line, furnishing the chief elastic sup- port of the perineum. Sutures which brought together fascia carrying the transverse perineal and bulbo cavemosus muscles were then applied. This satisfied the surgical sense, because the chief muscles involved in the operation were actually under observation when they were sutured. The operation made very strong repair in the average case, and could be done with no instruments excepting a pair of scissors and a needle in five or six minutes' time. The procedure was so simple that 1 called it 'the office boy perineum operation'] because an ordinary office boy could do it well, and without operative ado after once seeing it performed. Others have recently been publishing the technic of this operation and it appears to be well established. When scissors were employed in some of the surgical work for which a knife was customary, it promptly aroused comment, and was ascribed to my having peculiar ideas, matter of fact there seems to be less oozing when scissors are used, because of the constriction of small blood vessels which are 'sheared.' Certain work can be done more safely by advancing with scissors instead of with a knife, and the field in which they might be used to advantage was so large that they were made to supplant the knife practically altogether for tomorrow's topics. While just to show what could be done. Now as the subject has received sufficient comment, and enough demonstrations have been made before my class at the College, the knife will be employed rather more than during the past five or six years. There is abundant testimony to the advantage of using scissors instead of the knife in very much of our work that was previously done with the knife only. Letters from many surgeons tell of the advantages they have gained from observing the use of scissors, and they ask about particular models which are to be used. It is well that they ask this latter question, for it is a very important matter. One will have to devote considerable attention to the subject before making a choice of models of scissors, and getting the right sort of steel. Small matters are not small matters in surgery. It is not unlikely that the employment of scissors in place of the scalpel has cost me a plump hundred thousand dollars. The reason is because that sort of choice is looked upon as a mark of eccentricity, and serves to identify one with peculiar ideas, excepting in the minds of men who have time to stop and give the matter full consideration. The business man will ask why a surgeon should persist in employing a method which he knew would cost him a loss of a hundred thousand dollars. The answer is that a profession is better than a business. There are a number of advantages associated with the use of scissors of the right sort, in surgery. One may work much more rapidly and with less danger of injury to structures in certain operations, and my idea was to impress the profession with that fact by giving continued object lessons to my classes at the college and elsewhere. While surgeons in general are poking fun at such an idea, every once in a while somebody stops to think. <Callout type="tip" title="Advantages of Using Scissors">Using scissors can reduce oozing due to constriction of small blood vessels.</Callout> One may imagine that he foresees all the factors in a problem, and yet some little practical point will defeat all of his work. I devised a silver tube, placed one end of it in the lateral ventricle of the brain in a case of hydrocephalus and placed the other end of the tube in the temporal vein, believing that an advance step would thus be made in the treatment of these cases. The fluid would not flow from the ventricle into the vein because it apparently remained in a sort of equilibrium, a balanced pressure, without vis a tergo sufficient for distending the temporal vein which had collapsed at the point of introduction of the tube. When upon the house staff at Bellevue Hospital the question of suture in cases of recent simple fracture of the patella was brought up by Dr. Fraser Fuller, and after he had sutured one, I took up the work and we performed the first six operations of this sort that were done in this country. Dr. Fluhrer, the skilled technician, was visiting surgeon for my division, and it was through his kindness and under his direction that I was allowed to apply the principles of antiseptic surgery in a field (joint surgery) which made the older surgeons stand aghast at that time. My published paper on the subject called out violent protestations from surgeons over the entire country, and younger men of today who suture simple fractures of the patella as a routine procedure can have no conception of the feeling that was engendered by the proposition to do that sort of work in the early eighties. Osier brought out a storm of adverse criticism when he said that few men did any creative work after the age of forty, and men past that age should be chloroformed. As a matter of course this latter exaggeration was intended for fun, but was taken up by people without proper sense of humor who did not know Dr. Osier the wag. They neglected to place emphasis upon the key word 'creative.' Osier was quite right in the basic idea notwithstanding the fact that numbers of men achieve their greatest success from the world's point of view after they are long past forty. It will be found that most of them whose minds are engaged in creative work do most of that work before the age of forty. Curiously enough, Harvey chose to speak of the same age when stating that no one past the age of forty could be got to adopt his theory of the circulation of the blood. A letter of Darwin's in relation to the origin of species stated that he expected to convert only young and flexible minds. About thirty years was required for the adoption of Harvey's theory and his friend Hobbs said that he was the only man who had the good fortune to see a new doctrine accepted by the world at large during his life time. At the present time progress is much more rapid and we have seen a number of new doctrines accepted in as short a time as ten years. Galileo writing to Kepler on the subject of the telescope said, 'Oh, my dear Kepler, how I wish that we could have our hearty laugh together. Here at Padua is a principal professor of philosophy whom I have repeatedly and urgently requested to look at the moon and planets through my glass, which he pertinaciously refuses to do.' Our profession is certainly intolerant of any doctrine that does not agree with prevailing medical thought, and is often so intolerant as to be seemingly cruel. Men have died of broken hearts from ridicule or abuse, because they were advocates of theories which later became solid rocks in our foundations. If Semmelweiss was actually killed by the attacks made upon him because he argued that puerperal fever was a preventable bacterial disease, and if Oliver Wendell Holmes did die while being held up to scorn for the very same belief, it was probably because Dr. Holmes had a larger sense of humor than Semmelweiss. Men without sense of humor must be cautious about attempting accomplishments. This again illustrates the point which I have previously made about the weakness of sensitiveness. The colleagues who attacked these innovators were not to blame. The enemies were men of strong conviction based upon the perfectly legitimate knowledge which they had consistently and conscientiously gained to date, and their established ideas were about to be overthrown. Medical opinion which has been slowly and strongly formed in the interests of human welfare is not to be thrown over in a moment by the wish and will of any one individual. When such an individual believes that existing opinion wrong and that he must oppose it, he is not to complain if his vanity becomes battered and dented- It is a matter of injured vanity if he is distressed. What else is injured when one is attacked? Men who suffer and who die because of adverse criticism do so because of functional derangement of their vanity. That is the diagnosis one might make on post mortem examination of the psyche. Were it not for this natural opposition to novelty which is inherent in every stable profession, there would be no stability, no safe tradition, and we would whirl about in response to every gust of doctrine. It is well to distrust both the adventurer and the true investigator. The coins of both are certain to be handled by a profession which will find out quickly enough which ones ring true and which ones ring false. Nothing but vanity causes the wish for obtaining recognition for discoveries, provided that one is a true worker for science. A man must decide at the very outset of his career that whatever he does in an active way will hurt him, because every new movement in a profession or business will set up a series of reciprocal changes, and these vary proportionately with the degree of force which he expresses. He may find comfort retreat, if that seems to be worth while, and if retreat more satisfactory to his type of mind. He will no doubt read the histories of various innovators in all fields of human activity. These records are commonly couched in terms of sadness or of triumph by historians, who tell of the struggles against tradition and the obloquy and derision that were aimed at an individual who formed the subject of their essay. As a matter of fact, the contemporaries of an innovator who are held up in contempt by historians, had their own large and proper side for every question. A man who follows up a line of new work is by no means to be trusted fully by his responsible contemporaries, — and if free from self-delusion, does not even trust himself fully beyond the matter of intention. In olden times men who were engaged in disturbing the smooth course of tradition were sometimes put out of the way, — but now-a-days they are quite safe so far as the question of staying alive is concerned. Times change so rapidly now-a-days that if one can hold to a good new idea for a long enough time, and strongly enough, someone is almost certain to arise in the course of a few years and exclaim, 'By George, he is right!' He may kill off antagonists very much as a certain young hunter is said to have killed a grizzly bear. The hunter was reported to have run the bear to death, and on further explanation stated that he was ahead of the bear all of the time. The subject of medicine like that of other sciences has merely been scratched on the surface as yet, and our openings are simply deep enough to show the richness of the deep, unturned soil. One cannot go for a three-months' vacation without getting behind the times, and by the time when a book is published it is nearly out-of-date in medicine and in the other sciences to-day. Man having lost the rat stage of instinct and not yet developed to the point of making reason take its place, goes at his great questions very clumsily. Even such a great mind as that of Darwin engaged itself with adult forms of life when p 310 TO-MORROW'S TOPICS studying questions of struggle and of mutual dependence. The eugenists to-day are confused over their problems which relate to the higher and more complex forms of life. If the eugenist of to-morrow may have his reasoning methods guided by instinct like that of a rat, he will study his problems basically from some microbe like streptococcus viridans, which in the course of a few days may develop several strains with their respective hereditary characteristics, and mutant forms peculiar to each strain. These mutants and varietal forms in a very few days more may go back to the original parental type; a toy model of the whole subject of eugenics. A very large field of surgery is to be opened by our new knowledge relating to the influence of enteric toxins. A start was made in a rather crude way, surgically, when excision of all or part of the colon was done in cases of colonic stasis in which medical resources failed to relieve patients sufficiently. The next step in progress consisted in hanging up sagging colons and in that way lessening the degree of stasis. This was a marked advance with a smaller death-rate, and added a means for securing a great deal of comfort in well selected cases, when surgeons like Coffey and Reed did the selecting, and personally applied their highly artistic technic. A third step in progress at the present moment seems to be better still. It consists in making a short-circuit between parts of the bowel in such a way as to throw most of the colon out of commission. A fourth step with which I am now experimenting consists in making longitudinal inversion of the colon, folding it in upon itself and not removing any part of it. The operation is done so easily and with so little shock that patients bear this work without much difficulty or apparent risk, and it now remains to determine the sources of danger and failure. Almost every new procedure is found to have some unexpected drawback. We have moved very rapidly from the ruder features of this new work of relieving bowel stasis to more efficient and safer methods which rarely need to be supplemented by the severe work of colectomy. We shall tomorrow have a diminution in the number of certain cases which were formerly held to be purely medical. Some of the cases of intractable neuritis, neuralgia, migraine, epileptiform seizures, and some of the psychoses, will be disposed of by surgery, to say nothing of those cases of excessive nervous irritability, moroseness, rheumatism, arteriosclerosis, and skin diseases of the sorts which we have gradually begun to associate with poisoning from some part of the alimentary tract processes. One of my patients has been relieved from a most distressing spasmodic asthma by short-circuiting of the bowel. In fact, one does not know where to begin or to end in speculation over the possibilities of this new 'preventive medicine.' There will be a lessening of the secondary group of disturbances which lead to arrested development of organs of the embryo. At the present moment there is apparently no more promising field for inspiring new work than the proper and careful elaboration of cases which are to be recognized in competent consultation as belonging to the toxic enteric group and in which the patient may often be relieved and sometimes permanently cured by our new surgery in this field. Many mistakes will be made, to be sure. We are getting toward the point where the idea of very distant influence of enteric toxins may be considered practically, I have reported one case in which a clergyman after becoming nearly blind from chorioiditis was obliged to give up his work. Dr. Kirkendall of Ithaca acted upon the idea that such cases might be of toxic origin, and sent the patient to Dr. Stockton of Buffalo for consultation. Dr. Stockton went a step further, and stated that the condition was not only of toxic origin, but he specified colonic bacteria as the probable mischief makers. Both consultants then agreed that fibroid degeneration of the appendix might be the exciting factor for excessive development of colonic bacteria in this case. The appendix was removed. The patient did have fibroid degeneration of the appendix; he did have excessive growth of colonic bacteria, — and immediately after removal of the primary disturbing factor from the case the series of secondary results came to an end. The patient recovered from his blindness and went back to work. It is not so very long ago that such a series of events in connection with a case of chorioiditis would not have been anticipated. That is the sort of work we are now to do, instead of 'giving the patient something to try.' We all remember very well when physicians were quite ready to prescribe for dyspepsia or for chronic constipation without first having an X-ray picture of the stomach or of the colon for guidance. It was only a few years further back when doctors applied splints for fractured bones without having a radiograph for guidance. The X-ray is now quite as important a diagnostic resource in dyspepsia and constipation as it is in fracture. Our first interest in the study of microbes came with the knowledge of injury that is done to higher organic life by harmful species. It was this first knowledge that developed the hostile attitude of mind on the part of the public toward microbes in general. We next learned that cells of our bodies are amoebae, and inimical to many kinds of microbes, — next, that several species of microbes were useful to us, not only in making food for us, but in helping to prepare it for assimilation (symbiotic microbes). We learned later that some kinds of microbes were harmful to each other, and our last knowledge impresses
Key Takeaways
- Using scissors instead of knives can reduce oozing due to constriction of small blood vessels.
- Surgeons should be prepared for criticism and opposition when introducing new techniques or ideas.
- The field of medicine is rapidly evolving, with new discoveries and procedures emerging frequently.
Practical Tips
- Consider using scissors in surgical procedures where they can reduce oozing and provide a safer alternative to knives.
- Be open to new medical technologies and techniques as they emerge, even if they seem unconventional at first.
- Document your surgical practices and outcomes for future reference and improvement.
Warnings & Risks
- Be cautious of the professional backlash you may face when introducing innovative surgical methods or ideas.
- Understand that some traditional surgeons may be resistant to new techniques due to established practices.
- Do not rush into adopting new procedures without thorough research and testing.
Modern Application
While many surgical techniques have advanced significantly since 1915, the principle of innovation and the importance of overcoming professional resistance remain relevant. Modern survival preparedness can benefit from understanding historical approaches to medical challenges, recognizing that progress often involves facing skepticism and criticism.
Frequently Asked Questions
Q: Why did the author use scissors instead of knives in certain surgical procedures?
The author used scissors because they were less likely to cause oozing due to constriction of small blood vessels. This made the procedure safer and more efficient, as it reduced bleeding and allowed for quicker recovery.
Q: What challenges did the author face when introducing new surgical techniques?
The author faced significant professional opposition and criticism from other surgeons who were resistant to change. Despite this, he persisted in his methods because he believed they offered substantial advantages, such as reducing oozing during surgery.
Q: How did the author view the role of innovation in medicine?
The author viewed innovation as essential for progress in medicine but warned that it often met with resistance from established professionals. He emphasized the importance of perseverance and the potential long-term benefits of new ideas, even if they faced immediate criticism.