Surgery: The Best Hope of All

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to transplant, and some surgeons object that those organs probably would fail because they would be deprived of their nerve supply. Not so, says Stanford University's Dr. Norman Shumway, whose team has put a dog on the heart-lung machine, removed her heart, stored the heart in cold salt water for seven hours, then put it back. The arteries and great veins were reconnected, but the nerves were not. The mongrel has since had a litter of eight pups, with no evident strain on her nerveless heart.

But would anybody in his right mind dream of cutting out a human heart? Yes, say the Stanford enthusiasts. In certain cases, it may be the best way to give some newborn children a chance of normal life.

Babies born with transposition of the great vessels—the aorta where the pulmonary artery ought to be, and vice versa —now face a problem for which there is no true cure. Why not cut out the baby's heart, ask the Stanford men. turn it around and sew it back so that the two sides of the heart exchange jobs?

Doing Without. Dr. Richard Lillehei says flatly: ''We don't need all the nerves that nature has supplied." As proof, he cites vagotomy in man, and Shumway's dogs. Other surgeons have long since demonstrated how many more supposedly vital parts the body can do without. Thanks largely to medicinal hormones that replace its own supply, the body can function adequately without: the master pituitary gland in the brain, both adrenals, the thyroid, the thymus, spleen, pancreas, gall bladder, one hemisphere of the brain, the gullet, much of the stomach, anywhere from a few inches to several feet of small bowel, the colon, rectum, one lung, one kidney, one testicle, one ovary, one breast, the prostate gland.

Where all the spare parts for an expanding program of human transplantation will come from is still uncertain. But Dr. Moore is investigating how long tissues survive after what is generally regarded as death. And adventurous surgeons are searching for other answers; some are confident that if natural organs are in too short supply, inventive men will devise artificial parts to replace nature's. The day may come when the Tin Woodman of Oz, who wanted someone to build him a working heart, may not seem like such a hopeless case after all.

No Hands? Men like Francis Moore, who are advancing the frontiers of biochemistry, expanding man's knowledge of his own metabolism, often seem to be peering even beyond the future of successful transplants to a time when they will know enough not to have to use a knife at all, to a time when they will realize the hyperbolic hope expressed by Harvey Gushing: "I would like to see the day when somebody would be appointed surgeon somewhere who had no hands."

"Surgery," says Heart Surgeon Kirklin, "is always second best. If you can do something else, it's better. Surgery is limited. It is operating on someone who has no place else to go." But today, patients who have no place else to go are vastly more fortunate than their predecessors. To virtually all of them, surgery offers more hope than it ever did before. And to many of them with heart defects or in need of transplants—those for whom there never was any place else to go—surgery now offers the first and the best hope of all.