Ameliorative Surgery

MODERN SURGERY

The era of modem surgery probably began with the notable event of the performance (1809) of ovariotomy (removal of the ovaria) in the treatment of ovarian disease by the American surgeon Ephraim McDowell of Kentucky. Nathan Smith, a physician in Massachusetts, also performed ovariotomy in 1821, without knowing of McDowell’s work. The American surgeon Valentine Mott ligated important blood vessels in the treatment of aneurysm (abnormal expansion of a blood vessel); James Sims, of Alabama and New York, became known as the founder of modern gynecology; Samuel Gross of Philadelphia was a great surgeon and teacher. Sir Astley Cooper of England and Sir Charles Bell and James Syme of Scotland were outstanding surgeons.

With the discovery (1842-47) of anesthesia, the barrier to the progress in actual operations was removed. Hospital gangrene, septicemia, tetanus, and pyemia remained as problems, however. Not until the French chemist Louis Pasteur evolved his germ theory and discovered that fermentation is caused by microorganisms. When the British surgeon Sir Joseph Lister applied the discoveries of Pasteur to surgery and formulated his theory concerning sepsis and antisepsis, another major obstacle was removed.

Surgery today is practiced for the following purposes: diagnosis, such as surgical opening of the body for exploratory purposes, and excision of tissue for examination (although modern diagnostic tools eliminate the need for some of this); the correction of deformity or defect; the cure of disease; the amelioration of suffering; and the prolongation of life.

Corrective surgery

At present, corrective surgery is employed for clubfoot, harelip, cleft palate, bowlegs, deformed spine, congenitally dislocated hip joints, and many heart and blood-vessel diseases. In correcting defects caused by accident or disease, plastic surgery is used.

Curative surgery

Surgery is employed in the treatment of sarcoma, tuberculosis, and osteomyelitis. The brain is subjected to inspection and many kinds of operations, including removal of tumours, evacuation of abscesses, and clearing of blood clots and other obstructions to blood vessels are performed.

The vascular system, including the heart, has been brought within the domain of experimental and practical surgery. Whereas a large proportion of the practical surgical work on the heart formerly dealt with injuries such as stab or gunshot wounds, many current heart operations are performed to correct congenital heart abnormalities and tight or leaky heart valves resulting from diseases such as rheumatic fever. Many blood-vessel diseases that were formerly fatal or crippling are cured surgically today. The surgeon can restore normal blood circulation to vital organs by eliminating obstructions and stopping leaks in arteries. Arterial defects can be repaired by opening the vessel and scraping out the clot; bypassing or replacing the obstructed segment with a natural or synthetic graft; or widening the bore of an artery by inserting material in its wall.

The history of thoracic surgery was entirely changed as a result of the invention of means of operating upon the lungs and other thoracic viscera without collapse of the lungs. This is accomplished by various kinds of apparatuses designed to maintain the necessary differential air pressure during the operation, by the hypoatmospheric and the hyperatmospheric methods. In present-day surgery, one lung or portions of a lung can be removed safely in patients with cancerous conditions or inflammatory infections such as tuberculosis.

In surgery of the gastrointestinal tract, ulcers and tumors arc excised, injuries are repaired, adhesions resulting from inflammatory processes are broken up, and portions of the tract that are distorted as a result of adhesions are restored to normal function. Again, lasers may be used to cauterize lesions. Portions of the stomach and intestine are sometimes removed because of an ulcer or cancer. The liver and gallbladder and their appendages can also be operated on successfully. For example, when gallstones are present the gallbladder can be removed – the cholecystectomy is performed.

The genitourinary system, that is, the kidney, bladder, and organs of reproduction, is the site of many operative procedures. Surgery of the female generative organs, such as ovaria, uterus, and Fallopian tubes, is a field in which impressive achievements have been recorded. The present trend in the surgical treatment of these organs is toward conservatism.

Ameliorative Surgery

Surgery is often employed to ameliorate suffering when a cure is unlikely, especially in the relief of cancer. Suffering may be relieved by cutting nerves that are pressed on by the tumors; by removing portions of the malignant growth that impinge on other organs, causing pain or impaired function; and by clearing up ulcerating areas and skin grafting.

Date: 2016-04-22; view: 2197