Metabolic Care of the Surgical Patient [antikvár]

INTRODUCTION " The present age is prolific of works on physiology; therefore in offering to the public another book relative to an important branch of this science, it will perhaps be necessary to assign my motives." William Beaumont, Experiments and Observations on the Gastric Juice and the Physiology of Digestion, Plattsburgh, N. Y. (Allen), 1833. A. SURGERY IS RESPONSIBILITY Our motives in presenting this book are, first, to bring together in one volume a distinct area of knowledge that has grown from many sources in the past fifteen years and, second, to provide from this knowledge the data that are of direct daily bedside assistance in the care of the sick. The fundamental act of medical care is assumption of responsibility. Surgery has assumed responsibility for the care of a large section of human illness: a segment of disease which is largely acute, focal, or traumatic. This is responsibility for the care of the entire range of injuries and wounds, local infections, benign and malignant tumors, as well as a large fraction of those various pathologic processes and anomalies which are localized in the organs of the body. The study of surgery is a study of these diseases, the conditions and details of their care. The practice of surgery is the assumption of complete responsibility for the welfare of the patient suffering from these diseases. The surgeon employs any effective means available to serve the patient best. In most instances, these means include an open dissection under anesthesia, as a surgical operation, together with supportive measures based on an understanding of the patient's bodily processes in recovery. These latter steps assist normal metabolic processes and correct abnormalities, so that the natural sequences of convalescence ensue. These aspects of surgery are included in the term "metabolic care." The purpose of this book is to provide a general text and guidebook for metabolic care in surgery. The focus is entirely on the care of the patient. Although scientific and theoretical background of great interest underlies all aspects of surgical metabolism, such matters are discussed here only as a brief review (in each Part) or as they bear directly on that understanding required by the surgeon to discharge his responsibility to the patient. B. SURGICAL JUDGMENT AND SURGICAL METABOLISM Sick surgical patients do not oblige their doctors by separating "metabolic" from "tissue pathology" states. Their care is always a surgical problem in the truest sense; the whole problem must be solved together, not in sections. The loss of a patient by necrosis of a gangrenous loop of bowel is in nowise excused by the cleverness of his intravenous feedings or the normalcy of his extracellular chemistry. It has become a commonplace to state that surgeons who have been taught the Page vii