Medicine: Sawbones

In Philadelphia last week met 5,000 men who have seen and caused more blood and wounds than any 5,000,000 of their fellows. Two hundred years ago such men were rated on a level with barbers (a trade they often combined with theirs). But no one last week could have so mistaken their social standing. Neat, spry and greying, the American College of Surgeons wandered among the palms of the Bellevue-Stratford Hotel surveying wall-racks steely-bright with surgical knives, forks and spoons, rooms crowded with electrical vibrating beds, weird steel scaffolds for broken limbs, gently breathing rubber bellows for warming frozen toes. Among the most popular of the commercial exhibits was the table of urological tubes and periscopes shown by C. R. Bard, Inc. of Manhattan. Over the table hung a large panel of giddy French cartoons, drawn 30 years ago by A. Barrère, depicting the famed faculty of Sorbonne surgeons as inept and bloody butchers.

Besides examining new instruments, spending their afternoons at colored movies of surgical operations, and cutting up in 45 Philadelphia hospitals, the surgeons gathered at round tables, swapped the surgical shoptalk of the year.

One Lung. Six years ago a middle-aged Pittsburgh physician with cancer of the lung made a long, painful journey to St. Louis to beg a crumb of hope from famed Surgeon Evarts Ambrose Graham.* Both doctors thought that death was inevitable, and Dr. Graham decided on a last, desperate measure, never before tried in the history of surgery: complete amputation of the cancerous lung in one stage. An incision was made down the sick man’s back, beside and below his shoulder blade. Carefully Dr. Graham slit through tough chest muscles, removed sections of seven ribs, neatly severed the lumpy grey lung high up where the windpipe separates into two branches. Then he tied the stump with a tight catgut knot. Finally he stitched up the chest muscles. To his great joy, his colleague survived.

Four years later the happy Pittsburgh doctor attended a convention of the College of Surgeons. Late for a meeting, he raced up two flights of stairs with a couple of friends. To their amazement, said Dr. Graham last week, the only one not winded by the climb was the doctor with one lung. His healthy lung had expanded, had completely filled the hollow space in his chest cavity.

Since that first dramatic case, hundreds of lung amputations have been performed throughout the world, with great success. “In suitable cases,” continued Dr. Graham, “where the cancer is not too far advanced, the operation can be done with a mortality of only ten percent. When the cancer is advanced, however, the mortality jumps to 40 or 50%. A very discouraging feature is that about 80% of those patients who come for operation are too far advanced to have a chance.”

Death Eye. During operations, anesthetists watch closely the color of their patient’s skin. If his normal rosy tinge changes to bluish, they quickly pump oxygen into his lungs. But it takes several minutes for the skin to show its telltale sign, and even the keenest observers cannot scent death by this crude method until a short time before the end. Last week Dr. Roy Donaldson McClure of Detroit’s Henry Ford Hospital described a machine that notes the shadow of death long before death’s hue is seen.

Blood deprived of oxygen darkens, gradually turns purple. Dr. McClure attaches a sensitive photoelectric cell to the ear, and the cell, literally seeing beneath the skin, records minute changes in blood-color long before the anesthetist notes approaching collapse. Thus vital stimulants can be given the moment the patient needs them.

Vitamins. Even in California, the land of oranges and lemons, said Dr. Emile Frederic Holman of San Francisco’s Stanford University School of Medicine, “44% of ordinary run-of-the-mill patients [are] deficient in vitamin C and 13% [are] on the verge of scurvy.” They have no reserve of healing “cement substances” in their blood, and not enough of the elements that build bones, teeth and cartilage. Since healing wounds of vitamin C-deficient guinea pigs have “inferior tensile strength, a disposition to gape … a livid appearance, and a soft consistency,” they rupture easily. Lack of vitamin C may also be a factor in causing human peritonitis, for bacteria easily “leak” into an abdominal wound unprotected by healthy, growing tissue. Deficiency of vitamin B hampers restoration of blood-volume after operation; lack of vitamin A may pave the way for mumps, bronchitis, urinary infections, dread post-operative pneumonia.

For best operative success, all Dr. Holman’s patients are fed six haliver oil capsules, four oranges, two lemons, and “some form of vitamin B” every day for at least five days before operation. In emergency operations vitamins C and B are injected just before and just after operation. “On the third day following operation, the vitamin concentrates are resumed by mouth and continued throughout the full convalescent period.”

* Now president-elect of the American College of Surgeons.