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PHYSIOLOGY AND SURGERY.
940
importance. The avoidance of the dangerous which sometimes follow the operation symptoms TRADITION dies a slow death and custom often for exophthalmic goitre will never be achieved by remains the only basis for perpetuating a system anatomical studies, nor could it have been argued which long ago should have been superseded by from structure that, in order to anastomose the methods more in conformity with modern intellectual intestine, peritoneal surfaces must be brought and coneeptions. The idea that surgery is primarily a maintained in apposition. mechanical art is ineradicably fixed in the minds of Such examples might be multiplied almost indefimany who do not practise it, and, indeed, in some of nitely, but sufficient has been said to show the parathose who do. Physiology has always been an applied mount place which physiology plays in the problems science, and progress in it waits upon the advance of of surgery. It is not surprising to learn that the knowledge in other directions. The greatest service greatest surgeons have nearly always been physiothat can be done to physiology is the stimulation of logists. VICTOR HORSLEY was a great example of research in such sciences as those of chemistry, this, and it is well to be reminded that LISTER himself physical chemistry, and pure physics. That surgery made many physiological investigations. The associamust always be based upon physiology, whilst tion of the surgeon with the physiologist in many of physiology must derive benefit from the advance of our London hospitals is not as close as is desirable. surgery, is so clear to the thinking active surgeon Whilst the surgeon has everything to learn from the PHYSIOLOGY AND SURGERY.
that it is always a matter of amazement to him that the generally accepted training of the surgeon is not based more upon this conception of the interdependence of the two branches of
knowledge.
vast
physiologist, there is no doubt that he can contribute hugely to the common store of knowledge and so make physiological experimentation conform more to the actual conditions present during life. For it must be admitted that many of the experiments of the physiologist are crude in their commencements,
Sir EDWARD SHARPEY SCHAFER, in the first Victor Horsley Memorial Lecture, which we print in full in so that at firat the deductions made from them require this issue of THE LANCET, chose as his subject the careful evaluation. The ideal in all physiological relations of physiology and surgery, a subject is to disturb as few factors as possible experiments peculiarly fitting for a lecture instituted to com- and those affected should be known. Only in this memorate a surgeon of HoRSLEY’s stamp. In his It way can we obtain unequivocal results. most stimulating address he shows how false is our seems that the realisation of this ideal would belief in the adequacy of the training the surgeon be made appreciably nearer by a closer associaobtains by a prolonged apprenticeship in the dissecting tion of the surgeon with the physiologist, and room. Nothing but the trammels of tradition have there are not wanting signs that this is being allowed a system to persist under which the physician attempted. graduates through the physiological laboratory whilst the surgeon is relegated to the dissecting room. Powerful though many of the remedies of the physician PUBLIC HEALTH IN LOCAL are, the upset to normal physiology effected by the activities of the surgeon is, on the whole, enormously LEGISLATION. greater and infinitely more frequently brought about. THE Special Report of the House of Commons Select Surgery, against all the dictates of scientific methods, Committee on Local Legislation in 1923 gives promiCachexia seems usually to have worked backwards. nence once again to a matter to which once again removal of result from had to complete strumipriva the thyroid before investigation of the functions of we draw attention. " Most of the Bills which your this gland took place ; gastro-jejunostomy, introduced Committee have considered during this, as in previous on a sound basis, was applied to relieve other condisessions, contained provisions relating to public afterwards tions on assumptions which were proved health, sanitation, and other matters which were set the whilst to be large bowel out in the Special Report of 1922. Your Committee actually totally wrong ; was removed in man before the resulting changes would emphasise what they havepointed out in in physiology brought about by its absence had been previous years, that, as many of these powers are now studied in animals. The wonderful power of adapta- usually sought, a consolidation and extension of the tion possessed by the body has masked and remedied Public Health Acts, 1875-1907, so as to include such what otherwise would have been evil results. But powers under general legislation, would be extremely much suffering might have been avoided if surgical beneficial to local authorities." Owing to the problems had been tackled by the methods followed inexplicable delay in printing the Local Acts,1 in other sciences. Sir EDWARD SHARPEY SCHAFER comment on their general contents must be suspended points out how our legislation hinders investigation in till the text is available. Even the Special Report medicine and surgery. It is time to modify the from which we have quoted, though ordered by the dictum that anatomy is the basis of surgery. A correct knowledge of anatomy is as essential to the House to be printed as long ago as July 31st, has only art of surgery as an acquaintance with Greek to the now appeared. The Report, however, mentions an study of the classics. Each science has its own interesting clause in the Chesterfield Corporation Bill technique, the mastery of which is a necessity. There wliieh empowers the local authority to prohibit is a tendency to belittle the place of technique in squatters or gipsies who prove themselves a nuisance surgery at the present time. Nothing could foster or injurious to health from settling within certain delay in progress more than this. The manual work limits. The Report also comments on the measures of the surgeon must be as perfect as that of the for tuberculosis prevention authorised in the Torquay chemical or physical investigator, whose exactness isCorporation Bill. " Your Committee, bearing in proverbial. The mistake is to suppose that such mind the peculiar position of Torquay as a health technique is based solely on the teachings of anatomy. resort, considered it necessary that any person having Such physiological facts as the reaction of the tissues the charge, management, or control of any hotel, to the trauma of operating, or the changes of digestion 1 See THE LANCET, Oct. 6th, p. 796. brought about by new anatomical relations, are of
importance. The avoidance of the dangerous which sometimes follow the operation symptoms TRADITION dies a slow death and custom often for exophthalmic goitre will never be achieved by remains the only basis for perpetuating a system anatomical studies, nor could it have been argued which long ago should have been superseded by from structure that, in order to anastomose the methods more in conformity with modern intellectual intestine, peritoneal surfaces must be brought and coneeptions. The idea that surgery is primarily a maintained in apposition. mechanical art is ineradicably fixed in the minds of Such examples might be multiplied almost indefimany who do not practise it, and, indeed, in some of nitely, but sufficient has been said to show the parathose who do. Physiology has always been an applied mount place which physiology plays in the problems science, and progress in it waits upon the advance of of surgery. It is not surprising to learn that the knowledge in other directions. The greatest service greatest surgeons have nearly always been physiothat can be done to physiology is the stimulation of logists. VICTOR HORSLEY was a great example of research in such sciences as those of chemistry, this, and it is well to be reminded that LISTER himself physical chemistry, and pure physics. That surgery made many physiological investigations. The associamust always be based upon physiology, whilst tion of the surgeon with the physiologist in many of physiology must derive benefit from the advance of our London hospitals is not as close as is desirable. surgery, is so clear to the thinking active surgeon Whilst the surgeon has everything to learn from the PHYSIOLOGY AND SURGERY.
that it is always a matter of amazement to him that the generally accepted training of the surgeon is not based more upon this conception of the interdependence of the two branches of
knowledge.
vast
physiologist, there is no doubt that he can contribute hugely to the common store of knowledge and so make physiological experimentation conform more to the actual conditions present during life. For it must be admitted that many of the experiments of the physiologist are crude in their commencements,
Sir EDWARD SHARPEY SCHAFER, in the first Victor Horsley Memorial Lecture, which we print in full in so that at firat the deductions made from them require this issue of THE LANCET, chose as his subject the careful evaluation. The ideal in all physiological relations of physiology and surgery, a subject is to disturb as few factors as possible experiments peculiarly fitting for a lecture instituted to com- and those affected should be known. Only in this memorate a surgeon of HoRSLEY’s stamp. In his It way can we obtain unequivocal results. most stimulating address he shows how false is our seems that the realisation of this ideal would belief in the adequacy of the training the surgeon be made appreciably nearer by a closer associaobtains by a prolonged apprenticeship in the dissecting tion of the surgeon with the physiologist, and room. Nothing but the trammels of tradition have there are not wanting signs that this is being allowed a system to persist under which the physician attempted. graduates through the physiological laboratory whilst the surgeon is relegated to the dissecting room. Powerful though many of the remedies of the physician PUBLIC HEALTH IN LOCAL are, the upset to normal physiology effected by the activities of the surgeon is, on the whole, enormously LEGISLATION. greater and infinitely more frequently brought about. THE Special Report of the House of Commons Select Surgery, against all the dictates of scientific methods, Committee on Local Legislation in 1923 gives promiCachexia seems usually to have worked backwards. nence once again to a matter to which once again removal of result from had to complete strumipriva the thyroid before investigation of the functions of we draw attention. " Most of the Bills which your this gland took place ; gastro-jejunostomy, introduced Committee have considered during this, as in previous on a sound basis, was applied to relieve other condisessions, contained provisions relating to public afterwards tions on assumptions which were proved health, sanitation, and other matters which were set the whilst to be large bowel out in the Special Report of 1922. Your Committee actually totally wrong ; was removed in man before the resulting changes would emphasise what they havepointed out in in physiology brought about by its absence had been previous years, that, as many of these powers are now studied in animals. The wonderful power of adapta- usually sought, a consolidation and extension of the tion possessed by the body has masked and remedied Public Health Acts, 1875-1907, so as to include such what otherwise would have been evil results. But powers under general legislation, would be extremely much suffering might have been avoided if surgical beneficial to local authorities." Owing to the problems had been tackled by the methods followed inexplicable delay in printing the Local Acts,1 in other sciences. Sir EDWARD SHARPEY SCHAFER comment on their general contents must be suspended points out how our legislation hinders investigation in till the text is available. Even the Special Report medicine and surgery. It is time to modify the from which we have quoted, though ordered by the dictum that anatomy is the basis of surgery. A correct knowledge of anatomy is as essential to the House to be printed as long ago as July 31st, has only art of surgery as an acquaintance with Greek to the now appeared. The Report, however, mentions an study of the classics. Each science has its own interesting clause in the Chesterfield Corporation Bill technique, the mastery of which is a necessity. There wliieh empowers the local authority to prohibit is a tendency to belittle the place of technique in squatters or gipsies who prove themselves a nuisance surgery at the present time. Nothing could foster or injurious to health from settling within certain delay in progress more than this. The manual work limits. The Report also comments on the measures of the surgeon must be as perfect as that of the for tuberculosis prevention authorised in the Torquay chemical or physical investigator, whose exactness isCorporation Bill. " Your Committee, bearing in proverbial. The mistake is to suppose that such mind the peculiar position of Torquay as a health technique is based solely on the teachings of anatomy. resort, considered it necessary that any person having Such physiological facts as the reaction of the tissues the charge, management, or control of any hotel, to the trauma of operating, or the changes of digestion 1 See THE LANCET, Oct. 6th, p. 796. brought about by new anatomical relations, are of