Publisher: Geoffrey Bles.
The personal experiences of doctors and surgeons are of inestimable value and of unbounded interest to all medical men and to the general public. Medical men live largely in water- tight compartments. One doctor does not know what the other does. Yet by an exchange of experiences, the art of healing could be greatly advanced. Curiously enough there are only a few good books written by experienced doctors and surgeons in which the sum and substance of their experiences are laid down.
This is only natural. The busy practitioner has little time for anything except his work and the most necessary recreation. The highly successful doctor or surgeon is over-run with patients, and if he is conscientious, he works unceasingly at his job until he becomes incapacitated through age or illness.
Some years ago Dr. Erwin Liek, a German surgeon, wrote an invaluable book, summarizing his experiences and giving invaluable hints to his colleagues in a book entitled Der Arzt und seine Sendung. It had a fabulous success. In Germany 50,000 copies were sold, and I considered it my duty to translate it into English. It was published by John Murray under the title The Doctors Mission. I have just carefully read the book, Fifty Years a Surgeon, by Dr. Robert T. Morris, a leading American surgeon.
Morris is obviously an excellent surgeon and an excellent physician, a broadminded, humane man and a man of unusual grasp and originality and of great literary ability. His book reads like a novel and it ought to have a very great success, particularly as it is extremely cheap. It is a large volume, a volume of the type which is usually sold at a guinea or 15s., and it is published by Geoffrey Bles, of London, at the low price of 10s. 6d. No words of mine can do adequate justice to the excellency of this work, and therefore I give, with the permission of the publishers, some extracts herewith which will undoubtedly induce numerous readers to buy the volume. (Editor, “HEAL THYSELF”).
As early as 1800, Humphrey Davy wrote, “As nitrous oxide appears capable of destroying physical pain it may probably be used with advantage during surgical operations.” In 1818 Faraday wrote, “When the vapour of ether is inhaled it produces effects very similar to those of nitrous oxide.” The medical world, however, paid no attention to these suggestions until a British surgeon, Dr. Henry Hickman, in 1824, published a pamphlet showing that “suspended animation” brought about by the use of nitrous oxide had been safely employed by him in operations upon animals; as a result of such experiments he believed that it might be used for the human subject.
Investigation of his idea was not made by the medical profession – perhaps because of fear that suspended animation might remain that way and would be placed directly to the responsibility of the physician. In 1842, Crawford Long employed ether in surgery and two years later Wells used nitrous oxide. Morton used ether in 1846. Hickman is really the father of anaesthesia although his work went without recognition.
The germ theory of disease in general medical practice was received with general scepticism and even ridicule at the time when Dr. Welch began work in the pathological laboratory at Bellevue Medical School in 1878. this ridicule belonged not only to the rank and file but also to leaders of the profession.
A certain prestige is popularly supposed to inhere in operative work, although this is a mistake belonging to the more or less crude stage of our present cultural period in the United States. In response to this popular mis-conception at least one-half of the number of men on the average hospital staff feel it incumbent upon them to obtain the eclat that goes with operative surgery.
Two results follow. Here and there a man of natural talent and mechanical ingenuity becomes ascendant and a valuable addition to the ranks of surgery, but many of the operators, reaching their limitations quickly, bring discredit upon the speciality as a whole. My good friend, the late Dr. Maurice H. Richardson, said it was a misfortune that so many people recovered from surgical operations, no matter what was done to them. It is the so-called morbidity-rate or general knock-out, rather than the mortality- rate in particular, upon which we are to fix attention when a question of the revolting present-day abuse of surgery is under discussion.
The patient who goes to a specialist on his or her own responsibility without first obtaining advice from a family physician is jumping out of the frying-pan into the fire. I knew a patient who went on her own account to a famous stomach specialist because of persistent nausea. The specialist gave her a month of expensive rest cure and special diet without gaining much comfort for her. At the end of that time the question of possible pregnancy was suggested by a woman visitor. She was examined and found to be pregnant.
If a child slips a little button into his ear and forgets about it, he may develop a cough, which will lead his parents to go the round of lung specialists seeking an explanation. The cough instantly disappears when the family doctor takes the button out.
A patient with sciatica may go to many specialists – neurologists, electro-therapeutists, and what not – until the family physician called in at last, finds an enlarged prostate gland or a pelvic tumour. A patient with loose kidney may have her appendix taken out, uterus fixed up and various other things done by specialists until her neglected family doctor finally puts a stop to it all.
specialists who have not had general training are prone to go very far wrong. Within the past six months I have seen two patients with abscess of the breast who had made all preparation for entrance into a hospital for amputation for cancer; and a third case operated upon a few days later was almost certainly one of the same sort. The general practitioner might have told the people that cancer does not develop in ten days or less as did these cases of breast abscess.
Instances come to mind of men whom I knew personally in medical college days who passed excellent examinations and secured positions in which they went directly into special work. Some of them took up gynaecology, for example, without any previous general medical or surgical training. These are the ones who would remove neuralgic ovaries when the fundamental cause for neuralgia lay in splanchnic neurasthenia, caused perhaps by trouble as far away as nasal hypertrophies or an encapsulated wisdom tooth.
These men, to my positive knowledge, were not qualified to work out the question of distant causes before beginning to meddle with a flexion of the uterus, which is practically always a symptom of something else. Most of the operating which is done on flexions is pernicious anyway.
In most of our large hospitals, purely surgical cases are kept upon the medical side without receiving proper attention, quite as often as purely medical cases are subjected to operation unnecessarily. So long as this condition lasts we are in a larval state professionally, and we can emerge from our chrysalis only when the competent general clinician takes charge of the general supervision of all patients in a hospital.
Until very recently at least it was the custom at some large hospitals for a minor official in the admitting office to send special cases directly to special departments. Under these circumstances a patient with haemorrhoids due to cirrhosis of the liver was quite likely to be sent to the surgical department, where he did not belong.
A patient with sciatica due to the presence of enlarged anal papillae was almost certain to go where the refined neurological staff was a bit squeamish about making rectal examinations. A patient with arthritis dependent upon latent root infection or other focal infection was likewise almost certain to have the wrong thing done.
I remember the case of one young woman of sufficient means to secure unlimited skilled service who was badly deformed by small abscesses constantly appearing upon the face. She suffered much from digestive disturbance and had a notebook list of thirty physicians who she had seen over fifteen years, most of them known as experts. Not one of them had helped her for any length of time.
I sent her first to a gastro-enterologist in whom I had confidence, but she returned in the course of two months without having been benefited. She was then sent to a neurologist, who failed to help her, then to a skin specialist, who applied several up-to-date methods of treatment which he was sure would be of value, but which did not prove so. I finally sent her to an ophthalmologist, the late Dr. J.H Woodward, in order to have him look for an error of refraction as possible precipitating cause for digestive disturbances, without having in mind at that time any reference to trophic disturbances of the skin.
He proved to be the right man. An error of refraction through eyestrain had caused distant phenomena, and she was promptly and permanently cured of skin trouble as well as stomach trouble. Somewhere, if he can be found, there is some doctor who knows or who finds out the best way for treating almost any chronic illness.
At a time when too many colons were being removed following Lanes idea of disposing of toxic effects in that way, Dr. Von Strensch asked me to see a man suffering from a mania and who required two attendants day and night. He screamed so loudly and so constantly that a number of private sanitoria had refused to keep him.
I found that the ascending and transverse colons were constantly distended, and that he became temporarily better after colonic irrigation. I consented to remove these distended parts on the understanding that the procedure was one of questionable character, but permissible in view of the hopelessness of the case. The man promptly became well enough to dispose of all attendants and to take up again the management of a large business. (To-day I would try treatment for a toxic psychosis first.).
Another case of mania, cyclical in type, was brought to me later by the same physician. The patient, a beautiful girl, nineteen years of age, was very destructive during the depressive stage and would run about the room tearing down works of art and curtains, meanwhile putting her right hand to the right side of her head frequently. An examination of her head was made, to see if there might not be an old injury.
Someone then recalled that she had fallen from a chair and injured her head when a little child. Irritable dural adhesions had resulted. These were separated and there was no recurrence of mania subsequently. Surgery was the only thing for that patient.
A big, burly ice-man at Ithaca brought me his baby daughter suffering from prolapse of the rectum. When I began the operation of taking out alternate strips of mucous membrane the haemorrhage was not controlled very well by the device which was employed and it was necessary to back out of the case defeated. I told the father that we would have to employ another kind of operation when his little girl was older. About a month later the father came in and said that he had not received any bill, pulling out a roll of cash as he spoke. I said there would be no bill, and asked how baby was getting on.
His reply filled me with joy, “Oh, shes all well. After we got home my wife remembered that alum was kind of puckering. She mixed up a lot of it in water and put it on two or three times a day. Baby got all well in a week.” He still insisted upon paying me, and when I declined to accept anything on the ground that it was his wife and not I who had brought about the cure, he said, “Why, Doc., we all done the best we could and you had a whole lot the most trouble”.
A similar incident occurred some years later in New York. a charming young woman developed an ugly crop of warts on both hands. Several experts treated her expensively without gaining any result. Some neighbor told the mother to apply the castor oil locally at night. This cured the warts. The neighbor made no charge.
Surgeon are frequently asked if they are nervous when about to do an operation. I cannot imagine such a thing. We concentrate attention upon the idea of doing something that will help somebody out of trouble. How can one become nervous over the idea of being useful? My only worry has been that the wrong patient might be rolled into the operating-room out of turn at the hospital when several operations were on the schedule for an afternoon. Patients are prepared and covered up in such a way in the anaesthetizing-room that the particular patient who is brought in. The schedule is sometimes changed at the last moment.
In October 1820, newspaper reported that a Russian cobbler by the name of Kolesnikof, who had fraudulently acquired the licence and documents of a deceased Dr. Meski, went to surgery and actually became chief surgeon of the Kieff hospitals. He did six hundred major operations with a mortality percentage which was much lower than the average. Upon discovering his identity, Kieff surgeons were astounded at his record. At the trial it was testified that he operated with “brutal rapidity”. That was the reason for his success, but they did not know it. A brutal rapidity may be kindly.
Tait sneered at antiseptic or aseptic surgery at a time when it was close to our hearts. He presented better statistics in abdominal surgery than were presented by any surgeon of his day who was following Listerian principles. His results called for explanation which we could not then give.
Tait was a speedy operator through small incisions. He worked lightly, by the sense of touch. He did play to the gallery a bit, but with a sense of humour that seemed to be directed towards Treves. Tait was depending upon the patients naturals powers of resistance which, through rapid operating and the infliction of a small degree of surgical injury, were not shocked and put out of commission. It looked very much as if his patients were meeting infection better than the patient of the rest of us.