Ann Thorac Surg 1997;64:870-871
© 1997 The Society of Thoracic Surgeons
Our Surgical Heritage
Francisco Romero, the First Heart Surgeon
Alejandro Aris, MD, PhD
Cardiac Surgery Service, Hospital de la Santa Creu y Sant Pau, Barcelona, Spain
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Abstract
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Francisco Romero, a Catalonian physician, became the first heart surgeon when he performed an open pericardiostomy to treat a pericardial effusion in 1801. He presented his work at the Society of the School of Medicine in Paris in 1815, but the procedure was considered too aggressive and his work was silenced for many years. Proper credit should be given to Romero as the first man who directly approached the heart by incising the pericardium.
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Introduction
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Heart surgery is more than 100 years old, if the date of birth is taken at 1896, the year that Rehn first successfully sutured a heart wound [1]. However, the surgical treatment of heart conditions, mostly traumatic in origin, had been attempted before Rehn's historic operation. The need to include the pericardium as a part of the heart in the history of cardiac surgery was expressed by Shumacker [2], but he could not specify if the first treatment of a pericardial effusion through a thoracostomy was done by the French surgeon Larrey or by the Spanish physician Francisco Romero. In this article, the exact year of Romero's first case is documented, antedating Larrey's case by 9 years.
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Who Was Francisco Romero?
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Francisco Romero was born in Concabella, a small town in Catalonia. The exact date is unknown, but he graduated from the University of Huesca Medical School in 1796. He held a professorship at this University and also became a surgeon of the Royal College of Barcelona. After spending 2 years as a military physician posted in Madrid, he moved to Almeria, on the Andalusian coast. Working there, he saw many cases of pericardial and pleural effusions. Disappointed with the standard methods of treatment (eg, diuretics, blood-letting) he decided to approach it by an open method. In 1812 he went to France, with the French troops that left the south of Spain in September of that year. In 1815 he presented a memoir to the Society of the School of Medicine, in Paris, describing his technique of open drainage of thoracic effusions. The Society considered the procedure too aggressive and silenced his work. In addition, Romero wrote an essay on venereal disease and another on croup. Interestingly, in contrast with his aggressive approach to pericardial effusions, he cautioned against performing a tracheostomy.
Although he repeatedly expressed his desire to return to his homeland, he probably died in Paris.
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Romero's Memoir
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The retrieval of this important document was done by the late F. Pascual Rodriguez, MD. Obsessed by the lack of information regarding the life and work of Francisco Romero, he embarked on a research trip visiting Paris, Huesca, and Almeria. In Paris, he found the memoir, which had eluded previous search because it was originally located in the Royal Library and was not moved to the National Library until a later date. The work was in Latin but, with the help of a Salesian priest, he published it in Spanish [3].
Francisco Romero presented his memoir on April 13, 1815. The title was "Observatio experimentis confirmata, pro hydrope pectoris, pulmonum anasarca, et hydropericardio cognoscendis; et nova methodus dictos morbos operandi" ("Observation confirmed by experiments, for diagnosis of chest hydrops, lung anasarca and hydropericardium, and a new method of operating on these diseases"). On the cover (Fig 1
) and after an extensive description of academic acomplishments, Romero states "Novum posteritati sanitatis condidi signum, anno 1801" ("I have established a new medical landmark for posterity, in the year 1801"). This is the year of the first open pericardiostomy.
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Fig 1. . Cover page of the memoir presented by Francisco Romero in Paris. The year of the first pericardiotomy (1801) is indicated. (Reprinted with permission from the publisher, J. Uriach & Cía, SA.)
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The memoir gives a long report on the pathophysiology of pericardial and pleural effusions and its favoring factors. Among them, he blames the Austrus (a south wind), excessive fluid intake, and gazpacho, the tomato and vinegar-based Andalusian soup. A reference to smoking tobacco "rolled in white paper" is also made. In cases of pericardial effusions, he would make an incision next to the curvature of the sixth rib at the cartilage level and ascertain that there was liquid in the pericardium. In this case, he would open the sac with a small, curved scissors and allow the fluid to drain in the pleural cavity. He cautioned about the possibility of air entering the chest if all these maneuvers were not accomplished quickly. According to his memoir, Romero performed five open drainages of pleural effusions with success (1 patient died at 6 months) and two open pericardial drainages with no deaths. Postoperative care included dietary recommendations such as wheat bread soaked in red wine and sugar, partridge broth, and minimal doses of absinthe.
The revolutionary lecture did not meet general approval. The Society did not endorse such an aggressive approach and requested more details about the patients. Shortly after, Henry-Marie Husson and François Mérat de Vaumartoise gave a short account of the presentation [4].
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Response to the Society
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On July 7, 1815, three months after his initial lecture, Romero delivered a new memoir to the Society of the School of Medicine: "Responsio a Societatis Scholae parisiensis ex me scriptis petita" ("In response to the request by the Parisian Society of the School about my writings"). He made a complete description of the cases he had operated on. The first patient, a 35-year-old farmer named Antonio de Mira, was operated on in the spring of the first year of the century (meaning 1801). Five pounds of brick-colored fluid were drained. He made a good recovery, going back to work in 4 months. Three years after the operation his only complaint was pain in the incision. In the second patient, only 3 pounds of fluid were drained. His recovery was slower due to his "irritable temper." Romero conceded to have done a third case in which both sides of the chest were open but no fluid was obtained due to extensive adhesions between the lungs and the pleura. The patient died on the fourth day due to a wound infection. Despite that Romero offered money to furtively examine the body, this was denied. This third case was not mentioned in the original memoir. (Hidden mortality is as old as cardiac surgery!) The rest of the document related to the cases of open pleural drainage. Next to the original edition, letters of recommendation were found. Pierre-François Percy supported the application of Romero to become a member of the Society.
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Comment
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Francisco Romero was, by no means, "an obscure Barcelona surgeon" as stated by Shumacker [5]. He was a daring, well-trained surgeon who, frustrated with medical treatment, decided to treat surgically a chest disease. The history of cardiac surgery is made by men like him. He also believed in his technique and decided to present it to a major medical society. Romero's work was mentioned in the Dictionary of Medical Sciences published in 1819 [6]. The author of the chapter on pericarditis was Mérat, who had given an account of the presentation at the Medical School [4]. Without his update, the name of Romero would probably have sunk into oblivion. His work was scantly reported in the Spanish literature during the last century. Two important monographs on pericardial effusions appearing by the end of the century again mentioned Romero's name [7, 8]. A new monograph on the subject appeared in Spain in 1963 [9]. However, it was not until Dr José Pascual Rodriguez successfully searched for the original memoir, at the National Library in Paris, that the exact date of the first heart operation was known. Its translation from Latin and its further publication [3] were instrumental in properly crediting Francisco Romero as the first surgeon who approached the heart.
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Acknowledgments
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I thank Rev Frederick J. Murphy for his assistance with the Latin translations.
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Footnotes
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Address reprint requests to Dr Aris, Cardiac Surgery Service, Hospital de la Santa Creu y Sant Pau, San Antonio M. Claret 167, 08025 Barcelona, Spain.
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References
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- Aris A. One hundred years of cardiac surgery. Ann Thorac Surg 1996;62:636–7.
- Shumacker HB. When did cardiac surgery begin? J Cardiovasc Surg 1989;30:246–9.[Medline]
- Pascual Rodriguez J. Francisco Romero, padre de la cirugía cardiaca. Med Hist (Barc) 3a época 1985;7:2–26.
- Husson H-M, Mérat FV. Extrait d'une mémoire de M. le docteur F. Romero, médecin de Catalogne, sur l'hydrotorax et l'hydropericarde. Bull Fac Méd Paris 1815;4:373–6.
- Shumacker HB. The evolution of cardiac surgery. Bloomington: Indiana University Press, 1992:9.
- Mérat FV. Péricardite. In: Panckoucke, Crapart, eds. Dictionnarie des Sciences Médicales. Paris, 1819;40:369–75.
- Roberts JB. Paracentesis of the pericardium: a consideration of the surgical treatment of pericardial effusions. Philadelphia: Lippincott, 1880.
- Riedinger F. Verletzungen und chirurgische Krankheiten des Thorax und seines Inhalts. Band 42. In: Billroth T, Lücke A, eds. Deutsche Chirurgie. Stuttgart: Enke, 1888.
- López Piñero JM, Peset Reig R. Francisco Romero y los origenes de la cirugia cardiaca. Arbor (Madrid) 1963;54:59–70.
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Abstract
Introduction
