Speaking of Operations

If a man suffering from gallstones went to a textbook of surgery to study his disease, he. would find things like this: "Whereas in cases of simple cholelithiasis cholecystostomy is the operation of choice, in cases of acute calculous cholecystitis cholecystectomy is to be preferred." In plainer English: In cases of simple gallstones, it is best to remove the stones and leave the gall bladder alone; but if a patient has an inflamed gall bladder as well as stones, it is wiser to remove both stones and bladder together.

Such complex gibberish annoys Surgeon Moses Benmosche of Manhattan's Mount Sinai Hospital. Surgeon Benmosche believes that patients have more guts when they are told more about them. This week Dr. Benmosche published the first popular primer of surgery: A Surgeon Explains to the Layman (Simon & Schuster; $3). His book is chock-full of bold diagrams, simple descriptions of operations. Dr. Benmosche's bookside manner is calm and reassuring, should serve as a tonic for healthy-minded patients. Sample information:

Gallstones, says Dr. Benmosche, "are rather pretty to look at once they are out --very similar to roughly rounded, uncut, semiprecious stones . . . [in] various shades of yellow, pink or green with red flecks. . . . Some may be microscopic in size, others as large as a hen's egg. And a patient may be suffering from just one large gallstone or from a thousand tiny ones."

Gallstones are common in middle-aged gall bladders, attack three or four women to every man. Some people can live comfortably with them for years, but if the stones slip into the gall-bladder ducts and cork them up, they cause excruciating pains in the pit of the stomach, the breastbone, or the right side of the back.

The gall bladder is a "pear-shaped sack . . . [which] hangs from the under surface of the liver like a droplight from a ceiling." The liver manufactures from 30 to 50 ounces of bile every day, and the overflow (up to one ounce) pours into the gall bladder. From this tank, as well as from the liver, the bile trickles into the small intestine, where it helps digest fats.

The formation of gallstones, says Dr. Benmosche, is very like the process of cooking old-fashioned rock candy. In candymaking, slender threads are dropped into syrup, and sugar crystallizes around the threads. In the formation of gallstones: 1) the juices in the gall bladder become thickened by bacterial infection; 2) delicate cells drop off the bladder walls into the cavity, combine with the thick juices to form a tiny core; 3) cholesterol (one of the solids in bile) gathers around the nucleus, hardens into a stone.

Most surgeons prefer to cut out the gall bladder with the stones because a sack, once diseased, usually becomes inflamed again. The operation is not difficult, and since the gall bladder is not an essential organ (horses have none), a patient need only follow a low-fat diet to stay healthy.

Stomach Ulcers. An ulcer is a sore on the stomach wall, always accompanied by an excessive flow of hydrochloric acid. To the question "Why ulcers?" Dr. Benmosche frankly answers: "We don't know." Most doctors blame alcohol, cigarets and nerves.

Many ulcer patients worry about the advantages of medical treatment v. surgery. Surgeon Benmosche strongly urges that they give nature a chance. They should be put to bed, given small amounts of bland liquids, like milk, every hour from 7 in the morning till 10:30 at night. Between feedings they should take an alkaline powder to neutralize the excessive acid of the stomach juices.

If an ulcer becomes so bad that it "perforates" the stomach wall, operation is necessary. One group of surgeons believes in snipping out the ulcer, then patching up the stomach as though it were an inner tube. Others prefer to leave the ulcer alone and perform a short-circuiting operation that detours food away from the sore spot. Dr. Benmosche's verdict: "There is something to be said for each of them."

Tonsils. Tonsils are little chunks of lymphoid tissue on either side of the throat, at the back of the mouth. When badly infected they are a menace. A few decades ago, when doctors thought tonsils the root of all ills, the "tonsil slaughter" was "incredible." Often scraps of tonsils were left which grew back again. In the U. S. during the years 1928 to 1931 tonsillectomies amounted to more than one-third of the operations performed in a group of 40,000 cases.

Most commonly used instrument for removing tonsils is the wire snare. It has a long handle with a wire loop which is inserted into the throat, thrown around the base of the tonsil and gradually drawn tighter till it cuts through all the tissue.

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