Henry Barrett: pioneer paediatric surgeon.

BACKGROUND: Henry Barrett worked as a general surgeon in New Plymouth, New Zealand between 1939 and 1978. In this time, he made significant contributions to the development of paediatric surgery in New Zealand. METHODS: Henry Barrett's archive and personal papers remain in the possession of his family. These described his pioneering operations first hand. RESULTS: In an 18-month period from 1947 to 1948, in New Plymouth small provincial hospital, Henry Barrett successfully completed the first primary repair of an oesophageal atresia with distal tracheoesophageal fistula in the Southern Hemisphere and the second and third successful ligations of patent ductus arteriosus in New Zealand. All three patients survived into adulthood. CONCLUSION: Henry Barrett pioneered the undertaking of two complex paediatric surgical procedures in New Zealand. These operations were performed without specialist paediatric support at a time when procedures for these conditions, particularly patent ductus arteriosus, were viewed with suspicion.

Congenital anomalies of the esophagus.

Normal anatomy, embryology, and congenital anomalies of the esophagus are discussed in this article. The classification, epidemiology, embryology, diagnosis, and management, including outcome following repair of esophageal atresia with or without an associated tracheoesophageal fistula, are described. The diagnosis and management of less common anomalies, such as congenital esophageal stenosis and congenital esophageal duplication, are outlined.

The history of oesophageal atresia and tracheo-oesophageal fistula--1670-1984.

The history of oesophageal atresia commenced in the year 1670 with Durston's description of "A narrative of a monstrous birth at Plymouth". However, the most significant contribution in the 17th century was made by Gibson, who clearly described the clinical picture and necropsy findings in a baby with a proximal oesophageal atresia and a distal tracheo-oesophageal fistula. The 18th century was singularly lacking in contributions to the literature, but there were many important presentations during the 19th century. Early in that century Martin in France and Hill in United States of America contributed to the literature; subsequently, many anecdotal references can be found particularly in England, and ultimately a surgical attempt to correct the anomaly was made in 1888 by Steele in London. With this, the pre-surgical era gave way to the surgical era, and at a later stage pre-survival era was to give way to the survival phase. Reference will be made in the text to these various phases in the history and to the many pioneering surgical endeavours which took place in the earlier years of the 20th century. It will be seen that the surgical efforts employed palliative procedures, indirect attacks on the problem and finally direct attacks. The classic successes by indirect methods which were achieved by Ladd and Leven in babies born in 1939 were to be followed by the first successful end-to-end anastomosis which was achieved in Ann Arbor, Michigan, by Cameron Haight. Others had attempted primary anastomosis, and Lanman in particular deserves mention. However, it was Cameron Haight who opened a new era in the history of the treatment of oesophageal atresia; the recent history is largely concerned with increasing experience and refinements in technique. For the future historian many pathways can still be explored, including oesophageal replacement, the unstable trachea, follow-up studies and research projects. This history also included comments on the history of the less frequently encountered anomalies and such aspects as classification and radiology. The history of oesophageal atresia and tracheo-oesophageal fistula is a mini history of surgery - "oesophageal atresia is the epitome of modern surgery".

The first successful total repair of congenital atresia of the esophagus with tracheoesophageal fistula.

The details of the first successful total repair of congenital atresia of the esophagus with tracheoesophageal fistula are given, and the background of surgical experience against which this operation stands preeminent is outlined.

History of surgery of the esophagus.

The progress of esophageal surgery from the beginning of medical history through five historical eras, up to the second half of the 20th century, is reviewed. Progress was slow from the first surgical repair of the esophagus in ancient Egypt in 2500 B.C. until the end of the 19th century, when scientific discoveries made possible the solid beginnings of abdominal surgery. Thoracic surgery followed in the 20th century, with rapid strides in World War II. These wartime advances stimulated an interest in esophageal surgery in the postwar era, when operative techniques became well standardized and surgery of the esophagus was placed on a par with that of other parts of the gastrointestinal tract. Because of the limitations of time and space, much important material has had to be left out. Yet it is hoped that this brief historical overview will put in perspective the important advances of the second half of this century, which will be presented by our distinguished speakers. It has been a privilege for me to have had a part in the development of this type of surgery and to share these ideas with you.