Episode 3- Dr DWIGTH KARKEN

19 January 2018

Episode 3- Dr DWIGTH KARKEN

 

 

Dwight Emary Harken, surgeon, was born in the United States in 1910.

He received his Ph. D. from Harvard University in Massachusetts and pursued his fellowship in London, where he served the US Army Medical Corps during World War II.

During this war, the enemy deployed a vicious projectile named after its inventor, Major General Henry Shrapnel, from the 18th century.

In this projectile were small lead balls.

When the projectile explodes, the lead balls and metallic fragments are projected in every direction.  These small missiles penetrate the body as if hundreds of projectiles crippled it.

Cardiac impairment was a sure cause of death.  If the wounded did not die from the bleeding caused by the projectiles, the infection took over.

Dr. Harken knew Dr. Rehn’s principle to repair cardiac wounds.

It was very difficult for Harken to have the procedural surgery approved by his superiors at the US Amy Corps of Surgeons.  In the end, the British Royal College of Surgeons supported his actions.

On June 6, 1944 marked history as “D-Day”, but also because it is the day Harken successfully removed a metallic fragment from a right ventricle.

His technique is to place his finger on the bleeding wound after the removing the projectile and to put stitches all around.  Each stitch must be done when the heart is relaxing.

With this method, he became the first “heart surgeon” to have repeated success with this technique.  He saved more than 130 soldiers from a sure death after proceeding with the removal of cardiac “shrapnels”.

He published his astonishing success in the American Heart Journal in July 1946.

He cited the Greeks; “Aristotle once said: “the heart alone of all the viscera cannot stand serious injury””.  In addition, with pictures to prove his point, he continued, “The “do not touch the heart”, old of over 2 millenniums, is scratched from medicine.”

Upon his return from the war, he chose Boston, Massachusetts as home.  His next challenge was “mitral valve stenosis”.

His surgical intervention is to create an opening on the atrium.  From there, he had access to the mitral valve allowing him to open it up using a blade on his fingertip.  Once the opening of the mitral valve widened, he could close the atrium using the “shrapnel” technique.

This method was not successful.  After six deaths, he abandoned his idea.  He mentioned, “Primum non nocere” or “First, do no harm”.

He added, “No responsible man would continue after such devastation.”

However, only fools never change their minds!

After a visit from Dr. Lawrence Brewsher Ellis, heart specialist, Dr. Harken realized that he had to learn from these deaths and take advantage of the learnings and experience gained.

Less than a week after Dr. Charles Bailey successfully performed the surgery, Dr. Harken also accomplished what he was thriving for on his seventh patient.

The manuscript describing the surgery was quickly published later the same year in the still well known and respected “New England Journal of Medecine”.

It is important to note, however, that the head publisher, Dr. Joe Garland, was a good friend of Dr. Harken.  This friendship helped accelerate the publication process.

On the other hand, the procedure of the “first” mitral valve stenosis operation performed successfully by Dr. Charles Bailey was published the following year.

When we are searching for innovation, anything is allowed.

Dr. Harken would later say, in relation to this situation, “It’s a matter of personal opinion whether we give importance to the first surgery or the first published work.”

Dr. Harken attempted the same technique to repair the aortic valve.  He quickly understood that there was not any comparison possible between entering through the left auricle and the left ventricle… the blood pressure is much higher in the latter.

He died of pneumonia in 1993.

He is the father of intensive care services.  The first unit opened in 1951.

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