EDITORIAL NOTES

1889 Journal of the American Medical Association (JAMA)  
vice. The public, hearing of brilliant successes, but ignorant of possible dangers and disastrous failures, and impatient of the tediousness of safer and surer medical treatment, is readily in¬ duced to fly to evils that it knows not of, and thus aids skilled hardihood in bringing needlessly heroic measures more and more into vogue. A fanatical and exaggerated confidence in anti¬ septic methods plays no small part in perpetuat¬ ing the abuse, If ovariotomy be fatal in one seventh of the
more » ... ns performed, hysterectomy in one fourth, nephrectomy in one-third, or laparotomy for myomata in one-half, the deaths are at¬ tributed to neglect of some minor detail-to the employment of an ill-prepared ligature or the omission of this or that petty-precaution against the entrance of a few stray "germs,"-and the blame is ascribed to the individual surgeon, not to the operation. The principles which should guide the true surgeon's intervention are these : The fact that an operation is capable of curing a disease is not in itself a justification for operating ; the gravity of the operation must be compared with the gravity of the disease ; the benefit to the patient must be proportional to the danger to which he is exposed. It is not admitted that the mortal character of a malady is a sufficient reason for desperate expedients. There are cases where the surgeon must recognize the impotence of his art ; his first consideration should be to avoid doing harm, and he should learn to abstain whenever the immediate dangers of active interference are greater than the temporary amelioration that may be hoped for. He should not imperil life to re¬ lieve an infirmity or deformity which does not menace existence, unless it be such as to in¬ capacitate the sufferer from earning a livelihood. Ankylosis in a position rendering a limb useless, extreme genu valgum, exaggerated rhachitic distortions, ulcerated talipes preventing walking, may warrant resection, osteotomy, or even ampu¬ tation, but it is a different thing to expose a patient with reducible hernia to the risk of immediate death in order to save him the annoyance of wear¬ ing a truss, or to avert the improbable chance of a strangulation twenty or thirty years later. The interest of the patient is to be placed above all other considerations ; a cure sought by the surest and least hazardous therapeutic means rather than by dangerous displays of dexterity ; I = solicitude for the sanctity of human life, should override professional ambition or monetary covetousness. If any case give cause for doubt, let the surgeon pause and ask himself "what he would do, what he would advise, if the question concerned his mother, his wife, his child ; and let the answer dictate his conduct. So will he often reject perilous heroic exploits ; he will perform fewer operations ; he will acquire notoriety less easily, and fortune, perhaps, not at all ; but he will be sure of fulfilling his duty as a good and honest surgeon, and of being regarded by his pa¬ tients as vir bonus mcdendipcritus." The warning which we have briefly transcribed from its foreign source is reproduced in all its fervid eloquence by the Gazette Médicale de Mon¬ tréal from the latest edition of the Médecine Op¬ ératoire, of Malgaigne and LeFort, and most of our readers will be willing to admit its pertinence -at all events, to France. In displaying the beam which obscures the surgical eye of conti¬ nental Europe, it would, of course, be invidious to suggest the possibility that ophthalmic intro¬ spection might detect a mote in our own.
doi:10.1001/jama.1889.04440040021007 fatcat:rn7btquryzc7ffchuhkftpzkza