Surgery

sur'jer-y, the performing of operations on a patient. A proper definition excludes baths, massage, etc., and confines surgery to cutting operations, the dressing of wounds, and the setting of broken or disjointed bones. Even among primitive people a certain amount of skill in stopping the flow of blood, in binding up wounds, in the application of healing herbs, in setting broken limbs with splints, and in the extraction of arrow points is to be expected. The early practice of surgery was bound up, no doubt, with magic and superstition. In a more advanced civilization, as that of Egypt, surgery was practiced by the priests. We find the early barbers of Europe combining surgery physic, shaving, and hair cutting. As late as the day of Frederick the Great it was the duty of the army surgeon to shave the Prussian officers. It is only recently that surgery and medicine have been recognized widely as separate though allied branches of the healing art. The majority of doctors are yet physicians and surgeons.

The oldest literature on surgery is found in Sanskrit. It is said that Alexander the Great found an astonishing degree of surgical skill among the Hindus. A New York association of surgical specialists has taken the name of Charoka Club in honor of one of these Sanskrit writers. These Hindu writers describe or allude to a round hundred steel surgical instruments, including scalpels, lancets, saws, bone-nippers, scissors, trocars, hooks, probes, scoops, forceps, and syringes. They speak of fourteen ways of wrapping a bandage and of split bamboo or rattan splints. Hindu surgeons at the time of Christ, and possibly a thousand years earlier, amputated, set broken bones, sewed cuts, used a magnet to extract particles of iron, cut out tumors, tapped for dropsy with a trocar, removed cataract from the eye, and performed many other operations requiring knowledge and skill.

Figures on the walls and monuments of ancient Egypt represent patients wearing bandages or undergoing surgical operations. In various museums of Egyptian antiquities there are considerable collections of horn cupping vessels, bronze and steel surgical instruments, artificial teeth, etc., showing that surgery had made progress. It is believed that the practice of preparing mummies led to a knowledge of anatomy. The Greeks have left a considerable list of surgical works. They were impeded by a popular prejudice against the desecration of dead bodies by surgical study. The Greeks carried their knowledge of surgery as well as of literature and oratory to Rome. The Arabians, famous in other branches of science and in mathematics, made few contributions to surgery. During the Middle Ages, little advance was made and much was forgotten. The revival of surgery kept pace with the revival of art, literature, and other forms of learning in which Italy played an important part.

The remarkable advances of modern surgery are due to several causes. The chief of these are superior schools of instruction in which the bodies of the dead are studied in detail, and the bodies of the living are operated upon by specialists in the presence of students; the general establishment of hospitals in which facilities are at hand for operating and for the proper care of patients; the use of cocaine to deaden pain, and the use of ether, chloroform, and laughing gas to produce unconsciousness during the time of operation; and, lastly, the discovery that the formation of pus may be prevented by excluding bacteria, that is to say, the germs of putrefaction, from the wound. By the use of one of the anaesthetics named above, the surgeon is able to perform operations without the knowledge of the patient, so painful in their nature that otherwise human endurance would be overtaxed and the patient would die under the knife.

The study of the germs of decay has led to the utmost care in performing operations. The instruments, sponges, towels, and all other appliances are sterilized or rendered free from living germs by heat or a bath in some such substance as carbolic acid. The operator and his assistant bathe their hands in carbolized water to kill germs. In some cases the operation is even performed in a spray of germ-killing vapor. The thread used in closing an incision and the bandages are sterilized. Many operations, once certain to be followed by decay and death, are now deemed under skillful treatment as not more dangerous than a cut finger. The surgeon once taught that pus was a part of healing. The complete change of view may be expressed in the surgical phrase, "There is no laudable pus."

The practice of the army surgeon has undergone a revolution. His first care is to remove so far as possible all foreign, germ-carrying material from a wound. This done, he washes the wound with sterilized water, and puts on sterilized bandages to exclude germ-carrying air. Instead of dressing the wound daily, he seals it up to shut out germs and leaves nature to effect a cure. During the Cuban War intelligent army surgeons pursued this plan and sent their patients to bed to get well. The exclusion-of-germs or the let-alone theory is not always appreciated. "One poor woman who met her captain on a transport in New York Harbor cried out to the avenging heavens because the bandages of his wounds had not been changed since they had been put on in Cuba, weeks before; but her captain got well, in spite of the fact that a Mauser bullet had explored his abdominal cavity in a series of startling zigzags."

The Japanese surgeons had great success in the late war. They removed bits of cloth when carried into the wound, but refrained from probing. They washed with sterilized water, bound up the wound with sterilized water, bound up the wound with sterilized cotton, and sent the sufferer to the hospital to get well. One Japanese surgeon, who subsequently related his experiences in a medical congress in Detroit, lost but thirty-two patients out of six hundred and eighty treated in this way.

See Anaesthetics; Appendicitis; Catgut; Bacteria; Saw; Trepanning; Bullet; Hospital; Pasteur