Surgical procedure

“ 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. ”

“ GENERAL SURGEON- In this subsection, the term `general surgeon' means a physician (as described in section 1861 (r) (1) ) who has designated CMS specialty code 02-General Surgery as their primary specialty code in the physician's enrollment under section 1866 (j) . (B) MAJOR SURGICAL PROCEDURES- The term `major surgical procedures' means physicians' services which are surgical procedures for which a 10-day or 90-day global period is used for payment under the fee schedule under section 1848 (b) . ”

“ 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.” ”

“ 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 ”

“ 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. ”

“ The first two chapters have been added with a view to affording some information, first, as to the conditions under which a great part of the surgical work was done, and, secondly, as to the mechanism and causation of the injuries, which would not readily be at hand in the case of the general surgical reader. For much of the information contained in Chapter II. I must express my indebtedness to the work of MM. Nimier and Laval, so frequently quoted. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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) ”

“ 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. ”

“ 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. ”

“ Operative treatment is required in a certain number of the cases, but in the majority of instances we are met with the extreme difficulty that in a very large proportion of the occasions upon which these wounds are received an exploratory abdominal section is not warranted in consequence of the conditions under which it has to be performed. ”

“ But you may now ask what all this physiology and chemistry of the plasma has to do with a report on surgery. I propose to use it for the purpose of explaining some peculiarities in the process of repair in surgical cases.
A few months ago I had a case of delayed union in a fracture of the tibia, at the hospital, and spent more time in waiting for nature, unassisted, to accomplish a cure, than I should ever spend again. One week after putting the patient on the use of ten grain doses of hypophosphite of lime, I had the pleasure of seeing bony union commencing. And why? ”

“ 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. ”

“ Having operated with unvarying success, during the past twenty-five years, upon several thousand cases of varicocele, at the Invalids' Hotel and Surgical Institute, we now invite special attention to the results of our peculiar operation, which is neither severe nor dangerous, and from which the patient makes a much more rapid, and in every respect more satisfactory, recovery than from other operations in use by surgeons generally. In our practice we have never failed to secure the happiest results from our operation. ”

“ Again, the practical difficulty adverted to above does not come in the way when a single man happens to sustain an abdominal wound on the march. Under such circumstances an exploration may be not only justifiable, but obligatory, and the general rules of surgery must be followed rather than such incomplete indications as are suggested below. ”

“ I took a big gulp right away because I saw the New Girl stepping through the screen into Surgery and I hate to be reminded we have it and I'm glad Doc is too drunk to use it, some of the Arachnoid surgical techniques being very sickening as I know only too well from a personal experience that is number one on my list of things to be forgotten. ”

“ 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. ”

“ Abdominal operations, on the other hand, are unsatisfactory from a prognostic point of view, and their performance requires much time and the assistance of a considerable number of the men, who are obliged to neglect the treatment of the more promising cases for those of doubtful issue. ”

“ 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. ”

“ 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. ”

“ Care, however, should be taken to inject just sufficient of the solution to penetrate beyond the zone of operation laterally, to insure sufficient space for the insertion of sutures into anesthetized tissues. Only a small quantity of fluid is necessary in this procedure as it comes in direct contact with nerve terminals. By touching the injected line with the needle in several places along its length and inquiring of the patient if it is felt, we may make sure of the completeness of the anesthesia before making the incision which should begin and end inside the anesthetized area. ”

“ 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 ”

“ The incision. The surgeon, standing behind the patient’s head and holding the knife with the edge directed upwards, in the right hand for the right eye and in the left hand for the left, fixes the eye with a pair of forceps held in the other hand, by grasping the conjunctiva below and to the inner side as close to the limbus as possible (Fig. 94) . Most continental surgeons stand in front of the patient and cut upwards. The point of the knife is then passed on the flat into the anterior chamber from the outer side, 1.5 millimetres behind the corneo-sclerotic junction. ”

“ Operative Treatment.—Other things being equal, operation is more often indicated in adults than in children, because after the age of twenty there is less prospect of recovery under conservative treatment, there is more tendency for the disease to relapse and to invade the internal organs, and there is no fear of interfering with the growth of the bones. The state of the general health may necessitate operation as the most rapid method of removing the disease. The social status of the patient must also be taken into account ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”