Medical procedure

“ That is, after all, what chirurgy, the old form of our word surgery, means. Medical problems are more complex and involve both art and science, so that solutions of them are often merely temporary and lack finality. During the Middle Ages, however, and especially towards the end of them, the most important branches of medicine, diagnosis and therapeutics, took definite shape on the foundations that lie at the basis of our modern medical science. We hear of percussion for abdominal conditions, and of the most careful study of the pulse and the respiration. ”

“ A physician, skilled in the art of using surgical instruments, is always successful in his professional practice, and hence the practice of surgery should be commenced at the very outset of medical studies. ”

“ In determining the treatment of diseases, no mode can have less to recommend it than that which adapts the remedy according to the name of the disease. And yet it is very prevalent; even intelligent practitioners being sedulous to ascertain from medical records, what course of treatment has most generally succeeded, in order to apply it in some particular instance. ”

“ In these lectures the situation, figure, and structure of all the parts of the human body will be demonstrated, their respective uses explained, and as far as a course of anatomy will permit, their diseases, with the indications and methods of cure briefly treated of. All the necessary operations in surgery will be performed, a course of bandages exhibited, and the whole concluded with the explanation of some of the curious phenomena that arise from an examination of the gravid uterus, and a few plain general directions in the study and practice of midwifery. ”

“ 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 ”

“ Modern surgery may be said to owe its origin to a school of surgeons, the leaders of whom were educated at Salerno in the early part of the thirteenth century, and who, teaching at various north Italian universities, wrote out their surgical principles and experiences in a series of important contributions to that department of medical science. ”

“ Report on Surgery.
In presenting this report I will not attempt to give any historical data connected with the subject of surgery, since that has been ably done in the report of last year.
I shall assume, and that without hesitation, that surgery is a science, properly so-called. That it is an art, is also true. But what is science? What is art? Science is knowledge. Art the application of that knowledge. To be more explicit, science is the knowledge we possess of nature and her laws ”

“ From the days of the first successful abdominal operation to the present day research in laboratory or in the operating theater has pioneered the way, and the sooner this simple truth is known to all men the better for medical science. ”

“ Sarcognomy is the true basis of medical practice, while anatomy is the basis only of operative surgery and obstetrics.
Indeed, every magnetic or electric practitioner ought to attend such a course of instruction to become entirely skilful in the correct treatment of disease. ”

“ Examinations may be wholly or partly in writing, and shall be of an elementary and practical character, embracing the general subjects of anatomy, physiology, chemistry, materia medica, pathology, pathological anatomy, surgery, and obstetrics, but sufficiently strict to test the qualifications of the candidate as a practitioner of medicine, surgery, and obstetrics. ”

“ Many of the medicines in use, however, are exceedingly coarse and disgusting, and, we should hope, are never resorted to except in extreme cases. A very curious method of procedure is adopted by the doctor who is called in to see a patient. The sick man does not open the interview by detailing his symptoms, as with us. ”

“ Definition, Exceptions.—Any person is deemed practising medicine, surgery, or obstetrics, or to be a physician, who publicly professes to be a physician, surgeon, or obstetrician, and assumes the duties, or who makes a practice of prescribing, or prescribing and furnishing medicine for the sick, or who publicly professes to cure or heal by any means whatsoever ”

“ The more nearly the treatment of diseases can be brought throughout to this degree of accuracy, the more scientific will the art of physic become, and the tendency of all medical observation and of all medical writing, should be to advance in this direction. ”

“ When the examination in these subjects has been satisfactorily negotiated, she passes on to medical work proper, the study of disease and the result of accident in the living person—in other words, she walks the wards of the hospital and undertakes duties as clerk to physicians and dresser to surgeons, from whom she receives instruction in medicine, surgery, and pathology. Special branches are also studied, such as midwifery, women's diseases, and affections of the throat, ear, eye, and skin. The treatment of minor accidents also receives special attention. ”

“ Invasive physical examination.—The term `invasive physical examination' means any medical examination that involves the exposure of private body parts, or any act during such examination that includes incision, insertion, or injection into the body, but does not include a hearing, vision, or scoliosis screening. ”

“ Few persons have contributed more abundantly to the establishment of the true principles of surgery and medical science in those cases which require that minute criticism of the symptoms of disease, upon the proper knowledge and study of which the perfection of medical art must mainly depend. ”

“ Those who were opposed to such examinations upon human beings expressed their disapproval in [108] the following terms: “This practice is not only cruel, but useless, and at the same time it derogates from the dignity of the healing art, which is intended to be a blessing and not a source of pain to man; for those in whom the abdominal cavity is first opened and then the diaphragm divided, die before it is possible to make the scientific examination ‘during life’ which constitutes, as it is claimed, the justification for the entire procedure.” ”

“ In short, a physician or surgeon cannot contract with a patient that the patient shall waive any claim for damages growing out of his want of ordinary care and skill. Nevertheless, the physician or surgeon may frankly inform his patient of his want of knowledge and experience as to the particular kind of treatment required by any special and unusual disease or injury. ”

“ The necessity of discriminating between physic and surgery will more manifestly appear when we consider, that they are distinct in their nature, and that either of them is an art, sufficient of itself to engage the industry of one man to cultivate.
The various branches of knowledge which compose the science of medicine, are Anatomy, Materia Medica, Botany, Chymistry, the Theory of medicine, and the practice. ”

“ All of the classic historians of medicine tell us much of the surgery of the thirteenth and fourteenth centuries, and in recent years the republication of old texts and the further study of manuscript documents of various kinds have made it very clear that there is almost no period in the history of the world when surgery was so thoroughly and successfully cultivated as during the rise and development of the universities and their medical schools in the thirteenth and fourteenth centuries. ”

“ In ordinary practice, the physician's time is divided in his consideration of acute, chronic, surgical, and obstetrical cases; in fact, much of it is occupied in riding to reach his patients. His attention is continually diverted from one class of cases to another, effectually preventing investigation in any particular direction. ”

“ Now that our practice has become so very extensive as to require for its conduct a greatly increased number of physicians and surgeons. Thus four physicians and surgeons devote their undivided attention to the examination and treatment of diseases of the urinary and generative organs of men. ”

“ The facts of hygiene and therapeutic measures are widely scattered through medical literature, and extend over hundreds of years of time. Many volumes have been written on diseases of the eye, the heart, liver, and stomach, brain and other organs, to understand which requires special technical education. ”

“ 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? ”

“ 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. ”

“ All persons afflicted with diseases requiring Medical or Surgical treatment, shall be sent to their respective departments by the Examining Physician, and no patients shall be transferred from the Surgical or Medical Wards until cured of the malady for which they were admitted into it, unless subsequently attacked with a strictly pestilential disease ”

“ The good surgeon is careful to use the right sort and pattern of instrument, and the chief fact about the surgery of the present day, that it is aseptic or antiseptic, is recorded in the make of surgical instruments and in all the installation of an operating-theatre. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ At a period when pathological research is lending its aid in investigating the appearances of disease in every part of the body, and many nice distinctions in diagnosis are aimed at, which are better calculated for nosological than practical purposes, it seems to me not a little extraordinary, that so few have cultivated that most important branch of medicine, the study of the diseases of children. ”

“ Anatomy—the the knowledge based on principle—is the foundation of the curative art, cultivated as a science in all its branchings; and comparison is the nurse of reason, which we are fain to make our guide in bringing the practical to bear productively. The human body, in a state of health, is the standard whereunto we compare the same body in a state of disease. ”

“ In addition to those we treat medically, we perform all the most difficult surgical operations known to the most eminent Surgeons, and so frequently do many of these operations occur with us that some of our Specialists have become the most expert and skillful Surgeons on this continent. ”

“ It is only by constant practice and patient attention to technical details in the operating room and at the bedside, that the carrying out of surgical manipulations in such a way as to avoid bacterial infection will become an instinctive act and a second nature. ”

“ As all the salutary as well as diseased processes which occur in the human body are more or less attended or affected by this action, and as its regulation forms a principal part of the duty of the surgical practitioner, this work cannot be more properly commenced than by treating of its nature, consequences, and management. ”

“ 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) ”