Surgical operation

“ 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 ”

“ A surgical operation by an ignorant surgeon brings about, in most cases, the instantaneous death of the patient, or consigns him to the pangs of a life-long death.
The symptoms which generally manifest themselves in connection with the injudicious hurting of any of the five vital parts or principles of the body (such as the joints, bones, veins, ligaments, etc.) ”

“ 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. ”

“ To lay open the abdominal cavity from the sternum to the pubes, and rapidly dissect out of this cavity an enormous tumour with a narrow neck, the operator's only embarrassment being the peristaltic movements of the bowels, and his only care being to tie the neck of the tumour firmly with strong string, sew up the wound, and trust to nature, was an operation very easy to perform, and requiring free cutting rather than dexterity, and rashness more than true surgical insight. ”

“ When the public had thoroughly grasped the utility of anæsthetics, and recognised that operations could be performed painlessly, there were fewer refusals to submit to the knife; there was a rush to the hospitals, and the surgical wards throughout the length and breadth of the land became crowded with men and women actually longing for operation. ”

“ Before undergoing a surgical operation arrange your temporal affairs. You may live. ”

“ 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 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 small number of deaths between fifteen and twenty-five may be partly due to the circumstance that surgical operations are but seldom required at this period of life; but the decrease after the age of forty-five cannot be explained in this way; for persons become more liable to require surgical operations as they advance in years. ”

“ As a surgical patient, by means of a local anaesthetic, can look on with a clear consciousness while an operation is being performed upon him and yet feel nothing, I could repeat to myself some favourite lines, or watch my grandfather attempting to talk to Swann about the Duc d'Audriffet-Pasquier, without being able to kindle any emotion from one or amusement from the other. ”

“ 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 will send you to some honest and competent man. Operations usually should be performed as early as possible. In malignant disease the operation must be done early. This applies to cancers of the lip, face, tongue, breast, womb, ovaries, stomach and the abdominal cavity.
Then again, operations are far less dangerous now than before the days of aseptic and antiseptic surgery. Cleanliness on the part of the surgeon, nurses and patient is the first law of success in all operations. ”

“ 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. ”

“ Nothing illustrates better the progress of surgery than a picture of the operating-room in the first decade placed beside that of an operating theatre in one of our leading hospitals in this the last decade of the nineteenth century. In the quiet of the patient, in the painlessness of the 132 operation, in the calm deliberation of the operator, and the methodical order of all around him, in the respectful silence that prevails in the room so soon as the patient is laid on the table, we see the direct results of the introduction of anæsthetics. ”

“ 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. ”

“ 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.” ”

“ 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. ”

“ In a less severe attack, under the influence of rest, starvation and fomentation, and in cases of chronic and of relapsing disease, the surgeon may watch and wait and choose his own time for operating. But when the symptoms are steadily increasing in severity he should urge an immediate incision. When, as often happens, the inflammation begins suddenly and severely, and, under the influence of treatment, steadily quiets down, the surgeon does well to delay operation. ”

“ 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. ”

“ Operative Treatment.—In aggravated cases, when the patient is suffering pain, when his occupation is interfered with by repeated attacks of phlebitis, or when there are large pouches on the veins, operative treatment is called for. The younger the patient the clearer is the indication to operate. It may be necessary to operate to enable a patient to enter one of the public services, even although no symptoms are present. The presence of an ulcer does not contra-indicate operation; the ulcer should be excised, and the raw surface covered with skin grafts, before dealing with the veins. ”

“ 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. ”

“ 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) ”

“ Always seek his advice early; do not wait until the patient is weak or dying before you decide to allow the operation, as then the chances are it cannot help. If you are in doubt as to the necessity of the operation consult more than one surgeon. There is a possibility of a wrong diagnosis in some cases.
SPECIAL OPERATIONS. ADENOIDS.—Should be removed early when they obstruct the breathing. In another part of the book the reasons are given. The same advice is given for tumors and malformations in the nose passages. ”

“ But in many cases the patient prefers that the abdomen should be opened for exploration for a possible operation than that he should hopelessly give himself over to the disease. And sometimes the surgeon is enabled by operation to give great relief, though the removal of the growth itself is impracticable. ”

“ 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. ”

“ Leaving that lower region (which is, of course, deserted when we view it in the afternoon) we re-ascend to look at the little in-patients. From the first ward we seek to enter we are admonished by our own senses to turn back. We have barely looked in when the faint, sweet odour of chloroform hanging in the air, the hiss of the antiseptic-spray machine, and the screens placed round a cot inform us that one of the surgeons is conducting an operation. ”

“ The operation was long, difficult, and dangerous, taxing both nerve and skill. The operating-room was very hot. One of the nurses fainted, and a young doctor, sick at heart and stomach, helped her away, glad to get out himself.
The operating surgeon, a keen, self-possessed practitioner, looked at the patient when all was over, with a deep breath of relief. ”

“ The Disease is manifest by the great Swelling; and the Operation is perform'd with a Cane, or a Pipe made of Silver or Steel, with a sharp Stilet at the end; altho' the Ancients were wont to do it with a Lancet. The Patient being supported, sitting on a Bed, or in a great Elbow-Chair, to the end that the Water may run downward, a Servant must press the Belly with his Hands, that the Tumour may be extended, whilst the Surgeon perforates it three or four Fingers breadth below the Navel, and makes the Puncture on the side, to avoid the White-Line ”

“ In the operating-room we have better asepsis, better light and mechanical 460 appliances, better discipline of assistants and nurses, and greater opportunity of successfully dealing with unexpected complications.
In an operation which is performed in a private house something is always used which is more or less of a makeshift; and makeshifts should not be used in surgery, especially in abdominal surgery. If we hope to obtain perfect results, we must insist upon perfect surroundings and appliances. Continuous success is the result of scientific accuracy and attention to detail. ”

“ 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. ”

“ 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 operation of cutting out parts of the human stomach has, like any other new operation, been prepared anatomic-physiologically and technically by myself and my assistants. Every surgeon, having any experience in experiments on animals, and similar operations upon the human body, arrives at the conclusion that this operation must and will succeed. Pean, the Paris surgeon, was of the same opinion. He attempted the removal of a cancerous pylorus, about six centimetres in diameter, in the case of a patient very much reduced by suffering, and who died four days after the operation. ”