The profession of a surgeon is of the highest importance to society, and it requires a greater combination of talents than any other within the circle of scientific attainments. The object is certainly more nearly within the reach of the senses. The surgeon has not, like the physician, to contend often with a form or phantasm. Vet he cannot pursue a disease in all its bearings, in all its consequences, without the most careful discrimination of causes and effects, without an attentive examination of the influence of an injury on the most distant parts. With these powers, he must have a command of hand to enable him to direct his knife with the utmost nicety and precision; a mind unruffled by any accidental unexpected occurrence; and a readiness of resource to supply the assistance necessary in any emergency. His senses must possess peculiar acuteness, particularly the feeling, which is often more important than even the sight. His hand must not tremble; his mind be unassailed by fear, by apprehension, or doubt, when the necessary operation has been once decided on. It is observed by Celsus, that a surgeon should be able to use either hand; but, by attaining this power, the right might lose a portion of its dexterity; and, though the left may occasionally in the less nicer parts assist the right, yet it should not be wholly trusted. It is said that the surgeon should be young, at least so young as not to have the necessary powers impaired, and of sufficient age to have attained the requisite experience. Undoubtedly, by age the faculties are blunted: doubt and hesitation take the place of a proper confidence and a manly firmness; the hand is less steady; the feelings less acute. The age cannot be fixed, since the powers of each individual differ at a given time of life. We have known many surgeons of character and abilities who have limited their professional career at the age of sixty. But this decision, formed with the candour and ingenuousness of youth, has been forgotten when they reached the limit. It shows, however, their opinion; which were we to controvert, it would be by fixing a less extended period. But this we would only confine to capital operations; long after sixty a surgeon of abilities may be eminently useful in consultations.
A quality very necessary for a surgeon is, a knowledge of mechanics, and a readiness in adapting little mechanical contrivances to the exigencies of the moment. It is inconceivable how much pain and distress are alleviated by such ingenuity; how the cure is often accelerated, or the spirits supported.
Humanity is, above all, required to complete this first of characters, a good surgeon. In general, surgeons are proverbially cruel, and they often must be so to fulfil their duty. Yet there is a tenderness of manner that makes even cruelty tolerable; in comparison, amiable: and, though the surgeon ought not to feel, he should as much as possible lessen, the patient's pain, and appear to be sensible of his sufferings. A softness of manner, a gentleness of voice, and even a delicacy of form, are not without their effect; and whatever can alleviate distress, though trifling in the general scale, should not be neglected. To the one the patient looks with horror as the butcher; to the other as the ministering angel, bringing balm on his wings to heal and to save. We have employed these few lines for the sake of our younger brethren. May they not be without their effect!
We thought that we had completed our task, when we were reminded that the recommendation of the study of anatomy was omitted; but this first, this most important, qualification, can never be neglected by him who aims at the character of an accomplished surgeon. It should be his study day and night: the human body-should be the work, nocturna versari manu, versari di-urna. The knife should be constantly in his hand to attain a readiness in using it in every direction; to vary the direction in a moment at every angle of obliquity; to stop; to proceed; to alter the velocity with the readiness which governs the movements of the best managed horse, or, to employ a more delicate metaphor, the finger of the most experienced musician. But this must be a part of his education; nor should he claim the confidence of the public till all these qualities are attained.
The study of the practice of physic may not be considered as essential to a surgeon: yet, as the complaints which are occasionally arranged under each head vary in their minute shades and press on each other, it is highly necessary that medicine should make a part of his education. It has, however, often happened, that a knowledge of the one has led to a presumption that it has equally inspired an acquaintance with the other; and each has intruded in a department not his own, without a sufficient qualification for the due exercise of it. A surgeon should, we think, possess a sufficient knowledge of medicine, to regulate the general treatment of the diseases within his own limits. Beyond them he should not pass, without having paid that 3 I 2 attention to the other science, which, had he cultivated with care his own, he would have little opportunity of attaining. The physician should be equally careful of interfering; yet, in a comprehensive view, surgery becomes a part of his profession. A man of science grasps particulars in an outline; and as the operative part is beyond his limits, there is nothing to prevent his acquisition of so much of surgery as will enable him to assist, sometimes to direct, the less experienced practitioner.
One other subject only remains; a subject which we could not have supposed would ever have occurred in a questionable form, viz. whether surgery is improved by the labour of the moderns, and raised above its former state. Let humanity decide, and the cause will be soon determined; but we will not harrow up the soul by the repetition of former cruelties. The question will recur in another shape: Is the modern surgeon more successful than his predecessors ? The reply is easy. Do we still pour hot irritating oils on gun shot wounds ? Are not wounds quickly cured by the adhesive inflammation, which required months by the former methods of suppuration? Is not the stump healed, by means of the flap, in a few weeks? Docs the wound, from which the cancerous mamma has been extirpated, require any thing more than superficial dressings ? To pursue the subject minutely, would be to waste the reader's time and exhaust his patience. Let us select an instance or two. In herniae the operation was precarious and ill understood: it was consequently but seldom attempted. The modes of reduction were little known, and the trusses so imperfectly calculated for the purpose, that, when reduced, the intestine was seldom retained. We have selected this instance; because we can appeal to facts, viz. the numerous advertisements, even in the beginning of the last century, of rupture curers. The greater number we now know can be reduced and retained with little difficulty; and of those cases which require the operation, nearly one half escape. If the operation were not too long delayed, the proportion of successful cases would be greater.
In lithotomy, confined for ages to one set of practitioners, the means were limited and inadequate. The method described by Celsus was, from its nature, confined to the age of from nine to fourteen. How many years previous, how very many subsequent, to that age, must have been spent in 'unsufferable agonies ! What then was the attempt ? First, with the greater apparatus; and, secondly, in the higher way. Even When it succeeded, an incontinence of urine frequently followed each; and in the greater number it failed. When Frere Jacques pointed out the lateral operation, how crude and imperfect were his first ideas! The grooved staff and the cutting gorget were the improvements of very late years. But, previous even to the latter, Cheselden had so far simplified the operation, that many surgeons have professed being able to perform it in the dark. Indeed, it is one of many operations which depends on the nicety of the feelings rather than she sight.
The systems of surgery in our hands are few. The practice of the ancients may be found most eloquently described in Celsus; but at greater length, and often more satisfactorily, in Albucasis, with numerous improvements, which he claims as his own. It was published with Guido's Surgery, in folio, at Venice, 1500; again in 1506 and 1520; but the best edition is that of Strasburgh, in 1532, or that at Basil, 1541.
Heister connects, very properly, the ancients with the moderns; and, among the latter, Mr. Benjamin Bell almost stands alone; for Mr. Latta's system is less complete, and Mr. J. Bell's a very inferior work. Mr. B. Bell is, however, too minute and tedious; and so disproportionate is his share of attention, that bleeding occupies nearly as many pages as lithotomy. The chief inconvenience, besides unreasonably enlarging the work, is, that the young surgeon may attempt the more important operation with the same confidence that he has often successfully performed the less. From the character of Mr. Blair, we have reason to expect, with some impatience, his promised system.
To enumerate the other independent works is unnecessary, as they will occur under each head, and they are so numerous as to form an extensive catalogue.