The emergence of cardiac surgery. I. Personal recollections of the 1940s and 1950s.

"Personal recollections" is given temporal torture back to the pessimism of Aristotle, Bilroth, and Paget. The delightful triumph of the "doers" in Rehn's suture of a stab wound and Souttar's intracardiac mitral valve manipulations is saluted. The brave but disappointing adventures of Doyan, Duval, Tuffier, Carrel, Graham, Beck, and Cutler are noted. The unique role of heart surgery in the change from extirpative to physiologic surgery is illustrated by the spectrum ranging from Blalock and Taussig to intracardiac surgery to pacemakers. The question of "why not?" have cardiac surgery before World War II led to experimental designs for extirpation of bacterial endocarditic vegetations. These studies became obsolete because of the merciful correction by penicillin. They were reapplied to the removal of shell fragments in World War II. This was the first consistently successful intracardiac surgery and led to the closed correction of mitral stenosis and other conditions. Heart surgery now stands as the model for physiologic surgery and the actuarial forms of follow-up to tell all medical and surgical successors more about the basic "what and when" for better health care delivery.