Half of the 24,500 members of the American College of Surgeons left their scalpels in the autoclave last week and met in Chicago for the college's annual congress. There they heard news of outstanding progress in handling life-and-death problems in three of the body's most vital organs: the heart, the lungs and the brain.

Heart: A New Pump to Save The Ordinary Attack Victim

Surgeons, who have been trying for a quarter-century to develop an effective treatment for the commonest form of heart attack--a coronary occlusion--learned in Chicago last week of a daring and original method devised by a young Harvard researcher. The method is to hook the patient to a pump that beats out-of-step with the heart's own beat, to create the most favorable conditions for the heart to develop substitute channels of circulation around the area of the occlusion (the shutdown in one of the heart wall's own arteries).

Dr. John Arthur Jacobey started from the premise that if the heart has time, it can, in many if not most cases, repair itself. Back of this premise is the fact that post-mortem examinations, after deaths from other causes than heart at tacks, frequently reveal gradual coronary-artery shutdowns, which developed so slowly that smaller, collateral artery branches grew and took over the work of the closing artery.

These collateral branches are like residential side streets--little used when the through roads are open. Unfortunately, it is immediately after an attack that the heart is least able to use the side-street arteries: the blood pressure is low, and it takes above-normal pressure to open promptly the narrow, neglected collaterals. The time to do this, Dr. Jacobey concluded, is in the intervals (diastole) between heart contractions.

Dr. Jacobey and colleagues began by giving dogs standardized heart attacks by injecting plastic pellets into their coronaries. Five out of six dogs died. Then they hooked up six other dogs, also given heart attacks, to a small, simple pump that is timed by the electrocardiograph. When the heart contracts, the pump is relaxed and actually withdraws a little blood. When the heart relaxes, the pump gets in its "beat"' and forces blood through the aorta into the coronary arteries. After two hours on the pump, five out of these six dogs lived.

Dr. Jacobey explained that 1) the pump reduces the heart's work when it has just been damaged and its condition is most critical, 2) it increases the flow through all coronary vessels, but 3) it causes the greatest increase in the formerly dormant collateral branches.

In the first human trials of the new technique, at the Peter Bent Brigham Hospital, five patients in severe shock, with catastrophically low blood pressure and with little chance of survival, have been hooked up to the pump. The operation is relatively simple, requiring only an incision in an arm artery, for pressure measurements, and one in the femoral artery for the counterpulse pump tube.

The patients must be hooked up promptly, within hours after the heart attack, and are kept on the machine for two hours. Of the results obtained so far, Dr. Jacobey would say only that they have been "encouraging."

Lung: Why Patient May Die Even if Operation "Succeeds"

If the operation was a success, why did the patient die? Until 1942 surgeons explained it as "shock." Then they learned to control shock in most cases by transfusing lost body fluids, especially blood. In the remaining cases, the common explanation became "kidney failure." Now this can often be overcome, sometimes with the artificial kidney. Still, some patients die. Boston's Dr. Francis D. Moore told the College of Surgeons where to look for the causes of death: in the lungs.

Professor of surgery at Harvard Medical School and surgeon in chief of Peter Bent Brigham Hospital, Dr. Moore is the nation's--perhaps the world's--outstanding authority on the vital importance of "electrolyte balance" in preserving life (TIME, Oct. 6,1952). The balance is usually expressed simply in terms of sodium salt solutions v. potassium salt solutions in the blood. But recent years' work has shown that it is far more complex than that.

This critical balance is controlled by many automatic mechanisms in the heart, kidneys, the nervous system, the adrenal and sex glands. What concerns the surgeon is what happens, either before surgery or because of surgery, when the balance is upset. This results from what Dr. Moore called "erosion of the cell mass," which he translated as shrinking of the body's "engine," its mass of energy-coversion cells, in proportion to the "chassis," the skeleton and other less active tissues.

As surgery begins, the cellular engine may have already shrunk from starvation (for example, that caused by cancer of the gullet or stomach), from infection, or from the storage of excess water, as in the edema that goes with congestive heart failure. The faltering engine gradually loses its power to deliver blood-borne nutrients to the muscles. Then the most vulnerable points, said Dr. Moore, are in the diaphragm and the muscles between the ribs. And the effects are most severe on breathing and coughing. The cause of death in surgical patients, he said, is seldom found in the heart, brain, kidneys or liver. For the final mechanism of death, surgeons should look to the lungs.

The patient reaches a point where the mere act of breathing takes all the energy that his muscles can get. (In the normal person, breathing takes only 2% to 3% of total energy.) He cannot even get rid of carbon dioxide, so he goes into acidosis. The biochemical picture becomes so distorted that neither heart nor arteries can function properly, and neither transfusions nor stimulating hormones take effect. Inflammation develops in the lungs or bronchi or both. Then the effort to cough, which requires a big reserve of muscle energy, makes a final demand that the patient cannot meet. He literally "breathes his last."

To reduce deaths after operations, Dr. Moore said, surgeons must keep on trying to preserve the exquisitely delicate balance in blood and other fluids. Also, he suggested, they might use modified forms of artificial respiration to ease the load on patients' lungs and release more energy for the rest of the body.

Brain: Chilling Removes Blood During Operation

After a numbing discussion on how long a dog's brain can survive without oxygen at various temperatures, Dr. Robert J. Boyd brought the audience at the College's surgical forum straight up in their chairs with an unscheduled addendum: "We recently performed selective brain cooling successfully in a clinical case at Stanford Medical Center." In this way, Dr. Boyd reported an advance that may prove to be as epochal for brain surgery as was the development of the heart-lung machine for operations inside the heart.

Surgeons operating in or on the brain have been more hampered than those working on any other part of the body by their inability to get a "dry field" to work in. The brain has a superabundant blood supply, and is more exacting than any other organ in its demands: if deprived of blood (and therefore oxygen) for more than about four minutes at normal temperatures, it suffers irreparable damage. At lower temperatures the brain can survive longer, so some neurosurgeons have operated while the patient's whole body was cooled. But others felt that the brain needed to be more deeply chilled than the body can be, to give a longer safe time.

At Stanford University, Dr. Boyd and colleagues found from their dog experiments that if the rest of the body stayed at near-normal temperature and the brain alone was cooled, it could be dropped as low as 68DEGF. for up to an hour with no oxygen at all and without apparent damage. This meant that they could shut off its circulation entirely and give the surgeon a virtually dry field. Last month the team tried it on a 54-year-old woman with a tumor in the right mastoid and middle ear. The tumor was so heavily supplied with blood vessels that removal was judged impossible, because of the risk of massive hemorrhage unless circulation could be stopped completely.

The surgical team headed by Dr. John E. Connolly made an incision in the anesthetized patient's neck, to get at one of the carotid arteries that supply blood to the brain. First they drew out some blood, and added donor blood, to fill the pump-oxygenator ("heart-lung machine"). To this was attached a cooler that chilled the oxygenated blood. The surgeons led this chilled blood into the brain arteries. After about 15 minutes the brain temperature dropped to 68DEG. The doctors then stopped the flow and clamped all the brain arteries shut. The patient's own heart and lungs supplied fresh blood to the rest of her body.

When Surgeon Robin P. Michelson reached the brain to remove the tumor, he hit no gusher, but found the area cool, still and, for all practical purposes, dry. Under these ideal conditions he was able to remove virtually all the tumor within ten minutes, though he probably could have taken four times as long without added risk. The research team removed their tubes and clamps, let the patient's own blood rewarm her brain.

Though the patient has since had a stormy recuperation, this may have been mainly because of the unavoidable severity of the operation. She has shown no signs of brain damage due to oxygen shortage. Her case opens a surgical horizon with possibilities of far safer and more effective operations for aneurysms ("blowouts" in brain blood vessels) and some brain tumors.

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