The Lust for Operation.

New Zealand Graphic, Volume XXXIII, Issue II, 9 July 1904, Page 56

The Lust for Operation.

(An .ultlres-* before the annual meeting nf the New Zealand branch of the British Association.) (By Dr. Hafherley. Wanganui.) Tl.o old s bool of surgeons, who regarded operative treatment as a last lather than as a first resource, seems to be slowly yet surely dying out. A later school is springing up in our midst who arc extending the scope of operative procedure In every direction, and appear to be never quite happy unless t hey are using their one sovereign remedy for all the ills that flesh is heir io the knife. The fact that with a careful antiseptic or aseptic technique the human body will survive a marvellous amount of mutilation has created a demand and a supply of operating surgeons who are ever on the qui vive for something to find which will in their opinion necessitate an operation. They seem to be guided by the principle that a diligent search may often disclose some slight lesion which can either be cut out or stitched up. rather than seek to discover some method of treatment which does not necessarily involve an operation. I me the word “lust" advisedly, because with some practitioners the desire to operate is so tierce as to be well-nigh insatiable. They have their own private- hospitals, their own staff of nurses, and their own assistants; they studiously ignore the usual medical attendant. who. if consulted, might possibly be in favour of milder measures; and grave surgical operations are being performed almost daily without any of the which are strictly enforced in our public hospitals. What I have termed “the lust for operation" has been. I am firmly convineed, the main cause of many operations being performed, to say the least, prematurely, and too often without the least necessity. Let us take as an example the now very common operation for appendicitis. The leading English text-books on surgery state almost unanimously that a large proportion of eases recover without surgical interference, sometimes even when there is evidence of grave local mischief. I know of several instances, and can produce living patients who will confirm my statements, in which operation for appendicitis was strenuously urged as the only means of averting almost certain death. For some reason or other the operation was delayed too long, from an operator's point of view, or else the patient was too timid to submit, and what was the result? The patient made an excellent recovery, and has never had a recurrence of those symptoms which were held to have justified immediate abdominal section. There is a commercial as well as a professional aspect of this lust for operation, for in a great many diseases it is infinitely more remunerative to operate Uian not to operate. The case may be summed up as one of large profits against small ones. This matter of large profits constitutes a dangerous inducement to abandon the practice of medicine, and to cultivate almost exclusively the practice of surgery, The fees charged for surgical work are out of all proportion to those which are claimed for medical. Patients who will cheerfully impoverish themselves to enjoy the luxury of being repaired by a surgeon, who arc ready to scrape together anything from a tenpound note to a hundred guineas, and think the money well spent, will complain bitterly about 1 he exorbitant charges of the doctor who tides them over a dangerous illness for a few guineas. Between (he operating surgeons on the one hand, and the hospital*. the clubs, the prescribing chemist, the quack doctors, the patent-medicine vendors, and the Public Health Department on the ol her, the field for general practice in all bill country districts is becoming more and more limited. The pure physician, at one time held io have ndopted the highest branch of our profession. now occupies a very subordinate position in public estimation. The position in New Zealand at the present time i» that a medical practitioner must operate whether he possesses the necessary skill and manual dexterity or not, or else he must consent tn receive gratefully the crumbs from the rich operator’s table, or look after the survivals when they nre reduced to penury. Time after tone it has happened to me. and no doubt to many more, that 1

have had a child brought to me with perhaps enlarged tonsils; it may have been a case in which operation was unnecessary. What has been the result? Two or three days afterwards E hear that the child has been operated upon. 1 get 7/6 for giving nn honest opinion for whatever it may be worth, and all the discredit of having made-a mistake; the operating surgeon gets abundance of credit «nd a fee which is often considerable. 1 know of one case where as much as £7 7/ was charged for removing tonsils and post-nasal growths and a separate fee of £2 2/ for the chloroform is t. I could multiply similar instances, and have yet to discover a patient who is not firmly convinced that the operating surgeon is light and the non-operating one wrong: in fact, I have been told with very blunt discourtesy that 1 had not known what was the matter because I did not advise operation and another doctor 'did. What, I ask, will be the ultimate position of our profession in New Zealand if we are all engaged in operative work? The public demand is growing by what it feeds on, and before long the surgeon who does not operate whenever there is the least possible excuse will be regarded as an ante-dilurian fossil or a juvenile idiot. In the words of Mr Dooley, the American humorist, “They’re fin din’ new things the matt her with ye ivry day. an’ oF things that have to be taken out. ontil th' time is coinin' whin not more than half of tis’ll be rale an* the rest'll be rubber.” Not very long ago an English physician contributed to the “New Zealand Times” some of his impressions of medical practice in New Zealand. He writes, amongst other impressions, “Surgical operations occur with far greater frequency than in the Ohl Country. The* colonial appears to resent the existence of the slightest sign of bodily imperfection in the beloved self, and the very faintest excuse for undergoing a surgical operation is seized upon. Often quite serious operations are undertaken in order to remove conditions which offer not the slightest hindrance to complete health, causing no pain, but are perhaps slight bodily disfigurements, often out of sight of any but the bearers of them.” 1 have practised now in New Zealand for upwards of ten years, and have no hesitation in affirming that the frequency of operations has increased out of all reasonable proportion to the growth of population during that time. The time appears to be fast approaching when the whole science of medicine will become absorbed in the art of surgery, and when only the more mechanical part of our work will be deemed worthy of remuneration.

I submit, although my view is not tlie popular one, that a good surgeon is not always an expert operator, and conversely a brilliant operator is not necessarily a sound surgeon. Which demands the higher order of skill: to amputate a limb, or to preserve it? Sueh is, however. the perversity of popular taste that there are many people who will pay a higher fee to the surgeon who relieves them of an arm or a leg than they would willingly pay to the one who by less heroic treatment enables them to continue to wear it. The amputator gels abundance of kudos for a simple bit of work, and the other man. if he is paid at all. is seldom troubled with any overwhelming amount of gratitude. Nature did *he work whilst he looked on and did nothing more than apply some bits of wood and bandages. The moral of my paper is. “Never miss an operation if you get the chance, and a generous public will appreciate your services and pay for them handsomely,” provided always that the earning of a good income is the principal object of your professional life.

While those who participated in the discussion which followed did not for the most part go so far as to entirely endorse Dr. Hal hurley's paper, the majority of the speakers admitted that there was a great deal of truth in the doctor's statements.