William E. Adams: Thomas Mann and The Magic Mountain.

The lobectomy for carcinoma of the lung performed by William E. Adams in 1946 on Thomas Mann, author of the tuberculosis saga The Magic Mountain, deserves to be added to Harold Ellis's series of "historically famous operations." This lobectomy, by which the surgeon cured his far more famous patient, was only one episode in his 40 eventful years as Chicago's leading pioneer in early thoracic surgery. The historic case is well documented by preoperative, operative, and pathology reports obtained through the courtesy of still-living witnesses and associates, friends of the author. Thomas Mann died 9 years later of an aortoiliac rupture at the University Hospital in Zurich. At autopsy no local recurrence or distal metastasis was found.

History of emphysema surgery.

Ever since the advent of modern chest surgery, surgical pioneers have attempted operations to alleviate, if not cure, patients with emphysema. From the physiologic standpoint illogical procedures such as costochondrectomy, phrenisectomy, or thoracoplasty lead to disastrous results, whereas the effect of operations on the autonomous nervous system was unpredictable. The only worthwhile procedure was bullectomy for localized bullous emphysema. The concept of volume reduction developed by Brantigan in the 1950s and rediscovered by Cooper is the only successful surgical approach to an essentially incurable pulmonary disease.

Hugh Morriston Davies: first dissection lobectomy in 1912.

Hugh Morriston Davies (1879-1965), long before anybody else, performed the first anatomic dissection lobectomy for a tumor of the lung in 1912. By replacing the hilar mass-ligation-suture technique, he was decades ahead of his time, and had his patient not died 8 days after the operation, he would have preceded Evarts Graham's first lung resection for cancer by 21 years! An all-around chest physician and surgeon in one, he had introduced chest radiography and positive-pressure intratracheal anesthesia the year before, thus making the diagnosis and operation of this lung cancer possible. He concluded that lung cancer was accessible to surgical removal on condition of an early diagnosis. By destiny a surgeon as well as a physician, Morriston Davies was probably the earliest advocate of interdisciplinary teamwork in thoracic medicine.

Forgotten pioneers in thoracic surgery.

The names of Carrel, Sauerbruch and Blalock are milestones in the early history of thoracic surgery. The recognition of contributions by less renowned contemporaries does not diminish the decisive part played by these founders of prestigious schools of thoracic surgery. Krönlein who in 1883 successfully performed what was probably the first lobectomy is never mentioned. The esophagectomy without thoracotomy publicized by Orringer in 1978 had already been done by Gray-Turner 47 years before, in 1931. McLean who discovered heparin, and Forssmann who introduced cardiac catheterisation by passing an ureteral catheter into his own heart ended up as small-town general surgeons. Horace Smithy of Charleston successfully performed an operation for mitral stenosis four months before Bailey and Harken. Unlike his famous contemporaries, he was unable to publicize his cases at medical meetings because that same year, 1948, he died from an aortic vascular stenosis. Vineberg, who had recommended and successfully performed internal mammary artery implantation since 1946, was smiled at as a utopian until his rehabilitation by Mason Sones' coronarography and until coronary bypass surgery developed into the greatest boom in thoracic surgery. Sir Henry Souttar, who is known to have operated successfully a mitral stenosis a quarter of a century before Bailey, when asked why following his 1925 success he did not persue mitral surgery answered: "Because I could not get another case!" As usual, surgical "break-throughs" met with the resistance of medical men. Before doctors became enthusiastic advocates and referred thousands of cases of pulmonary tuberculosis, and mitral and coronary stenosis, their opposition had to be overcome by successful operation of generally desperate cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Tuberculosis--the starting point of thoracic surgery]. / La tuberculose--point de départ de la chirurgie thoracique.

The amazing development of thoracic surgery was due to the extraordinary number of operations necessary in the treatment of diseases of epidemic proportions: tuberculosis, rheumatic heart disease and coronary disease. From 1939 onwards, the young chest surgeons were confronted with war wounds of the heart and great vessels. Back in civilian practice, they became the pioneers of an initially primitive, blind cardiac surgery. In the course of 40 years this surgery developed to become the highly specialized interdisciplinary specialty of today's cardiovascular surgery, the crowning of which is the routine heart transplantation of 1990.

Successful closure of chronic BPF by thoracoscopy after failure of endoscopic fibrin glue application and thoracoplasty.

We report a case of chronic debilitating BPF following right upper lobe resection. Despite several endobronchial applications of fibrin glue, we could not close it. Since the patient was extremely debilitated by symptoms due to the BPF, a thoracoplasty was attempted but was not successful. Finally, the BPF was definitely closed by instillation of talc into the pleura through thoracoscopy. To our knowledge, this is the first reported case of chemical closure of a recalcitrant BPF by the route of thoracoscopy. It also shows the failure of endoscopic fibrin glue application in such a condition.

[Progress in thoracic surgery since 1980]. / Les origines des progrès de la chirurgie thoracique des années 1980.

Modern thoracic surgery was born at about the time the Swiss Surgical Society was founded. Tuffier, Rehn, Lilienthal, Thorek were some of the pioneers. Today the important developments are esophagectomy without thoracotomy, the routine performance of cardiac transplantation and the emergence of lung transplantation. The past, present and future of these developments are outlined.