Gentle Science

In the last 20 years, surgery has explored every organ of the body. Many a surgeon, flushed with scientific and financial success, thinks of his profession as a game of skilled slashing and speedy patching. Greatly worried by this too-common, hardboiled attitude are Dr. Elliott C. Cutler, chief surgeon of Boston's famed Peter Bent Brigham Hospital, and his associate, Dr. Robert Zollinger. To them surgery is not only a science but an art, a religion, and a means of self-expression. Last week they published their new folio-sized manual of surgery,* first book of its kind since 1853. Full of brief, "intimate" instructions for every type of standard operation from appendectomy to tonsillectomy, their manual is also crammed with scalpel-neat pen-drawings by Medical Artist Mildred Codding. As important to the authors as the practical instructions for "unfledged surgeons" are the simple, poetical introductory chapters on the "science of gentleness."

Young surgeons, say Drs. Cutler and Zollinger, may not recognize the dangers in disturbing the mosaic of living cells, because they are usually taught anatomy and pathology on "tough, dead, chemically fixed tissues." Older surgeons may be "irked by the constant emphasis on gentleness." But each cell in an operation must be protected "with exquisite care." With "careful hemostasis [damming of blood] and gentleness to tissues, an operative procedure lasting as long as four or five hours [leaves] the patient in better condition . . . than a similar procedure performed in thirty minutes. . . .''

For maximum surgical success, hundreds of delicate precautions must be observed. A surgeon should make incisions with "a deliberate sweep of the scalpel." but "the belly of the scalpel should be swept across the tissues, not pressed into them." Sutures should be of silk "so fine that it -- breaks when such strain is put upon it as will cut through living tissue. . . . One-handed knots and rapidly thrown knots are unreliable. Each knot is of vital importance in the success of an operation." Fresh wounds should be sealed with silver-foil, for "silver has bactericidal qualities." A surgeon must know the benefits and dangers of every type of anesthetic; local anesthesia, for example, should not be used in malignant tumor operations, or in the presence of infection, for the anesthetic needle may pick up cancerous cells and start the "seeding" of tumors, or it may injure healthy cells and make them prey for dangerous bacteria already lodging in the body.

"Handling of tissues with fingers cannot be as facile, gentle or safe as handling with properly designed, delicate instruments." A surgeon should spend his life in "a constant search for better instruments until he emerges finally as an artist, not an artisan." Blood transfusion is "essential in certain disorders, and most valuable in preparing the patient for a major ordeal; but its use following a surgical performance is at least suggestive that a more careful technique would have made this unnecessary."

Of great importance is the setting of the stage for operation. "Loud talking will appear out of place, the noise of scrub basins will be subdued, the unnecessary dropping and rattling of instruments will disappear, and the operating room will be what it should always be--a place for serious labor where each day lives are risked. . . . The ritual of a well-performed surgical procedure should have much in common with religious functions."

*-ATLAS OF SURGICAL OPERATIONS--Macmillan ($8).

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