Things move along.

Lung surgery developed, albeit at a moderate pace and all for infection. In the pre-antibiotic era the only therapeutic options were to drain an abscess cavity or to excise an infected area of the lung. In 1885 an Italian surgeon performed perhaps the first successful lobectomy in a woman with a tubercular cavity.  Ironically she died on post-operative day nine with the diagnosis of carbolic acid poisoning. This diagnosis may reflect the surgeon’s attempt to deflect blame but it is a possibility as it was common surgical practice to bathe all tissues with this disinfectant, demonstrating the difficulty in comprehending Lister’s principles. Perhaps the liquid was considered to be a semi-magical ointment, as the germ theory was far from well understood, or perhaps the aphorism of “If a little is good then more is better” was applied.

The pace quickened as the century drew to a close. In 1891 the famous French surgeon Tuffier resected part of a patient’s lung for tuberculosis by tightening a chain around the middle of the upper lobe of the right lung like a lasso. In 1895 the Scotch surgeon Macewen operated on a patient with long-standing TB and found a lung so riddled with both TB and bacterial infection that he could more or less scoop it out. Given the amount of infection, the vasculature and the main bronchus (the “windpipe” to the lung) would have been buried in an inflammatory mass. It would have been impossible to identify or control the individual blood vessels and the bronchus. The pulmonary blood vessels were undoubtedly full of blood clot so they would not bleed. The patient survived a complicated postoperative course. While this was arguably not a “true” surgical pneumonectomy, as neither tissue dissection nor ligation of individual vessels was performed, the entire lung was extracted. This again demonstrated the ability for a patient to survive and function after such a profound loss of respiratory capacity.

Macewen the man was not to be taken lightly. Once in a railway carriage with two ladies and a loudly offensive drunk, after persuasion failed to calm the offender, “…he placed his two thumbs inside the mouth of the drunken fool and dislocated the man’s lower jaw so that he sat absolutely dumbfounded and silent with his mouth compulsorily open for the rest of the journey. Then by an equally skilled surgical manoeuver, the jaw was liberated.” Yikes!

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