Horace Smithy

Smithy's family left money to the Medical University of South Carolina after he died. The money built up over time, and after a local surgeon added to the fund, the university created the Horace G. Smithy Chair of Cardiothoracic Surgery in 1997. MUSC hosts the Horace G. Smithy Lecture annually.

In early 1948, Smithy prepared to perform his first heart valve surgery on a human. Although two surgeons had attempted mitral valve surgery on several patients in the 1920s, most of those patients had died and mitral valve repair had not been attempted since then. Smithy's first patient, a 21-year-old woman named Betty Lee Woolridge, had sustained heart valve damage from rheumatic fever at the age of ten. Woolridge explained that she had been in heart failure for two years, that diuretics and dietary modifications were no longer effective, and that she hoped Smithy would operate on her heart.

Heart surgery on Woolridge commenced on January 30, 1948. After Smithy opened Woolridge's chest, he placed a purse-string suture around the heart so that the heart tissue could be pulled tight to compress the heart muscle around the valvulotome to minimize bleeding. He also injected novocaine into the heart to lessen the risk of arrhythmias. The valvulotome was inserted through a small hole made in the heart. The device was advanced to Woolridge's mitral valve by feel and then used to cut away scar tissue in the 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 the time of the radio broadcast, Smithy had carried out a second valve surgery; the patient had died. He performed valvulotomies on seven patients by the summer of 1948.

As Smithy began to perform valvulotomies on humans, he knew that his own heart disease was worsening and that a valvulotomy might be his only hope as a patient. He began corresponding with famed cardiac surgeon Alfred Blalock of Johns Hopkins Hospital, who he thought he could convince to perform the novel procedure. Smithy knew that he would need to demonstrate the procedure's feasibility to Blalock. In their communications, Blalock must have asked for one of Smithy's valvulotomes, as a March 1948 letter from Smithy's secretary indicates that Coleman was about to send one to him.

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. In late June, Smithy sent Blalock a letter indicating that he had a young man from New York whose aortic stenosis was nearly identical to Smithy's. He wrote that the patient was willing to travel to Baltimore for surgery.

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. The accounts of Smithy's nurse, Agnes Bowen Kleckley, and an associate, J. M. Stallworth, differ; Smithy either dictated the last few pages of the paper to Stallworth or discussed the remaining portions of the paper with Stallworth for him to finish. In any case, a conference presentation was given by Stallworth and a paper on the surgical treatment of valvular disease was later published in Surgery, Obstetrics & Gynecology.

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.

By 1946, Smithy had devised what he called a valvulotome, an instrument he used to cut away scar tissue from the aortic valve. He made a presentation on the device at an American College of Surgeons (ACS) forum. The next year at the annual ACS meeting, he gave a more formal presentation. An Associated Press science editor heard Smithy's talk at the 1947 ACS conference and the possible breakthrough was widely published in newspapers. The topic was of wide interest because valvular disease affected so many people at the time. Tuberculosis killed the most people under 50 in the 1940s, but because of the prevalence of rheumatic fever, narrowing of the mitral valve was the next most common cause of death in this age group.

Smithy moved on to a surgical internship and residency at the Medical College of South Carolina in Charleston. He may have chosen to go to Charleston in part because the father of a high school classmate had once been the chief surgeon and residency program director at Roper Hospital. The hospital was not affiliated with the medical school when his classmate's father worked there, but it was the medical school's primary teaching site when Smithy arrived. Remaining at Roper Hospital after finishing his residency in 1942, Smithy established a surgical practice. He also worked in an animal laboratory at the medical school, using dogs to learn more about valve function and possible repair. Smithy's interest in this area was heightened by his own heart valve problem; he suffered from narrowing of the aortic valve related to his childhood bout of rheumatic fever.

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.