Report on Surgery to the Santa Clara County Medical Society   By: Joseph Bradford Cox (1840-)

BY J. BRADFORD COX, M. D.

READ MARCH 2d, 1880.

SAN JOSE: MERCURY STEAM PRINT. 1880.

REPORT ON SURGERY.

In presenting this report I will not attempt to give any historical data connected with the subject of surgery, since that has been ably done in the report of last year.

I shall assume, and that without hesitation, that surgery is a science, properly so called. That it is an art, is also true. But what is science? What is art? Science is knowledge. Art the application of that knowledge. To be more explicit, science is the knowledge we possess of nature and her laws; or, more properly speaking, God and His laws.

When we say that oxygen and iron unite and form ferric oxide, we express a law of matter: that is, that these elements have an affinity for each other. A collection of similar facts and their systematic arrangement, we call chemistry. Or we might say, chemistry is the science or knowledge of the elementary substances and their laws of combination.

When we say that about one eighth of the entire weight of the human body is a fluid, and is continually in motion within certain channels called blood vessels, we express a law of life, or a vital process. When we say this fluid is composed of certain anatomical elements, as the plasma, red corpuscles, leucocytes and granules, we go a step further in the problem of vitality. When we say that certain nutritious principles are taken into this circulating fluid by means of digestion and absorption, and that by assimilation they are converted into the various tissues of the body, we think we have solved the problem, and know just the essence of life itself. But what makes the blood hold these nutritious principles in solution until the very instant they come in contact with the tissue they are designed to renovate, and then, as it were, precipitate them as new tissue? You say they are in chemical solution, and the substance of contact acts as a re agent, and thus the deposit of new tissue is only in accordance with the laws of chemistry. Perhaps this is so. Let us see as to the proofs. In the analysis of the blood plasma, we find chlorides of sodium, potassium and ammonium, carbonates of potassa, soda, lime and magnesia, phosphates of lime, magnesia, potassa, and probably iron; also basic phosphates and neutral phosphates of soda, and sulphates of potassa and soda. Now in the analysis of those tissues composed principally of inorganic substances or compounds, it will be seen that these same salts are found in the tissues themselves.

So also the organic compounds lactate of soda, lactate of lime, pneumate of soda, margarate of soda, stearate of soda, butyrate of soda, oleine, margarine, stearine, lecethine, glucose, inosite, plasmine, serine, peptones, etc., are found alike in the tissues and in the blood plasma. That they are in solution in the plasma is well known, that they are in a solid or precipitated form in the tissues is also true, and that the tissues are supplied from the blood is also evident, because the blood is the only part that receives supplies of material direct from the food taken and digested.

That carbonate of lime and phosphate of lime are precipitated or assimilated from the plasma to form bone, is admitted by all physiologists. That the carbonates and phosphates already deposited act as the re agent to precipitate fresh supplies from the plasma is not a demonstrated fact, but may be inferred. So also with the other tissues. Should this be admitted without positive evidence we would not then be at the end of our problem; for the question may be asked as to what causes the first or initial deposit. Here we must stop and acknowledge our ignorance.