From Mysticism to criticism
Heart wounds have been described for centuries. Iliad and Odyssey
manuscript contains references to weapons implanted in the chest, mainly
by spearing, and thirty-four cases of thorax-torso trauma are reported
in the epics [1]. This legendary story even described the cardiac
impulse transmitted through a spear that hurt in the chest Alkathoos.
Some historians and researchers suggested that Homer himself might have
been a military surgeon to provide so precise descriptions of the
treatment of battle wounds [2]. According to Aristotle
(3rd century AD) the heart was a vital organ that may
not withstand major affection. Moreover Galen (2ndcentury AD) who had to manage severe injuries in warriors and gladiators
reported that cardiac penetrating wounds were fatal in all cases. One
should keep in mind that Galen kept a scornful look about surgery and
described wrongly the human heart anatomy and function. As he embarked
on monotheism and Catholicism, his point of view was carved in stone for
centuries. Ambroise Paré (16th century), who started
his career as a barber-surgeon and is considered for many as the father
of surgery, described later the prognosis of cardiac wounds and reported
the autopsy of a man stabbed to the heart at Turin, Italy(3). At that
time, and according to Fabricius, it appeared obvious that “if the
heart is wounded the affair is desperate and it is therefore unnecessary
to attempt any treatment” [3]. If Francesco Romero is considered by
some authors to be the first surgeon having drained a pericardial
effusion in 1801, the Baron Dominique Jean Larrey also reported in 1810
his first pericardiotomy on a soldier who tried to commit suicide by
stabbing himself in the chest [4, 5]. Although this Surgeon-in-Chief
of the Grand Army did not suture any heart wound, he drained the
pericardium space and described a surgical approach to do so, through
the base of the xiphoid (still known as the Larrey point).
Despite the beginning of few animal experiments by Block in 1882,
contemporary opinions on heart surgery at that time were set up as dogma
and in 1883 the well-known Austrian surgeon Theodor Billroth even
declared: “the surgeon who should attempt to suture a wound of the
heart would lose the respect of his colleagues” [5]. Moreover in
1896 the British surgeon Stephen Paget established a fatalistic
statement: “Surgery of the heart has probably reached limits set by
nature to all surgery. No new method; and no new discovery, can overcome
the natural difficulties that attend a wound of the heart” [6].