Principles and practice of surgery / by James Syme ; edited with notes and illustrations by Robert S. Newton.

  • Syme, James, 1799-1870.
Date:
1857
Catalogue details

Licence: Public Domain Mark

Credit: Principles and practice of surgery / by James Syme ; edited with notes and illustrations by Robert S. Newton. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    as to prevent the possibility of primary union ; -while another plan was to plaster up the orifice, so as effectually to prevent the escape of blood or other discharge from it, and thus insure the cavity being converted into an abscess ; and a third method was to delay dressing the wound for six or eight hours, until all oozing had ceased ; a fourth method, being to keep the edges wet; and a fifth, to apply some permeable substance, as a sponge over the wound, so as to press the sides together and absorb any discharge which, if re- tained, might tend to separate them. When lately spending a few days in Paris, I was requested to operate upon a gentle- man resident there, who required a tumor to be removed, and had determined to come here and place himself under my care for the purpose, but who, happening to learn that I was there, urgently entreated me to perform the operation. I did so, inserted the neces- sary stitches, and placed over the wound a large sponge, which was removed at the end of forty-eight hours, when union by the first intention had taken place completely, and literally without a drop of matter being formed. This case was peculiarly interesting to me, since, when I resided at Paris as a student, thirty years ago, the invariable practice was to stuff the cavities of wounds, their primary union being regarded as an impossi- bility, and I should have been very happy if some of my old associates at the Hotel Dieu could have compared the effect of placing a sponge on the outside, instead of the inside of a wound. Amid such a confusion of conflicting opinions and procedures, how are you to select your principles of practice? Are you to try in succession all the projects that have ever been suggested, and from your own experience determine which should be preferred? Such a course is obviously no less impracticable than inexpedient, and it is plain that you ought to be guided in your choice by some authority deserving confidence. You may hence perceive the heavy responsibility which is incurred by a teacher of surgery, or the author of a practical surgical work, and perhaps appreciate the recklessness with which principles are too often laid down without any good foundation, as well as the in- cautiousness with which they are apt to be adopted without any investigation. $ot long ago, in an American journal, I saw an advice to students for the choice of a surgical book, always to prefer the one most recently published, from which it would appear that novelty, instead of experience, was held to stamp the value of principles—a most dangerous doctrine, as it seems to me, when we take into consideration the baneful influence that may be exercised over a whole professional life, by the adoption of a single erroneous view in regard to the treatment of disease. Let me, therefore, beg that you will never adopt as your own the opinions of others, merely because they appear in print, or are promulgated from a professor's chair. Regard prejudices as your worst enemies, and believe nothing that has not a foundation in reason. You may now expect that I should next insist upon the importance of manual dex- terity, and will probably be surprised when I tell you that it has no real existence in surgery, so far as the overcoming of mechanical difficulties is concerned. The carpenter who constructs a piece of furniture from the rough plank, or the blacksmith who forges a horseshoe from a bar of iron, requires dexterity, but not so the surgeon, whose manipu- lations are of the easiest and simplest kind, since it is not the doing, but knowing what is to be done, that constitutes the difficulty of practice. The manual duty of the sur-