COMMON SENSE AND SURGERY.

Manawatu Herald, Volume XXXI, Issue 449, 21 January 1909, Page 3

COMMON SENSE AND SURGERY.

(By Marcus Woodward.)

“ What is your opinion of operations, doctor?” said I; and this was the answer made me by the wise and widely-experienced and highly - respected physician and surgeon in whose consulting-room I sat: —

In my opinion a great number of operations are the outcome ol an irresistible temptation. I believe that the foundations of the practice of surgery .are utterly rotten. The craze for appendicitis operations is succeeded now by the craze for tonsilitis operations. Of the former, I believe that an enormous proportion were performed chiefly for the sake of gain, many valuable lives being lost thereby ; and I hold that 90 per cent, of operations for enlarged tonsils ar^unnecessary. The'public at& to blame for the temptations of the surgeon. A surgeon, needy or greedy; who has the chance to operate; hardly can avoid taking it. The more operations the greater his income—the greater the income the greater the. fame—and the man. Experience teaches that to operate 'and to kill often means a higher gain in patients than when sound advice against operations is given. Suppose a man of sixty - five suffers from some little growth. (Usually, people who need or seek operations on account of pathological changes are over 40}. He consults his doctor, who advises him to see a specialist, knowing he can afford the best advice. Now, the Harley-street specialist has had his day of operations ; he is rich. In view of the age of the patient, and the fact that his trouble entails little pain and is no eyesore, and because the man may die, or the growth recur if cut, he simply advises the patient to take a sedative when in discomfort, and, above all, to think as little about the thing as possible. His patient pays three, guineas add goes home," and rests content for two or three months. Then he has a twinge of pain—-

perhabs a pretty sharp.one. He is advised by frieuus to consult a young operating surgeon with a rising reputation. This one is not so well off as the other —he has his name to make —perhaps he pays a year in rent. To himself he says :

‘ ‘ Experience teaches that patients who think themselves in need of an operation go from one to another until a willing surgeon is found. This man is not content with good advice already given. It will be as easy for me to make fifty or a hundred guineas from the case as to make three. I shall gain reputation. I shall gain patients. Therefore* 1 shall operate.” There are people who have a craze for operatious—especially nervous women and neurotics generally. About an operation there is, they think, something heroic. If their backs ache they desire kidney operations; in case of stomachache, their thoughts fly to gastric operations; headaches suggest that their brains should be opened. Women sometimes take to operations wheu about 40 years of age, and continue to have them every three or five years uutil operated into their graves. Doctors, therefore, have inauy temptations; moreover, in such-' cases as those of tonsililis they may believe firmly that < operations are essential. I went to a London •hospital and saw enlarged tonsils, bung cut off right and left, T think about fifty in the one afternoon. " It surprised me very much to see so many operations on the throat. The amount of blood lost was , considerable, and no doubt after-sufferings were very severe. In my own practice I have attended many cases of enlarged tonsils, aud I have found always that as a child grows older and stronger they grow down and give no trouble, or very little. Nature has no further use for them. But I have had patients ou whom opertious had been performed in hospitals, and I have had to treat them for weeks for very serious effects.; The other day four children came to me who had been told at school, that their tonsils must' be taken out. The children could breathe aud swallow freely and speak clearly, I told their parents that if a child of mine w , ere no worse than they, I would not accept to allow the operation to be done.

For the enlarged tonsil has a use. It is a protection to a weaker part, and whenever Nature does not want it, it will go down, and do little cr no harm. To cut away a tonsil is not a simple operation, like cutting one’s hair, or nails, or corns, but it is a dangerous operation, causing sometimes illness, sometimes death.

We find that enlarged tonsils are more common in cities than in the country. Town children are not so robust as country children, nor are their throats or bronchial tubes so strong ; Nature assists to protect them'by throwing up this additional structure to warm and’ impede the currents of cold air entering the larynx. I beleive that if there were not enlarged tonsils and adenoids in many delicate children, there would be something a great deal worsepharyngitis, laryngitis, bronchitis, pneumonia, pleurisy, and perhaps ulceration and abscess over important blood-vessels, Which would be'dangerous, if not fatal, in many cases.

An important function of the tonsil is to give off heat, and it stands to reason that a thick hot plate will give off more heat than a thin one —therefore the tonsils are thickened when needed for the special purpose. I do not look upon enlarged tonsils and adenoids as a disease, but as symptoms of a disease. To cut them off, thinking you are curing a disease, is, I believe, an absolute fallacy. I only hope that operating surgeons do hot intend riding to death this new hobby of cutting tonsils, as they rode the appendicitis and many another hobby. Nature does not make so many mistakes as some surgeons would have us believe. Tonsils have their uses, and the appendix serves its purpose, though, few understand it.

If the practice of surgery is to be put on right lines, and is to be above temptation, one of three courses must be adopted. Either an inquest must be held if a patient dies within three months of an operation, and the operating surgeon must be called as a witness. Or a higher fee than must never be charged ior :ahy operation. Or a consulting operating surgeon must be appointed in every district, to take in surgery the position of the County Court Judge in law. He should decide if an operation is necessary.—Daily Express.