History of Pulmonary Resection **

Except for the heart itself, the lung is the last of the major viscera to yield to the surgeon's scalpel. As late as 1896, Stephen Paget,' a distinguished, although apparently somewhat pessimistic and pragmatic British surgeon, wrote concerning malignant tumors of the chest: ".. . We have to consider only what hope can be offered to these cases by surgery. The most that can be done, and, so far as we can see, that ever will be done is to withdraw the effusion. The one or two procedures of a more serious nature that have been recorded have been rather matters of chance than formal operations...." When one recalls that the first successful subtotal pneumonectomy for bronchiectasis was accomplished in 1931, and the first for cancer in 1933, it might appear that the technical trials of pulmonary resection have encompassed only the brief span of two recent decades. On the contrary, in addition to the necessary basic developments in hemostasis, in asepsis, and in anesthesia (especially the technique of positive pressure endo-tracheal insufflation) the struggle to develop a safe and effective method of removing all or portions of one lung has continued over a period of not less than five centuries. It is not surprising to learn that Galen,17 that ancient writer with catholic interests, experimented with the problem of ventilatory dynamics. This native of Pergamon in Asia Minor who studied anatomy at Alexan-dria and eventually settled in Rome to become its leading practitioner of the medical arts early in the second century A.D. was not only an anato-mist and physician but the first recognized experimental physiologist. His great curiosity and imagination led him to consider the problems of respiratory mechanics. So we read of an ingenious experiment in De anatomicis administrationibus (Book VIII, Chapter 10, translation of Charles Singer). There is another experiment which is thought to show that some of the air filters through to the pleural cavity from the lungs. Prepare in advance a bladder with a mouth of suitable size. Then cut the skin over the ribs in a circle, so that the area of