COMMONSENSE AND SURGERY.

Rangitikei Advocate and Manawatu Argus, Volume XXXIV, Issue 9389, 8 March 1909, Page 2

COMMONSENSE AND SURGERY.

(By Marcos Woodward..)

“ What is yoar opinion of operations, doctor?” said I; and this was the answer made me by the wise ana. widely-experienced and highlyrespected physician and surgeon in Whose consulting room I sat ■' Id my opinion a great number ot operations are . the outcome ■ of, 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 chiefly for the sake of gain, many valuable lives being* lost thereby; and I hold that 90per cent, of operations for en- > larged tonsils are unnecessary ■The ;pnblio is to blame for the temptations of the surgeon. A surgeon, needy or greedy, 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 mean 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 seek or need operations on account of pathological changes are over forty). He consults bis 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 ont, he ’ simply advises the patient to take a sedative when in discomfort, and, above all, to think as little about the thing as possible. GUINEAS AND CONTENT. K

His patient pays three guineas and goes home and rests content for two or three months. Then he has a twinge of pain—perhaps a pretty sharp one. He is advised by friends to consult a .young operating surgeon with a Arising reputation. This one is not so well off as the other—he has his name to makef-perhaps be pays £3OO a year in rent. To k himself he 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, X shall operate. ” There are people who have a craze for operations —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 stomacn ache, their thoughts fly to gastric operations; headaches suggest that their brains should be opened. Women sometimea'take to operations when about forty years of age, and continue to have them every three or five years until operated into their graves. MANY TEMPTATIONS.

Doctors, therefore, have many temptations; moreover, in such cases, as those of tonsilitis they may believe firmly that operations are essential. I went to a London hospital and saw enlarged tonsils being cut off right and left, I think about fifty in 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 enlargged tonsils, and I have found always that as a child grows older and stronger they go down and give no further ' trouble, or very little. Nature has no further use for them. But I have had patients on whom operations had been performed in Hospitals, and I have had to treat them for weeks for very serious effects. The other day four came • to me who had been told at school that their tonsils mnst be taken out. The children ■ could breathe and swallow freely and speak clearly. I told their parents that if a child of mine were no worse than they 1 would not accept £IOOO to allow the operation to be done. *“ For the enlarged tonsil has a use. It is a protection to a weaker part, find whenever Nature does not want It it will go down, and do little or no harm. To out 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. CITY TONSILS. 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 believe that if there were not enlarged tonsils and adenoids in many delicate children here would he something a great deal worsepharyngitis, laryngitis, bronchitis, pneumonia, pleurisy, and perhaps ulceration and abscess over important blood-vessels, which would he dangerous, if not fatal, in many oases. 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. Ido not look upon enlarged tonsils and adenoids as a disease, hat as symptoms of a disease. To out them off,, thinking you are curing a disease, is, I bej lieve, an absolute fallacy. 1 I only hope that operating surgeons do not intend riding to death this new hobby of cutting enlarged 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 he put on right lines and is to be above temptation, Jone of |three courses must be adopted. Either an inquest most 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 £lO must never be charged for any operation. Or a consulting operating surgeon must be appointed in every district, to take in surgery the position of the country court judge in law. He should decide if an operation is necessary. —London Express.