Lectures on Surgery
Boston Medical and Surgical Journal
Professor of Surgery in Harvard University. I. GENERAL considerations. We are going to speak of some of the genoral considerations iu surgery, not by any means that this is your first instruction in that branch, but because as the beginning of a systematic course it seems proper to review the general subject. One might say that by the brilliancy of modern Burgery, by its triumphs and by its boldness there was danger of being led away from the first aud soundest principles of conservatism, which
... conservatism, which should make one prefer to avoid an operation rather than to do it, if that were equally beneficial to the patient. Now there is a great charm about surgery, because it is visible and tangible aud demonstrable, and also because we know at once when we have done right, and when we have done wrong, -a thing that we do not always know in medicine. The difficulties of diagnosis in medical practice and the doubts about the effect of drugs, make the practice of medicine full of uncertainties. Surgery is to some degree uncertain but not nearly as much as medicine. We know at once when we have done wrong, for instance, when we have attacked a tumor which had better have been left alone or mistaken a fracture for a dislocation ; we are conscious at once of the wrong we have done, and perhaps can correct it tho next time. Our mistakes in medicine are more apt to be concealed, and we cannot learn as much from them, in consequence. I think there is no doubt that medicine requires a higher grade of intellect and more judgment, than the practice of surgery. Formerly it occupied a much more advanced plane than now ; but latterly surgery has been so bold and patient and successful, and has made truly such enormous advances, that it is displacing medicine a good deal iu certain departments. This is particularly true, I think, in certain specialties, like gynecology where now it is all surgery and no medicine, while formerly there was a good deal of medical, local and mechanical treatment. But surgery really is a part of medicine, and it does not demand so varied a culture to make one successful in it; and surgical diagnosis is, and should be, a great deal easier than medical diagnosis. The French give to it the name of "external pathology," pathology that can be seen, and appreciated by the touch ; and although certain regions, like the abdomen and scrotum, are very obscure as to their contents when diseased, yet in many caBes external pathology is very easily read and recognized. It is one of the earliest things that the student sees. He sees the displacement of a fracture, the deformity of a dislocation. He sees unnatural outlines, be feels the outlines of a tumor ; neither of which can he do in medicine. This, then, is probably one of the great charms of surgery, its tangibility, aud its certainty, when we succeed. Wo feel sure, when we have done right, that we have done a great deal of good ; but equally sure, when we have done wrong, that we have made a very grave mistake. 1These are unwritten lectures printed from the stenographer's reports. Verbal corrections are made in revision, but no rhetorical changes. They were delivered to the third and fourth classes as part of the regular course. One is tempted to think that surgery means operation. It does not necessarily mean that ; and although the operative part of surgery is brilliant, it is not the best part, nor does it require the highest attributes of mind. Surgical pathology is a matter of much finer grade than surgical operations. A man with a good knowledge of surgical pathology and good judgment is more valuable to his patient than one who can amputate dexterously, because that is to a certain degree a mechanical art combined with anatomical knowledge.