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Daniel Hale Williams MD, First African American Heart Surgeon (1856-1931)

January 21, 2019

History of Medicine

Daniel Hale Williams MD in 1900
Photo source: By Unknown - Source now defunct; images fetched from the Wayback Machine. Public Domain,

Daniel Hale Williams (January 18, 1856 - August 4, 1931) was an African-American general surgeon, who in 1893 performed the first documented, successful pericardium surgery in the US. Dr. Williams also founded Chicago's Provident Hospital, the first non-segregated hospital in the US. The heart surgery at Provident, which his patient survived for the next twenty years, is referred to as “the first successful heart surgery“ by Encyclopedia Britannica. In 1913, Dr. Williams was elected as the only African-American charter member of the American College of Surgeons.

At the time that Williams graduated from what is today Northwestern University Medical School, he opened a private practice where his patients were white and black. Black doctors, however, were not allowed to work in American hospitals. As a result, in 1891, Williams founded the Provident Hospital and training school for nurses in Chicago. This was established mostly for the benefit of African-American residents, to increase their accessibility to health care but its staff and patients were integrated from the start. In 1893, Dr. Williams became the first African American on record to have successfully performed pericardium surgery to repair a wound. On July 10, 1893, Williams repaired the torn pericardium of a knife wound patient, James Cornish. Cornish, who was stabbed directly through the left fifth costal cartilage, had been admitted the previous night. Williams decided to operate the next morning in response to continued bleeding, cough and “pronounced“ symptoms of shock. He performed this surgery, without the benefit of penicillin or blood transfusion. He undertook a second procedure to drain fluid. About fifty days after the initial procedure, Cornish left the hospital.

In 1893, during the administration of President Grover Cleveland, Williams was appointed surgeon-in-chief of Freedman's Hospital in Washington, D.C., a post he held until 1898. That year he married Alice Johnson, who was born in the city and graduated from Howard University, and moved back to Chicago. In 1897, he was appointed to the Illinois Department of Public Health, where he worked to raise medical and hospital standards. Williams was a Professor of Clinical Surgery at Meharry Medical College in Nashville, Tennessee and was an attending surgeon at Cook County Hospital in Chicago. He worked to create more hospitals that admitted African Americans. In 1895 he co-founded the National Medical Association for African American doctors,.

Daniel Hale Williams was born in 1856 and raised in the city of Hollidaysburg, Pennsylvania. His father, Daniel Hale Williams Jr. was the son of a Scots-Irish woman and a black barber. His mother was African-American and likely also mixed race. The fifth child born, Williams lived with his parents, a brother and five sisters. His family eventually moved to Annapolis, Maryland. Shortly after when Williams was nine, his father died of tuberculosis. Williams' mother realized she could not manage the entire family and sent some of the children to live with relatives. Williams was apprenticed to a shoemaker in Baltimore, Maryland but ran away to join his mother, who had moved to Rockford, Illinois. He later moved to Edgerton, Wisconsin, where he joined his sister and opened his own barber shop. After moving to nearby Janesville, Wisconsin, Williams became fascinated by the work of a local physician and decided to follow his path. He began working as an apprentice to Dr. Henry W. Palmer, studying with him for two years. In 1880, Williams entered Chicago Medical College. After graduation from Northwestern in 1883, he opened his own medical office in Chicago.

In the 1890s several attempts were made to improve cardiac surgery. On September 6, 1891 the first successful pericardial sac repair operation in the United States of America was performed by Henry C. Dalton of Saint Louis, Missouri. The first successful surgery on the heart itself was performed by Norwegian surgeon Axel Cappelen on September 4, 1895 at Rikshospitalet in Kristiania, now Oslo. The first successful surgery of the heart, performed without any complications, was by Dr. Ludwig Rehn of Frankfurt, Germany, who repaired a stab wound to the right ventricle on September 7, 1896. Despite these improvements, heart-related surgery was not widely accepted in the field of medical science until during World War II. Surgeons were forced to improve their methods of surgery in order to repair severe war wounds. Although they did not receive early recognition for their pioneering work, Dalton and Williams were later recognized for their roles in cardiac surgery. Williams received honorary degrees from Howard and Wilberforce Universities, was named a charter member of the American College of Surgeons, and was a member of the Chicago Surgical Society.

Medical science has advanced significantly since 1507, when Leonardo da Vinci drew this diagram of the internal organs and vascular systems of a woman.Graphic credit: Leonardo da Vinci; Public domain

William Harvey (1578-1657) is recognized as the man who discovered and published the first accurate description of the human circulatory system, based on his many years of experiments and observations as a scientist and physician. Harvey had accumulated a mass of irrefutable experimental evidence in support of his dramatic new view, knowing that a tremendous amount of criticism and disbelief would be mounted against his groundbreaking, revolutionary theory of the physiology of blood circulation. Although the majority of the physicians and scientists of his day refused to accept his research, Harvey's discovery and written description of the true functioning of the heart and circulatory system remains as one of the landmark medical textbooks and the foundation of modern physiology.

Most physicians, scientists, and philosophers of 17th century Europe were adherents of Galen's doctrine, which contained several significant errors regarding the movement of blood and the workings of the heart. These were actually quite ancient ideas and notions, still accepted more than 1,400 years after first being postulated by Galen, the Greek physician of Rome. Over time, the dogma of Galen became sacrosanct, even though most of his anatomical knowledge and physiological investigations were based on his studies of monkeys and pigs, because dissections of human bodies were typically not permitted. Galen recognized the usefulness of comparative anatomy for gaining understanding of the human body, and he studied the workings of animal bodies and various structures in some detail. He was a prolific writer and dedicated scientist, venerated for centuries, and long considered to be the authority on medicine and health. Galen and his proponents believed that the circulation of blood began in the gastric and intestinal blood vessels, and was carried to the liver, where it was “elaborated“ by the liver. This “venous blood“ then entered the hepatic vein, which he believed to be the origin of the vena cava, and the “descending“ vena cava transported blood to the lower body, while the “ascending“ branch sent blood to the upper body. As blood entered the right side of the heart, it was thought to pass through invisible pores in the septum that divided the heart, forced into the left ventricle, mixed with air brought in from the lungs by the pulmonary veins, and transformed into the “arterial blood.“ The heart was seen as a type of bellows, expanding when a small volume of blood in the left ventricle was greatly heated by the addition of “vital spirits,“ forcing the heart to expand and draw blood inside. In a similar fashion, the arteries carried this “boiled up“ blood away from the heart to the body, but the blood did not return to the heart. According to Galenic doctrine, the liver was seen as the continual source of new blood, replenishing the blood that was vaporized and converted into waste material, and released from the lungs as “soot.“ As the personal physician of King Charles I and the recipient of the best medical education possible, Harvey was perhaps the preeminent physician in England and perhaps all Europe, and he long doubted the accuracy of many of the “facts“ that the medical profession espoused. Harvey finally published the results of his research in his text Exercitatio anatomica de motu cordis sanguinis in animalius (On the movement of the heart and blood in animals) in 1628. Harvey only accepted as facts those ideas that were supported with repeated experimental evidence, and, as was his nature, he methodically and forcefully exposed the errors of the long held misconceptions about the heart and blood circulation. His new system completely altered the Galenic concept of blood circulation, proving that the heart is a hollow muscle that contracts regularly to provide the single motive force of the blood's movement. He patiently exposed the other unacceptable aspects of Galen's erroneous system, using well-designed experiments that attempted to dispel various falsehoods.

Harvey was able to fully illustrate the actions of the heart, its chambers and valves, as well as clarify the long misunderstood pattern of pulmonary circulation. Harvey concluded that blood moved from the right ventricle into the lungs via the renamed pulmonary artery (correctly changed from pulmonary vein), which Galen thought carried only air and “soot“ back and forth between the lungs and heart. Harvey properly stated that the blood then returned to the left side of the heart via the pulmonary veins. Harvey would not attempt to answer why the blood traveled to the lungs and back, as he did not have any knowledge about gas exchange during pulmonary respiration. Harvey also fully detailed the systematic circulatory system, tracing the flow of blood through the arteries coursing within the body, returning to the heart via the network of veins. He also artfully illustrated the workings of the valves in veins, proving the one-way circulation of venous blood towards the heart, and refuting the notion that the valves were actually reinforcement structures that prevented the over expansion of the veins as blood was forced through, as his university mentor Girolamo Fabrici (1537-1619) had taught. When Harvey found that his experimental evidence could not provide an answer to a question, he did not attempt to evoke rational mysticism by way of explanation, as in the case of how and why blood in the arteries eventually passed into the veins and traveled back to the heart. Harvey could not see the capillaries found in tissues and had no way of addressing blood's metabolic function, but he did anticipate the presence of the “anastomoses“ between arteries and veins and the possibility of blood providing nourishment or some other function. These blood-carrying structures were too small to be seen with the naked eye, but Harvey strongly believed that their existence would be detected eventually. Later, in the seventeenth century, both Marcello Malpighi (1628-1694) and Anton van Leeuwenhoek (1632-1723) would use the improved microscope to describe the presence of capillaries and blood cells in a wide variety of animals, including humans.

Harvey worked long and hard to create what became the starting point for modern mammalian physiology. His still impressive research is also seen as the first milestone of modern experimental science, and can be used as an example of how to perform experimental scientific research. Being the person to inaugurate two new scientific systems that condemned long-held beliefs, Galen's doctrine and the school of rationalism, Harvey must have recognized the likelihood of dire consequences. The derision and attack of the medical community was inevitable, and accusations and charges made by the Church and legal authority would not be without common precedence. New ideas that change entire systems of knowledge were always viewed with skepticism and apprehension, often evoking harsh criticisms and accusations of quackery. Harvey risked being rejected as foolishly misled or even acquiring the stigma of being labeled a quack. After his publication, his private practice suffered a great decline as a result of the intense controversy he created, but Harvey steadfastly maintained himself and his convictions during the controversy.

As a professor and physician, Harvey advocated the use of comparative techniques to study anatomy and physiology, recognizing the advantages and practicality of using the animals that were available for study. Harvey worked with fish, amphibians and reptiles, birds, mammals, and humans, experimenting and comparing where ever possible, building his theory methodically and with great care. In the case of the action of the heart, he found that in many lower animals, the heart's movement was slower and could be seen more readily, and he used the slower heart rate of chilled fish and amphibians for analysis and comparison to the faster mammalian heart. Many of Harvey's experiments would later be described as direct, artfully simple, and beautifully designed. Throughout his career, Harvey emphasized the experimental method of scientific research, which would become a basic tenet of modern science. Harvey would not accept any rationalism or mysticism as evidence for determining how or why something occurred in the body. Only experimental evidence that was repeated many times, using as many different animal examples as possible, could be considered in reaching any conclusions. Harvey avoided having any preconceived ideas about his experiments, rather, he gathered his evidence, analyzed the data, and then created a scientific hypothesis that he knew he could further test directly with more experiments. He built his new theory of blood circulation in a straightforward analysis of each step in the process, gathering extensive experimental data to confirm every aspect. He anticipated potential criticisms and designed more experiments to refute future controversies. His reliance on the experimental method was in contrast to many scientists and philosophers of his time, who instead employed rationalism or dialectics to essentially think their way through a question or problem, often following anecdotal or casual observational information, and using little to no experimental evidence. This type of analysis typically evoked the presence of unseen forces or “principles,“ usually a supernatural or divine phenomenon. Harvey tended to avoid this kind of philosophical reasoning, referred to as ratiocination.

The adherents of the Galenic doctrine did not surrender to the new physiology quietly, but rather a great controversy raged for many years and long after Harvey's death. Harvey, humble and dignified as a person and in his work, was patient and understanding when dealing with his critics and doubting contemporaries. Occasionally he would answer his critics with a direct letter or a publication that would add to or reiterate the existence of the relevant experimental evidence that confirmed his conclusions. Nevertheless, recognition of the truths that he illuminated did not come in his lifetime. Eventual acceptance came much later, when scientists developed new tools of investigation and better understanding of modern science. Harvey is remembered and revered both as the founder of modern physiology and a champion of modern experimental science.

Sources: Society for Vascular Surgery);;; Wikipedia

Videos below for more information:

History of Vascular Surgery

Interview with Michael DeBakey MD

Interview with Denton Cooley MD

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