RED-HOT IRON IN SURGERY.

Otago Daily Times, Issue 20380, 11 April 1928, Page 12

RED-HOT IRON IN SURGERY.

PROFESSOR BIER’S THEORY. At a. meeting in Beilin Professoi August Bier expressed his belief that in its onward march the medical irofession has left behind an invaluable weapon the “actual cautery.’’ He urged that we should go back and fetch the redhot irons with which our forefathers so vigorously wrought against disease, and he supported this plea by reference to nearly 100 patients treated by “ burning “ in his own clinic (saysa medical correspondent of the London Observer). Among those for which he claimed success were cases of inflammation round the heart, in which the outlook seemed hopeless, and of suppurating joints where the onlv chance seemed to lie in amputation.

Inflammation and fever, he said, are the two chief means by which the body reacts against infection, and where the reaction is inadequate it must be stimulated artifically. When a method of treatment has been in use for 1000 years or more, it may be a mistake to discard it too suddenly. For example, we are to-day discovering that “ bleeding ” has more to recommend it than is commonly supposed, and the same is doubtless true of cautery, though there are certain good reasons for its decline. Before the days of antiseptics, the application of a hot iron was the only effective means of combating infection v in a septic wound; nothing else would stop bleeding, kill bacteria, and leave a clean surface when the damaged tissues had sloughed away. The method is still employed, with admirable results, in various operations where a blunt “ knife,” electrically heated, is used to divide one structure from another. But in a minor surgical practice the cautery has been almost displaced by antiseptics, irrigation, and the knife. It is not, however, as a cleansing agent that Professor Bier seeks to reintroduce it, but rather as a counter-irritant, and he is probably right in saying that counterirritation has" been too much neglected. Many different methods were formerly employed for the purpose. There were blisters and plasters—still used today. There was the seton, a piece of thread drawn to and fro through the skin, so as to set un inflammation over a small area, and there were other devices with the same such as insertion of a bead under the skin, or burning saltpetre on its surface. It is said that piercing of the ears was so much practised for ophthalmic disorders that anyone wearing earrings might be assumed to have had weak eyes, unless he was a sailor.

Counter-irritation, properly done, Is rational, because internal organs are indirectly connected with particular areas of skin through the nervous system, and can be influenced from without. . Irritation, moreover, directly increases the flow of blood to the selected locality, and this may b e of the utmost value, because healthy blood contains cells and substances directly hostile to bacteria. Unless remedial steps are taken the amount of pure blood reaching a particular area is apt to be reduced when it becomes infected. Thus cautery and the other stimulants mentioned may be of assistance against sepsis by drawing more blood to the scene of battle. Professor Bier however, does not think that the effect of cautery is purely local, and where for any reason local treatment is undesirable he applies a special form of burn to the chest. For this he employs what seems to be an entirely new technique. The skin is first raised by dissection ; then the upderlying tissues are cauterised; and, lastly, the skin is replaced so that hardly any scar is left. This subcutaneous cauterisation, he claims, causes substances to pass into the circulation -which protect the body against bacteria, but this view will not appeal to those who regard the products liberated in burns as directly poisonous. Nor will deliberate destruction of tissues, involving liability to infection, commend itself to practitioners who ar e satsfied with other ways of getting the same results.^ Fomentations, leeches, cupping, hot air,, and various applications enable us to increase the flow of blood to an area with out causing damage, whilst electricity can be used to heat the tissues to any required degree short of burning. The actual cautery may have its own special advantages, But Bier’s appeal—although it comes with weight from a man who has rendered great services to surgery—is unlikely to replace the hot iron in the terrifying position which it formerly occupied in the medical armamentarium.