Episode 1- Dr LUDWIG REHN

25 November 2017

Episode 1- Dr LUDWIG REHN

 

Ludwig Rehn was born in Germany on April 13th, 1849. Considered as an innovator, he became Director of Surgery at the Frankfurt hospital.

At the start of his career, the belief was that surgery of the heart was impossible.

Theodore Billroth, father of the digestive tract surgery, said in those years that ‘’ any surgeon who would try to suture a wound of the heart would lose the respect of his colleagues”.

Stephen Paget, the English surgeon known to have proposed a theory on metastases, said in 1896 that ‘’ surgery of the heart probably reached the limits imposed by nature”

On September 7th, 1896, a police officer finds a drunken 22 year-old man named Wilhelm Justus, on the ground in middle of the night. By withdrawing the bloody hand covering his chest, he notices that the poor man was stabbed.  He brings the unfortunate man to the Frankfurt City Hospital.

The surgeon on call that night is Dr. Ludwig Rehn. The young man is in distress. He has a very low blood pressure, he is agonizing!

Dr. Rehn decides to insert a metal probe into the deep wound of the chest and sees it moving in synchrony with the cardiac beats.

There is no possible treatment.  This young man is about to die if not saved by a Good Samaritan….

The heart is naturally protected by the sternum.  Sternum originates from the Greek word ‘’sternon”, which means soldier armor.

The heart  is also protected by the pericardium.  The pericardium is a thick, fibrous pocket.

If there is something that penetrates the pericardium, it may reach the right ventricle, lying in front of the left ventricle.

The stabbed man has a laceration in his right ventricle.  The blood coming of it is trapped in the pericardium.  The cut made by the tip of the blade is not large enough to let it drain properly.  The heart is getting crushed by the blood accumulating in the pericardium.  The heart is choked and cannot fill. The medical term used for this situation is cardiac “tamponade”.

In the operating room, Dr. Rehn decides to further open the pericardium, which releases the blood compressing the heart.

He then can see the half-inch wound created by the blade in the right ventricle. Blood is coming out on every cardiac beat

While applying a small pressure on the wound with his left index, he makes a stitch around it. Once done, he pulls both ends of the thread gently, to avoid tearing the thin wall of the right ventricle. It has the same effect as pulling on the strings of a purse. The bleeding stops.

The first cardiac surgery was performed!

Unfortunately, his report was deemed anecdotal…

In medicine, credits often go to people who are convincing, not necessarily those who had the idea first!

 

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