Physicians and Surgeons

IT is a commonplacethat certain diseasesare claimed by surgeonsor by physicians as surgical or medicalaffections. Man is cursedwith a heritage of disease and the medical practitioner whose function it is to alleviate, mitigate or cure, sets up an artificial division in the categoryof diseases, so that those which lie on the one side may be handledby therapeuticmeasures,supposedlybased on a foundationof eetiology, while thosethat lie on the other, are to be subjectedto the drastic remedy of mechanicalremoval. This unnaturaldivision of diseasesis but the logical corollary of the very natural division of the medical professioninto surgeons and physicians. Since the surgeon requires to be trained in manipulativedexterity and in the knowledgeof the finer points of anatomy,it follows that it is the interestsof the communitythat certain members should deliberately set themselves the task of acquiring the special knowledge and skill neededfor operative treatmentof diseaseand injury. Similarly the physician has to learn many things that scarcely concern the surgeon and his whole specialisttraining may be expressedin terms of physiology or as wewould rather expressit, in terms of medical physics and medical chemistry. Only rarely does the physician need that manual clevernessthat distinguishes the competent surgeon. It must be rememberedthat both have the same fundamental knowledge and each should ascertainby readingwhat advanceshave beenmade in the science and practice of the other division, The generalpractitioner standsmidway and by a judicious blending of the attributes and qualities of both often saves the patient from the extreme views of his specialist colleagues. It is thus admitted that the practice of medicine benefits not a little by the introduction of practitionerswho have equipped themselves either as surgeons or as physicians. Naturally these votaries seek to extend, and enlargethe scope of their activities. The physician does so less than the surgeon, merely becauseeverything appearsto belong to him that the surgeon cannot show without doubt to be his domain. In some instancesthere can be nodispute concerningthe wisdom of operativetreatmentof a special condition. As soon as an appendicitis is diagnosed,the patient is subjected to the tender merciesof the surgeon,not becausethe affection is a surgical one, but becauseit has been found that the mortality after early operation is much lower than the mortality after the highly unsatisfactory medical treatmentof today. If enoughwere known concerning the exact eetiology and pathology of appendicitis,it might be possibleto obtain as good or better results without the aid of surgery and then surgerywould be out of place. Similarly the surgeonis requiredto treatpersonswith malignant disease,provided that the diseaseis situatedin an organ that is accessibleand that can be mutilated without unduerisk to life. But some day we may know the causeof cancer and we may be able to discoverwhat are its precursorsand which of them can be attacked. Cancer is not a surgical disease in the accepted senseof this term. The treatment of the diseaseis still surgical, becauseof the complete failure of medicine and pathology to shed light on the process.