Today, 124 years ago, 1st successful distal gastrectomy by Theodor Billroth
29th Jan 1881: Christian Albert Theodor Billroth Billroth (* 26. Apr 1829 in Bergen, Island of Rügen, Germany; † 6. Feb 1894 in Abbazia, Istria) performed the 1st successful distal gastric cancer resection, known as the Billroth-I-operation (B-I operation) in the 43y female patient Therese Heller, a mother of 8 children [Billroth 1881]. It was the 3rd reported try performing a distal gastric resection but the first successful one, these days known as the Billroth-I-operation. Therese Heller died 4 months later due to metastatic spread into the liver.
Earlier, in 1879, the french surgeon Jules Émile Péan alias "The Pean" (* 29. Nov 1830 in Châteaudun; † 30. Jan 1898 in Paris) performed the 1st known and reported distal gastric cancer resection, but the patient died at the 4th postoperative day [Pean 1879].
And in 1880, Nov 16th, the polish surgeon Ludwik Rydygier (* 1850 in Graudenz [= today Grudziądz]; † 25. Jun 1920 in Lemberg / Ukraine) had performed the 2nd but not successful distal gastric resection on a 63-year-old man named Julius Mickotajewicz who was known to have a duodenal ulcer, the patient died 12 hours later [RYDYGIER 1882]. A 2nd try at 21st Nov 1881 in a gastric ulcer patient was successful.
The achievements above had been possible – despite of course due to the experimental work of Billroth’s pupil’s Czerny, von Mikulicz-Radecki, Woelfler and von Hacker - due to the detailed report of a medical student from Giessen, Germany, Daniel Karl Theordor Merrem [* 1790 in Duisburg, Germany; † 1859], who demonstrated the operation in three dogs, and two survived, in a dog.
I would assume, we can learn a lot fom historic achievements not only in regard to technical surgical perspectives,
Did you know that already these days, fast track - one of the newer hype man-made therapies in patient treatment was performed? Therese Heller received sour milk, starting "1 hour" after the operation, so maybe some surgeons start smiling as they recognize that the hype “fast track” had been already in use long time ago.
However, Billroth performed 41 gastric resections until 1890 and only 19 had been successful, meaning less than 50%.
Other achievements of Billroth had been:
1870 1st successfull esophagectomy ina a dog
1873 1st successfull laryngectomy in a human
1874 discovery of the streptococcus
References:
PEAN, J. E. (1879), Gaz. Hop. (Paris), 52, 473.
RYDYGIER, L. VON (1882), Berlin. klin. Wschr., 19, 39 and RYDYGIER, L. VON (1882), Zbl. Chir., 9, I98.
BILLROTH T (1881), Ibid., 31, 162.
BILLROTH T (1881): Offenes Schreiben an Herrn Dr. Wittelshofer. Wien Med Wochenschr;31:162-5.
Dear Björn,
one will never understand the future without understanding (the) history. There are many quotes underscoring this statement:
'When the past no longer illuminates the future, the spirit walks in darkness'. - Alexis de Tocqueville
I make a habit of keeping (and, actually buying) old medical textbooks: the description of symptoms and diseases is a constance source of enlightenment.
it is only due to work of thee stalwarts who had no way to fight bacteria and similaf time almost paallel louis pasteur came out with the anti bacterial treatments and as bilroth came out with streptococcal infections how they must have fought infections after their surgeries and yet success rate not as high as 50%can also be attributable to other factors and these dog experiments and then carrying out so many gastrectomies in humans without a y precedence sets guidelines for others to atleast venture althouh most of advances came around france and germany one doesnt know other unpublished observations but these have helped advance medical science by leaps and bounds so thanks for updating as one shpuld pay homage to thesedforgotten figures as years passby .an d they become antique,
Very true @Matthias and of course Joseph Joubert may have triggered all of them (maybe). *laugh - I am the same type of guy who keeps the text books!
One important point in this manner at least to me is that increasingly scientific content is read receptively and by this over-read and I would argue that this is one major reason, how it occurred that many opinion's mutated to dogma's and holy grail's through the decades, as the original literature was not read and even not re-cited anymore.
I would further assume, that the majority is not aware, that the paper of Watson and Crick was based on hard and time costly intellectual debate and not on biological experiments, because such had been performed earlier.
However, if we remind us about the achievements of earlier findings and credit the necessary recognition, we receive much more than an honorable habit only.
Dear Andrey, dear Matthias
your insights are highly appreciated and for sure it is important remembering about the past understanding the present for changing the future (Joseph Joubert, * 07.05.1754 - † 04.05.1824). Therefore I allowed myself thinking about your both words and will try formulating as words.
In an exchange about history, its achievements and its reflection, it is also important realizing about the real evil in science and mankind and as I do not prefer surfaced exchange – we have enough of those surfaced discussions without content elsewhere - I will of course try answering more detailed: Why do others try controlling others and what is the real essence of this? Is it the excuse, that they are not good enough or they do not believe in the skills of others? I think in reality, those people are insecure and they have the impression controlling others would enlighten themselves. By this it comes up, that this kind of darkness - at least to me - seems being triggered by the real evil, hidden envy. As older I get as more I get the impression that this is the worst basic behavior of darkness and that it s independent if we observe positions in subjects of science or social life. If we further are honest we recognize that reality is often fabricated as well and if such is triggered by hidden envy it’s getting worse as well. This may be one aspect, the real basic of evil.
Another one may be reflecting us. We already had a continuing global rise in IQ performance over more than 100 years and an increasingly lack the cognitive socialization — the informal education but scientific thinking goes beyond the techniques provided by visual literacy, highlighting the importance of a number of other qualities: reflection, inductive analysis, critical thinking, mindful thought, and imagination [Greenfield PM, Science 2009; 323: 69-71]. If we know that reading a book is the only – along the long list of audio media such as radio, etc – medium which stimulates our reflection and also our imagination while reading (!) it rather seems that this helps significantly developing a profile with cognitive skills and therefore it comes up why Matthias’s comment was so important: the written word is the only communication technology providing time to reflection “while” performing it (reading)(!).
By this, the important theme of history, presence and future gets on the one hand into the direction of philosophy, and I would assume, yes, it is necessary again reminding us as I have the impression (I may be wrong), that especially clinicians and scientists have less active connection compared to physicists and mathematics, and I get the impression it would be of help increasing that again. If this would be reflected with the decrease of hidden envy in each single human being, we – I would assume – would have much less problems in science, our clinical work and our life.
Excuse myself for getting into the direction of philosophy and reflection.
@Andrey: Thank you for the flowers (phrase) but I do not agree on the general statement re the social sciences. Having done studies in anthropology among other things, I do know that they have their "tools". if and when applied appropriately, social sciences can be as exact as the natural sciences. Very few cross borders, e.g. Hans Popper, the hepatologist and Wilhelm Doerr, the pathologist.
Dear Andrey,
thank you, yeap right. However, while we read sentence by sentence we are reflecting and although if we communicate with each other or looking at a video, this is not the way of reflection as reading something.
Yesterday I was in a subway, from 8 people, 6 were typing their cell and / or listening to music or looking video's - of course we all sometimes are concentrated with something, but this little story reflects a lot: people increasingly do not talk and exchange.
Guys, this is becoming too much of a philosophical debate. Nevertheless, we need scholars! In the (very) old days, every particular education was by default preceded by what then was called "Studium Generale". I rest my case for now. Read Sir Francis Bacon on "Essays or Counsels—Civill and Morall" from 1639 (no miss-spelling here!). It was Hans Poppers key source ...
I have some very old books from Theodor Billroth and it seems to me, that Hans Poppers read some articles of him.
However, philosophy - at least to me - also defines us what we are, where we are from and where we go.
Dr.Bruecher,
'Should we remember in the History of Gastric Surgery the following achievements?'
Yes, we should remember and learn from our great ancestors of the XIXth century, and earlier (Abraham Richter, Petit, etc.). It was the generation of the giants we stand their shoulders on these days. They gone forever, unfortunately. Who from the modern surgeons has ever discovered a bacterium? Who has invented a major procedure? Modern papers on Surgery are full with figures, but few of thinking. It is a damp these days, IMHO...
completely agree Professor Borodach, of course it was a provocative question and experienced surgeons and physicians are aware, that reflection and knowledge of history nd achievements of our Godfathers and Giants are a necessity, as we start understanding why and which kind of technique was developed, how health care changed and whay and plenty reasons more.
Dr.Bruecher,
Thank you for the question asked here. I think that Billrothschen 'Offenes Schreiben' is the amazing possibility to learn the way of thinking and making his tasks of one of the greatest surgeons of all times. I try to read it to my medical students when we through the cancer of the stomach, and I can feel that they become 'infected' too with the huge enthusiasm of Prof.Th.Billroth. And this is a great feeling, I must confess.
I was utmostly surprized to find some data about the gallstone prevalence in Tomsk 100 years ago (a town near Novosibirsk) in 'Chirurgie der Gallenwege' (Ferdinand Enke Verlag, Stuttgart, 1913, 971 S.) by H.Kehr. I discovered that the gallstone prevalence has not changed much in Germany and has raised about 10-fold in Siberia for the last century. Really, small is the world!
yeap, even the fever curve within the patients file's is originated to him while some surgeons call it the Billroth' curve
Dear colleagues
i would specify several point
- First, i'am agree that the medical history is important. When a young surgeon think that his "new" idea is wonderful. the first step is to read the medical history and frequently our ancester has often try this "new" procedure. The historic medical culture is too often neglected.
- Second, i'm not agree that the modern surgeon are not equal than the old generation. the face transplantation, the transanal rectal resection... are new and wonderful procedure. It's not new that surgeons thinks that the surgery is no longer able to progress. Hartmann said at the begining of the XX century that "the surgery has reached a high level of perfection and will no longer be changed". Funny, not?
- Third, Western medical history is easy to find in our universities. For Historic reasons, the Eastern medical history is more difficult to find for us (West surgeon). We discover, frequently by lucky, some interesting East technique (Autologous peritoneo-fascial graft for vascular reconstruction for example). I'm sure that we will learn a lot from surgical history from another country .
Thanks Frederic
ad 1 & 2 completely agree. It is always funny in a retrospective manner, that some declare ‘there wont be any progress’ or ‘this or that will be “solution” ….’. History teach us, that there are always different views and that we can learn from such
ad 3: unfortunately that is true. Many achievements of the Eastern World even had not been published and by this it is nearly impossible receiving the correct information. And you are right: it is easier with Western Achievements.
Did you know that William Stewart Halsted got the book of education written by Theodor Billroth after his traveling through Europe and by this transferred Billroth’s ideas into education at John Hopkins? Of course during the decades they had been tried attributing to Halsted, but originary had been Theodor Billroth’s ones. This may be one example how reality changes, if originary literature is not cited anymore.
Theodor Billroth *26 Apr 1829 †06 Feb 1894
Remembering giants in science, medicine and surgery - German Surgeon & Co-
Founder of academic surgery
Happy Birthday
"Only those who know the past & present of science and art, will boost their progress with awareness"
"I can not understand how someone can read receptively only"
~ Theodor Billroth
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