There are certain forms of expression which once heard fit themselves
into the mind so firmly, and re-appear in one connection or another so
frequently, that one scarcely recognizes the fact even when one changes
a word or two in order to make the original idea fit the case in point.
So when I stood watching the ingenious method by which the trainers
of the English fox-hounds induced each dog to perform his own surgical
operations after a hunt, I remarked, with no recognition of the
plagiarism from Dr. Holmes, "Every dog his own doctor."
"No," replied the trainer, with a fine sense of distinction which I had
not before observed--"no; I am the doctor; the dogs are the surgeons. I
prescribe; they perform the operation. They do that part far better than
I could; but they wouldn't do it in time to save the pain and trouble of
a much more serious operation that they could not perform, if I did
not set them at it in time, and keep them at work until all danger of
inflammation is past."
It was after a hunt. The dogs--splendid blooded fellows, a great pack
of over sixty of them--had gotten many thorns and briers in their feet.
They came back limping, foot-sore, and with troubled eyes that looked up
piteously for relief from their pain. They were very hungry too, after
the long chase; but "No doctor will allow a patient to eat just before a
surgical operation," remarked the trainer, dryly. "Now watch."
He threw open a door leading into an outer room of the splendid Hunt
Club Kennel, and gave the word of command.
There was a rush, and the entire pack burst through the wide entrance.
Then every dog lay suddenly down, and began with great vigor to lick his
feet.
Why? Simply because in rushing through that door they had waded through
a wide, shallow trough or sink of pretty warm soup. This basin was sunk
in the stone floor, and reached entirely across the door, and was too
wide to jump over, even had it been visible from the outside, which it
was not.
The dogs had plunged into it before they knew it was there, and were
instantly out of its rather uncomfortable heat.
Each dog worked at his feet with vigor. He was hungry. The soup was
good; but dogs object to soup on their feet. This process was continued
and repeated until it was thought that all thorns and briers and pebbles
had been licked and picked from the crippled feet. Then the dogs were
fed and put to bed--or allowed to lie down and sleep--in their fresh
straw-filled bunks.
"A doctor and a surgeon may be the same person," remarked the
philosophical trainer, oracularly, "but they seldom are. If you
whine--as the dogs do when their feet hurt after a hunt--or if you
limp or complain, a doctor guesses what is the matter with you. Then he
guesses what will cure you. If both guesses are right, you are in luck,
and he is a skilful diagnostician. In nine cases out of ten he is giving
you something harmless, while he is taking a second and a third look at
you (at your expense, of course) to guess over after himself."
His medical pessimism and his surgical optimism amused and entertained
me, and I encouraged him to go on.
"Now with a surgeon it is different. Surgery is an exact science. Before
I took this position I was a surgeon's assistant in a hospital. In
some places we are called trained nurses. In our place we were called
surgeons' assistants. That's why I make such a distinction between
doctors and surgeons. I've seen the two work side by side so long. I've
seen some of the funniest mistakes made, and I've seen mistakes that
were not funny. I've seen post-mortem examinations that would have made
a surgeon ashamed that he had ever been born, looked upon by the doctor
who treated the case as not at all strange; didn't stagger him a bit
in his own opinion of himself and his scientific knowledge next time.
I remember one case. It was a Japanese boy. He was as solid as a
little ox, but he told Dr. G------ that he'd been taking a homoeopathic
prescription for a cold. That was enough for Dr. G------. A red rag in
the van of a bovine animal is nothing to the word 'homoeopathy' to Dr.
G------. Hydropathy gives him fits, and eclecticism almost, lays him
out. Not long ago he sat on a jury which sent to prison a man who had
failed in a case of 'mind cure.' That gave deep delight to his 'regular'
soul. Well, Dr. G------ questioned the little Jap, who could not speak
good English, and had the national inclination to agree with whatever
you say. Ever been in Japan? No? Well, they are a droll lot. Always
strive to agree with all you say or suggest.
"'Did you ever spit blood?' asked Dr. G------, by-and-by, after he
could find nothing else wrong except the little cold for which the
homoeopathic physician was treating the boy.
"'Once,' replied that youthful victim.
"'Aha! we are getting at the root of this matter now,' said Dr. G------.
'Now tell me truly. Be careful! Did you spit much blood?'
"'Yes, sir; a good deal.'
"The doctor sniffed. He always knew that a homoeopathic humbug could not
diagnose a case, and would be likely to get just about as near the facts
as a light cold would come to tuberculosis.
"'How long did this last?' he inquired of the smiling boy.
"'I think--it seems to me--
"'A half-hour?' queried the doctor; 'twenty minutes?'
"'I think so. Yes, sir. About half an hour--twenty minutes,' responded
the obliging youth.
"I heard that talk. Common-sense told me the boy's lungs were all right;
but it was none of my business, and so I watched him treated, off and
on, for lung trouble for over a month before I got a chance to ask him
any questions. Then I asked, incidentally:
"'What made you spit that blood that time, Gihi?' "'I didn't know I
ought to swallow him,' he replied, wide-eyed and anxious. 'Dentist pull
tooth He say to me, "Spit blood here." I do like he tell me. Your doctor
say ver' bad for lungs, spit blood. Next time I swallow him.'
"I helped another practitioner, in good and regular standing, to examine
a man's heart. He found a pretty bad wheeze in the left side. I had to
nurse that man. He had been on a bat, and all on earth that ailed him
was that spree, but he got treated for heart trouble. It scared the man
almost to death.
"I'd learned how a heart should sound, so one day I tried his. He was in
bed then, and it sounded all right, so when the doctor came in, I took
him aside, and told him that I didn't want to interfere, but that man
was scared about to death over his heart, and it seemed to me it was all
right--sounded like other hearts--and his pulse was all right too. The
doctor was mad as a March h*are, though he had told me to make two or
three tests, and keep the record for him against the time of his next
visit. Well, to make a long matter short, the final discovery was--the
man don't know it yet, and he is going around in dread of dropping off
any minute with heart failure--that at the first examination the man had
removed only his coat and vest, and his new suspender on his starched
shirt had made the squeak. That is a cold fact, and that man paid over
eighty dollars for the treatment he had for his heart, or rather, for
his suspender."
I was so interested in the drollery of this ex-nurse, and in his
scorn for one branch of a profession, while he entertained almost a
superstitious awe and admiration for surgery _per se_, that I decided
upon my return to New York to visit a great surgeon, and ask him
to allow me to see an operation that would fairly represent the
advance-guard so to speak, the upward reach of the profession as it is
to day.
We all know the physician who follows his profession strictly and solely
as a means of support. Most of us also happily know something of one or
more medical men who are a credit to humanity, in that they subordinate
their ability to extort money from suffering to their desire to relieve
pain, even though such relief conduces not to their own financial
opulence. Very few of us who are not close students of the medical
profession realize, I think, some of the magnificent developments not
only of surgery, but of the character of the surgeon. We are led to
think of them as rather hard and brutal men. The side of their work and
nature that means tenderness and devotion to the relief of those who,
but for the skilled and brave surgeon, must die or suffer for life, is
seldom laid before us. The quiet, sweet, and simple devotion of such men
does not reach the public ear.
The operation of which I learned, and which is the first of its kind on
record, was so strange, so great, and so far-reaching in its suggestion
and promise that it seemed to me it could not fail to interest and
inspire the general reader, who never sees a medical or surgical
journal, and who would not read it if he did.
Can you think of an operation that would create a mind? Can you conceive
of the meaning to humanity of a discovery that would transform a
congenital imbecile into a rational being? Such an operation was the one
I was privileged to see.
The patient was a child about one year old, of good parentage and of
healthy bodily growth, aside from the fact that its skull was that of a
new-born child, and it had hardened and solidified into that shape and
size. The "soft spot" was not there, and the sutures or seams of the
skull had grown fast and solid, so that the brain within was cramped and
compressed by its unyielding bony covering.
The body could grow--did grow--but the poor little compressed brain, the
director of the intelligent and voluntary actions of the body, was kept
at its first estate. Even worse than this, its struggle with its bony
cage made a pressure which caused distortion and aimless or unmeaning
movement--the arm and leg turned in, in that helpless, pathetic way
that tells of imbecility. In short, the baby was a physically healthy
imbecile--the most pathetic object on this sad earth. Upon examination,
the surgeon, a gentle, sweet-natured man, whose enthusiasm for his
profession--for the relief of suffering--makes him the object of
devotion of many to whom he has given life and health, and the inspirer
and final appeal for many a brother practitioner, discovered what he
believed to be the trouble. Led by that most uncommon of all things,
common sense, he believed that this little victim of nature's mistake
might be changed from a condition far worse than death to one of comfort
for itself, and to those who now looked upon it only in anguish of soul.
After explaining to the parents and the surgeons who had come to witness
the wonderful experiment (for, after all, at this stage it was but an
experiment based upon common-sense) that it might fail; after a modest
and simple statement of his reason for undertaking so dangerous an
operation, with no precedent before him; after explaining that the
parents fully understood that not to try it meant hopeless idiocy, and
that the trial might mean death--he began the work. I shall try to tell
what it was in language that is not scientific, and may seem to those
accustomed to surgical terms inadequate and unlearned; but to those who
are not technical medical students I believe the less technical language
will be far clearer.
The child's skull was laid bare in front. Two tracks were cut from a
little above the base (or top) of the nose up and over to the back
of the head. One of these tracks was cut on each side, the surgeon
explained, because it would give equal expansion to the two sides of the
brain, and because it would cause death to cut through the middle of the
top of the head, where lies "the superior longitudinal sinus." He left,
therefore, the solid track of bone through the middle, and cut two
grooves or tracks through the bone, one on either side, where nature
(when she does not make a mistake) leaves soft or yielding edges, by
means of which the normal skull expands to fit the needs of the brain
within.
The trench made displaced, or cut away, one-quarter of an inch of solid
bone all the way from near the base of the nose to the back part of the
head. In the middle of the top of the head on each side a cross-wise cut
was made, and one inch of bone divided. Another cut was made on either
side, slanting toward the ears. This was one inch and a half long. The
surgeon then tenderly inserted his forefinger, pressed the internal mass
loose from the bones where it adhered, and pushed the bones wider apart.
This process widened the trenches to one inch.
The wound was now dressed with the wonderfully effective new aseptics,
and the flesh and skin closed over. The operation had taken an hour and
a half. There was little bleeding. The baby was, of course, unconscious
during the entire time. Oh, the blessings of anaesthetics! And now comes
the wonderful result of this bold and radical but tender and humane
operation.
The baby rallied well. In three days it showed improved intelligence.
In eight days this improvement was marked. From a creature that sat
listless, deformed, and unmindful of all about it, it began to "take
notice," like other children. From an "it," it had been transformed into
a "he." It had been given personality. It ate and slept fairly well.
On the tenth day the wound was exposed and dressed. It had healed, or
"united by first intention," as the doctors say; and again one can but
exclaim, "Oh, those wonderful aseptic dressings!" It had united without
suppuration. It was a clean wound, cleanly healing.
One month after the operation the feet and hands had straightened out,
and lost their jerky, aimless movements. The child is now a child. It
acts and thinks like other children, laughs and cooes and makes glad the
hearts of those who love it.
Not like other children of its age, perhaps, for it has several months
yet to "catch up," but the last report, in one of the leading medical
journals, said:
"One month after the operation the change in its condition was
surprising and gratifying. The deformities in the extremities had
entirely disappeared, and there was evidently a remarkable increase in
intelligence. It noticed those about it, took hold of objects offered
it, laughed, and behaved much as children of ordinary development at six
or eight months. The pupils were no longer widely dilated, but appeared
normal. It eats and sleeps well, and is in general greatly improved as a
result of the operation."
If in one month the little imprisoned brain was able to "catch up" six
or eight months, we may surely believe that the remaining four or five
months which it lost, because nature sealed the little thinking-machine
firmly in too small a casket, will be wiped away also, and the little
victim of nature's mistake be given full and normal opportunity through
the skill and genius of man.*
*It has now been several years since the operation, and the
child is like other children.--H. H. G.
Is not that common-sense in surgery?
Could anything be more wonderful? Could any operation open to the future
of the race wider possibilities and offer more brilliant hope? I may
quote here farther from the same medical journal the report of Dr.
Wyeth, himself:
"The operation differs from any yet done. Lanne-longue, Keen, and others
cut a trench about a quarter of an inch in width, and on one side, at
a single operation. It seemed to me if the brain was penned in by
premature ossification of the cranial bones, these should be torn loose
and permanently lifted, thus allowing a thorough expansion. Should
only temporary benefit be secured, the operation should be repeated.
Experience alone can demonstrate whether the expansion of the brain will
be able to spread the cranial bones to such an extent that it may reach
even an ordinary development. The condition of these patients is
so hopeless and deplorable that, in my opinion, very great risk is
justifiable in any surgical interference which offers even a hope of
amelioration."
Thus the race is quietly achieving mastery over the blind forces of
nature, and the steady hand of science, coupled with tenderness and
sincerity, is pushing back some of the worst horrors of life, and
throwing a flood of light and hope into the future! It makes one's
step lighter and one's face happier only to think of these marvellous
achievements and victories. A new impulse of hope and happiness
dawns upon life. I owed this new inspiration to my pessimistic
acquaintance--he of the Hunt Club Kennel--and the introduction he gave
me to the rudiments of applied surgery. It was indeed a long sweep from
the one operation to the other.
My first and second glimpses of the operating-room were surely the two
extremes, and yet when I suggested this to Dr. Wyeth, the great and
gentle surgeon who performed this operation, he smilingly replied that,
after all; either or both--indeed, all of it--was simply common-sense in
surgery.