Office Surgery

Cuts, bruises and broken bones make up a large part of an ordinary doctor's practice. But an ordinary doctor does not know much more than his mother or Boy Scout leader taught him about such minor surgery. Medical schools pay little attention to the subject, medical journals less, medical conventions practically none at all. This gap in a doctor's education made the president of the American College of Surgeons, Dr. Eugene Hillhouse Pool of Manhattan, complain recently. Partly because of Dr. Pool's complaint, mainly because he has a fine, two-fingered feel for medical necessities, Editor Thurston Scott Welton of the American Journal of Surgery last week produced a 416-page issue chock-full with 87 articles about the minor surgery which an ordinary doctor can perform in his own office. Dr. Pool blessed Editor Welton's venture. So did the president of the American Medical Association Surgeon Charles Gordon Heyd of Manhattan. And Philadelphia's self-controlled Surgeon William Wayne Babcock, who once awed doctors by violating a surgical apothegm and performing an operation on his wife, contributed the first paper. This was terse, factual advice on--

Wounds & Complications. Wound should be thoroughly, but gently, cleaned was Dr. Babcock's primary injunction Wounds of the scalp, face or neck should be freely flushed with antiseptics (half-strength tincture of iodine is good), grease removed with turpentine or ether, dirt-begrimed tissue cut away, bleeding stopped. Bandages may be applied for 24 hours to limit oozes. After that "no dressing is necessary. . . . Dressings about the openings of the mouth, eyes and nose are particularly objectionable, as they retain decomposing secretions in contact with the wound." Infection or disfigurement, declared Dr. Babcock, "from an incised or even the average lacerated wound of the face or the scalp, as a rule, indicates a slipshod operation or lack of surgical skill."

Wounds of the feet should be treated with mild antiseptics, and vitality of the tissues should not be destroyed by handling, tight bandages or sutures. Drains should not be used in foot wounds because "they provide a path for the entrance of surface bacteria to the depths of the wound. At times they are used to salve the conscience of the operator who knows that he has been inexcusedly careless in his sterilization or hemostasis [arrest of bleeding]."

If great swelling follows contusion of arm or leg, tension in the tissues should be relieved quickly by bold incisions into the flesh on opposite sides of the limb. Copious dressings of weak bichloride of mercury solution will then promote healing. Such incisions are rarely necessary for contusions of the trunk or head. "An uncomplicated wound should not cause intense pain."

Dr. Babcock forbids the use of formalin, carbolic acid or lysol in dressing wounds because they retard healing. He recommends weak wet dressings of bichloride of mercury or iodine, bromine (for fetid wounds), and aluminum acetate (for raw skin).

More Babcock apothegms: Use only alloy steel wire to suture wounds, never catgut. "Suturing with living fascia to me recalls the barbaric surgery of savage tribes." Cold retards healing, warmth favors healing. "Ice bags or cold solutions should not be used on tissue of low vitality." In infections by staphylococci (e.g., boils), operate. In streptococci infections (fever is a sign), wait. "Transfusion has a high mortality in infancy. Many more babies have been killed than saved by the injection of blood."

Human Bites often cause deformities and amputations because deadly germs which may flourish in the mouth get into the torn flesh. Such wounds suppurate horridly. About 80% occur on hands and fingers. Most common place is the big knuckle of middle or index finger. This injury occurs when a clenched fist strikes against a row of teeth. To prevent infection, Dr. Edward Patrick Dunn of Brooklyn cauterizes every bite with fuming nitric acid or electric cautery, makes no attempt to close the wound. If infection sets in, he lances the wound to establish drainage of pus, applies warm, moist dressings, irrigates with potassium permanganate or hydrogen peroxide.

Stye, or hordeolum. Dr. Edward Joseph Bassen of Manhattan treats styes with hot moist compresses for 15 minutes three or four times a day, until they come to a head. Then he lances them and evacuates the pus. He never uses yellow oxide of mercury, which "is still the universal home remedy."

Cinders & Splinters-Before trying to remove a cinder from the eye instill a drop of cocain or other local anesthetic. If nothing is then visible instill a drop of 1 % aqueous Mercurochrome which will show up any scratches on the cornea. Before trying to remove a splinter from a hand, soak the hand in hot soapy water for 15 minutes. Not every splinter need be removed. Many work to the surface by themselves.--Dr. Howard Leighton Updegraff, Hollywood, Calif.

Pimples on Face. The flesh of the face is very spongy. The veins there form a complicated web and have no valves. Therefore an infection may spread rapidly and a pimple become deadly. Advised Dr. Gerald Hillary Pratt of Manhattan: "If the pimple is not disturbed it will invariably subside."

Moles. "Some moles have an element of potential malignancy, but it may also be stated that the common mole, especially if it has hair, rarely becomes malignant even when irritated. ... It is absolutely safe to remove any ordinary pigmented mole, especially if it contains hair."--Dr. Joseph Louis Morse of Manhattan.

Spinal Dislocations. In the frequent accident where a person falls or is thrown in such a way that his spine telescopes, the injury usually occurs in the small of the back. Dr. Robert Louis Preston of Manhattan said: "If they can be treated within 24 hours, most of the wedging of the body can usually be overcome by careful manipulation under general anesthesia." Dr. Preston lays the patient face downward with head and shoulders on one table, hips and legs on another, the trunk sagging downward between the tables. This "forces the spine into hyperextension and reduces the deformity." A plaster cast keeps the spine stretched that way for twelve weeks, eight of which the patient must remain in bed.

Fractured Ribs. Children seldom break their ribs. Adults usually break theirs by falling or being struck, and in rare cases, by coughing, sneezing or laughing. A broken rib hurts precisely where it is broken. Treatment is by immobilization. The patient stands with his back to a wall with the arm on the fractured side raised. He exhales and holds his breath. Quickly the doctor wraps strips of adhesive plaster around the injured ribs, running the plaster from breastbone to spine. After two weeks, the plaster is replaced, and after two more weeks the ribs are healed. Dr. Lester Breidenbach of Manhattan remembered to note: "A hairy chest should be shaved."

Bunions. More women have bunions than men. High heels make women walk on the balls of their feet. Walking that way spreads the small bones of the foot. The spreading makes the big toe twist and turn towards the little toe. That distortion inflames the main joint of the big toe and causes new bone to form in the joint. First treatment for bunions which Dr. Wilder Price Armstrong Jr. of Springfield, Ill. uses is hot compresses to the bunion to reduce inflammation and pain. After that he chisels bones in the feet, shortens tendons, applies plaster casts.

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