SURGERY

The modern practice of surgery may be said to date from the work of Lord Lister. Attracted by the experiments of Pasteur, who discovered that certain fermentative changes were due to the action of micro-organisms, Lister conceived the idea that septic and putrefactive changes in wounds might be due to the same cause. He began to apply carbolic acid and other antiseptics to wounds and injuries, and immediately effected an enormous saving of life from sepsis and blood poisoning. It has since been found that in ordinary circumstances Lister’s solutions were unnece arily strong, and since strong antiseptics are poisons to animal ti ues, surgeons have striven to exclude microorganisms from wounds rather than to kill them by chemical means after admi ion. This has led to the era of aseptic as distinguished from antiseptic surgery. Remarkable preparations are now made for an ordinary operation. The operating room is lined with glazed tiles or smooth enamel, the corners are rounded, and all unnece ary furniture is excluded. The surgeon is arrayed in a sterilized overall. He wears a head covering and india-rubber gloves, and the mouth and nostrils are covered with sterilized gauze. The site of. operation is shaved, and the patient’s skin specially treated. Instruments, towels, and dre ings are boiled or disinfected by steam under pre ure. A great change has overtaken the cla of case operated upon. In pre antiseptic days an operation was only undertaken for some very urgent condition. In the case of a severely injured limb the risk of blood poisoning was so great that the only way of comparative safety lay in immediate amputation. At the present time an amputation is a rare operation, and unle there is damage to main arteries or some other factor which seems to preclude recovery, the surgeon relies on antiseptics to exclude organisms, and recovery of both life and limb is the rule. On the other hand, the number of operations done for the relief of mere disability or disfigurement has increased enormously, A patient undergoes an operation for hernia to avoid the inconvenience of wearing a tru .’ Another has a limb fractured and reset to overcome a deformity, and cleft palates, lop ears, and unshapely noses are promptly submitted to the surgeon for correction. The treatment of deformities has attained to the distinction of a specialty, orthopedic surgery. Operations to improve scars and unsightly features constitute plastic surgery. Lister’s discoveries have opened the field of exploratory surgery, and when a case presents insuperable difficulties in diagnosis the surgeon is often called upon to cut down on the affected part, and deal with what he may find. A _ recent aid to surgical diagnosis has been afforded by the introduction of the X-ray s, which are employed to show the position of fractured bones and the results of setting them; and the existence of a stone or a deep-seated tumor can often be determined by this means. A rather remarkable change was effected in surgical practice during the World War. Wounds received on the highly cultivated fields of France and Flanders were so heavily infected with virulent organisms that aseptic surgery broke down, and a return was made to the strong antiseptic régime. Amputations again became common operations, since a mangled limb was usually so infected that the danger of death from blood poisoning was extreme, and the fortunate few who recovered With both life and limb after declining amputation are to be congratulated more upon their good fortune than upon their strength of mind. The war gave.a great impetus to orthopedic and plastic surgery in the opportunities which arose to correct disability and deformity caused by wounds, and an immense amount of work has been done in restoring paralyzed limbs to usefulne by the suture of severed nerves. The advances of surgery in the United States have been rapid in recent years. The remarkable work of the Mayo brothers has won recognition all over the world.