From Mysticism to criticism
Heart wounds have been described for centuries. Iliad and Odyssey manuscript contains references to weapons implanted in the chest, mainly by spearing, and thirty-four cases of thorax-torso trauma are reported in the epics [1]. This legendary story even described the cardiac impulse transmitted through a spear that hurt in the chest Alkathoos. Some historians and researchers suggested that Homer himself might have been a military surgeon to provide so precise descriptions of the treatment of battle wounds [2]. According to Aristotle (3rd century AD) the heart was a vital organ that may not withstand major affection. Moreover Galen (2ndcentury AD) who had to manage severe injuries in warriors and gladiators reported that cardiac penetrating wounds were fatal in all cases. One should keep in mind that Galen kept a scornful look about surgery and described wrongly the human heart anatomy and function. As he embarked on monotheism and Catholicism, his point of view was carved in stone for centuries. Ambroise Paré (16th century), who started his career as a barber-surgeon and is considered for many as the father of surgery, described later the prognosis of cardiac wounds and reported the autopsy of a man stabbed to the heart at Turin, Italy(3). At that time, and according to Fabricius, it appeared obvious that “if the heart is wounded the affair is desperate and it is therefore unnecessary to attempt any treatment” [3]. If Francesco Romero is considered by some authors to be the first surgeon having drained a pericardial effusion in 1801, the Baron Dominique Jean Larrey also reported in 1810 his first pericardiotomy on a soldier who tried to commit suicide by stabbing himself in the chest [4, 5]. Although this Surgeon-in-Chief of the Grand Army did not suture any heart wound, he drained the pericardium space and described a surgical approach to do so, through the base of the xiphoid (still known as the Larrey point).
Despite the beginning of few animal experiments by Block in 1882, contemporary opinions on heart surgery at that time were set up as dogma and in 1883 the well-known Austrian surgeon Theodor Billroth even declared: “the surgeon who should attempt to suture a wound of the heart would lose the respect of his colleagues” [5]. Moreover in 1896 the British surgeon Stephen Paget established a fatalistic statement: “Surgery of the heart has probably reached limits set by nature to all surgery. No new method; and no new discovery, can overcome the natural difficulties that attend a wound of the heart” [6].