Thread by @sjauhar

130 yrs ago this month, Dr. Daniel Hale Williams, a Black surgeon at Provident Hospital in Chicago whose ancestors were slaves, performed what was then believed to be the first open #heart #surgery. A thread... (1)

The patient, 24yo James Cornish, had been stabbed with a knife in the chest in a saloon scuffle. He was bleeding profusely when he was dropped off at the hospital by a horse-drawn ambulance. (2)

With no diagnostic equipment other than a stethoscope - X-rays would not be discovered for another 2 yrs—Williams examined him. The stab wound was slightly to the left of the breastbone and directly over the right ventricle. (3)

Initially, he thought it was superficial, but when Cornish started to exhibit lethargy, listlessness, and low blood pressure— signs of shock—Williams knew he had to act. (4)

Nothing in Williams’s hardscrabble life could have predicted this epoch-making moment. His father, a barber, died of tuberculosis when Williams was only 10. He was sent to live with family friends in Baltimore. (5)

Largely self-taught, he took up odd jobs, becoming a shoemaker’s apprentice, then a barber and a guitar player on lake boats, before deciding to pursue medicine. (6)

He ended up in Chicago, working as a surgical apprentice and eventually completing his training at Northwestern. He set up his own practice on the South Side, becoming the first black surgeon to work for the city’s railway system. (7)

Williams worked w/ the Equal Rights League, a civil rights organization that was active during Reconstruction and beyond. In 1891, he founded Provident, the nation’s first racially integrated facility for young black doctors and nurses. (8)

The facility, championed by the social reformer Frederick Douglass, gave blacks in Chicago another place, besides overcrowded charity hospitals, to receive care. (9)

Until that summer day in 1893, surgery had scarcely ever been attempted on a live human heart. Though it is difficult to fathom today, the heart was essentially off-limits to doctors until almost the beginning of the 20th century. (10)

All major human organs, including the brain, had been operated on, but the heart stood apart, encased in historical and cultural prohibitions. (11)

Heart surgery had been performed on animals and human cadavers, but suturing the dancing organ in a live person was considered beyond the realm of the possible. (12)

“The heart alone of all the viscera cannot withstand injury,” Aristotle wrote, because it was believed to be impossible to mend a heart wound. Galen himself noted that heart wounds in gladiators were always fatal. (13)

Theodor Billroth, a distinguished Viennese surgeon, wrote in 1875 that “[heart surgery] in my opinion approaches very closely to that kind of intervention which some surgeons would term a prostitution of the surgical act and other madness.” (14)

Enter Daniel Williams, a showboating surgeon who made up in boldness and technical prowess what he lacked in humility. Later in his career, he would become famous for inviting the public into the hospital on Sundays to watch him operate. (15)

James Cornish was no well-chosen public demonstration, though. When Williams opened his chest wound with a 6-inch incision that sweltering day in 1893, he had no idea what he would find. (16)

On the inner surface of the ribs, a lacerated artery was trickling blood. Williams sutured it closed with catgut. The operating room was like a sauna; assistants wiped a similar dribble from Williams’s brow. (17)

Williams was getting ready to close the chest when he noticed the knife had traveled deeper, puncturing the pericardium with a hole about 1/10 of an inch in diameter. (18)

With little time to mull over his options, he asked for more catgut and needle and stitched the wound closed, carefully timing the movement of his needle with the beating heart in a sort of surgical tango. (19)

He noted that there was also a small wound in the thin-walled right ventricle—in the heart muscle itself— but it had formed a dark clot on its surface and was no longer bleeding. Williams decided to leave it alone. (20)

Cornish’s wound re-bled after a few days, so Williams took him back to the OR to evacuate more clot. The wound eventually healed, and Cornish escaped the clutches of sepsis, the great postoperative killer in those days. (21)

On August 30, nearly 2 months after he was stabbed, Cornish walked out of the hospital. Apart from a few more bar fights, he went on to live a normal life, even outliving his surgeon by 12 years. (22)

Williams’s operation, we now know, was not the very first pericardial surgery. Probably 3 others had been performed over the previous decade, though they had not been reported widely. Williams almost certainly did not know about them. (23)

By applying needle to pericardium in “the first successful or unsuccessful case of suture of the pericardium that has ever been recorded,” as Williams himself declared, he did as much as any doctor in history to demystify the heart... (24)

and advance the notion that it was a machine that could be repaired. For this he received worldwide acclaim. The fact that he was a black man living in the era of Jim Crow makes his achievement that much greater. (25)

In 1894, he moved to Washington, D.C., where he was appointed by President Grover Cleveland surgeon in chief at Freedmen’s Hospital, which provided care for former slaves. (26)

He eventually moved back to Chicago, where he had an honorable (and honored) career, dying in 1931 of complications from a stroke. (END)

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