Surgery: The Best Hope of All

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progress, per brick and per patient, than any other hospital in the world."

The toughness of the human heart and its ability to withstand intrusion had made a deep impression on Brigham Surgeon Dwight Harken during World War II, when he removed shell fragments from servicemen's hearts. His main postwar concern has been with heart valves, especially mitral valves that have been damaged by rheumatic fever. In 1948, he was one of a few bold surgeons who first dared to slip a finger, with a tiny surgical knife at the tip, into a beating heart to separate the leaflets of a mitral valve partly closed by scarring.

But some mitral and aortic valves are so badly damaged and distorted that they are beyond repair. If he could take a piece of metal out of the heart, Harken wondered, why couldn't he put one in? Then he could replace an irreparable valve. When heart-lung machines were perfected, the way was opened for valve replacement. By now. Dr. Harken has implanted 47 heart valve replacements and many hundreds of similar heart valve operations have been done across the U.S. Human Substitute. Aside from Dr. Harken's work, most of the pioneering in heart surgery has been done away from the Brigham, though some of it only a block away at Children's Hospital. There in 1938, Dr. Robert E. Gross led the way toward heart surgery with his pioneering patent-ductus operation (to shut off a vessel that is necessary during fetal life, but should close automatically soon after birth). He followed this with a more daring operation in 1946 to remove a narrowed section of the aorta—a crippling and potentially fatal defect with which some babies are born. Baltimore's Dr. Al fred Blalock opened the field for surgery directly on a malformed heart with the first blue-baby operation, which he devised in 1944 with Pediatrician Helen Taussig.

After Philadelphia's Dr. John H. Gibbon Jr. did the first successful operation in which the patient's circulation and breathing were taken over completely by his heart-lung machine (1953), variant machines appeared at several medical centers. One of the most successful was built at the University of Minnesota, where Surgeon C. Walton Lillehei had already gone so far as to use another human being as a heart-lung substitute in a cross-transfusion hookup. Heart-lung machines are now so good that at least one operation once rated impossible has become standard in many medical centers: total correction of Pallet's tetralogy,* the most common cause of blue babies.

If an infant has a condition so severe as to be an immediate threat to life itself, there is now virtually no lower limit to the age at which surgeons will move in. Dr. Gross has operated on 300 premature babies, one of whom weighed only11 Ib. 14 oz. Houston's Dr. Denton A. Cooley. 42, another bold vanguardsman in this field, regularly schedules four operations a day. By now, he has done 450 major operations on infants less than a year old. He will put even these tiny patients on the heart-lung machine if necessary, though he prefers not to. Either way, baby surgery is far safer than it used to be, says Dr. Cooley.

Digestive Cripples. At the opposite end of the life scale, where a whole group of other surgical emergencies are concentrated, Baylor University's professor of surgery. Dr. Michael E. DeBakey, has developed a series of operations to