THE CHILD AND SURGERY surgery of childhood stands in the same relation to general surgery that infantile therapeutics bears to internal medicine. Old methods and traditions connect them, and the great strides of the last few decades permit of extending operative procedures to the tender tissues of the infantile organism which had formerly been regarded as inaccessible to major interference.
The difference is not only quantitative in that the smaller local pro portions render the work more difficult, but the response of the infantile organism both to the irritation of disease and especially to that of oper ative interference is totally different from that of the adult. The oper ative possibilities in the child are subject to different factors: On the one hand considerable interference is well tolerated under certain condi tions; indeed, the healing tendency is generally better than in the adult; while on the other hand minor interference often affects the tender organism so profoundly that the shock is overcome only with difficulty. I need only refer to anesthesia and peritoneal operations.
Besides, in childhood there are other factors, partly known and partly unknown, which often play an ominous role and demand the greatest caution: shock and the status lymphaticus are dreaded spectres, the nature of which is but little understood; rachitis demands attention, especially in its complex relations to normal and abnormal growth. Injuries and infections, their onset, their pathological changes, and their treatment, differ considerably from the analogous processes of the adult organism.
Disturbances of the embryonal mechanism of development and derangements of postnatal growth dominate the domain of infantile surgery. Congenital deformities and affections of the apparatus of locomotion, which generally belong to the field of orthoinedics, are most frequent. In France this fact finds expression in the estabffiffiment of a specialty under the name of "La Chirurgie Infantile"—a happy union between infantile surgery and orthopedics which supplies a practical want and will be duly considered in the present volume.
In order not to exceed our narrow space limits, the greater impor tance has been placed upon congenital deformities and disorders of loco motion. Certain conditions have been described which demand special consideration in childhood, such as treatment of hernia, tuberculosis of the joints in its various forms, fractures in early childhood, treatment of paralysis, appendicitis, intussuseeption, and rectal prolapse, while other subjects, such as tumors, are only superficially treated on account of their slighter importance, and only their more prominent points are discussed.
In those pathological conditions whose clinical treatment has been fully described in other volumes of this work, only the surgical aspects with their special diagnosis and indications have been taken into con sideration, and reference has been made to the chapters dealing with the clinical aspect.