SURGICAL INTERFERENCE.
FROM what I have said above, the rashness of surgery in interfering with these vitally important organs when they are doing their office of destroyers and filterers of disease, will have became apparent to my readers. In the process of “arresting and filtering” disease, the glands sometimes become over- burdened, and inflammation and abscess takes place. But they are discharging their function all the time. If they cannot arrest disease without becoming inflamed, the next best thing is for them to do it by suppuration.
By homoeopathic treatment, as my first case showed me, and as I shall prove by other cases later on, it is possible to so assist them in their operations as to prevent the necessity of suppuration, and even to enable them to remove the products of suppuration without opening externally; but even without homoeopathic treatment it is far kinder to the patient to let the glands take their course and leave their own scars, than to cut them out and leave only the neat scar of the surgeon. How often do we not see in phthisical families that those who have on their necks the marks of old abscesses have lived and become strong, whilst others who have not had this disease-filtering and disease-arresting process have succumbed?
It is not always possible to trace the remote results of surgical interference. After the operation the patient is often temporarily relieved, and is to all appearance quite well; and when the disease comes back again it is in such a different form that its connection is easily over looked. I think, however, in the two cases now to be narrated the connection is obvious.
CASE II.- TUBERCULAR MENINGITIS AND DEATH FOLLOWING REMOVAL OF STRUMOUS GLANDS OF THE NECK.
Ronald P., aged 4, was admitted to the London Homoeopathic Hospital on Feb. 10th, 1892, with the following history.
Sometime before (the exact date is not stated in the notes), he had had strumous glands removed from the neck by operation. Two days before admission he began to be fretful, crying for no apparent reason. In the afternoon of the same day he complained of irritation in the back, and a rash came out in the form of a group of pustules which quickly burst, being very irritable. The morning before admission he woke up and found he could not stand. This lasted some hours and was accompanied by complete loss of sensation. The power and sensation gradually returned, and he found he could stand but not walk well. On admission he had an unhealthy appearance, but was not wasted. There was an eczematous eruption on the left shoulder, running and irritable. There was no pain in the back and no curvature. There was much loss of power, and defective sensation in the legs. When he walked he trod on the outer sides of his feet, and kept the toes raised. The superficial reflexes were less than normal; the knee-jerk about normal. His temperature was 100 per cent. Passed water in bed at times.
Under Calcarea he seemed to make some progress, but on Feb. 22nd sickness set in, and on the 24th there was commencing optic neuritis. After this there were fluctuations.
March 3rd.-Very drowsy; semicomatose; screams out when moved; no sickness; bowels constipated; marked tache cerebrale; p73 keeps perfectly still; pupils dilated, react to light. From this time he gradually sank, and died on March 8th-Cheyne-Stokes respiration setting in before the end. From the beginning of this seizure on Feby. 8th, the boy, in my opinion, had not a chance. It is, of course, impossible to say that he would not have had this illness in any case, but my own belief is that he would not. If the neck glands had been left to do their work, unsightly though they may have been, they would in all probability have “filtered and arrested” the disease, which was undoubtedly tubercular.
Possibly it would have taken them years to have done it; but as it was, they were taken ruthlessly away in the midst of their restorative work. No doubt the patient was very efficiently “cleaned up.” The ugly sores were all removed, and he was made quite presentable once more. But he was not cured of his tubercle-surgery never can do that. It developed again, and this time attacked a part much more dangerous than the first, and the organism, being deprived of the eliminative powers of the removed glands, was unable to withstand the attack. The common notion about the danger of driving in a disease has a very substantial foundation in fact.
The next case is one of a different kind.
CASE III.-TUBERCULAR DISEASE OF NASAL BONES AND VALVULAR DISEASE OF THE HEART FOLLOWING REMOVAL OF GLANDS OF THE NECK. At the beginning of the winter of 1893 I was consulted by a lady, Mrs. W., 56 who gave me the following history. She came of a very tuberculous family. When very young she had sore eyes. She had all her life been liable to rheumatism of the limbs. In 1870 she began to suffer from lupus of the nose. This was treated surgically and “cured.”
The following year it recurred, and was again treated in the same way. Afterwards she had polypus, and this was removed. Volkmann treated her in 1872. Seven years later the nose began to fall in from disease of the bones, and she has been under treatment ever since.
In 1886, as the result of a cold, she had enlargement of the glands on the right side of the neck. A year after, these glands were removed and were pronounced tuberculous by the surgeon who performed the operation. For a time she felt much better, but then the nose become more troublesome, and in 1890 she had to undergo a very severe operation, bone having to be chiselled away to open a breathing passage.
When she consulted me she was complaining of nervousness and irritability, with attacks of palpitation. She was less able to walk or bear fatigue than she had been formerly. When I came to examine the chest I found the cause of the trouble in disease of the aortic valve.
In this case the sequence and consequence of the events are, perhaps, not as clear as in the first; but, at any rate, there was a history of a surgical “cleaning up ” of the outer structures, followed by an attack on deeper ones, and to my mind it is clear that if for the skin and gland affections the patient had been treated medically instead of surgically from the first, she would have been spared the attack on the bones of the nose and the last development of all, disease of the heart.
I am confirmed in my opinion by a discussion on the subject held at the meeting of the British Medical Association at Newcastle on-Tyne in August 1893, and reported in the British Medical Journal of Nov. 25 of the same year. Mr. Pridgin Teale of Leeds, on the suggestion of Dr. Clifford Alibutt, first performed the operation of excising scrofulous glands in the year 1881. Their guiding principle in this operation was-“that, where ever septic material is contained in the system, we rest not until it is expelled and its burrows are laid open and disinfected.”
At the meeting above referred to, Mr. Teale spoke, and among other points referred to the ultimate effect of the operation upon health. In 23 cases he made enquiries into the subsequent history of the patients. Twelve of these were in very good health; there were in “fair health,” which means indifferent health; five failed to report; three had died. Now these deaths are remarkable. One died of tuberculosis of the lungs; one died suddenly of heart disease, and one died of abdominal cancer. This was thought by those present to be a very excellent balance- sheet. This only shows how very modest are the expectations of old-school surgeons and physicians.
Most of the surgeons who spoke dwelt on the encouraging fact that they had lost no patient as a consequence of the operation. In addition to the three cases of death in Mr. Teale’s practice, Dr. Ashley Cummins of Cork mentioned two cases in which extensive operations on the neck and axilla had been followed by acute consumption, and Mr. Wm. Thomas of Birmingham quoted a case of removal of “a large glandular mass which necessitated the division of the sterno-mastoid muscle, and drawing up some glands from the thorax. The wound healed favourably, but the patient died fifteen months after from extension of the disease to the bronchial glands.”
Mr. T. Barlow of London, president of the meeting, summed up the belief of the speakers on the question of medicine as follows:- “Drugs were of use for improving the general nutrition, but had little demonstrable effect on masses of caseous material.” However, he was not so enthusiastically in favour of operating as most of the speakers. “There was little doubt as to the right treatment of glands which were actually suppurating.”-the old fallacy of which my hawker patient cured me-“but there were many p73 borderland cases of enlarged glands in which one hesitated about immediate surgery.”
This madness for operating (furore operations, as it is called) is by no means confined to the operation for the removal of glands.
An eminent French surgeon not long ago entered a protest against it. “We operate too much,” he said, “and it would be a good thing if we listened more to the protestations of our patients. Quite recently three severe cases have occurred to myself in which I was convinced that nothing but an operation could do any good. The patients, however, insisted on being treated medically. I told them that it was sheer waste of time; but they remained firm, and were rewarded by being perfectly cured without operation.”
