OPERATIONS IN CHILDREN "The child is too young and weak for operation, bring it again in a few years." Parents are frequently put off with these words when they bring a child to the physician with a congenital or incipient deformity.
The questions to be considered are whether the child's organism is able to withstand an operation or is our technic unable to adapt itself to all conditions in childhood? It seems that the latter is the case, for it is often more necessary to operate early in the case of the child than in the adult.
A serious injustice may be clone to the child by deferring an opera tion. A deformity in its primary condition often can be easily corrected, while at a later stage it may be accompanied by so many secondary deviations that it is very difficult to restore the normal state. The coefficient of growth in early childhood in the normal body is as great as the coefficient of deformity.
Anomalies which cannot be corrected in their early stages may interfere with the growth and well-being of the child and stand in the way of its physical development. The great psychic factor which the constant ailing and the anxious guarding entail upon the growing generation, even in our best social circles, is also to be considered. How, then, (I() the lower social strata fare? Smaller earning capacity and increased misery of family conditions throw their shadow upon coming generations.
The child's organism meets us half way. This is the time of rapid development, when Nature tries with all her might to bring the body to maturity for the "preservation of the species." After that, her interest in the individual appears to diminish considerably.
The ability to preserve and direct the impetus to growth and regen eration is not so groat in later life as during the period of childhood. We may profit by these facts and count upon the aid of Nature much more in the child than in the adult. We need not work with so large an "assurance," for it is frequently sufficient to remove an obstacle and the budding organism does the rest, while in later life Nature frequently disappoints us. For example, we can dispense with complicated muscle
closure in hernia operations, and in the case of fractures union takes place more rapidly. Operative procedures in childhood can, therefore, be simplified. An important axiom in the surgery of childhood is that the extent of the operation must be proportioned to the vital energy of the child. This would be but a hollow phrase hail not clinical and operative experience taught us certain fundamental rules which we recommend should be adopted in practice: 1. No operation should be performed on a newborn infant unless his weight is over 3000 Gm. (6 lbs.). (Of course, this does not apply in a question of life and death.) The weight is a reliable index of vital energy in the newborn. The normal birth weight is 3000 Gm. (6 lbs.); below this weight there is a certain vital deficiency which is greater the older the feeble infant. (See Harelip, Hernia.) In older infants the question of operation should be decided with due regard to the other factors of bodily nutrition. If possible, the operation should be deferred until the baby is better nourished.
2. Never operate when the child is losing in weight. Observation of this rule will prevent many deaths of "intercurrent disturbances of nutrition." A few days' observation are sufficient to reach a conclusion.
3. The operation should be as simple as possible so that it can be done in the shortest possible time. Complicated plastic operations should be avoided. Several small operations will be better tolerated by the child than one long operation, even if executed with brilliant skill and technic.
4. Work as rapidly as surgical thoroughness and care will admit. Minutes may be decisive. The child's heart is relatively a better organ than that of the adult as it is not yet toxic and overworked, but it cannot bear as much, and if the cardiac depression has once occurred the heart rallies with difficulty.