Surgeon

“ 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. ”

“ He said, in his textbook on surgery, as to what the training of the surgeon should be:
“A surgeon who wishes to operate regularly ought first for a long time to frequent places in which skilled surgeons often operate, and he ought to pay careful attention to their operations and commit their technique to memory. Then he ought to associate himself with them in doing operations. A man cannot be a good surgeon unless he knows both the art and science of medicine, and especially anatomy. ”

“ His inclination was towards surgery. He considered surgery to be his métier. Although circumstances had condemned him to the drab life of a family doctor in a little town, he persisted that he was, first and foremost, a surgeon, and, indeed, on his door-plate had inverted the usual wording and had described himself as “surgeon and physician.” In his hospital days he had assisted at many operations, but his opportunities of acting as a principal had been few and insignificant. In a small practice in a small town surgical opportunities are rare. ”

“ 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. ”

“ Over and over again, I have heard the presumed analogy between the surgeon and the soldier advanced as a proof of the absurdity of the English system. I believe that no such analogy exists. Surgery is an exact science. To perform even the most trifling surgical operation requires careful technical training and experience. ”

“ 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. ”

“ 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 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.” ”

“ 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 ”

“ 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 ”

“ 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. ”

“ Surgery, a name derived from chirurgy—handwork—might seem to be dependent almost entirely on mechanical and technical skill, yet there has always been the conviction that the patient's attitude of mind towards an operation is almost as important a factor in the success of surgery as the surgeon's skill. ”

“ The surgeon of each ward makes out his list of men fit for service, and hands it to the surgeon in charge, who in his turn examines the men so reported and returns them to their different posts; but, as we all know how much the mind has to do with the body, men who have seemed quite unfit for duty, often, under the stimulus of one of these departures, rouse themselves, make an effort, and find that a little exertion was the only thing needed to fit them for their work. ”

“ 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. ”

“ And it should be remembered that the training of the surgeon has been almost identical in type with the teaching and training which is given to the workman under scientific management. The surgeon, all through his early years, is under the closest supervision of more experienced men, who show him in the minutest way how each element of his work is best done. They provide him with the finest implements, each one of which has been the subject of special study and development, and then insist upon his using each of these implements in the very best way. ”

“ 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. ”

“ Bernard, principal surgeon to king William, affirms respecting ancient surgical skill as follows:—
There is no doubt but the perfection to which surgery has been carried in these last ages, is principally owing to the discoveries which have been made in anatomy. But the art of curing wounds, to which all the other parts ought to give way, remains almost in the same state in which the ancients transmitted it to us. ”

“ Very many with no pretense to this dexterity, and no equipment but a superabundance of assurance, graduate as surgeons and assume and aspire to a position of prominence that it has taken the true surgeon years of the hardest, closest, most untiring study, observation and work to reach. We are told as an excuse for this remarkable evolution from the student to the surgeon that the young man of today is taught so much more than the old men were ”

“ To apply his art intelligently and successfully, it is essential that the surgeon should be conversant not only with the normal anatomy and physiology of the body and with the various pathological conditions to which it is liable, but also with the nature of the process by which repair of injured or diseased tissues is effected. ”

“ This hypothesis should teach us to view our patients as a whole; and especially should it teach the surgeon gentleness. It should teach us that there is something more in surgery than mechanics, and something more in medicine than physical diagnosis and drugs. ”

“ 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. ”

“ 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. ”

“ Merrick, you need a physician and surgeon combined. Wounds lead to fever and other serious ailments, which need skillful handling. You might secure a young man, fresh from his clinics, who would prove a good surgeon, but to master the science of medicine, experience and long practice are absolutely necessary. ”

“ The patient is seated in a surgeon's office, and the surgeon, who is behind him performing an imaginary operation, ostentatiously places some stones in a basin that an old woman is holding in the full view of the patient. ”

“ 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. ”

“ But to-day, with anæsthetics, hæmostatics, and antiseptics, the surgeon may operate as calmly as on an insensible wax figure; and, moreover, with a reasonably correct technique, be assured of success in a vast majority of cases whose result was formerly, even under the best skill, always doubtful. The very greatness of the achievements of surgical genius have lessened the amount of ability requisite to perform many surgical operations ”

“ 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. ”

“ 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. ”

“ The surgeon's hands must be delicate, but they must also be strong. He needs a lacemaker's fingers and a seaman's grip. He must have courage, be quick to think and prompt to act, be sure of himself and captain of the venture he commands. The surgeon has often to fight for another's life. ”

“ 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? ”

“ It is necessary that a surgeon should have a temperate and moderate disposition. That he should have well-formed hands, long slender fingers, a strong body, not inclined to tremble, and with all his members trained to the capable fulfilment of the wishes of his mind. ”

“ This is a scene sufficient to try the presence of mind of any man; but he is not a good surgeon who is not equal to it—who does not delight in the recollection of it when his patient is in safety, and his recovery assured. ”

“ 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. ”

“ 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. ”