THE RELATION OF SURGERY TO GYNAECOLOGY


THE RELATION OF SURGERY TO GYNAECOLOGY. SOME years ago there appeared in Madison Square, New York City, a colossal hand; neither its functions nor relationship was readily discerned. It projected above the greensward as though some mighty Titan had been poorly buried, or as though some mythical creature were again emerging from the dreamless sleep of an ancient sculpture. Though bared to the wrist only, it towered high above the head of the observer who gazed with awesome curiosity upon this emblem of marvelous skill and power and wondered at its significance.


SOME years ago there appeared in Madison Square, New York City, a colossal hand; neither its functions nor relationship was readily discerned. It projected above the greensward as though some mighty Titan had been poorly buried, or as though some mythical creature were again emerging from the dreamless sleep of an ancient sculpture. Though bared to the wrist only, it towered high above the head of the observer who gazed with awesome curiosity upon this emblem of marvelous skill and power and wondered at its significance. It was the hand of Bartholdi’s Goddess, destined to light a universe.

Years passed, and across the water the body of this famous goddess was assuming form under the deft direction of its originator. When the hand was next seen it had abandoned its long divorcement and appeared as the crowing glory of the statue, piercing the blue ether far above its Parisian surroundings, and ready to again across the ocean, leading the fair goddess to her permanent home, where she should stand beneath the effulgence of its radiant torch. There she stands to day, personifying “Liberty enlightening the world”.

The relation of surgery to gynaecology is not unlike that of the torch-bearing hand to the goddess of Bartholdi, which symbolizes the upward and onward progress of art, and illuminates not only itself, but also all that comes within its influence. So surgery symbolizes the growth of medical art, illumines the entire gynaecological structure, and throws its light upon the whole world of medical science.

What has surgery done and what is it doing to merit so great an encomium? It has turned, and is turning, doubt into certainty, ignorance into knowledge, insecurity into safety.

Gynaecology was but a stumbling and a halting child before the strong hand of surgery led its wavering footsteps firmly by the pitfalls of uncertainty and developed its unsteady gait into the sturdy pace of athletic progress.

For the purposes of this paper we take gynaecology to mean that branch of medical science which pertains to the anatomy and physiology of the special organs of generation and their immediate surroundings-the aetiology, pathology and management of their diseases. As the management of gynaecological cases must be either surgical or non-surgical, we take the term surgery to mean that science which develops the principle of mechanical and operative procedures for the relief of any disease and determines the principles of their application.

It is not the intention to institute invidious comparisons between operative and non-operative methods of treatment; for they are so intimately joined, and their objects so identical, that they must ever be considered as forming a union whose unity of purpose is its strongest bond, but still it may not be unprofitable to pass in review the achievements of surgery which have brought fame to gynaecology.

The progress of gynaecology during the last twenty-five years is marvelous, but rendered so by the triumphant march of surgery, which, like a veritable Moses has led and is still leading the gynaecological hosts up out of the wilderness of crudity. The scalpel in living tissue is the open sesame which unlocks both pathological and functional mysteries and brings nearer to our grasp the very secret of life itself.

Before passing to the consideration of specific performance let us emphasize the fact that in antisepsis, or the more refined asepsis, we have the foundation for the brilliant surgical exploits of which we are so justly proud. The renown of surgery no longer depends upon the glamour of exceptional success, but upon that uniformity of result which must ever follow the recognition and application of universal principles.

Primitive surgery and modern surgery do not differ alone in the application of the principles of antisepsis, but in the development of principles which govern the process of repair and the recognition of pathological methods and new insight into physiological function. Primitive surgery was, of necessity, external surgery and experimental. The auto-amputation of extremities and to initiative surgical procedure. Modern surgery, and especially gynecian surgery, is internal surgery and demonstrative, and marks the highest degree of adaptation of principles deduced from external work. The so-called citadels of life are no longer defended against operative attack, yet here, as in primitive surgery, we work upon the periphery.

Accidental surgery has been the precursor of deliberative imitation, the tamping-rod emphasized the use of the trephine, and the ripping horn of the infuriated animal, whilst it led us to fear the bull more, has certainly caused us to dread the peritoneum less. Two cavities were thus opened whose viscera are now daily attacked by the knight of the bistoury.

Primitive abdominal surgery was first confined to the repair of accidental injuries. When the intestines protruded through a wound in the abdominal wall, the prudent surgeon cleansed the bowels and replaced them, sewed up the rent, and gave his patient rest; a rest which was not always the one which knows no waking. When the intestines were wounded, however, long and patient study was required before modern surgery evolved the rule which not only justifies but commands the immediate laparotomy which furnishes exact scrutiny of the parts injured, and an opportunity for the application of exact operative methods.

In this, gynaecology has been the gainer. The operative problems which have been presented to the gynaecologist, have, many times, been solved n advance through the development of surgical truths and principles which are found to be the most valuable when the most general in their application.

When the harassed gynaecologist of the non-operative type has exhausted all the resources of mechanical and medicinal methods in the vain endeavor to restore a retroverted uterus, and asks of surgery for assistance, the answer comes unhestitatingly-open the abdomen, release the adhesions, and anchor the uterus to the abdominal wall; or, after the method of the Alguie-Alexander-Adams operation, take a reef in the round ligaments.

Are the ovaries and tubes caught within the octopus grasp of a pelvic inflammation, and deprived of their liberty of action, the appendages are removed, and the patient relieved at least of one great source of irritation or nerve waste. Do they develop a cyst whose ever increasing pressure not only imperils the comfort but the very life of the patient; surgery leads the gynaecologist to remove the cyst as soon as discovered, and not to till further jeopardize the patient by inane assaults of the aspirating! Does a persistent intra-metritic haemorrhage drain the vitality and resist the “indicated remedy.” surgery curettes that uterus, clearing it of placental debris or granular proliferations; the devastating current is stayed and damage soon repaired.

Has a cervix or perinaeum yielded to the force of a parturient assault, surgery restores their autonomy; saving the patient on the one hand from a cancer-breeding nidus, and on the other hand from a displacement-courting impairment.

Do fistulae deflect the natural course of rectal and bladder contents, the surgeon’s skill repairs the openings and the excretory channels resume their normal functions. Dose vesical wall or rectal pouch encroach on vaginal space, the surgeon, with the skill of a modiste, takes a tuck in the redundant tissue and each viscus is restored.

Does the study gonococcus, ambitions to conquer new territory, invade the secluded precincts of the Fallopian tube, and there multiply and replenish its pus until the confines of its operations, sell to dangerous proportions, surgery again rescues the patient, and puts those tubes where the coccus must cease from troubling, and menstruation takes a rest.

Does the erratic myoma explore peritoneal space, or, seek the outer world through polypoid transmigration, or, stay at home and enjoy its intra-mural development, it falls a prey to the surgical poacher, who does not hesitate to remove, not only the game, but the very preserves in which it abounds.

Does that great enemy of womankind, the cancer, attack with all its malignity the primitive home of foetal nativity, and seek to overthrow with inevitable encroachment the temple dedicated to the cause of maternity, the alert gynaecologist knows that the only hope of rescue lies in a total surgical ablation. Medicine has not yet furnished the remedy, and surgery, at best, furnishes only a possible reprieve.

Does pelvic inflammation run riot in the delicate tissues which form the uterine surroundings, and, by the violence of its assault, melt all before it in the fury of a purulent conflagration, the early relief of the surgeon’s knife furnishes the speediest means of staying its ravages, and supplements, with potent co-operation, all therapeutic endeavor.

Does pain, with continuous grasp, wring from the chronic sufferer the imperative cry for help, and surgery, with deft skill, remove the innocent appendages and leave the pain behind, gynaecology has even then been a gainer, and diagnostic acumen receives a new impetus and finds in the uterine cavity the hitherto unsuspected pathology.

Charles E Walton