Volume 1

The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen.

  • John Eric Erichsen
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    49/1274 (page 17)
    PREPAEATION FOR OPERATION. The Surgeon, being convinced of the necessity of an operation, should full}'- lay before his patient the state of the case, in order to obtain his consent and that of his family. In the event of the patient refusing to submit, the Surgeon must be guided partly by the nature of the proposed operation ; and partly by the state of the patient, and his capability of forming a correct judgment of his case. If the operation be one of expediency, merely for the relief of an infirmity or the removal of an ailment which does not directly jeopardise life, no Surgeon would think of undertaking it without the full consent of his patient. If, on the other hand, it be an operation that is necessary for the preservation of life, in which delay may be fatal, as in one of the four cases of surgical urgency, viz., dangerous hemorrhage, asphyxia, over-distended bladder, or strangulated hernia, and if the patient, unaware of, or incapable of being made to understand, the necessity for immediate action, be unwilling to assent to the proposal, the Surgeon will truly be placed in a dilemma of anxious responsibility; between allowing the patient to fall a sacrifice to his obstinacy, iguorance, or timidity, and attempting, perhaps unsuccessfully, to rescue him from death without his consent. I believe the proper course for the Surgeon to pursue under such circumstances, is to judge for the patient in a matter on which he is clearly unable to form an opinion, and to compel him, so far as is legal and practicable, to submit to the necessary steps for the preservation of his life, or to put him under an anesthetic, and, when he is unconscious, to perform any operation that may be required. In the event of the patient being insensible, as after an injury of the head, the Surgeon must necessarily take upon himself to act as the case requires. Children cannot be considered capable of giving an opinion as to the propriety of an operation ; the consent of the parents alone is necessary; and, in their absence, if the case is an urgent one, the Surgeon must stand in loco parentis, and take all responsibility upon himself. In order to persuade a patient to submit to a necessary operation it is often advisable to speak to him more encouragingly than the circumstances may justify, but if this be done the wife or husband or next friend must be made acquainted with the exact state of the case. In the after-treatment the same rule must be followed. It would often rob a patient of his last chance of recovery to tell him that his life was in imminent danger, but the fact must never be concealed from his friends, and the responsibility of communicating it to him, if they think fit to do so, may be left with them. These points having been determined, the patient should, if possible, be Prepared for the 0])eration. In a great number of cases requiring operation, as in strangulated hernia, bad compound fracture, &c., no time is allowecl for preparation, but the Surgeon must at once submit the patient to the knife, whatever the state of his health may be. But in the more chronic cases, time is given for improving the constitution. This preparation must not consist of any routine system of purging and starving, which is ill calculated to make the constitution fit to meet the call that will be made upon its powers ; nor, on the other hand, in blindly adopting a tonic or stimulating regimen ; but in adapting our means to the condition of the patient and the nature of the operation to be performed. The tendency to erysipelas, pyemia, and diffuse inflammations generally, is materially lessened by supporting the VOL. I. 0