New York Medical College - Fleuroscope Yearbook (Valhalla, NY)

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RECENT ADVANCES IN MCDERN SURGERY 1935 - 1936 IF we were to compare surgery at the beginning of the twentieth century with that of our present decade, we should find amazing progress in operative technic, in the methods for the early recognition of surgical conditions, and in the rapidly expanding number of human disorders amenable to surgical treatment. It is very difficult for surgeons of any age to appraise the value of existing methods as to their permanence and lasting merit. They are apt to consider their procedures as having reached the acme of perfection and the finality of law. Improvements, if possible, surgeons have often agreed, would be slight and inconsequential. Many surgeons of the last century would have considered as heresy the frequent sympathectomies and thoracoplasties of today. However, we must not be too severe in our criticism of their self-com- placency and peremptoriness. In general, good surgeons have acquired their knowledge of operative procedures, their skill, and their diagnostic judgment through years of patient study and diligent application in the development of their own methods as well as those of their contemporaries. Surgery has been concerned for many years with the correction of mechanical defects of the body. The surgeon of today is no longer content with the removal of diseased organs. His desire is to restore the whole organ- ism to its physiological harmony-reconstructive surgery. Many of the ductless glands are now being treated with brilliant success. Surgical treat- ment of dysfunctions of the adrenals, parathyroids, even the pancreas is being practiced rather widely and many ,spectacular results are reported in the literature. So, too, a better knowledge of the anatomy, physiology, and pathology of different parts of the nervous system has in recent years aided much in the diagnosis of abnormal conditions of that system, and has permitted great advances in their surgical treatment. Now there is no ganglion or strand of the sympathetic nervous system which is not exposed or removed for various conditions of pain, paralysis, or dysfunction. When one reads of all the bene- fits which accrue from ablations of parts of the sympathetic nervous system one cannot help wondering why it was censured at its inception, for every one seems better in every way when he gets rid of it. This question might be asked of the appendix vermiformis which may be only a useless vestigial structure but what a boon to the young rising surgeon. With the trend of medicine, generally, toward prevention, surgery will and must contribute its share. 'New instruments, we are almost convinced, will not only improve technical skill, but as diagnostic aids will enable the surgeon to determine and correct disorders of function possibly even before morbid pro- cesses develop. It will be necessary to include only the most important contributions to surgery of recent years in this report, although the usefulness and significance of many others remains unquestioned. Most of the procedures mentioned have been tried with repeated success, some very recent ones however, are waiting One hundred seventy-two

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THOUGHTS OF A SOUL With reverential awe I soft approached the gate Of entrance into I-Ieaven's holy fields. My fate Was soon to be adjudged-my acts, my wants, my Soul On earth. My death but marked the start of this my scroll. I sat in silence mute with mingled fear and joy, Emotions not like those of any but a boy. The court convened, the justices arrayed in white- Their brilliance burned into my being, cowed with fright I turned to flee. A sharp command rang thru the court That stopped my ev'ry move, that sensed my very thought. Then sudden as it came my fear was vanished-swept Away as by a supernatural will. I wept With joy. For He had come by Whom we all are born, For Whom our sorrows, joy and pain, and all are borne. My mind was living once again. I rose to heights Undreamt by mortal man. For God gave me the light To guide my steps to Paradise forever more: A God so merciful, so just, forever more. Edward I. Gallagher SOLILOQUY To live to die-t'is one to be, Who in this maze called life, With staggering gait, with strife In mind, unable to foresee the light. Unanswered to questions asked, Possessed with fear, in bondage kept-when Toward Heaven turns: a prayer to her For revelation-his soul's unmasked. To live, to die: to die with work undone? To die with faith unfelt? - T'is but to live eternal life Of thwarted visions, of one unsung. Diodato Villamena I UNDERSTAND WOMEN She told me that she loved me- Said I carried her away: So I asked her May I kiss you? And she murmured, Yes, you may . My mind was quite unbalanced As I pressed her lips to mine, My emotions quite unstable, I thrilled as from red wine. So, completely overpowered, She enjoyed my fond caress- But I never popped the question For I knew she'd answer Yes. . Gallagher One hundred seventy-one

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BY WILLIAM RUBIN to emerge from their experimental stage into one of general, unanimous approval. The major development in surgery during 1933 had been in the field of the endocrine system. Hollman and Railsback added to the number of cases of hyperinsulinism already treated successfully by surgery, their own case of partial resection of the pancreas. Adenomata of the islands of Langerhans has been found not to be a rare condition. The change in secondary sexual characteristics with virilism, hirsutism, amenorrhea and abnormal deposits of fat in adrenal cortical tumors, basophilic adenomata of the pituitary tCushing's Syndromel, and, that peculiar ovarian tumor, arrhenoblastoma, no longer presents the hopeless prognosis of former years. The large group of disturbances due to endocrine deficiencies such as myxedema, diabetes mellitus, parathyroid tetany and Addison's disease may all become amenable to surgical treatment. Already much work has been done along these lines of hetero-glandular and homoglandular transplantation. Difficulties which are gradually being overcome are: ill surrounding the transplant With a suitable nutrient medium: C23 providing adequate circulation for each cell: C39 preventing pressure necrosis of the tender grafts by surround- ing tissue. To prevent the last, the loose areolar tissue of the axilla or groin is selected as a bed for the transplant. ln order to help the gland to adapt itself to its new environment, it is first grown in a culture medium of beef embryo juice and serum saline, next in the serum from the donor finally in the serum from the recipient and then heparinized plasma for one month before trans- planting. We may very Well ask, Are We on the threshold of the door to the fountain of youth? Much interest has been aroused in the field of thoracic surgery, especially by the increasingly frequent and successful removal of a lobe or even of an entire lung. Advances in technic have been rapid so that the mortality in several clinics has been reduced to less than fifteen per cent. Carr has con- tributed an important improvement to the operative procedure. He has devised a small automatic hilum clamp by which strong ligation tension may be applied. This appears to have marked advantage in safety over the previous methods of ligature or suture of the contents of the hilar stump. The clamp is left on for fifteen days and is then removed through a small intercostal incision. I-lilum occlusion is complete, so that resection of the diseased lobe may be carried out immediately after application of the clamp. Excision of an entire lung is now practiced in selected cases of bronchioqenic carcinoma. Lobec- tomy is gradually winning the approval of Graham, Lillienthal, Coryllos, and others, in selected cases of bronchiectasis and lung abscess. An extremely interesting approach to coronary disease of the heart has been undertaken by C. S. Beck. By means of a pedicle graft to the heart from the pectoralis major he was able experimentally, and then in one patient, to develop a collateral circulation to this vital organ. Further reports on other patients subjected to this operation are yet to be published. One hundred seventy three