continuous tube that averages about thirty feet in humans. It is comprised
of the esophagus, stomach, small intestine (duodenum, jejunum, and
ileum), large intestine, rectum, and anus. The “tube” of the gastrointestinal
tract is comprised of many soft-tissue layers that are waterproof and
bacteria-proof, so long as the integrity of the layers is maintained. The
curvy, writhing, self-contained conduit has attachments to the deep portion
of the abdominal cavity that suspend the intestines and connect the blood
vessels that nourish the guts, and absorb the nutrients being processed.
Importantly, outside the alimentary cylinder, the abdominal (or
“peritoneal”) cavity is perfectly sterile and lethally vulnerable to
infection. While the stomach and small intestine are relatively “clean,” the
large intestine and rectum are teeming with bacteria; while these bacteria
often maintain a symbiotic relationship with the host (us), they represent a
grave danger if the contents of the tube cross the layers of the large
intestine and spill into the peritoneal cavity.
The second half of the scientific sleight of hand is the possibility of any
two surgeon-connected tissue ends healing together. We take this
proposition for granted, but how is it that we presume that the distinct
edges will harmonize, nurture each other, and synthesize a bond that is
functional, waterproof, and resilient? This is surgery in a nutshell:
connecting, stapling, sewing, screwing, splinting, and gluing entities
together, and soliciting the body to microscopically, even at the molecular
level, lay down connective tissues to supplement those artificial
connections, and in time, supersede the temporary scaffold-works.
Billroth, in heroic quantum surges, was making proper diagnoses
(remember, they had no MRI machines, CT scanners, ultrasound devices,
or X-rays), achieving anesthesia under the most primitive of conditions,
and performing surgery with no electrical lighting. Hence, the positioning
of operative theaters on the top floor of hospitals to harness skylights
above; the gods of surgery beckoned the sun to shine upon them. Billroth
was avoiding infections with early antiseptic techniques and with limited
sterilization of instruments, cutting and manipulating flesh with bare
hands, and sewing together intestinal tissue with primeval catgut and silk
ligatures. Somehow, hubris be damned, Professor Billroth was achieving
significant success, and the world was noticing.
It is estimated that 40 to 50 percent of the leading physicians of the
United States between 1850 and 1890 studied in Germany and Austria. No
marcin
(Marcin)
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