Thoracic Surgery Before the 20th Century

In this book entitled Thoracic Surgery Before the 20th Century, Dr. Lew A. Hochberg has pictured the development of this art during its hundreds of formative years. In most instances, the author has gone to original references and translations for the material to fill this volume of 858 pages. The reader is brought chronologically through the 18th century in the first 186 pages, the remainder of the book being devoted chiefly to the 19th century in a subject-oriented pattern. An extensive bibliography is included. Although virtually complete and certainly authoritative, the physical make-up of this book makes neither for smooth reading nor ready reference in review. The multiplicity of direct quotations-many of them merely case reports and descriptions of individual, but not particularly contributory, operative techniques-makes it difficult for the reader to retain the central theme of the author, and many times the Gestalt is lost. The intervening narrative is, for the most part, interesting, but its worth is frequently lost by fragmentation. The intriguing story of Dr. John B. Murphy beginning on page 392 is the best of these bridges, and its three-page length qualifies it as the longest bit of narrative, unbroken by quotation, found in the book. More such glimpses through the partly open door would have been welcome. An especially valuable section is entitled "Non-surgical Contributions to the Advancement of Thoracic Surgery." Such related topics as antisepsis, anesthesia, and x-ray are discussed, together with pertinent historical facets of each. Of especial interest was the reproduction of the "first x-ray taken by Roentgen." This print of a hand in the positive is crude indeed by present day standards, but it taxes the imagination only slightly to realize what an important addition to the physicians' armamentarium this was to become. One interesting aspect of the direct quotations is the insight provided thereby into the medical thinking of the times, especially as related to judgments of the future based on knowledge of the present. Representative outlooks of the 1890's are expressed by Milton, an obscure English surgeon working in Cairo, Egypt, and by Billroth, "one of the most progressive and enlightened pillars of surgery of his day." The former, with rare vision and astute judgment based on his own experimental work and the works of others, believed that "extirpation of the whole lung may some time or other be classed amongst established operations," and, apropos of heart surgery, that "it requires no great stretch of fancy to imagine the possibility of plastic operations in some of its valvular lesions." The latter, in a far less hopeful vein, wrote that "The surgeon who would attempt suture of a wound of the heart should lose the respect of his colleagues." Sir Stephen Paget went so far as to say, in 1896, that "Surgery of the heart has probably reached the limits set by nature." This only serves to illustrate the fact, implied in several instances in the book, that the important contributions of obscure men may easily escape from view, whereas errors in judgment or prophecy of more prominent persons are not infrequently overlooked. A book of this type contains many facts and much interesting information and speculation. It is of virtually encyclopedic breadth. I take issue