On June 10, 1948, Dr. Charles Bailey was down to his last chance. His experimental heart surgery to correct mitral stenosis had already killed four people. Behind his back, some were calling him “the Butcher.” Now he drove to Philadelphia’s Episcopal Hospital where 24-year-old Constance Warner awaited his scalpel. Her heart failure was so severe that she could barely walk or breathe.
Bailey’s patients faced almost certain death. Their mitral stenoses stemmed from childhood rheumatic fever, which resulted in scarring of the mitral valve whose leaflets no longer opened or closed properly. The resulting bottleneck prevented blood in the heart’s left atrium from fully emptying into the left ventricle before each heartbeat, which in turn caused fluid to back up into the lungs. As patients’ lungs filled, they became unable to breathe and coughed up blood.
But how could anyone dream of operating inside a beating heart? At this time, before the advent of the heart-lung machine, it seemed impossible to approach this sacred organ, constantly in motion and hidden deep in the chest behind a wall of ribs.
Bailey’s strategy benefited from the experience of another surgeon, Dwight Harken, who had encountered grievously wounded servicemen with chest wounds during World War II. Sometimes, pieces of shrapnel punctured soldiers’ hearts and remained in place, plugging the holes they had created. Harken needed to remove these metal fragments, but doing so was certain to result in profuse bleeding that would make it impossible to see and fix the wound. To solve this dilemma, Harken tried a simple maneuver.
After removing the metal from a patient’s heart, Harken immediately plugged the hole with his finger. This “finger in the dike” approach stemmed hemorrhaging and gave him precious seconds to pass sutures one by one, closing the hole.
It was Charles Bailey’s intention to use this finger-plugging technique to treat mitral stenosis. He planned to place a purse-string suture in the left atrium and then make an intentional incision in the center of the ring, plug the hole with his finger and draw the suture tight to limit blood loss. Now with his finger inside the heart, he could poke it through the scarred and narrowed mitral valve orifice to open it wider.
The risks were enormous and largely unknown.
What if his finger upset the heart’s rhythm and caused ventricular fibrillation and death? How would he know how hard to poke? Or if he’d poked enough?
Bailey had tried his operation for the first time two and a half years earlier in Philadelphia, on a 37-year-old man named Walter Stockton. Bailey opened Stockton’s chest, exposed the heart, placed a ring of suture, incised the left atrium, and plugged the hole with his finger. But when the purse string was tightened, the suture tore through the cardiac tissue and would not hold. Bailey watched helplessly as his patient’s blood drained away. Within minutes, Stockton was dead.
Bailey was determined to try again. Seven months later, he operated on a patient who survived the operation but died two days later.
After these two deaths, Bailey’s operating privileges at Hahnemann Hospital were revoked. The chief of cardiology told him, “It is my Christian duty not to permit you to perform any more such homicidal operations.”
Bailey was tenacious. He took his procedure to Wilmington Memorial Hospital in Delaware, where he operated on another patient in 1948. This time Bailey succeeded in separating the fused mitral valve leaflets, but was too forceful and damaged the leaflets so badly that they lost their normal capacity to prevent backflow from the ventricle into the atrium. The patient’s disease had been converted from mitral stenosis to mitral insufficiency, and he also died. Wilmington Memorial Hospital subsequently revoked Bailey’s operating privileges.
Bailey still had operating privileges at two Philadelphia hospitals — Philadelphia General and Episcopal. But with word of his failure spreading, he worried he might have only one more chance to attempt his procedure before these institutions banned him as well. To maximize his chance of success, he decided to schedule two operations on the same day, June 10, 1948, one in the morning at Philadelphia General and another in the afternoon at Episcopal Hospital. This way, even if his first patient died, he hoped to start the second before news traveled across town and someone stopped him. If both operations failed he would likely be finished — his reputation ruined with no hospital willing to accept him.
The first patient at Philadelphia General Hospital died on the table.
No doubt feeling the stress and gravity of the moment, Bailey went to Episcopal Hospital and started his operation on Constance Warner.
He opened the mitral valve; his sutures held, and, to Bailey’s relief, no major hemorrhage occurred.
Warner survived the surgery. Her breathing improved, and by the fourth post-operative day she was walking. Bailey was elated. Warner ultimately lived to age 62.
Six days after Bailey’s triumph, Dwight Harken also performed successful mitral valve surgery on a patient in Boston. Prior to this, Harken had attempted the operation on six patients; all of them died. After one death, Harken returned home despondent. That evening there was a knock at the door and a woman caller handed him a note, previously written by the deceased patient. It read: “Dear Dr. Harken: Thanks for the chance. A small portion of my estate has been left to see that this doesn’t happen again.”
Dwight Harken and Charles Bailey were pioneers of cardiac surgery who failed more often than they succeeded. Seventy-five years ago, their perseverance produced a crucial milestone in the history of modern cardiac surgery. We owe a debt to them, and their courageous patients whose sacrifices continue to serve us all.
Dr. Andrew Lam (www.AndrewLamMD.com) is a retina surgeon, assistant professor at the University of Massachusetts Medical School, and author of “The Masters of Medicine: Our Greatest Triumphs in the Race to Cure Humanity’s Deadliest Diseases” (BenBella Books, April 2023), from which this essay was adapted.