gms | German Medical Science

18. Jahrestagung der Deutschen Gesellschaft für Thoraxchirurgie

Deutsche Gesellschaft für Thoraxchirurgie

08.10. bis 10.10.2009, Augsburg

An outside view on the German Thoracic Surgery

Meeting Abstract

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  • Tamas F. Molnar - University of Pécs, Department of Surgery, Medical School, Pécs, Ungarn

Deutsche Gesellschaft für Thoraxchirurgie. 18. Jahrestagung der Deutschen Gesellschaft für Thoraxchirurgie. Augsburg, 08.-10.10.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocHS6.1

DOI: 10.3205/09dgt31, URN: urn:nbn:de:0183-09dgt319

Published: November 20, 2009

© 2009 Molnar.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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There is no present and therefore no future without the active presence of the past. Surgery for thoracic empyema, usually tuberculotic in origin, led to the birth of chest surgery, while thoracic trauma, military in origin opened the road leading to lung surgery and eventually to the development of esophageal and cardiac surgeries in the late 19th and early 20th century. The dominant language of surgery was German in pre-World War One Europe and and was the nearly exclusive one in contemporary Central European region.

Tuberculosis (see: Th. Mann. Der Zauberberg) challenged birth of pleural space management pioneered by Schede and Bülau. (Schede’s thoracoplasty 1879–90, Bülau’s drainage: 1875). Early attempts of lung resection failed ( Block 1882, Krönlein 1883) while de Cerenville and Quincke succeeded with drainage. Koch (1882) and Röntgen (1895) contributed significantly to the surgical understanding of the White Death. Mikulicz-Radetzky and Sauerbruch focused on the behaviour of the pleural space in their low-pressure approach (1902). Thoracoplasty was developed further by Brauer (1908, Friedrich (1907–10), Wilms (1913 ) and others. Abrashanoff’s myoplastic plug (1911) and Kirchner (1921) developed their own space filling procedures. Saugmann’s arteficial ptx machine (1908) and Jacobeus’s thoracoscope (1910) refined methods to control pleural pathologies. While basics of chest surgery were laid down, serious attempts of parenchyma resection were prevented by the lack of standardised positive pressure anesthesia and proper postoperative pleural management.

Modern chest surgery was born in the Lazarettes and Base Hospitals in both sides of the WW1 trenches. Lung was proven to be an operable organ by 1915 and as one to be operated on in case of emergency by 1916 advocated by Sauerbruch, at least for the surgeons of the Central Powers. Post-injury pleural infections and the1918–19 influenza epidemic with the consequent empyema crisis revealed the superiority of Bülau’s method. A great number of surgeons became familiar with lung injury management: thoracic surgery and anesthesia as independent specialties were born in the mud of the Great War.

In spite of the new frontiers, inflammatory lung diseases (bronchiectasis, tuberculosis) resisted routine resective surgery as no proper supportive mecication (antibiotics, antituberculotics) were yet available. Nissen and others developed lung hilum ligation techniques by early 1930s, a „sine qua non” of any safe lung resection. Standard pneumonectomy was developed first, followed by minucious details of lobectomy by 1933–35. Advantage of interwar German thoracic surgery gained by the achievement and unquestionable authenticity of Friedrich Sauerbruch (1875–1951) started to loose its impetus as no sufficient attention was paid to intratracheal narcosis and as the French and British and American surgical schools followed a different but romising pathway. Medical schools of Central Europe and Soviet Union, however followed their inherited historico-cultural genes and were relied and influenced by the German-speaking literature in the interwar period. Increasing and rigid conservativism in chest surgery dominated military surgical practice of lung injury management in WW2 heralded a change in deserved dominance in this particular field of surgery.

By the end of WW2 lung cancer emerged as to replace tuberculosis posing a challenge to thoracic surgeons: and a completely different period has started with new players and altered priorities. However no one can ignore the names of those who made the foundations.