In 1925 Henry Souttar, a surgeon whose invention, ‘Souttar’s Eyeless Needle’, is still in use in operating theatres around the world, carried out the first successful mitral stenosis (blockage of the mitral valve) operation on a patient called Lily Hine, who had been given a mere six months to live. It was an extraordinary operation, and it illustrated a feature of surgery that has often struck me as fundamental: the need for thinking quickly ‘on your feet’ and adapting to the circumstances of the moment.

Souttar had begun the operation with the intention of opening up the blocked valve with a surgical instrument, just as Cutler had done. But, during the course of the operation, he changed his mind and instead used his index finger, passing it through the valve orifice, where it met with no resistance: the blockage was cleared. Souttar then began to sew up the incisions he had made. Suddenly a snag occurred. The suturing gave way and he had to work fantastically fast in order to complete the proceedings within a reasonable space of time. In total, the operation had lasted one hour – not lengthy by today’s standards, perhaps, but it was a long time in 1925.

With this successful operation Souttar had fully justified a prediction he had earlier made in the British Medical Journal:

Incisions can be made in its [the heart's] chamber, portions of its structure can be excised and internal manipulations carried out without the slightest interference in its action and there is ample evidence that wounds of the heart heal as readily as those in any other region.

In the wake of the Lily Hine success, other valve operations were carried out during the 1920s by surgeons elsewhere. There were just a handful, though, and unfortunately all the patients died. So what might have been a flood turned out to be a mere trickle, with most of the medical establishment being reluctant to promote further operations of this type. Souttar himself was, for all his undoubted skill, never sent any more mitral-valve cases to treat, the general feeling being that such operations were still just on the fringes of the reputable.

In other words, although the tide seemed to be about to turn so far as cardiac surgery was concerned, there was no spectacular attempt by surgeons to force the pace. Heart injuries were still their principal interest. The correction of mechanical defects would have to wait more than 15 years before the next major steps could be taken: the modern assault on the diseased and malfunctioning heart.

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