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Ludwig Rehn

ARTICLE 1

Son of a physician

He was a medical student, learned diagnostic and operative technique amid the failures and terror of the pre-Listerian era. He became a general practitioner, then moved on to open a small private surgical clinic in Frankfurt at 28 years old. In 1886, he became surgical director of the Frankfurt State Hospital and later professor of surgery at University of Frankfurt.

1895: found chemical cause of bladder cancer in aniline dye workers

1898: known for his work on surgery of the thyroid and appendix

Heart Surgery: September 9th, 1896: First successful suture of a heart wound, a stabbing. Before this, wounds of the heart were considered fatal. Patient was a 22 year old gardener, who was discharged from the military because of an irregular heartbeat, Sept. 7th he got wounded by a knife and a passerby found him. He arrived at the State Hospital at 3:30 am. At the hospital, he was found to be deathly pale, barely palpable pulse, labored breathing. He had a non-bleeding 1.5cm wound in the left fourth interspace. Sept. 8, patient had  but a hemothorax (a collection of blood in the space between the chest wall and the lung) had developed. Orders were to just apply ice bags to the wound, and a camphor (pain relieving topical cream) injection, he had a fever of 100.76 and a respiratory rate of 68, normal is 12-20. Sept. 9, pulse was weak and irregular, area of wound was increasing, respiratory rate was 76 breaths/min.

Operation: a 14 cm long incision made in the left fourth interspace, fifth rib divided just medial to mammary line and turned back at the sternum, dark blood appeared in the wound, the stab wound was grasped together with forceps, but quickly was torn in an attempt to bring it together. Venous blood flooded the cavity, the pericardium (membrane enclosing the heart) was opened, exposed was the beating a heart, a sight not seen by anyone before, blood continued to flood, but the 1.5 cm wound was found in the right ventricle.

Rehn goes on to described the heart: it was unaffected by touch, rolling motion of the heart made possible by freeing it of its pericardium, during systole (phase of heartbeat when the heart muscle contracts and pumps blood into the arteries) the muscle was hard as stone, hear then went into diastole (phase of heartbeat when heart muscle relaxes and allows it’s chamber to fill with blood) which lasted longer than systole.

Needle with silk was employed, beginning at left corner of the wound, needle passed quickly during diastole phase, first suture stemmed flow of blood, second helped even more, third suture stopped the bleeding completely, the heart began to pulse normally again. The cavity was irrigated with saline to remove the clot, this drainage occurred with iodoform-soaked gauze. The rib of the patient was turned down and the top layer of tissue were reapproximated into their original position.

Post-op: breathing rate slowed from 76 to 48 minutes after surgery, then all the way down to 28 in the hours after operation, heartbeat went from 112 to 132 beats per minute and became stronger. Sept. 10: patient’s temperature was 101.66, the cavity was drained of blood-tinged fluid. Sept.11, patient had normal body temp, normal respiratory rate, normal heartbeat, and the dressings on the wound were replaced regularly. Sept. 19, body temperature went up again, however after drainage of the wound, it went down again.

Conclusion

Rehn concluded that the patient became healthy and was doing light work. He stated that the operation was not only lifesaving, but also prevented the subsequent development of an inflamed pericardium (membrane that surrounds the heart). Cardiorrhaphy (surgical operation of suturing the heart muscle) became widely accepted and known after this surgery. 1907, Rehn could gather 24 instances of heart suture with 60% mortality, an improvement from the 90% mortality rate in the presurgical era. The methods were changed very little, however by 1943 the mortality rate decreased to 19%. This improvement could be attributed to better methods of diagnosis and an increased safety of thoracotomy (surgical incision into the chest wall).

Rehn was accredited with being a self-taught surgeon and applying “ordinary surgical principles” to the heart suture he successfully performed, this success opened the field of cardiac surgery, shows the impact of a single individual on the development of surgery.

ARTICLE 2

His surgery is considered the worldwide first successful direct suture of the heart. In 1911, Rehn was nominated Chairman of the German Association of Surgery. In 1974, the Chamber of Commerce in Frankfurt founded the Ludwig-Rehn-Award for scientific publications in general surgery.

Rahel Hirsch

Rahel Hirsch, born in Frankfurt, daughter of a long line of rabbis. She passed her first teacher’s exam in 1889 at a ‘Normal School’ in Wiesbaden. The German Reich did not permit women to study medicine so she studied in Zurich, Switzerland. In 1899 she continued to study in Leipzig, Germany and Strasbourg, France to earn her medical doctor title in 1903. She was hired to work at the Medical Clinic of the University of Berlin at the Charité as an intern. This hospital was military strong and she was the second female to ever be hired here. Hirsch began to work as an assistant to the physiologist Professor Friedrich Krause. (1) She wanted to work here because of the other celebrated scientists who worked there, including surgeon Ernst von Bergmann and anatomist Wilhelm von Waldeyer-Hartz. She worked here until 1919. In 1906, she was the first scientist to find the presence of starch granules in the blood and urine. She found that tiny cells no more than 0.2 mm could penetrate the kidneys and be removed by the urine. She was mocked at a meeting of the Society of the Charité’s Directors and her research was ignored since the doctors present said the only thing that could pass through the kidneys was urine. She was unable to convince anyone of her research. In 1957, however, G. Volkheimer, an assistant at Charité came across her work and publicized it, naming it the “Hirsch Effekt.” (2) After her fail at publicizing her research, she was appointed head of the polyclinic at the Charité’s Medical Clinic in 1908, however she was never a paid employee here. After being replaced as director of the Polyclinic, she left the Charité and started her own internal medicine practice in Berlin. (1) At her private practice, she had modern x-ray equipment and wealthy clientele that allowed her to live comfortably. (2) Rahel Hirsch was the first female to be awarded the title of Professor in Prussian in 1913. However, since she was a woman and a Jew, she was not allowed to teach. She wrote a treatise titled the “Physical Culture of Women” in 1913. (1) She wrote to counter the medical prejudice against physical activity for women and favored naturally-fitting clothing. Hirsch tried to bring attention women’s public health by raising awareness about hygiene, nutrition, and physical strengthening. In an article published in the Munich Medical Weekly, she writes to her male colleagues to not look at women from just the point of view of a gynecologist. She also argued that women’s inferiority to men due to their biologically determined lighter brains was not true. She stated that women’s physical and psychological weakness compared to men came from a faulty upbringing. (2) In 1914, she published a study titled “Accidents and Internal Medicine.” As Jewish persecution began, she lost her professional opportunities ending in the loss of her license to practice medicine in 1938. When she heard that she was going to be arrested, she escaped to England at 68 years old. There, she re-took her medical exams and was allowed to work as a physician. She worked in the laboratory and translated scientific texts. She became depressed because of her persecution and exile. She was put into a ‘mental house’ and soon died at the age of 83. (1)

Her reputation was upheld by the aforementioned G. Volkheimer. Many internal medicine textbooks refer to the “Hirsch Effekt” and the State of Israel honored her by including her in the gallery of Famous Jewish Scientists in Jerusalem. In 1995, a bronze statue of Rahel Hirsch stands in the old lecture hall at the Charité. (1)