Facts and Fictions of Life

COMMON SENSE IN SURGERY

There are certain forms of expression which once heard fit themselves into the mind so firmly, and re-appear in one connection or another so frequently, that one scarcely recognizes the fact even when one changes a word or two in order to make the original idea fit the case in point. So when I stood watching the ingenious method by which the trainers of the English fox-hounds induced each dog to perform his own surgical operations after a hunt, I remarked, with no recognition of the plagiarism from Dr. Holmes, "Every dog his own doctor."

"No," replied the trainer, with a fine sense of distinction which I had not before observed – "no; I am the doctor; the dogs are the surgeons. I prescribe; they perform the operation. They do that part far better than I could; but they wouldn't do it in time to save the pain and trouble of a much more serious operation that they could not perform, if I did not set them at it in time, and keep them at work until all danger of inflammation is past."

It was after a hunt. The dogs – splendid blooded fellows, a great pack of over sixty of them – had gotten many thorns and briers in their feet. They came back limping, foot-sore, and with troubled eyes that looked up piteously for relief from their pain. They were very hungry too, after the long chase; but "No doctor will allow a patient to eat just before a surgical operation," remarked the trainer, dryly. "Now watch."

He threw open a door leading into an outer room of the splendid Hunt Club Kennel, and gave the word of command.

There was a rush, and the entire pack burst through the wide entrance. Then every dog lay suddenly down, and began with great vigor to lick his feet.

Why? Simply because in rushing through that door they had waded through a wide, shallow trough or sink of pretty warm soup. This basin was sunk in the stone floor, and reached entirely across the door, and was too wide to jump over, even had it been visible from the outside, which it was not.

The dogs had plunged into it before they knew it was there, and were instantly out of its rather uncomfortable heat.

Each dog worked at his feet with vigor. He was hungry. The soup was good; but dogs object to soup on their feet. This process was continued and repeated until it was thought that all thorns and briers and pebbles had been licked and picked from the crippled feet. Then the dogs were fed and put to bed – or allowed to lie down and sleep – in their fresh straw-filled bunks.

"A doctor and a surgeon may be the same person," remarked the philosophical trainer, oracularly, "but they seldom are. If you whine – as the dogs do when their feet hurt after a hunt – or if you limp or complain, a doctor guesses what is the matter with you. Then he guesses what will cure you. If both guesses are right, you are in luck, and he is a skilful diagnostician. In nine cases out of ten he is giving you something harmless, while he is taking a second and a third look at you (at your expense, of course) to guess over after himself."

His medical pessimism and his surgical optimism amused and entertained me, and I encouraged him to go on.

"Now with a surgeon it is different. Surgery is an exact science. Before I took this position I was a surgeon's assistant in a hospital. In some places we are called trained nurses. In our place we were called surgeons' assistants. That's why I make such a distinction between doctors and surgeons. I've seen the two work side by side so long. I've seen some of the funniest mistakes made, and I've seen mistakes that were not funny. I've seen post-mortem examinations that would have made a surgeon ashamed that he had ever been born, looked upon by the doctor who treated the case as not at all strange; didn't stagger him a bit in his own opinion of himself and his scientific knowledge next time. I remember one case. It was a Japanese boy. He was as solid as a little ox, but he told Dr. G – that he'd been taking a homoeopathic prescription for a cold. That was enough for Dr. G – . A red rag in the van of a bovine animal is nothing to the word 'homoeopathy' to Dr. G – . Hydropathy gives him fits, and eclecticism almost, lays him out. Not long ago he sat on a jury which sent to prison a man who had failed in a case of 'mind cure.' That gave deep delight to his 'regular' soul. Well, Dr. G – questioned the little Jap, who could not speak good English, and had the national inclination to agree with whatever you say. Ever been in Japan? No? Well, they are a droll lot. Always strive to agree with all you say or suggest.

"'Did you ever spit blood?' asked Dr. G – , by-and-by, after he could find nothing else wrong except the little cold for which the homoeopathic physician was treating the boy.

"'Once,' replied that youthful victim.

"'Aha! we are getting at the root of this matter now,' said Dr. G – . 'Now tell me truly. Be careful! Did you spit much blood?'

"'Yes, sir; a good deal.'

"The doctor sniffed. He always knew that a homoeopathic humbug could not diagnose a case, and would be likely to get just about as near the facts as a light cold would come to tuberculosis.

"'How long did this last?' he inquired of the smiling boy.

"'I think – it seems to me —

"'A half-hour?' queried the doctor; 'twenty minutes?'

"'I think so. Yes, sir. About half an hour – twenty minutes,' responded the obliging youth.

"I heard that talk. Common-sense told me the boy's lungs were all right; but it was none of my business, and so I watched him treated, off and on, for lung trouble for over a month before I got a chance to ask him any questions. Then I asked, incidentally:

"'What made you spit that blood that time, Gihi?' "'I didn't know I ought to swallow him,' he replied, wide-eyed and anxious. 'Dentist pull tooth He say to me, "Spit blood here." I do like he tell me. Your doctor say ver' bad for lungs, spit blood. Next time I swallow him.'

"I helped another practitioner, in good and regular standing, to examine a man's heart. He found a pretty bad wheeze in the left side. I had to nurse that man. He had been on a bat, and all on earth that ailed him was that spree, but he got treated for heart trouble. It scared the man almost to death.

"I'd learned how a heart should sound, so one day I tried his. He was in bed then, and it sounded all right, so when the doctor came in, I took him aside, and told him that I didn't want to interfere, but that man was scared about to death over his heart, and it seemed to me it was all right – sounded like other hearts – and his pulse was all right too. The doctor was mad as a March h*are, though he had told me to make two or three tests, and keep the record for him against the time of his next visit. Well, to make a long matter short, the final discovery was – the man don't know it yet, and he is going around in dread of dropping off any minute with heart failure – that at the first examination the man had removed only his coat and vest, and his new suspender on his starched shirt had made the squeak. That is a cold fact, and that man paid over eighty dollars for the treatment he had for his heart, or rather, for his suspender."

I was so interested in the drollery of this ex-nurse, and in his scorn for one branch of a profession, while he entertained almost a superstitious awe and admiration for surgery per se, that I decided upon my return to New York to visit a great surgeon, and ask him to allow me to see an operation that would fairly represent the advance-guard so to speak, the upward reach of the profession as it is to day.

We all know the physician who follows his profession strictly and solely as a means of support. Most of us also happily know something of one or more medical men who are a credit to humanity, in that they subordinate their ability to extort money from suffering to their desire to relieve pain, even though such relief conduces not to their own financial opulence. Very few of us who are not close students of the medical profession realize, I think, some of the magnificent developments not only of surgery, but of the character of the surgeon. We are led to think of them as rather hard and brutal men. The side of their work and nature that means tenderness and devotion to the relief of those who, but for the skilled and brave surgeon, must die or suffer for life, is seldom laid before us. The quiet, sweet, and simple devotion of such men does not reach the public ear.

The operation of which I learned, and which is the first of its kind on record, was so strange, so great, and so far-reaching in its suggestion and promise that it seemed to me it could not fail to interest and inspire the general reader, who never sees a medical or surgical journal, and who would not read it if he did.

Can you think of an operation that would create a mind? Can you conceive of the meaning to humanity of a discovery that would transform a congenital imbecile into a rational being? Such an operation was the one I was privileged to see.

The patient was a child about one year old, of good parentage and of healthy bodily growth, aside from the fact that its skull was that of a new-born child, and it had hardened and solidified into that shape and size. The "soft spot" was not there, and the sutures or seams of the skull had grown fast and solid, so that the brain within was cramped and compressed by its unyielding bony covering.

The body could grow – did grow – but the poor little compressed brain, the director of the intelligent and voluntary actions of the body, was kept at its first estate. Even worse than this, its struggle with its bony cage made a pressure which caused distortion and aimless or unmeaning movement – the arm and leg turned in, in that helpless, pathetic way that tells of imbecility. In short, the baby was a physically healthy imbecile – the most pathetic object on this sad earth. Upon examination, the surgeon, a gentle, sweet-natured man, whose enthusiasm for his profession – for the relief of suffering – makes him the object of devotion of many to whom he has given life and health, and the inspirer and final appeal for many a brother practitioner, discovered what he believed to be the trouble. Led by that most uncommon of all things, common sense, he believed that this little victim of nature's mistake might be changed from a condition far worse than death to one of comfort for itself, and to those who now looked upon it only in anguish of soul.

After explaining to the parents and the surgeons who had come to witness the wonderful experiment (for, after all, at this stage it was but an experiment based upon common-sense) that it might fail; after a modest and simple statement of his reason for undertaking so dangerous an operation, with no precedent before him; after explaining that the parents fully understood that not to try it meant hopeless idiocy, and that the trial might mean death – he began the work. I shall try to tell what it was in language that is not scientific, and may seem to those accustomed to surgical terms inadequate and unlearned; but to those who are not technical medical students I believe the less technical language will be far clearer.

The child's skull was laid bare in front. Two tracks were cut from a little above the base (or top) of the nose up and over to the back of the head. One of these tracks was cut on each side, the surgeon explained, because it would give equal expansion to the two sides of the brain, and because it would cause death to cut through the middle of the top of the head, where lies "the superior longitudinal sinus." He left, therefore, the solid track of bone through the middle, and cut two grooves or tracks through the bone, one on either side, where nature (when she does not make a mistake) leaves soft or yielding edges, by means of which the normal skull expands to fit the needs of the brain within.

The trench made displaced, or cut away, one-quarter of an inch of solid bone all the way from near the base of the nose to the back part of the head. In the middle of the top of the head on each side a cross-wise cut was made, and one inch of bone divided. Another cut was made on either side, slanting toward the ears. This was one inch and a half long. The surgeon then tenderly inserted his forefinger, pressed the internal mass loose from the bones where it adhered, and pushed the bones wider apart. This process widened the trenches to one inch.

The wound was now dressed with the wonderfully effective new aseptics, and the flesh and skin closed over. The operation had taken an hour and a half. There was little bleeding. The baby was, of course, unconscious during the entire time. Oh, the blessings of anaesthetics! And now comes the wonderful result of this bold and radical but tender and humane operation.