Surgeon General

“ The organization is complete and excellent. There is a supervising Surgeon-General, who has great powers and great responsibilities, a medical purveyor, surgeons, passed-assistant surgeons, and assistant surgeons. These treat an immense number of cases, and not a few have lost their lives in combating epidemics. These officers are selected by examination and entirely removed from any politics, and are bound to go wherever they are ordered, and obey regulations. ”

“ After the war he was stationed at different army posts east and west, and from 1875 to 1880 was surgeon in charge of the Soldiers' Home at Washington, from 1880 to 1887, working in the surgeon-general's office. ”

“ The deliberate and confident manner and word of the surgeon go a long way in guiding the feelings of his patient, and a worried or apprehensive surgeon makes for a doubtful and sensitive patient, ready to cry out at the first prick of the needle. Therefore it is a part of good general technic for the surgeon to deport himself in a way conducive to cheerfulness, and conversation must be guided along these lines.
There are many who will writhe and groan at sensations (which they will admit later were not painful) incident to local anesthesia, such as the grating vibrations of instrumentation. ”

“ The truth about modern surgery told by a master surgeon is of value both to the members of the medical profession and the general reader. Dr. Keen treats the historical and antiquarian aspects of practical anatomy, covers the ground of modern surgery, shows the position of the medical college to-day, its mission and needs, and closes with an address on “The surgical reminiscences of the Civil war.” ”

“ The treatment of wounds, injuries and deformities, with operative interference in general, is the special department of surgical practice (the corresponding parts of pathology, including inflammation, repair, and removable tumours, are sometimes grouped together as surgical pathology) ; and where the work of the profession is highly subdivided, surgery becomes the exclusive province of the surgeon, while internal medicine remains to the physician. A third great department of practice is formed by obstetric medicine or midwifery (see Obstetrics) ”

“ In many of the more severe conditions not to be classified as minor surgery, the surgeon may consider the comfort of the patient and his own convenience and employ local in preference to general anesthesia, even tho the patients may be of the most robust type. ”

“ These Kaffir specialists show a considerable surgical skill. They are called in for all surgical complaints.
In most cases the surgeon exhibits internal as well as external remedies, using purgatives and emetics freely to assist healing and relieve pain. ”

“ They tend to show that however good a general rule may be, it may admit of many and important exceptions; and they prove that experience, aided by sound and correct observation, is essentially necessary for the formation of a scientific surgeon. ”

“ In the management of wounds and other diseased conditions the main object of the surgeon is to promote the natural reparative process by preventing or eliminating any factor by which it may be disturbed. ”

“ It is a striking commentary on the immediate results of anæsthesia to learn that, in five years before the introduction of ether, only one hundred and eighty-four persons were willing to submit themselves to such a dreadful ordeal in the Massachusetts General Hospital—an average of thirty-seven operations per annum, or three per month.... During the last year, in the same hospital—a Mecca for every surgeon the world over—over thirty-seven hundred operations were performed. ”

“ At last, however, you reach the sick-bay in safety, and retire within the screen. Here, if a strict service man, you will find the surgeon already seated; and presently the other assistant enters, and the work is begun. There is a sick-bay man, or dispenser, and a sick-bay cook, attached to the medical department. The surgeon generally does the brain-work, and the assistants the finger-work; and, to their shame be it spoken, there are some surgeons too proud to consult their younger brethren, whom they treat as assistant-drudges, not assistant-surgeons. ”

“ During the last session of Congress an unsuccessful attempt was made to do away with the inferior titles of assistant surgeon and passed-assistant surgeon in the navy, and, in plain English, to call a surgeon a surgeon, as we call a spade a spade. The medical service of the army descends not only to the assistant surgeon, but also to the lower estate of acting assistant surgeon. ”

“ He would have some forty or fifty patients to study and report upon, to watch the progress of their maladies, or the processes of their cure, to dress the wounds, bandage, apply the remedies ordered by the house surgeon, or the surgeon-in-chief, and himself perform such operations as in their discretion he might be entrusted with. Everybody must have a beginning, and upon whom can one begin surgery so well as an hospital 61 patient? ”

“ F.R.C.S. 1843; assist. surgeon first life guards 27 Oct. 1812, placed on h.p. 30 July 1816; present at Waterloo and in garrison in France; surgeon Devon and Exeter hospital, Aug. 1816 to 1858; a general practitioner in Cathedral close, Exeter 1816 to death; president Exeter meeting of Provincial medical and surgical assoc. 1842; sheriff of Exeter 1826, mayor 1828; one of the few surgeons who tied the abdominal aorta for aneurism of the internal iliac; author of Observations on some of the general principles and treatment of inflammation 1821 ”

“ He insists that surgeons must learn by seeing surgical operations, and watching them long and diligently. They must be neither rash nor over-bold, and should be extremely cautious about operating. While he says that he does not object to a surgeon taking a glass of wine, the followers of this specialty must not drink to such an extent as to disturb their command over themselves, and they must not be habitual drinkers. ”

“ He was looked upon as the leader of surgery in his time, and this is his advice as to what the surgeon should be as given in the introductory chapter of his "Chirurgia Magna": "The surgeon should be learned, skilled, ingenious and of good morals; be bold in things that are sure, cautious in dangers; avoid evil cures and practices ”

“ If an assistant-surgeon, he must be prepared to practice his profession in the most comprehensive sense of the word: no distinction is made between medicine and surgery. Every medical officer must act in either capacity, as circumstances demand, (which is more reasonable after all than drawing a line between two branches which cannot be separated) ,and perform the duty of aurist, oculist, accoucheur, chemist, and medical jurist, as occasion presents itself. ”

“ The surgeon, before commencing an operation, is enjoined to equip himself with all the requisites, such as the instruments, salts, bandages, honey, oil, water, etc. He should have practical experience of his art, and should have seen many surgical operations performed by others. He should be intelligent, steady, skilful, and should execute his work with a light hand. He should have by his side steady and strong attendants to assist him. The patient should be allowed to take light food before any operation is performed upon him. ”

“ Who will question, that there is more merit in saving one limb by superior skill, than in lopping off a thousand with the utmost dexterity?
To treat surgical diseases as they ought to be treated, the practitioner must be thoroughly acquainted with the healthy and morbid structure; he must also have a mind vigorous and firm from nature, well instructed in the best precedents, and matured by observation.
Years are not the measure of experience. It does not follow, that the older the surgeon is, the more experienced and trustworthy he must be. ”

“ Without dissection what can they know of anatomy? and unskilled in anatomy, how can they guide the knife healingly among the intricacies of the human frame? Yet all the operative surgery in this hospital is the care of the native surgeon, by whom the most formidable operations are successfully performed. ”

“ A surgeon is a dangerous fellow, and must be treated with respect. But as a rule the physician gives his blessing, the surgeon does his operation, but it is the nurse who does the work.
III The Day's Work
In any hospital at home or abroad there is a large amount of routine work, which must be carried on in an orderly and systematic manner, and upon the thoroughness with which this is done will largely depend the effectiveness of the hospital. Patients must be fed and washed, beds must be made and the wards swept and tidied, wounds must be dressed and splints adjusted. ”

“ These memoranda read as follows: “There shall be a doctor of physic upon whom rests the duty of visiting all the poor patients in the building, females as well as males; a doctor of surgery whose duty it is to apply ointments to all the poor people in the hospital who have wounds of any kind; and a barber who is competent to do, for the women as well as for the men, all the other things that a good surgeon usually does.” ”

“ Any case that becomes infected through fault of the surgeon or attendants is no longer looked upon as a thoroughly successful operation, even though the patient recovers.
As in other branches of medicine, there are now many specialists in surgery. In the major operations it is best to employ a specialist, but in the minor cases the "family doctor" should be competent. If he does not care to perform the operation himself he can advise and direct you in selecting a competent surgeon. ”

“ In order to insure the maximum of surgical ability every acting Surgeon is bound to resign his appointment on his attaining the age of 55 years, or on becoming physically unable to discharge his duties in an efficient manner. ”

“ Shall any man's misery prevail upon his credulity to make him more miserable? or will any Surgeon expose his patient? For your own sake, apply to some man of ingenuity and probity, who appears to justify his practice by his success; one of which invites you to his house, at the Golden-heart and Square-lamp, in Crane-court, near Fetter-lane. Ask for the Surgeon, who is to be advised with every morning till 11 o'clock, and from two till nine at night, in any distemper. ”

“ He lectured on physiology in the medical school from 1859 to 1861, was promoted full surgeon in July 1861, held the lectureship on surgery from 1865 to 1869, resigned the office of surgeon in May 1871, and was immediately appointed a consulting surgeon to the hospital. ”

“ Great surgeons do surgery only and have innumerable operations to give them skill; but a country physician and surgeon must be a sane being to keep his nerve when called on to use the knife, and he must have a more than usual gift for such business. ”

“ Another class of mistakes, to which the uneducated bone-setter is liable, have relation not to the mechanical principles of bone setting, but to what may be called the medical in distinction from the surgical, or operative part of the treatment. The mere operator, however skillful he may be, is not a finished surgeon. Very far from it. In order to be able to do his whole duty to his patients, the surgeon must in addition to his skill in operating, understand well the principles of inflammation and irritation, and must be in fact familiar with the whole range of disease. ”

“ The Surgeon is to have recourse to his own conscientious Discretion, which ought to serve as a Guide, and requires that we should always act according to the known Rules of Art; insomuch that after having well consider'd the Accidents, with all the Circumstances of the Wound, if there be no good grounds for the undertaking of the Operation, it is expedient to desist, and in this case to have deference to the Advice of other able Surgeons of the same Society, rather than to rely too much upon his own Judgment, to the end that he may be always secure from all manner of Blame. ”

“ How many parsons are there who would not lend you five pounds, would willingly lend you their pulpit, and the commonest courtesy from a hospital surgeon is, to present his visitor with a knife and entreat him to carve a patient. He has never seen the individual before, he doesn’t know whether he be short-sighted, or nervous, or ignorant, or rash, all he thinks of, is doing the honours of the institution ”

“ A patient, who is discreet, and is not in a special hurry to end his earthly sojourn, would do well to shun the presence of a bungling, unskilful surgeon, who can not even keep himself unhurt in the course of a surgical operation. ”

“ The surgeon answered, "He should take proper care; but
he defied all the surgeons in London to do him any good."--"Pray, sir,"
said the gentleman, "what are his wounds?"--"Why, do you know anything
of wounds?" says the surgeon (winking upon Mrs Tow-wouse) .--"Sir, I have
a small smattering in surgery," answered the gentleman.--"A
smattering--ho, ho, ho!" said the surgeon; "I believe it is a
smattering indeed."
The company were all attentive, expecting to hear the doctor, who was
what they call a dry fellow, expose the gentleman. ”

“ The newly graduated surgeon is not as dangerous as the man who left medical school years ago, before the students received one-third of the surgical training that they do now. Many of these men have not taken a post-graduate course, have never been associated with a hospital, nor have they had even an opportunity for moderate surgical observation; and yet they are attempting to do the work that only a skilled specialist should undertake. I am not speaking of emergency surgery for which any man should try to prepare himself, and be brave enough to undertake when human life is at stake. ”

“ In America, historians agree, the differences based on specialization of practice between surgeons and physicians soon tended to disappear, a superior education often being the only attribute or function of a physician not shared by the surgeon. ”