac called pericardium, which encases the heart, and with a burr abraded a raw spot on the beating heart. Against that raw spot he placed the raw end of the pectoral muscle. Within a short time blood vessels grew out of the muscle and into the heart, thus supplying blood by a roundabout channel from the aorta across the chest and into the side of the heart.

The patient lived, as did seven others like him.

Last week Dr. Beck promised to cut down his 50% operative mortality. He has also developed roundabout circulation in a man’s heart by putting some pulverized beef bone in the pericardial cavity. This irritated the pericardium, caused it to cleave to the heart muscle. The blood vessels, which are numerous in the peri cardium, then sent branches into the heart, thus making a graft of the pectoral muscle unnecessary.

Thyroidectomies. Another sobering surgical discussion at Philadelphia last week came from Dr. Frank Howard Lahey of Boston who, like the Mayos and Dr. George Washington Crile, built up a great surgical clinic on a foundation of excised goitres. Dr. Lahey and his associates have performed 15,200 thyroidectomies since the War, have had only in deaths. Last week Dr. Lahey told how he achieved that happy record.

A goitre produces more thyroid hormone than the body requires, observed Dr. Lahey, causes more energy to be dissipated than the body can afford to expend. Immediate source for this energy is sugar in the blood. The blood gets its supply from sugar stored in the liver. When the liver’s store runs out, a thyroid crisis is apt to develop. Delirium, vomiting, diarrhea, temperatures of 105 degrees to 106 degrees ensue. Infections such as tonsillitis or abscessed teeth accentuate this condition. Explained Dr. Lahey:

”Any change in a patient’s psychic state should be accepted as an indication of the onset of a possibly serious thyroid state. Nothing will more certainly foretell such a state than the appearance of diarrhea or vomiting as the result of an increase in the hyperthyroidism. One must realize that with the appearance of these two symptoms, the most unfavorable conditions possible for this disease come into play. The combustion process associated with hyperthyroidism continues, but the ability to provide combustible fuel for this increased metabolism is lost, with the result that the patient suffers not only from the intoxication of the hyperthyroidism, but also from that which arises from utilizing his own body for fuel.” Few patients have the stamina to endure a thyroid crisis. Their hearts give out or a blood clot stops circulation.

Soon as Dr. Lahey recognizes the approach of thyroid crisis in a patient he takes “combative measures not only toward control of hyperthyroidism by iodine, rest and sedatives, but also toward protection of the liver by the continuous intravenous injection of fluids and large amounts of glucose. The result is that our clinical experience has been much more gratifying. It has even been possible in many cases not only to extricate the patients from a thyroid crisis, but to operate upon them after a period of preparation of two to three weeks with a very reasonable mortality rate, 31%.”

Childbirth.Two of the nation’s best and highest priced obstetricians, both Philadelphia patricians, took opposite corners in a discussion of too much or too little surgical interference in obstetrical cases. Declared Dr. Charles Camblos Norris: “Recent increases in hospital confinements in this country have greatly increased unnecessary surgical interference with labor, with results so unfortunate as to nullify the improvements in maternal mortality statistics which should have been expected from the concurrent extension of antenatal care. Human nature being what it is, the environment of the general hospital has tended to make of obstetric art a sort of surgical specialty in which many an ill-fitted practitioner may essay to shine. The answer is not a return to domiciliary care of normal parturients. Paradoxical as it may seem, the answer is in a greater degree of hospitalization and specialization within the hospital.”

Retorted Dr. Norris Wistar Vaux: “We are not going back to the days of midwifery. We are going ahead to greater and better operative technique. The policy I of watchful waiting in delivery is as old and obsolete as mid-wifery.”

*Also in Philadelphia last week met six groups of anesthetists. Their gravest concern was a new anesthetic called divinyl ether. Professor Isidor Schwaner Ravdin of the University of Pennsylvania, who used divinyl ether in 2,675 operations, praised this highly volatile liquid because a few deep inhalations cause complete unconsciousness. Recovery is very rapid. Nausea or vomiting rarely occurs after divinyl operations. It is less poisonous than chloroform, more poisonous than ether.