Surgery

“ GENERAL REMARKS ON THE DEVELOPMENT OF SURGERY IN EUROPE DURING THE FIFTEENTH AND SIXTEENTH CENTURIES
In the early period of the Renaissance surgery was apparently the first of the practical branches of medicine to spring forward into active life. Anatomy,—that is, human anatomy,—the foundation that is absolutely necessary to the solid growth of surgery, scarcely existed before the beginning of the sixteenth century; and it is therefore not surprising that the records of the past reveal to us so very few instances of men who attained any eminence as surgeons. ”

“ 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 two great branches of the healing art--Medicine and Surgery--are so intimately related that it is impossible to draw a hard-and-fast line between them, but for convenience Surgery may be defined as "the art of treating lesions and malformations of the human body by manual operations, mediate and immediate." ”

“ It is often thought that medicine is the curative process. It is no such thing; medicine is the surgery of functions, as surgery proper is that of limbs and organs. Neither can do anything but remove obstructions; neither can cure; nature alone cures. Surgery removes the bullet out of the limb, which is an obstruction to cure, but nature heals the wound. So it is with medicine; the function of an organ becomes obstructed; medicine, so far as we know, assists nature to remove the obstruction, but does nothing more. ”

“ In operative surgery the art is not less available. In trance the patient is insensible, and a limb may be removed without the operation exciting disturbance of any kind. And what is equally important, in all the after-treatment, at every dressing, the process of mesmerizing may be resorted to again, with no possible disadvantage, but being rather soothing and useful to the patient, independently of the extinction of the dread and suffering of pain. ”

“ 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. ”

“ 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. ”

“ 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 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. ”

“ 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 ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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 chirurgeons of yore are recorded to have performed incredible feats in surgical operations, just as modern surgery is able to do many things which ordinary folks will hardly believe to be possible. In its onward progress, modern surgery may yet be able to succeed in doing what the ancients claim to have performed. ”

“ 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.” ”

“ 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 ”

“ They had at this time a period of wonderful surgical practice, of which we have learned from the republication of their text-books of surgery only in recent years, and there is a definite, direct ratio between surgery and proper hospital organization. Whenever there is good surgery there are good hospitals, and whenever there are good hospitals, surgery will be found occupying a prominent, progressive place in the history of medicine. ”

“ We do not wish to be understood as condemning unqualifiedly any and all surgical interventions in the treatment of human ailments. An operation may occasionally be absolutely necessary as a means of saving life. Surgery is also indicated in cases of injury, such as wounds or fractured bones, in certain obstetrical complications and in other affections of a purely mechanical nature. ”

“ The more we know of this great period in the history of surgery, the more is the surprise at how much was accomplished, and how many details of our modern surgery were anticipated. Most of us have had some inkling of the fact that anæsthesia is not new, and that at various times in the world's history men have invented methods of producing states of sensibility in which more or less painless operations were possible. ”

“ 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. ”

“ 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? ”

“ Eventually the most noteworthy literary events and remains of the representatives of the great schools of the Middle Ages--Salerno, Bologna, Paris and Montpelier--concern quite as much the department of surgery as of practical medicine. These medieval literary contributions constitute the principal steps in the historical development of scientific surgery. The Crusades represent an extremely important influence upon the perfecting of the surgery of wounds. Italian surgeons in large numbers took prominent parts therein. ”

“ 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. ”

“ 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. ”

“ Until the advancing age admits the efficacy and supremacy of Mind, it is better to leave the adjustment of Surgery. broken bones and dislocations to the fingers of a surgeon, while you confine yourself chiefly to mental reconstruction, and the prevention of inflammation or protracted confinement. ”

“ Knowledge of Anatomy and of Surgery enables the surgeon to bind up dangerous fractures and wounds, and to remove, even from the internal parts of bodies, ulcers and diseased formations that would otherwise be fatal to life. ”

“ If by clear and simple description of the phenomena attendant on morbid action, and of the changes which it produces,—if by plain rules for the treatment of the diseases, and performing the operations for their alleviation or cure,—he contribute to the progress of surgery, and the consequent diminution of human misery, he will consider himself fully rewarded for the time and the labour spent on this production. ”

“ 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. ”

“ It is well known that during the Middle Ages the practice of surgery in western Europe was generally regarded as disreputable, and operative surgery was for the most part relegated to butchers, barbers, bath-keepers, executioners, itinerant herniotomists and oculists, et id omne genus, whose pernicious activity continued to make life precarious far down into the modern period. ”

“ Conditions past as well as present must be understood before one would dare prescribe remedies for the present threatened disintegration of the family. A surgeon, before attempting a certain operation, has his assistant spend hours with the patient, writing up the history of the case, as to heredity, environment, causes and effects, not only for his own benefit and the patient's benefit, but for the benefit of surgery in general. ”

“ The end is often lost, not for want of wisdom in the lesson itself, but for lack of discretion in the mode of imparting it. A thorough knowledge of anatomy is necessary to a judicious and successful practice in the operations of surgery. Ere he venture to make his incision, the surgeon ought to understand all about the region where it is to be made—what arteries, veins, glands, nerves, lie in the way of his instrument ”