Chirurgeon

“ 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. ”

“ I have often felt the need of such a work; people can understand emergency or accident surgery, military surgery, or reparative surgery, but such a thing as surgery to remedy a seemingly medical disease, or what might be called the preventive practice of surgery, is something they cannot understand. First, and not the least, among the incentives to skepticism on this subject is the unwelcome fact of a surgical operation, which, no matter how trivial it may seem to the surgeon, is a matter of considerable magnitude to the patient, his parents, or friends ”

“ His text-book of surgery is full of expressions that reveal the man and the teacher. He said the surgeon who cuts the human body without a knowledge of anatomy is like a blind carpenter carving wood. He insisted that men should make observations for themselves and not blindly follow others. He discussed operations on the head, the thorax and the abdomen. He said that wounds of the intestines would surely be fatal unless sewed up, and he described the technique of suture for them. His specialty was operation for hernia. ”

“ They are Tumours, Impostumes, Wounds, Ulcers, Fractures, Dislocations, and generally all sorts of Distempers whereto Manual Operations may be applyed.
What are the Instruments in general which are commonly used in Surgery for the curing of Diseases?
They are Five; viz. the Hand, Bandages, Medicines, the Incision-Knife, and Fire.
What is the general Practice which ought to be observ'd in the Application of these different helps?
Hippocrates teacheth us, in saying, that when Medicines are not sufficient, recourse may be had to the Incision-Knife, and afterward to Fire ”

“ 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. ”

“ We also hear that "I want to be a surgeon, because surgery accomplished positive results." This is very true also, and it is evident that if you amputate a leg your patient will be minus a member. Don't lose sight of another fact, however, that if without being competent to meet any unforeseen emergency that may arise, you lightly open the abdominal cavity, you will have a positive result in the shape of your own little private graveyard. ”

“ A man bruises his foot or sprains his ancle. A surgeon is called, and informs the patient that there is no fracture nor dislocation, and advises a proper course of treatment. The patient continues lame, and perhaps a second or third physician is called, and confirms the diagnosis of the first; but his officious neighbors will never let him alone—they assure him that there must be some "bone out," and advise him by all means to send for one of the "natural bone-setters," lest by trusting educated surgeons he should become a cripple for life. ”

“ 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. ”

“ The surgical operations are performed on what are considered auspicious days. The patient is made to sit or stand with his face to the east, the surgeon before him with his face to the west. The surgeon should be cautious that no vital part, artery, vein, joint, or bone is carelessly injured in the course of the operation, and that the instrument does not go deeper than the requirements of the case actually demand. In serious surgical operations, and in diseases of a painful nature, the patient was made insensible by the administration of anaesthetics. ”

“ 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. ”

“ For the surgeon’s far more than the physician’s successes depend upon the vis medicatrix naturæ, and he who is best versed in physiological and pathological processes, and administers the surgical art accordingly, will secure the best results.
They who neglect their surgical cases from ignorance, carelessness, or a wanton disregard of the great pathological dicta of the day, can find no justification in these teachings, for the truth, as embodied in the author’s closing words, puts all such to shame and confusion: “A good deal of skill is required in order to neglect wounds well. ”

“ It was in surgery, however, that the greatest triumphs of teaching of the medieval universities were secured. Most people are inclined to think that surgery developed only in our day. The great surgeons of the thirteenth and fourteenth centuries, however, anticipated most of our teaching. They investigated the causes of the failure of healing by first intention, recognized the danger of wounds of the neck, differentiated the venereal diseases, described rabies, and knew much of blood poisoning, and operated very skilfully. ”

“ 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.” ”

“ 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. ”

“ 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. ”

“ History.—Surgery in all countries is as old as human needs. A certain skill in the stanching of blood, the extraction of arrows, the binding up of wounds, the supporting of broken limbs by splints, and the like, together with an instinctive reliance on the healing power of the tissues, has been common to men everywhere. In both branches of the Indo-European stock surgical practice (as well as medical) reached a high degree of perfection at a very early period. ”

“ 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. ”

“ The discovery of anæsthesia and the promulgation of the germ theory of inflammation, together with the subsequent perfection of the means of destroying microbes, all within the memory of many now living, have revolutionized surgery to such an extent that the surgeon reaches fearlessly into regions which before were impracticable, and undertakes operations which620 were never even dreamed of a generation ago. One can readily imagine that no surgeon would care to undertake, and no patient would endure, the agony of an operation lasting for several hours without an anæsthetic ”

“ The characteristics of a good surgeon are that he should be moderately bold, not given to disputations before those who do not know medicine, operate with foresight and wisdom, not beginning dangerous operations until he has provided himself with everything necessary for [Pg 118] lessening the danger. He should have well-shaped members, especially hands with long slender fingers, mobile and not tremulous, and with all his members strong and healthy, so that he may perform all the proper operations without disturbance of mind. ”

“ 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. ”

“ Another little episode in the front surgery was when [Pg 87] a baby took us all by surprise by being born there! We should have sent it on to the Infirmary, but the mother was rather bad, so we had to take them in.
One Sunday evening I was in chapel when I heard some one come to the door, and then the porter came to fetch me, and at the door I found one of the dressers who told me there was a bad compound fracture in the surgery, and the house surgeon would be glad if I would come, as he wanted to give an anæsthetic. ”

“ In a case requiring surgical operations, the physician says to his patient, " Atra Dhanvantarinam adhikaras kriyavidhau," meaning, "It is for the surgeon to take in hand this case." It is true the ancient surgery did not reach that perfection to which the modern science has attained. The successes of modern surgery are admitted on all hands to be prodigious, but that should not detract from the credit due to the ancients. ”

“ Operations performed by the hand, such as venesection, cauterization, and incision of arteries, are not becoming a physician of respectability and consideration. They are suitable for the physician’s assistants only. These servants of the physician should also do other operations, such as incision of the eyelids, removing the veins in the white of the eye, and the removal of cataract. For an honourable physician nothing further is becoming than to impart to the patient advice with reference to food and medicine. ”

“ There were five men in Germany and German Switzerland who, during the Renaissance, attained distinction as surgeons, and who at the same time contributed, by their published writings as well as by the force of example, to the advancement of medical science. The names of these five surgeons are: Pfolspeundt, Brunschwig, von Gerssdorff, Fabricius of Hilden and Felix Wuertz. The first three mentioned were born in the early part of the fifteenth century, and all five of them derived their practical knowledge of surgery in large measure from their experience in warfare. ”

“ 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? ”

“ I know well how much that knowledge of character acquired by a regimental surgeon—that interest on the one hand, and that confidence on the other—engendered between him and his patients, contributes to the successful treatment of disease. I have, myself, been sent for to amputate the limb of a soldier, lying in a garrison hospital, a few miles distant from the spot where I happened to be encamped. This young man, finding that his limb must come off, asked as a special favour that his own surgeon might be asked to operate. ”

“ The most pronounced division is that between physicians and surgeons. The origin of this has been confused in various ways, and seems now the more obscure because there has been of late arising not a further distinction between the two but a fusion of them. All along they have had a common function in the treatment of ordinary disorders and in the uses of drugs; and the "general practitioner" has come to be one who avowedly fulfills the functions of both. Indeed in our day it is common to take degrees in both medicine and surgery, and thus practically to unite these sub-professions. ”

“ 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. ”