PRELUDE to the HISTORICAL DEVELOPMENT of MECHANICAL EXTRACORPOREAL CIRCULATION

 

Michael S. Vinas, MA-HRM, RRT, CCP

Administrator of Cardiovascular Perfusion Technology

Bellevue Hospital Center

New York Health and Hospitals Corporation

Manhattan, New York, U.S.A.  

 

PREFACE

 

The road that lead to the development of mechanical extracorporeal circulation has been a long, arduous one. The history of medicine dates back to Ancient Egypt, Sumaria, Greece, Rome and other Mediterranean civilizations. The success of cardiac surgery with its less than 3% mortality has been an accumulation of nearly 5,000 years of applications, observance and innumerable failures from “trial and error.” The greatest strides, due to technological advances, and oftentimes accidents, occurred in the past 100 years. The following presentation is a tribute to these pioneers of procedures and techniques that has permitted Cardiothoracic surgery to occupy a prominent position with other surgical professions.

 

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TREPANNING - The first surgical procedures were performed in the Neolithic Age (about 10,000 to 6000 BC). Trepanning, a procedure in which a hole is drilled in the skull to relieve pressure on the brain, may  have been performed as early as 8000 BC. In surgery, removal of a disk of bone from the skull to provide entrance to the brain or to relieve intracerebral pressure. The procedure is done most often in cases of bleeding between the brain and the skull. Collections of blood of this kind, if not evacuated, may compress the underlying brain and cause damage or even death. The cranial bones are cut with a small cylindrical saw, called a trepan or trephine, equipped with a center pin. The center pin extends a short distance beyond the blade of the saw and is inserted first to prevent slippage. In modern surgery the disk is replaced by a metal plate after the operation is completed.

Trepanning is the most ancient form of surgery for which objective evidence exists. Examination of fossil skulls indicates that trepanning was performed as early as the Neolithic Age. In ancient times trepanning was performed on live patients suffering from fractured skulls, convulsions, and insanity. Disks of bone from the skulls of cadavers were often carved and used as religious amulets in ancient Egypt and Sumeria.  “Trepanning,” Microsoft’s Encarta Encyclopedia Deluxe 2001, Redmond, WA

IMHOTEP "FATHER OF MEDICINE" (2600 B.C.)

(lived about 2600 BC), ancient Egyptian priest, officer, and builder who is credited as the architect of the earliest of all Egyptian pyramids. Some scholars assert that this engineering feat would earn Imhotep, who served the Pharaoh Djoser during the 3rd Dynasty, the honor of being the earliest known scientist. In the centuries after his death, Imhotep's memory became increasingly linked to far greater (and more dubious) achievements in medicine, the arts, and other fields. He was one of few ancient Egyptians born outside of royalty who later was raised to a godlike rank. Renowned as an Eqyptian architect of pyramids, was worshipped as a god and healer.  “It is Imhotep,” says Sir William Osler, “who was the real Father of Medicine." The first figure of a physician to stand out clearly from the mists of antiquity." Imhotep diagnosed and treated over 200 diseases, 15 diseases of the abdomen, 11 of the bladder, 10 of the rectum, 29 of the eyes, and 18 of the skin, hair, nails and tongue. Imhotep treated tuberculosis, gallstones, appendicitis, gout and arthritis. He also performed surgery and practiced some denistry. Imhotep extracted medicine from plants. He also knew the position and function of the vital organs and circulation of the blood system, he was familiar with the pulse. The Encyclopedia Britannica says, "The evidence afforded by Egyptian and Greek texts support the view that Imhotep's reputation was very respected in early times...His prestige increased with the lapse of centuries and his temples in Greek times were the centers of medical teachings." It would be over 4,900 years from Imhotep’s time before physicians and surgeons would be skilled enough to undertake complex procedures requiring mechanical extracorporeal life-support.

                                                                                                                              Ancient Eqyptian Medical Papyrus