The 
Relation of the Abdominal 
Surgeon to the Obstetrician 
and Gynecologist. 
BY 
A. VANDER VEER, M.D., 
OF ALBANY, N. Y. 
REPRINT FROM TRANSACTIONS, 
VOL. I, 1888. THE 
RELATION OF THE ABDOMINAL SURGEON 
TO THE 
OBSTETRICIAN AND GYNECOLOGIST. 
BY 
A. VANDER VEER, M.D., 
OF ALBANY, N. Y. 
REPRINTED FROM TRANSACTIONS OF 
AMERICAN ASSOCIATION OF OBSTETRICIANS AND GYNECOLOGISTS, 
SEPTEMBER, 1888. . 
PHILADELPHIA: 
WM. J. DORNAN, PRINTER. 
1 889. THE RELATION OF THE ABDOMINAL SURGEON TO 
THE OBSTETRICIAN AND GYNECOLOGIST. 
By A. VANDER VEER, M.D., 
ALBANY, N. Y. 
As I study the coustitutiou, by-laws, and make-up of this new 
society, I observe that we have brought together elements which, if 
properly harmonized and " the principle of unity and research " 
preserved, cannot fail to benefit ourselves as individual members, 
and also that the influence which will go out from us will be for 
good to our profession throughout this broad land. In the paper I 
now present to you, I shall endeavor to bring out the points of the 
specialty which I in a small degree represent, and in such a manner 
as, I trust, may result in mutual good to us all. I have, in 
revolving in my mind the subject of this paper, been led to ask the 
question : Is there such a special department as Abdominal Surgery 
in our profession ? 
That was a grand union when surgery, freed from its barbarisms 
and ignorances, and no longer associating with or being part of the 
'' Barbers' Company," united in honorable wedlock with medicine, 
and helped to establish that household in the healing art from which 
many of us who are here to-day have seen springing and going out 
the most of the grand specialties that have done so much for 
suffering humanity. We have seen Ophthalmology, Otology, Gyne- 
cology, Dermatology, Neurology, Laryngology, and many other 
specialties, develop and grow, and with such vigor that medical 
colleges have found it necessary to provide professorships for them, 
and hospitals have made appointments of attendants peculiarly fitted 
by study, education, and clinical observation to treat such cases as 
were necessarily relinquished by the active general practitioner in 
medicine. Just here I wish to quote from an address delivered 
not long ago by Prof. Virchow, who said : " Within twenty-five 4 
VANDER VEER, 
years the great host of specialties has developed, and it would be 
vain, anyhow fruitless, to oppose this tendency; but I think I 
ought to mention it here, and hope that I shall be certain of 
approval, when I say that no specialty can flourish which separates 
itself entirely from the common source of science; that no specialty 
can develop fruitfully and beneficially if it does not ever and anon 
draw from the common fountain, if it does not take other specialties 
into account, and if all the specialties do not mutually assist one 
another, thereby acknowledging a fact which is not always consid- 
ered necessary for practice, receiving knowledge through that unity 
on which our position internally and, I can also say, externally 
rests. It would be the most foolish and most dangerous develop- 
ment, if the system of specialties should ever come to such a pitch 
that special schools were to be founded, in which special branches 
were taught without any knowledge of the other things offered us 
by the science of medicine." 
I would say all this positive and signal advance has been made, 
not in the spirit of hostility to general medicine, but to render aid 
to one another as we work against disease, and to make comfortable 
our suffering fellow-beings, and to add to the length of human life. 
Surgery has not accomplished it entirely alone, she has had the 
assistance of true medicine, but in doing what she has done, she has 
undoubtedly advanced medicine in a very great degree. To-day, 
and for the past ten or fifteen years, there can be no doubt that 
surgery, as represented in the work of our societies and in our text- 
books, has led medicine. One has but to consult our excellent 
medical journals to be convinced of this assertion. Of those who 
remember the crusade that was early made against ovariotomy, 
which was but the beginning of abdominal surgery, and who cherish 
the belief that the latter is not yet a distinct part of general surgery 
but so limited as scarcely to command special attention, I would 
inquire : Why is it that special works are being published on abdo- 
minal surgery alone, and meeting with ready acceptance by the 
profession ? And why is it that institutions that not many years 
ago issued commands that no abdominal section be done in private 
room or public ward, now build wards for abdominal surgery, and 
encourage the work by every manner of special appointment as to 
nurses, care, surroundings, etc. ? Especially so can this be said of 
the Massachusetts General Hospital. I believe it safe to assert that SPECIALISM IN ABDOMINAL SURGERY. 
5 
Abdominal Surgery may be said now to be a part of the specialties 
of Obstetrics and Gynecology. Just here I wish to assert that our 
profession is so great, and the benefit to it so marked, from year to 
year, that specialties must continue to exist, and in close relation. 
Would general hospitals have done what they have to accommodate 
specialists, but for the fact that the latter, in their special hospitals 
and otherwise, have demonstrated the necessity for such work ? I 
am proud to state that in this country there are many hospitals that 
have both an obstetric and gynecological department, and this, I am 
sure, is a necessity that all general hospitals will have to meet. 
Has not the work of such men as the late Prof. S. D. Gross, Tait, 
Parkes, Sands, Weir, Senn, Greig Smith, Bull, and a host of others, 
now living, whom I might mention, demonstrated the fact that 
abdominal surgery has become a specialty ? If we inquire into the 
manner of its development, we find that it has been the outgrowth 
of work done by the general practitioner. Not content to go on in 
the beaten track, he has seen fit to break away from tradition, and 
by careful and, it is true, bold innovation establish methods in 
practice that have resulted in untold good. I remember with 
pleasure a conversation I had with the elder Gross, but a few years 
before his death, in which he stated that his experience and observa- 
tion had taught him that they made the best specialists who, having 
engaged for a number of years in general practice, finally confined 
themselves to that special department for which their studies, inclina- 
tions, and clinical observations and experiences had best fitted them. 
I am firm in the belief that these words apply with peculiar refer- 
ence and force to him who attempts to practise as an abdominal 
surgeon. When we consider that every organ within the abdominal 
cavity is subject to surgical treatment, if from disease or traumatism 
it becomes necessary, it is difficult to conceive of a specialty that 
requires more careful knowledge of the minute and gross anatomy 
of the parts in and among which he has to do his work, or greater 
coolness and experience as an operator, or technique as au antiseptic 
surgeon. 
As I have stated in previous papers, I am convinced that it is a 
specialty that must have for its successful issue certain operators 
assigned to certain territorial limitations. Many of the cases that 
call for treatment cannot be transported far, and the surgeon must 
go to them, though the surroundings may not be so good as in a 6 
VANDER VEER, 
well-regulated private hospital or sanitarium; yet the abdominal 
surgeon learns by repeated experience to make them comparatively 
safe. 
The intelligent public of to-day know so well of the advances 
made in this department of surgery, that every medical centre is 
presumed to have some one surgeon fully capable to cope with the 
sudden accidents that may and are so apt to occur to this portion of 
the human body. Does this same public opinion call for a gyne- 
cologist, be he ever so prominent, in a case of gunshot wound, intes- 
tinal obstruction, acute or chronic, or any abdominal traumatism ? 
Is it not likely to be some surgeon in general practice, and especially 
one who has made abdominal surgery a study, and is not this opinion 
likely to receive the indorsement of the profession at large in that 
locality? 
The operation for removal of a simple uncomplicated ovarian 
cyst is probably the easiest operation that occurs in all the range of 
the major operations in surgery; but when we come to the opera- 
tion embarrassed, as it may be, by all the complications now known 
to us, it becomes one of the most difficult of all operations. The 
surgeon in its performance requires the greatest amount of skill, 
cool judgment, experience, and familiarity with the contents of the 
abdomen. Therefore, when operations are to be done for the relief 
of the traumatisms that may occur to the intestinal tract, or patho- 
logical changes therein that endanger life: or when the liver, gall- 
bladder, pancreas, spleen, kidneys, suprarenal capsules, the ureters, 
bladder, the uterus and its appendages, the appendix, the mesentery, 
and all that pertains to the abdominal cavity in its pathological 
changes of whatsoever nature requires operation ; it is then that the 
calmness and experience that come from years of study in the post- 
mortem room, and of continued practice in general surgery, become 
of the greatest service to the patient and of benefit in the compila- 
tion of successful tables of recoveries. Wells, Tait, Keith, Peaslee, 
Sims, and others were once engaged in general practice. I would not 
be understood as doubting that many obstetricians, and especially 
gynecologists, have all these requirements to a large degree. Not- 
withstanding all that has been done within a short time by obste- 
tricians, gynecologists, or abdominal surgeons to advance abdominal 
surgery, we are yet at the half-way house on the road leading to com- 
plete success, for not yet is made clear the best manner of operating, SPECIALISM IN ABDOMINAL SURGERY. 
7 
the best place for the operation, nor the best way of dealing with 
all the various complications. Our entire profession must yet be 
taught much that pertains to abdominal surgery, and it must, to a 
great extent, be done by men of creative genius; men, who, seeing 
the work before them, and though not meeting with success at first, 
yet have the patience to work with method and perseverance, and 
with sincerity and earnestness, to accomplish that which will do 
what is yet required. The public are expecting much from us, and 
our work iu this branch of surgery must be such as to command 
their entire confidence and utmost respect. In our society meetings, 
in the presentation of papers, in our discussions, we must be honest, 
and not hesitate to present our mistakes along with our successes. 
And then another good in societies like this, where men of various 
thoughts, working along different lines come together, we not only 
learn of points in operative surgery, but all that pertains to the use 
of drugs, etc., in the palliative and conservative treatment of the 
cases that come under our observation. 
As regards the profession at large, think of it, only a short time 
since, at a discussion before one branch of one of our largest medical 
associations, there were only two or three present who were able to 
define clearly the improved Sanger operation, or knew much about 
the Cesarean section. 
What we need, is not the elaborate presentation of theories by 
long and well-prepared papers, or the advancing of them with an 
emphasis that forces conviction for a time, and then a reaction that 
leaves us to doubt and cynicism, but rather the offering of practical 
papers that will give facts, and the accumulated wisdom and experi- 
ence of honest workers. We should encourage the reporting of 
cases as has been done by many workers, both in this country and 
abroad, and study carefully the hard, laborious, practical experiments 
of men like Senn and his associates. 
Specialism in society work and journalism should be encouraged 
by the profession at large. It is only in this manner that the 
traditional errors transmitted frequently from one text-book, or 
from one edition to another, are corrected. Perhaps one of the 
greatest benefits to the profession in our time, and which has been 
developed so thoroughly abroad, is the writing of prize essays on 
some special subject. Equally so are we indebted to those who, in 
this country, have edited and published encyclopedias upon medicine 8 
VANDER VEER, 
and surgery, in which the very best specialists have been employed 
to write up the different subjects. The result has been, that the 
great thinking and reading portion of our profession, go where you 
will, have in their libraries, and at their command, the most 
advanced thoughts and experiences from which to draw when treat- 
ing their difficult cases. I wish to emphasize the admiration I 
have for the out-of-the-way practitioner in some far-off lonely 
town, where his lot has been cast, who is so often obliged to rely 
upon himself. He does his work in many instances more bravely 
than his city brother, who has but to call upon the specialist near 
at hand to help him out by consultation and otherwise. Think of 
Bopps in his first cholecystotomy, of McDowell in his ovariotomy, 
of Sims in working out the early problem that presented in his 
gynecological work. Also of the elder Atlee, and Kimball, and 
that quiet and earnest man, of whom we are now just learning, 
when he is sleeping the sleep of death. I refer to the late Dr. Walter 
Burnham, of Lowell, Mass., whose three hundred and thirty-eight 
cases of abdominal section have just been reported by his grandson, 
Henry P. Perkins, Jr., M.D., in the Annals of Gynecology for 
May, 1888, Boston. Dr. E. R. Peaslee told me, some time previous 
to his death, that he did much of his best writing when doing 
comparatively a country practice, and jotted down his rough notes 
while riding from one patient to another. 
I would that our medical colleges, in the advances they are 
making, might do more in the teaching of specialties by appointing 
practical teachers, men who, from hospital appointments, have 
acquired, by close study, rare opportunities for observation, and 
faithful work, knowledge that should be given to the medical 
student. For the doing of much of this, we should give all credit 
to our post-graduate schools, which in this country are giving forth 
such creditable work. It has been well said that the greatest 
advances in surgical science and art, at the present time, are made 
through special attention to certain lines of study and practice. As 
abdominal surgeons, we should move carefully, but at the present 
time we must be active, and on the alert to make use of the con- 
stantly increasing material that presents, and from which to draw 
our practical deductions. Think of the improved change that has 
occurred in the practice of general surgery within a period of ten 
years. All things must be utilized by the abdominal surgeon. The SPECIALISM IN ABDOMINAL SURGERY. 
9 
greatest comfort and strength to be drawn from all this change, 
is the tolerance by, and its acceptance on the part of older, staid, 
and conservative members of the profession. They have learned to 
know that the improvements are real, and accept them as such in 
true faith. There was a time when it would have been safer to ask 
these men to change their form of religious worship, than to change, 
as they have, their methods of surgical practice. 
This country is rich in its strongly conservative, yet strongly 
progressive men. The words of one, Prof. Fordyce Barker, I feel 
impelled to quote, saying that " he learned only from the young 
men in the profession." The time has passed by when prejudice 
can be, and is, allowed to maintain and perpetuate error. 
You will observe that my views are in favor of supporting 
abdominal surgery as a specialty, but it cannot stand alone, it must 
have the support of other specialties, and of the profession at large. 
Pardon me for repeating my belief, that in this new society we 
have formed a combination that illustrates well that trite but true 
saying, that " in union there is strength." 
I believe there is no country in the world where the obstetric art 
has progressed to a greater degree of perfection than in America. 
Those of us who have been in general surgical or gynecological 
practice for twenty-five or more years can attest how gradually have 
lessened the cases of vesico-vaginal fistula and other forms of trau- 
matism to the female sexual organs during parturition. Much, very 
much of this, is the result of increased skill on the part of the 
obstetrician. The vectis is now obsolete, and would not those who 
once employed it so honestly, could they rise from their graves, 
laud and praise the improved obstetric forceps, and its royal 
assistant chloroform ? The work of the obstetrician is the most 
arduous, important, and responsible of any part of our profession- 
To him are trusted the lives of our dearest ones, and yet how weari- 
some and anxious is the calling. He becomes perfect in all that 
pertains to his art, particularly in any abnormal condition that 
presents, and yet in acquiring it in individual cases he is often too 
tired to go on with a major operation. Especially is this true as 
applied to obstetricians who practise in country towns, larger 
villages, and smaller cities. The exacting nature of their work, 
that admits of no postponement, the additional care of family 
practice that is forced upon them; these, together with other pro- 10 
VANDER VEER, 
fessional exactions, carry them into an atmosphere that is uncon- 
genial to the technique and preparation necessary for abdominal 
section when the emergency of the lying-in room requires it. The 
abdominal surgeon finds comfort, as his cases require it, in the 
throwing off of his general surgical practice, and, conversely, I have 
seen good, thorough obstetricians unwilling to enter the abdominal 
cavity because the case or cases they had just attended, or were 
attending, unfitted them for it. 
There are many excellent, bold, grand, and intelligent abdominal 
surgeons among our obstetricians in this country, and this is 
fortunate, especially among those who live in large cities. Every- 
where they are to be found, who are able to tell all about the 
measurements of the pelvis, and when a case can no longer be 
trusted to nature, in consequence of some malformation or abnor- 
mality present. And I believe I state the truth, that the tendency 
in their practice is to lessen the number of craniotomies, and to 
resort to what seems a more modern successful operation; that is, 
abdominal section in some form whereby both mother and child 
may be saved, and the former, at least, be kept from long, weari- 
some and fruitless suffering. I may be wrong, but I am convinced 
that the obstetrician and abdominal surgeon should work in perfect 
harmony, that the latter bears to the former much the same relation 
that the general surgeon does to the neurologist in his brain surgery. 
The obstetrician, like the neurologist, will make his diagnosis, but 
the surgeon will often be called upon to do the operation. I do not 
wish to be understood as refusing the right to obstetricians to 
operate, and especially does this latter remark apply to those who 
live in the larger medical centres. 
The work of the abdominal surgeon will necessarily lead him into 
the field of gynecological practice ; that is, the major portion, not 
the minor part of gynecology. The obligation is so great, that he 
must prepare himself accordingly. There are many good gynecolo- 
gists who are successful in treating of misplacements-in fact, in 
everything that pertains to their specialty, aside from doing an 
abdominal section, and this they assign to some one else. Many of 
them are good in all that pertains to the repair of organs external to 
the peritoneum. They treat all forms of pelvic inflammation, and 
yet are unwilling to incise tissues that may be said to be out of 
sight. There is a number of such gynecologists, and they are SPECIALISM IN ABDOMINAL SURGERY. 
11 
found throughout the country and in cities also. The abdominal 
surgeon cannot do without them, they assist him in diagnosis, in 
consultation, and in practice; and the public in the first wail of 
distress will insist that these two kinds of practitioners join hands 
in treating the dangerously sick one. The gynecologist may be the 
very best of abdominal surgeons, and especially in the section of 
territory he may occupy, and yet for all abdominal work, I think it 
is the exception. With pride, one can look upon the work done by 
the gynecologists of this country. It would hardly be proper for 
me in this brief paper to speak of individual members dead or 
living. Neither they nor the abdominal surgeons can do well 
without each other's assistance. I believe it requires years of the 
hardest study and effort to become a thorough abdominal surgeon ; 
the number must ever be somewhat limited. Those who come 
from the ranks of general surgery, early, find it necessary to relin- 
quish the rougher part of that practice, the performance of which 
in the years past has brought them an experience which is ever of 
service to his associate obstetrician and gynecologist. 
Finally, is it not a fact that there is some danger that abdominal 
section may be carried too far if made too much of a specialty? 
Have we not in this society the conservative combination ? It has 
been proven in the past, that the strictly obstetrical, and the strictly 
gynecological society does not always command the endorsement of 
friends or the profession at large. That our new society is moving 
in the right direction, witness the new Obstetrical and Gynecological 
Society that has just been organized in Vienna, and of which Prof. 
Breisky has been elected president.