Ernst Ferdinand Sauerbruch

1875-1951

German Surgeon

Ernst Ferdinand Sauerbruch was one of the most outstanding surgeons of the first half of the twentieth century. His inventiveness and technical brilliance solved a problem that had stumped physicians for centuries—how to open the chest without losing respiratory function. In addition to this breakthrough, Sauerbruch introduced many advances in surgery of the lung and was the first to devise an artificial hand worked by the muscles of the amputated arm.

Born in Barmen, Germany, on July 3, 1875, Sauerbruch was raised in humble circumstances by his mother and grandfather after his father's death in 1877. His family sacrificed to send him to medical school at Marburg, Jena, and Leipzig, where he qualified in 1902. His highly original essay on cerebral pressure attracted the attention of the renowned surgeon Johann von Mikulicz-Radecki (1850-1905), who invited Sauerbruch to his surgical clinic at the University of Breslau. Mikulicz immediately challenged him to research the problem of pneumothorax, inrushing air leading to collapse of the lung, which occurred whenever the chest cavity was opened.

Sauerbruch realized that respiratory function depends on maintaining a lower pressure inside the chest than in the surrounding atmosphere, and conceived the idea of building a low pressure chamber within which the chest might be safely opened. After repeated experiments on rabbits and dogs, the chamber was successfully used on human subjects. At the age of 28, Sauerbruch was invited to demonstrate his device at the prestigious German Surgical Congress in Berlin in 1904.

Following brief periods at Griefswald and Marburg, Sauerbruch was invited in 1910, at age 35, to fill the Chair of Surgery at the University of Zurich, near the Swiss mountain region that had become a haven for patients with lung diseases, especially tuberculosis. Here he developed the two-stage thoracoplasty—removal of portions of the ribs—as a treatment for tuberculosis, which became a classical operation practiced throughout the world. Also significant were the reliable techniques he developed for lung resection—removal of a lobe or an entire lung—which were fundamental to successful treatment for lung cancer.

During his World War I service as a military surgeon, Sauerbruch witnessed the suffering of soldiers who had lost arms or hands. In response he designed the "Sauerbruch hand," an artificial limb controlled by the muscles of the amputated stump.

After the war Sauerbruch was called to the University of Munich and ten years later to the Charite Hospital in Berlin, where his operating theater became a mecca for thoracic surgeons from around the world. Would-be entrants, however, were required to sign their names in support of the restoration of German surgeons to the membership of the International Society of Surgery, an unacceptable condition to many who had fought against Germany. During World War II he was appointed Surgeon-General of the Armed Forces. His relations with the Nazis remain uncertain; though he accepted its rewards he professed opposition to the regime, and in 1949 he was cleared by a denazification court.

Sauerbruch's later years were marred by dismissal in 1949 from his Berlin post: due to the debilitating effects of cerebral sclerosis he had become dangerous to patients, a fact that others could recognize but he could not. Increasingly incapacitated from that point on, Sauerbruch died on July 2, 1951, a day short of his seventy-sixth birthday.

In this half century no other single individual so decisively influenced the direction of surgery. His innovations were known and sought after not only in Europe but throughout the world. Although his low pressure chamber was soon superseded by less cumbersome techniques using inhalation anesthesia under pressure, the underlying principle of pressure differential remains valid. His definitive work, Surgery of the Organs of the Chest (1920-1925), was the first to treat this subject systematically and became the foundation for future developments in the field. Because of his work, surgeons gained the knowledge and confidence to attempt life-saving operations involving not only the lungs but also the heart and esophagus.

DIANE K. HAWKINS