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I am here to learn, not to teach! here not as a professor, but as a pupil. The title of this association designates the field of your surgery, the field has not been mine to any considerable extent; but in this connection I will not plead the extent of ignorance illustrated by the man who said he only knew two tunes, one was Old Hundred and the other wasn't.
You are experienced in your field; to be experienced is to know your subject and to be able to teach, otherwise not-except theoretically-and in practical and successful surgery, theory plays no very prominent part.
Railroad surgery, I take it, means something more than a free pass over the railroads. The pass we are pleased to regard as a species of diploma; a certificate that the holder has that scientific skill and experience which can repair those accidents to the individual which so repeatedly occur in railroad travel, and can give intelligent, honest and unbiased testimony in courts in those suits for damages by which railroad companies are often causelessly annoyed and not unfrequently mulcted to a degree offensive to principles of common justice. In this reckoning we pass over the loss of time and the vexation of the surgeon.
As I have indicated, my experience in the kind of surgery in which you are engaged, is limited, and I can not assume to speak with the same authority with which many here can. I hesitate the more for the reason that the discussions of this society, as of others, go out as information to the profession at large, and it is therefore important that there should be wisdom and certainty in its voice.
My subject is the suggestion of my own method of surgical procedure, of my failures and successes. It does not relate to the more intricate and abstruse problems of the science and art of surgery. It touches alone those simple truths which the aggregate of my experiences have crystalized with a strong surgical faith. In my specializing I may
* Read at the Second Annual Meeting of the Association of Surgeons of the Southern Railway Co., held at Lookout Inn, Lookout Mountain, Tenn., June 29-30, 1897.
DENVER MEDICAL TIMES.
have limited my field within too narrow limits to be in strict accord with the ambitious, outreaching, grasping spirit of the period, but the motive in my specializing has been to do, even if it was very little, to do that very little thorougbly and well. To do this I have adopted the simplest forms of procedure. Nowhere is simplicity and orderliness more forcefully taught than in the processes of nature itself.
In using the term simplicity I mean to interpret it in its broadest scientific significance as it applies to surgery. Every surgical operation, whatever its character, should be done with the least possible fuss, amid the fewest, plainest and simplest of surroundings. Only the very least of the needful appointments and furnishings should be in the operating room and the room of the patient. All the surgery, down to the smallest detail, should be done, as far as possible, by the operator himself with little assistance, and that little should be as trained and skilled assistance as it is possible to obtain. There is a great risk that our skill and successes may make us careless as to many important factors of success. There is no possibility of our ever over-estimating our responsibility.
There should be few nurses in the operating room, little talk, and that in the lowest possible tones; every step and move should have a considered and definite purpose.
I remember to have witnessed a simple operation--the operator's attendants were seven residents and nine nurses. The loins of the attendants were neatly bound around by baseball belts, their hair thick, long and carefully plastered down and parted in football fashion. The nurses were trim in Oriental costume. The scene amid this preparation for a funeral was unique, solemn and impressive. Listerism was carefully practiced. The operation lasted one hundred and forty minutes. I did not stay to see the patient re-opened and the lost sponges searched for.
Our faith in the simplicity of methods is grounded in experience and the observation of facts. This experience has proven the need of but few instruments and improved our mechanical technique. A high mortality in surgery is always in accord with the limit of experience, inaptitude, inaccuracy, inattention to details, non-observance of the simple precautions which cleanse away and ward out dust. In this connection I will quote from one of the most eminent scientists of our generation, an original investigator of rare genius and success, Prof. John Tyndall:
"I have spoken of the floating dust of the air, of the means of rendering it visible, and of the perfect immunity from putrefaction which accompanies the contact of moteless air; consider the woes which this wafted matter, during historic and prehistoric ages, has inflicted on mankind; consider the loss of life in hospitals from putrefying wounds; consider the loss in places where there are plenty of wounds but no hospitals, and in the ages before hospitals were anywhere founded; consider the slaughter which has hitherto followed that of the battlefield when those bacterial destroyers are let loose, often producing a mortality far greater than that of the battle itself; add to this the other conception that in times of epidemic diseases, the self-same floating matter has frequently, if not always, mingled with it the special germs which produce the epidemic, being thus enabled to sow pestilence and death over nations and continents; consider all this, and you will come with me to the conclusion that all the havoc of war, ten times multiplied, would be evanescent if compared to the ravages due to atmospheric dust.
“This preventable destruction is going on to-day, and it has been permitted to go on for ages without a whisper of information regarding its cause being vouchsafed to the suffering sentient world. We have been scourged by invisible thongs, attacked from impenetrable ambuscades, and it is only to-day that the light of science is being let in upon the murderous domain of our foes.
"From the vantage ground already won, I look forward with confident hope to the triumph of medical art over scenes of misery. The cause of calamity being once clearly revealed, not only to physicians, but to the public, whose intelligent coöperation is absolutely essential to success, the final victory of humanity is only a question of time. We have only a foretaste of that victory in the triumphs of surgery as practiced at your doors."
The corollary, the conclusions to be drawn from Prof. Tyndall's reasoning, would seem to be that the germ or bacterium is the primary cause of the calamities to which he refers, and that but for the dust or dirt the germ or bacteria could not exist. It is in the dust or dirt the poison, germ or by whatever pame you may be pleased to designate it, germinates; avoid or remove this and you have a clean, unirritated and aseptic wound; one you can cure. We know what a little atom of contagion will do. The dust or dirt is the seed and it spreads as does the pollen of the growths of the fields.
We know the effect of the smallpox virus. Let this impure floating matter of the air fall into a wound and it will poison it, and this poison will be taken into the circulation and you will have general and dangerous septic conditions. The success following cleanliness, following going to and doing our work in a scientifically clean state explains the pathology of many conditions. What is said in this connection applies to all surgery.
The low mortality of our surgery in the late years has not been due to the extent claimed to antiseptic precautions, but to scientific cleanliness.
The sources of infection are very numerous. Invalids are a common source of the infection of healthy people. The transportation of children convalescing from scarlet fever or diphtheria spreads the contagion. In my own surgical work I have always dreaded a contaminated atmosphere, dreaded an overcrowded operating room, and for this reason 1 keep an empty room on each floor of a small private hospital. If I do three sections, each is done is a separate room, thus avoiding the too great risk of atmospheric infection. Infection may come from the old books of circulating libraries or those of a second hand book store.
Since time does not kill septic germs, they must be removed by the most rigid cleanliness. We have learned no more important truth than