Horace Smithy

Horace Gilbert Smithy Jr. (July 19, 1914 – October 28, 1948) was an American cardiac surgeon who in 1948 performed the first successful mitral valve repair (mitral valvulotomy) since the 1920s. Smithy's work was complicated because it predated heart-lung machines or open heart surgery. Though his procedure did not become a definitive treatment for valvular heart disease, he introduced the technique of injecting novocaine into the heart to avoid arrhythmias during surgery, and he showed that it was feasible to access and operate on the heart's valves.

A graduate of the University of Virginia School of Medicine, Smithy completed a surgical residency in Charleston, South Carolina, and then practiced surgery at Roper Hospital in Charleston. He also began working with a colleague in a dog laboratory to devise a valvulotomy (surgical treatment for diseased heart valves). Smithy's interest in heart valve dysfunction was also personal; he suffered from narrowing of the aortic valve related to rheumatic heart disease.

As Smithy began to operate on a series of patients with heart valve disease, he started to correspond with eminent heart surgeon Alfred Blalock, hoping that ultimately Blalock would agree to perform a valvulotomy on him. Smithy had a patient come to Baltimore so that Blalock and Smithy could operate on the patient together. When that patient died on the operating table, Blalock refused to be involved with further surgery of that type. Smithy died at Roper Hospital of cardiac asthma, pneumonia and another attack of rheumatic fever. His death came a few months after he performed his first valvulotomy; he had been unable to convince anyone to perform the surgery on him.

Early life Smithy was born in Norfolk, Virginia. He was the son of Rosalia and Horace Smithy Sr. The elder Smithy, who was lifelong friends with Assistant Secretary of Commerce Monroe Johnson, worked in real estate before acquiring his own 50-person real estate brokerage firm, the H. G. Smithy Company. Until high school, Horace Jr. was educated at the Friends School in Washington. At some point during his childhood, he suffered from rheumatic fever. Smithy attended Episcopal High School in Alexandria, Virginia. He was becoming sick with frequent colds, which were thought to be weather-related, so he was sent to the Miami Military Academy. The New York Times indicated that he once boxed professionally and played professional baseball.

Although the original valvulotome had allowed him to start working on aortic valves, he knew that he needed a more sophisticated device to contend with scar tissue found in the mitral valve. In conjunction with C. D. Coleman, who ran the university's machine shop, he developed a new valvulotome. The device consisted of a plunger inside a hollow tube and a set of jaws. As the plunger was depressed, the jaws closed. The jaws would "bite" out a small portion of the narrowed valve. Woolridge seemed to recover well. On February 9, Smithy introduced Woolridge at a medical meeting being held in Charleston and she was said to be "up, walking and apparently nearly well."

By February 15, Woolridge had returned to her home in Canton, Ohio. Smithy told reporters that he hoped to perform the same surgery on other patients soon, but that definite results of the surgery could not be determined for at least five years. After Smithy operated on Woolridge, the South Carolina General Assembly issued a resolution in his honor. He performed valvulotomies on seven patients by the summer of 1948.

John Boone, chief of medicine at the Medical College of South Carolina, wrote to Blalock on Smithy's behalf in May 1948. Blalock wrote back within days, asking Smithy to arrange a trip to Johns Hopkins where they could locate a patient and operate together. "Nothing would give me greater pleasure than being able to help you by the use of your method," Blalock wrote.

Smithy came to Baltimore and did laboratory work with technician Vivien Thomas and resident Denton Cooley. When Smithy and Blalock operated on their first patient, a very sick man between the ages of 35 and 40, things did not go as they had hoped. The events have been described with slight variations, but it seems that the patient developed a fatal arrhythmia while being anesthetized or while the chest incision was being made. Cooley said that he saw Smithy's face drop noticeably when the patient died, perhaps because he saw Blalock as his only chance at having the surgery himself.

Death In early October 1948, Smithy developed pneumonia and was admitted to Roper Hospital; his condition was further compromised by cardiac asthma and another bout of rheumatic fever. He was scheduled to present a paper at a conference of the American College of Chest Physicians that month.

On October 22, The New York Times reported that complications had ensued and that Smithy was in critical condition. On October 28, Smithy died; he had never been able to undergo surgery on his own aortic valve.

Woolridge died ten days after Smithy did. Though she died at home, she had been in the hospital frequently after returning to Canton, and she spent two months in the hospital shortly before she died. Four of Smithy's seven valvulotomy patients were still alive and doing well at the time of Woolridge's death. Smithy was posthumously named an "outstanding young man of 1948" by the South Carolina chapter of the Junior Chamber of Commerce. After Smithy died, Blalock exchanged letters with Smithy's widow. Blalock said that he had recently been in Berryville, Virginia, and that he had gone with his wife to the cemetery where Smithy was buried.

Legacy Ultimately, most of Smithy's success with valvulotomy was short-lived and his procedure was soon replaced with more effective interventions. However, Smithy's intracardiac injection of novocaine significantly decreased the likelihood of arrhythmias that could occur when the heart was surgically manipulated. A Medical University of South Carolina library exhibit says that "etter operations than Smithy's were already accomplished, and their value would become apparent. In going the wrong way, Smithy nonetheless achieved positive results and invited comparisons that eventually led to the realization that commissurotomy was the operation of choice... his work, well publicized at the time, encouraged patients and physicians and prompted the concept that operative treatment of valvular heart disease could be successful."

Heart surgeon Charles P. Bailey, who was working on heart valve surgery at a different institution at the same time as Smithy, later commented on Smithy's personality. He said that though surgeons tended to be egotistical, Smithy was "not only a southern gentleman, but a true gentleman." MUSC hosts the Horace G. Smithy Lecture annually.