Sir Denis Browne,the father of modern pediatric surgery

Sir Denis John Wolko Browne (1892–1967), while not the first in the British Isles to devote his entire surgical practice to pediatric surgery, is accepted as “the father of pediatric surgery in the United Kingdom.” He made contributions to operations as varied as tonsillectomy, pyloromyotomy, and hypospadias repair, and provided fundamental insights into the proper treatment of club foot, congenital dislocation of the hip, and cryptorchidism. He introduced the transverse laparotomy incision, primary repair of congenital intestinal obstruction, and the end-to-back anastomosis for intestinal atresia, techniques so commonly used that it is difficult to think of pediatric surgical operations done any differently. In addition, he invented the elegant Denis Browne retractor that remains in use today, one of the few eponymic instruments known by its originator's first and last name. He was among the founders of the British Association of Pediatric Surgeons, one of the first professional organizations in the field, and served as its first president. His legendary status was enhanced by an acerbic temperament that often surfaced in an outspoken and uncompromising advocacy on the behalf of the proper care of children. A larger-than-life figure in pediatric surgery, Browne's legacy is so wide-ranging and enduring that his unofficial title has been broadened to “the father of modern pediatric surgery.”     

Julian Smith: scientific surgeon, photographer, inventor

Julian Augustus Romaine Smith was one of the surgeons who, in the company of Thomas Dunhill, Hugh Devine, Douglas Shields and David Murray Morton, established Saint Vincent's Hospital, Melbourne, as arguably the premier surgical hospital in Victoria, if not Australia. Smith abandoned a most promising scientific career to study medicine, completing his medical course in Melbourne where he graduated top of his year in 1898/1899. He gained his MD in 1901 and set up practice in Morwell, a Victorian country town, where he initiated his surgical career. In 1905 Smith returned to Melbourne and worked as assistant to Mr F. D. Bird, a prominent surgeon. He travelled overseas in 1906, visiting leading medical centres in England where Almroth Wright's work on vaccination made a deep impression on him. On his return to Australia in 1908 he joined the surgical staff at Saint Vincent's Hospital as surgeon to outpatients, finally retiring as surgeon to inpatients in 1928. Smith was made a Foundation Fellow of the Australasian College of Surgeons in 1927. Smith was regarded by his peers as a brilliant innovative surgeon with a special interest in urology. He became an expert cystoscopist. After he retired, he continued his long-standing interest in portrait photography for which he was considered a master. During World War II he designed and built an elegant roller pump for use in direct blood transfusion. He died in 1947, survived by his wife, a daughter and three sons, one of whom became President of the Royal Australasian College of Surgeons.     

Rudolf Nissen's years in Bosphorus and the pioneers of thoracic surgery in Turkey

Rudolph Nissen is one of the most distinguished pioneers in thoracic surgery, well known for his pneumonectomy operation performed for the first time in surgical history. He migrated to Istanbul like most of his contemporary colleagues, avoiding the fascist regime in Germany in the 1930s. He was enthusiastically welcomed in Turkey and appointed as the Chief of the First Surgery Clinic in Istanbul University in 1933. He worked with discipline and in cooperation with his Turkish colleagues, such as Ahmed Burhaneddin Toker, Fahri Arel, Dervis Manizade, and others, who were to become the leading authorities of general thoracic surgery in Turkey. During his 6 years of residence and working in Istanbul, he contributed highly to the practice of general and thoracic surgery. He had to leave for the United States in 1939 for treatment of his lung abscess due to a retained bullet from World War I. He stayed in New York and later in Basel until his death. He was presented an honorary professorship from Hacettepe University, Ankara in 1973.     

J. H. Louw Memorial Lecture. Outreach, origins and a hedgehog

Professor J. H. Louw is honoured in this lecture for the major contribution he made to the development of paediatric surgery in South Africa as a specialty in its own right. Although he is perhaps best known internationally for his contribution to our understanding of the aetiology of small-bowel atresias, it may be that his greatest legacy lies in those he taught, many of whom are in the audience. He was a man who demanded the highest standards, both of himself and of his colleagues, and despite many other leadership roles and responsibilities in surgery generally, always considered that his first responsibility was to paediatric surgery. It may be fitting, therefore, that this lecture deals with two aspects that were dear to Professor Louw, namely the provision of specialist care for children with surgical conditions, and recent research into the causes of congenital structural abnormalities.     

Recurrent cardiac arrest after splenectomy in a patient with ITP and diabetes mellitus

We report a case of 58-year-old man who had repeated cardiac arrests on the first post-operative day. The patient underwent splenectomy due to ITP (idiopathic thrombocytopenic purpura). He also had diabetes mellitus and nephrotic syndrome. There was no abnormal finding at the preoperative examination, except bleeding time of 6 minutes. The operation was finished without complications under general anesthesia. Midnight on the day of surgery, the first cardiac arrest occurred, and lasted for about 10 seconds. He recovered soon from the incident, but at 6 o'clock next morning, he developed severe bradycardia and cardiac arrest. He recovered again, but around 10 o'clock, he developed bradycardia and arrest again, and fell into a fit of convulsions and lost his consciousness. Again he recovered soon and no bradycardia and cardiac arrest occurred after this episode. Two years later, he was scheduled for vitrectomy due to diabetic retinosis. There were a few PACs and PVCs in his Holter-ECG, but no typical bradycardia and ST changes. During the operation, we injected atropine sulfate, dopamine hydrochloride and bucladesine sodium to increase his heart rate above 60 per minute. The operation was finished smoothly and there was no trouble perioperatively. A year later, he also underwent bilateral cataract extraction under local anesthesia without any troubles.     

The early history of cardiac surgery in Stockholm

Cardiac surgery in Stockholm grew on a sound foundation of well-developed general thoracic surgery. The portal figure is Clarence Crafoord (1899-1983) who already in 1927 had succeeded with the Trendelenburg pulmonary embolectomy operation. He went on to develop lung surgery in general. With foresight he stimulated the chemists of Karolinska Institute to purify heparin, first for prophylaxis against venous thromboembolism and later for use with the heart-lung machine. In 1944 he became the first surgeon to successfully operate on patients with coarctation of the aorta. With Viking Olov Bjork and Ake Senning the heart-lung machine was improved, finally allowing its clinical use in a patient operated in 1954 for a myxoma of the left atrium, with long-term survival. This was the first successful use of the heart-lung machine in Sweden and the second in the world. He and his coworkers, first at the Sabbatsberg hospital and from 1957 at the Karolinska hospital made major contributions to cardiology and radiology, apart from the progresses in cardiac surgery. Contributions such as pressure recording from the left atrium by needle puncture in 1950, the Senning operation for transposition of the great arteries and the first use of a totally implantable cardiac pacemaker in 1958 are indeed medical history.     

Pierre-Joseph Desault (1738-1795)--a forerunner of modern medical teaching

Pierre-Joseph Desault (1738-1795) was the first French professor of clinical surgery. He was chief surgeon at La Charité and H?tel-Dieu in Paris, where he developed a new method for teaching anatomy and modified the teaching of surgery. His fame was due to his dedication and to the number and quality of fellows, who included Bichat, Louis, Corvisart, Dupuytren, Percy, Richerand, Petit, Chopart, and Gavard. He taught while performing surgery, and his school included up to six hundred fellows at a time, practicing in the 1200-bed H?tel-Dieu. He "imprinted" his pupils with his professional teaching, his surgical procedures and his personal charm.     

Dr. W.W. Babcock und seine Varizenoperation

The 100^th anniversary of Babcock’s operation for varicose veins is a worthy occasion to honour Babcock and his contributions to the development of the operative procedure for varicosis. He was one of the most important surgeons in America, and he was a driving force in his profession for many years. He was especially a pioneer in the field of colorectal surgery. Special emphasis is given to a medical-historical analysis of his operative method for varicose veins – which is still being used today – placed in the context of the phlebology of his time. The influence of his investigation, both on the technical development of his extractor and on surgery in Germany, is discussed. Biographical information about Babcock and a bibliography complete the current publication. Note that some of the visual material used in this article is being published for the first time in German-speaking areas.     

Harvey Cushing: "From tallow dip to television".

Harvey Cushing was not only a leading founder of neurosurgery, but his work in general surgery provoked research which advanced medical knowledge, and he made substantial contributions to medical education and general literature. He discovered (with L.E. Livinggood) that the stomach and small intestine could be rendered sterile by fasting before operations; he successfully sutured the cervical thoracic duct without subsequent leakage; he suggested, after attempted repair of chronic valvular lesions in the dog, the possibility of surgery on cardiac valves in man; he demonstrated the relation of intracranial pressure to blood pressure; he devised one of the first charts for recording pulse and respiration and introduced routine blood pressure determinations during operation; and he stimulated continuing research by internists and endocrinologists through his work on the pituitary body and its disorders-work which was crowned by his discovery of pituitary basophilism. His unique course in operative surgery for medical students at the Johns Hopkins was adopted by other medical schools and he advanced other provocative theories concerning the organization and content of the medical curriculum. He provided elective clinics at Harvard Medical School for students and established postgraduate fellowships at the Hopkins, Harvard, and Yale schools of medicine. Cushing brought distinction upon himself and the medical profession through his books and essays of high literary quality and originality, most notably his biography of Sir William Osler, which was awarded a Pulitzer Prize in 1926.     

Samuel Robinson, pioneer thoracic surgeon (1875-1947)

Sam Robinson was born in Augusta, ME, in 1875. A graduate of Harvard Medical School, and of the Massachusetts General Hospital (MGH), he worked in the laboratory of Walter Cannon. While a junior at MGH he spent four months abroad with Ferdinand Sauerbruch. He returned to Boston and remained there until 1912, performing his first successful lobectomy for bronchiectasis in 1909. He made important contributions to the management of pneumothorax during operation, notably Sam Robinson's box. In 1912 he moved to Clifton Springs, NY. From 1915 to 1917 he was the first Chief of Thoracic Surgery at the Mayo Clinic. Illness, probably bronchiectasis, led him to abandon academic thoracic surgery in 1918 and retire to Santa Barbara, CA, where he practiced general surgery until 1947. He was President of the Association for Thoracic Surgery in 1922. In addition to the use of positive pressure and early resections, his contributions include artificial pneumothorax for tuberculosis and management of acute and chronic empyema. His colorful writings provide a vivid picture of the early days of our specialty.     

Excerpts from the eulogy of Jean-Louis Petit presented during the public session of the Royal Academy of Surgery on May 26 1750 by A. Louis]

Jean-Louis Petit (1674-1750) was first enthusiastic about anatomy, received a master's certificate in surgery in Paris in 1700, became a member of the Royal Academy of Sciences in 1715, and was named director of the Royal Academy of Surgery by the king when it was created in 1731. He acquired great notoriety because of his skill and experience, thanks to his case reports of hemorrhage, lacrimal fistula, operation on the frenum, for his treatise on bone diseases and especially for his general treatise on surgical operations on which he worked 12 years and which was finished after his death by F.D. Lesne.     

Morio Kasai: a remarkable impact beyond the Kasai procedure

Morio Kasai is one of the most influential Japanese pediatric surgeons. He is best recognized in the United States for his pioneering efforts in the field of biliary atresia. His work revolutionized the treatment of infants born with biliary atresia throughout the world. Less is known about his remarkable impact in the fields of general surgery and pediatric surgery. This review highlights some of Dr Kasai's major contributions and highlights the influence he had in the establishment of pediatric surgery as a field.     

A case of surgery for annuloaortic ectasia and aortic regurgitation complicated by ulcerative colitis and aortitis syndrome]

We performed an operation for AAE and AR complicated by ulcerative colitis and aortitis syndrome. The patient was a 20-year-old male who had been treated for ulcerative colitis in our hospital since 1983, when he was 18 years old. In 1985, he was admitted to our hospital for treatment and evaluation of left heart failure. He was diagnosed as having AAE and AR due to aortitis syndrome, and steroid therapy was started. He developed heart failure, and surgery was indicated. At operation, before clamping the aorta we made a composite graft. The ascending aorta and aortic valve were replaced by the composite graft, and button-shaped coronary ostia were sutured directly into the graft. His postoperative course was uneventful and he was discharged. He is now maintained on steroid therapy for his aortitis syndrome.     

Theodor Emil Kocher, modern surgery pioneer

Theodore Kocher was awarded the Nobel Prize in 1909 for his work on the physiology, pathology and surgery of the thyroid gland. He was the first Swiss citizen and the first surgeon to ever receive such a distinction. He was a pioneer and a world leader in the surgical revolution of the end of the nineteenth century. After graduation in 1865, he traveled in Germany, England, France and Austria to observe the work of Langenbeck, Paget, Wells, Nelaton, Billroth.... In 1866, he returned to Bern and was appointed assistant in the surgical clinic of Lücke. In 1872 he applied for the succession of Lücke. After a lively debate, he was appointed by the Board of Regents against the recommendation of the faculty who wished to nominate a German surgeon, K?nig. It proved to be a good choice, as, over a period of 45 years, Kocher developed a considerable activity in various fields of surgery leading to world-wide acclaim and renown. Kocher's most significant contribution to medicine concerned the thyroid gland. He considerably improved thyroid surgery. His anatomical knowledge, precise operating technic and respect of the aseptic principles defined by Lister, whom he had met in Glasgow, contributed to a reduction of mortality from 13% to 0.18%. He described postoperative hypothyroidism, which he called cachexia strumipriva and concluded that total thyroidectomy was not indicated in benign diseases. When he died, more than 7,000 thyroidectomies had been performed in his clinic. Kocher was also interested in orthopedics, abdominal and genitourinary surgery, surgical oncology, neurosurgery (Cushing conducted experimental research with him). He developed or modified many surgical instruments. He conducted a large number of experimental studies and published 249 articles and books.     

In Vivo Evaluation of the Effects of a New Ice-Free Cryopreservation Process on Autologous Vascular Grafts

John B. Murphy (1857–1916), one of the most outstanding and controversial surgeons of his age, was a product of the strong clinical programs that developed in Chicago in the late 19th century. Heavily influenced by Christian Fenger, surgeon and surgical pathologist, he went to Europe for training under Theodore Billroth and others. He applied results of his dog lab experiments to human problems while maintaining a large private practice. He is best known for his teaching clinics, for his groundbreaking work with a button for intestinal anastomosis, and for encouraging early operation in appendicitis. Though often in trouble with his fellow surgeons who accused him of stealing patients, especially in the Haymarket affair and when Theodore Roosevelt was shot, he nevertheless made many contributions to the care of surgical patients and development of academic surgery.     

Giovanni Battista Morgagni and his contribution to pediatric surgery

Pediatric surgery is a less than a century old surgical specialty. However, early knowledge of human malformations and pediatric surgical conditions dates back to centuries before. One of the main contributors to progress in these fields was Giovanni Battista Morgagni (1682-1771), who also had a substantial weight in the development of future pediatric surgery. With his masterpiece De Sedibus et Causis Morborum per Anatomen Indagatis (On the Seats and Causes of Diseases Investigated by Anatomy) (1761), he set the basis for modern pathology.In this textbook, Morgagni was the first to describe anatomical elements like the trigonum sternocostale dextrum (the Morgagni's foramen), the appendix testis (the Morgagni's hydatid), and the vertical folds of distal rectum (the Morgagni's columns). He was also the first to describe pediatric pathological conditions like epispadia, meconium peritonitis, Crohn's disease, and coarctation of the aorta. Finally, he substantially contributed to the understanding of the pathophysiology of conditions like the vesico-ureteral reflux, the anterior wall defects (gastroschisis/omphalocele), and the spina bifida. For this, it was said of him: “If all the anatomical findings made by Morgagni should bear his name, probably one third of human body would be called Morgagni's.”     

Alfred Blalock. Surgeon, educator, and pioneer in shock and cardiac research.

Alfred Blalock (1899-1964) was a pioneer American surgeon who made significant advances in the knowledge and treatment of hemorrhagic and traumatic shock as well as in the palliative treatment of congenital heart disease, particularly tetralogy of Fallot. This historical note reviews highlights in the life and accomplishments of Alfred Blalock, noted academic surgeon and researcher. Blalock originated from Culloden, Georgia and attended Georgia Military College, the University of Georgia, and Johns Hopkins Medical School. He finished his surgical training at Vanderbilt University where he remained ultimately as professor of surgery until 1941 when he became the Chairman and Professor of Surgery at Johns Hopkins Medical School. His research in shock saved many soldiers' lives in World War II. In 1944 he performed the first subclavian-pulmonary artery shunt for tetralogy of Fallot with the support of the superb pediatric cardiologist Helen Taussig and the great technical help of Viven Thomas. Hundreds of operations followed. He educated and trained an incredible cadre of cardiovascular surgeons. He passed away in Baltimore, Maryland, on September 15, 1964.     

Serafeddin Sabuncuo?lu, the author of the earliest pediatric surgical atlas: Cerrahiye-i Ilhaniye.

The author of one of the earliest surgical books was Serafeddin Sabuncuo?lu, who was born in one of the ancient cities of Central Anatolia. In 1465, he wrote a surgical book in Turkish. The aim of this study was to investigate the details of this book and compare it with the old classics. It was observed that the book of Sabuncuo?lu did not contain only pictures or miniatures of pediatric surgical procedures, but there were many important and major new contributions to the surgical literature originally described by Sabuncuo?lu himself. He based his contributions and techniques on formerly designed and described procedures, moreover, developing and nourishing pediatric surgical culture of that era. Thus a combination of Greek, Roman, Arabic, and Turkish pediatric surgery combined extraordinarily and influenced the development of European pediatric surgery.