The training of the surgeon : the annual address in medicine delivered at Yale University, June 27, 1904 / by William Stewart Halsted.

  • Halsted, William, 1852-1922.
Date:
[1904]
Catalogue details

Licence: In copyright

Credit: The training of the surgeon : the annual address in medicine delivered at Yale University, June 27, 1904 / by William Stewart Halsted. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    [270] But no truly great and essential progress in fundamental surgical principles had been made since Hunter’s time, until the monumental labors of Pasteur opened the vista through which for a time only the eyes of Lister could peer. It is hard to realize that forty years have passed since Lister and Pasteur made to surgery a contribution rivalled only by Har- vey’s in importance. It was in 1867 that Lister first made known the almost incredible results of his experiments with carbolic acid in the treatment of wounds. The great merit of Lister lies in his clear recognition of the significance of Pasteur’s discoveries in revealing the underlying causes of the infection of wounds and in the adoption of measures fitted to prevent and combat such infection. This merit will re- main whatever changes may be made in the details of anti- septic and aseptic surgical procedures. It was not, however, until 1875 that even in Germany occasionally by the senseless chattering or joyous singing of the patient. Familiarity with the use of cocaine in surgery has robbed somewhat the pre-ansesthesia days of their interest to the surgeon. We used to admire and wonder at the courage of the old-day surgeons who could inflict such torture for such small rewards, but we know now that certain operations can be performed with very little pain even without the employment of a local anmsthetic. It is often unnecessary to do more than anaesthetize the skin to perform a very considerable operation, in the neck for example. Prom cocaine we learned in one year (1885) more about the relative sensi- tiveness of the various tissues and organs than from all the literature of our forefathers. The skin being anaesthetized and incised, we were sur- prised to find that the underlying parts were comparatively insensitive to handling and, for the most part, even to cutting. The accidental cutting or crushing of nerves caused the most exquisite pain, and we noticed that the nerve supply of the blood vessels “ is so abundant that the sev- ering or clasping of even very small bleeding points usually startled a cry of some sort of remonstrance from the patient; and now after many years of experience with cocaine we interpret an unexpected moan as sig- nifying an insult to some small unseen blood vessel or nerve. These facts learned, I say, in one year, perhaps in six months of experimentation with cocaine, were not clearly revealed by all the previous ages of surgery. The explanation undoubtedly lies in the facts that in olden times the first cut through the skin so unnerved the patient and perhaps the surgeon that differentiation was impossible, and that the operation was performed in such haste as to preclude careful observation. I fear that so much prac- tice with cocaine as an anesthetic has obtunded to some extent our sensi- tiveness to pain in others. Formerly it taxed one severely to employ cocaine in certain operations which we now perform with equanimity ; we are in danger perhaps of acquiring the kind of immunity (it is not indif- ference) which it seems to me dentists possess or have cultivated to such a high degree. Briefly, then, the story of the surgery of pre-anssthesia days has become less interesting because it has been robbed of its terrors by the lessons which cocaine has taught us. If the surgeon of the past could only have known what it seems to the modern surgeon he should have known better than all else, namely, the relative sensitiveness of the various tissues, he could hardly have failed to discover methods of pro- ducing anaesthesia of the skin. That one could deliberately divide a nerve of the size of the sciatic or ulnar or even the minutest filaments visible without exhausting his ingenuity to find something to deaden the exquisite or agonizing pain seems inconceivable. How blind we are and how blind we ever shall be. '-John Hunter recognized the fact that parts richly supplied with blood were much more sensitive than the comparatively bloodless parts.