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A younger generation of surgeons, trained to operate inthe casualty-clearing stations, and taught to look onclean dissection, gentle handling, and accurate haemo-stasis as the chief safeguards against infection, had takenover and were setting a new standard. Rapid operatingwas no longer regarded as the hallmark of surgical skill,but on the other hand an operation lasting much overan hour was a thing to be avoided. Anaesthesia wasemerging as a specialty, but pink ears and a relaxedabdomen were still the exception rather than the rule.

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Nowadays we are a bit too complacent about surgicaladvances. From 1870 to 1915 things really did move.Victorians imbued with the spirit of the Elizabethans, gayadventurers armed with weapons of a potency hithertounknown, hacked their way through an unexplored jungleto discover lands of rich promise. From 1915 to 1935 theirsuccessors cultivated the land so hardly won, broughtit into production, and extended its territory. Since1935 further advances have been made : we have seena steady improvement in the scope of surgical enterprise,in the increased safety of surgical operations, and inthe diminution of postoperative morbidity ; but I don’tthink that we surgeons can claim any of the credit.The surgeons of 1920 were better than the surgeons of1910, but I don’t think that the surgeons of 1953 are anybetter than those of 1920-than men like Gordon-Taylor,Charles Saint, John Fraser, Richard Charles, and manyothers who worked behind the lines in 1917 and 1918.On the other hand, surgical environment, surgical method,surgical equipment, and surgical auxiliaries haveimproved out of recognition. Continuous intravenousadministration-the basis of planned resuscitation andof all supportive and postoperative therapy-wasintroduced in 1925 only, and reached England in 1930.Gastric suction appeared about the same time, andintestinal decompression followed later. The physio-logical outlook that abolished purgation and starvation,that brought the study of fluid and salt balance, and thattaught the dangers of postoperative immobility, was aresult of the break with tradition and the rational outlookthat came of the first war. Chemotherapy first appearedin 1935, and was not in effective use till 1940, whilepenicillin came three years later.The position of surgery today depends more on the

improvements that have taken place in anaesthesia thanon anything else. Men like Macewen, Trendelenburg, andArbuthnot Lane advocated operations on the lungs andheart half a century ago, and Sauerbruch played with hisdifferential pressure chamber thirty years ago ; but itwas not till the advent of closed-circuit anaesthesia andcontrolled respiration that pulmonary and cardiac surgerybecame a reality.

Just watch that patient on her way back to the wardafter a mitral valvulotomy. (How I wish that our thoracicsurgeons, brilliant and lovable colleagues as they are,were not so careless with their language. We shouldshudder if a gynaecologist talked of caesariotomy, or aphysician of renitis, yet we allow this bastard offspring oftwo noble languages to defile our literature. " Valvu-

lotomy "-ugh ! " Valvotomy "-even worse. The

valve is one of nature’s inventions applied by man tohis own uses from the earliest times, and the Greekscertainly had a word for it. Epistomion has a pleasantring about it, but I am told at Balliol that it does notoccur in the classical period. Saridon is better. Let theInternational Society of Thoracic Surgeons, when theynext meet in Buxton, Stockholm, Locarno, Hot Springs,Santa Barbara, or Buenos Aires, table a discussion onthe relative merits of epistomiotomy and saridotomy asthe first item of their agenda, and, having made theirchoice, apply for readmission to the ranks of the educated.)We shall have to run down the stairs to catch our

patient at the bottom of the lift. She looks as if she had

just woken from a pleasant sleep. Her eyes are bright,her breathing is quiet, her skin is warm and dry, and shehas just started to chat to the nurse who is seeing herback to the ward. Her wound is covered only by a stripof gauze held in position with a few bits of strapping.Soon she’ll have a cup of tea. Tomorrow she’ll be sittingin a chair. In five days’ time her stitches will be out,and in ten days she’ll go home. Yes Peter, surgery haschanged in our day.

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Personally I’d say that the most important improve-ments of the last five years have lain in receding fromthe advances of the previous ten. The radical surgeryof malignant disease of the pancreas has been found,except in ampullary growths, to shorten rather thanprolong life and to make the end more miserable. Vago-tomy, the vaunted cure of peptic ulcer five years ago,is now a thing we had rather not talk about. The surgicalremoval of prolapsed intervertebral discs has beenfound, on the whole, less satisfactory than treatmentby manipulation or by a spinal brace. Sympatheticoperations for hypertension have proved unnecessaryin early cases and useless in late ones, and they survivemerely as an occasional palliative to relieve intolerableheadaches and failing vision. Shunt operations for portalhypertension have hitherto escaped debunking, but theyare in urgent need of it.But ground is also being won that will never be lost

again. The surgery of mitral stenosis, the surgery ofcoarctation, the grafting of arteries, these will remain;and next week when we come back from the prostatesession to a good dinner and a glass of port we shallremember others. At any rate we shall thank our starsthat we have spent our lives in a job that can never bestandardised or planned on mass-production lines.

Your old friend,DANIEL WHIDDON.

Parliament

QUESTION TIME

MyxomatosisReplying to a question Mr. G. R. H. NUGENT, joint parlia-

mentary secretary to the Ministry of Agriculture, said thatin the past four weeks 5 fresh outbreaks of myxomatosis inwild rabbits had been confirmed. There were now 3 centresof infection in Kent, 2 in East Sussex, 2 in Essex, and 1 inEast Suffolk. The most recent -outbreaks were in Essex,East Suffolk, and Kent. There had been no appreciable localspread of the disease at the existing centres of infection.About 800 rabbits were known to have died of the diseasesince it was first reported. More infected rabbits might havedied in their burrows either from the disease or gassing.

Mr. SoMEnviLLE HASTINGS : What are the latest ideas asto how the disease is conveyed ? Is it by birds or by humanbeings, or only by direct contagion ? Mr. NUGENT: I thinkit is probably conveyed by direct contact between the rabbitsand by insects-probably to some extent by birds as well,but mainly by insects in the spring and the summer.

Mental-hospital Nurses and National ServiceReplying to a question, Mr. H. A. WATKINSON, parlia-

mentary secretary to the Ministry of Labour and NationalService, said that student nurses in mental hospitals werenot exempt from National Service, but their call-up could bedeferred until they had completed their training.

Sale of Condemned MeatIn answer to a question, Major GWILYM LLOYD GEORGE,

the Minister of Food, gave the following summary of therevised conditions for sale of condemned meat.Condemned meat and offals bought at auctions from Govern-

ment slaughterhouses must now be processed, boiled, or sterilisedbefore re-sale. Where the meat is re-sold to a retailer for animalfeeding, or to a processor, the liability for processing, boiling,or sterilising must be included in the contract of sale. Sellers ofraw condemned meat and offals must inform the medical officer ofhealth in the area where the meat is delivered of the names andaddresses of the consignees.