“Men die of the diseases which they have studied most,” remarked the surgeon, snipping off the end of a cigar with all his professional neatness and finish. “It’s as if the morbid condition was an evil creature which, when it found itself closely hunted, flew at the throat of its pursuer. If you worry the microbes too much they may worry you. I’ve seen cases of it, and not necessarily in microbic diseases either. There was, of course, the well-known instance of Liston and the aneurism; and a dozen others that I could mention.”

[In an established surgical practice] there is a ghost in every bed [and fortunately] surgeons get long lives and short memories.

Epitaph of John Hunter
The Royal College of Surgeons of England have placed this tablet over the grave of Hunter, to record their admiration of his genius as a gifted interpreter of the Divine Power and Wisdom at work in the Laws of Organic Life, and their grateful veneration for his services to mankind as the Founder of Scientific Surgery.

In a 1852 letter, Nightingale records the opinion of a young surgeon:
The account he gives of nurses beats everything that even I know of. This young prophet says that they are all drunkards, without exception, Sisters and all, and that there are but two whom the surgeon can trust to give the patients their medicines.

A great surgeon performs operations for stone by a single method; later he makes a statistical summary of deaths and recoveries, and he concludes from these statistics that the mortality law for this operation is two out of five. Well, I say that this ratio means literally nothing scientifically and gives us no certainty in performing the next operation; for we do not know whether the next case will be among the recoveries or the deaths. What really should be done, instead of gathering facts empirically, is to study them more accurately, each in its special determinism. We must study cases of death with great care and try to discover in them the cause of mortal accidents so as to master the cause and avoid the accidents.

A physician is someone who knows everything and does nothing.
A surgeon is someone who does everything and knows nothing.
A psychiatrist is someone who knows nothing and does nothing.
A pathologist is someone who knows everything and does everything too late.

A statistician is one who has learned how to get valid evidence from statistics and how (usually) to avoid being misled by irrelevant facts. It’s too bad that we apply the same name to this kind of person that we use for those who only tabulate. It’s as if we had the same name for barbers and brain surgeons because they both work on the head.

A surgeon should give as little pain as possible while he is treating the patient, and no pain at all when he charges his fee.

All truths wait in all things,
They neither hasten their own delivery nor resist it,
They do not need the obstetric forceps of the surgeon.

As he approached the place where a meeting of doctors was being held, he saw some elegant limousines and remarked, “The surgeons have arrived.” Then he saw some cheaper cars and said, “The physicians are here, too.” ... And when he saw a row of overshoes inside, under the hat rack, he is reported to have remarked, “Ah, I see there are laboratory men here.”

At a given instant everything the surgeon knows suddenly becomes important to the solution of the problem. You can't do it an hour later, or tomorrow. Nor can you go to the library and look it up.

Casting off the dark fog of verbal philosophy and vulgar medicine, which inculcate names alone ... I tried a series of experiments to explain more clearly many phenomena, particularly those of physiology. In order that I might subject as far as possible the reasonings of the Galenists and Peripatetics to sensory criteria, I began, after trying experiments, to write dialogues in which a Galenist adduced the better-known and stronger reasons and arguments; these a mechanist surgeon refuted by citing to the contrary the experiments I had tried, and a third, neutral interlocutor weighed the reasons advanced by both and provided an opportunity for further progress.

Dr Ian G. MacDonald, a Los Angeles surgeon who smokes (but doesn't inhale), contends that “For the majority of people, the use of tobacco has a beneficial effect, far better for you than taking tranquilizers.”

Excessive and prolonged use of tobacco, especially cigarettes, seems to be an important factor in the induction of bronchiogenic carcinoma. Among 605 men with bronchiogenic carcinoma, other than adenocarcinoma, 96.5 per cent were moderately heavy to chain smokers for many years, compared with 73.7 per cent among the general male hospital population without cancer. Among the cancer group 51.2 per cent were excessive or chain smokers compared to 19.1 per cent in the general hospital group without cancer.
[Co-author with Evarts Ambrose Graham]

From earliest memory I wanted to be a surgeon, possibly influenced by the qualities of our family doctor who cared for our childhood ailments.

Gauss was not the son of a mathematician; Handel’s father was a surgeon, of whose musical powers nothing is known; Titian was the son and also the nephew of a lawyer, while he and his brother, Francesco Vecellio, were the first painters in a family which produced a succession of seven other artists with diminishing talents. These facts do not, however, prove that the condition of the nerve-tracts and centres of the brain, which determine the specific talent, appeared for the first time in these men: the appropriate condition surely existed previously in their parents, although it did not achieve expression. They prove, as it seems to me, that a high degree of endowment in a special direction, which we call talent, cannot have arisen from the experience of previous generations, that is, by the exercise of the brain in the same specific direction.

Here the most sublime scene ever witnessed in the operating room was presented when the patient placed himself voluntarily upon the table, which was to become the altar of future fame. … The heroic bravery of the man who voluntarily placed himself upon the table, a subject for the surgeon’s knife, should be recorded and his name enrolled upon parchment, which should be hung upon the walls of the surgical amphitheatre in which the operation was performed. His name was Gilbert Abbott.
Description of the first public demonstration of ether at the Massachussetts General Hospital (16 Oct 1846).

I am just laboring in the vineyard. I am at the operating table, and I make my rounds. I believe there is a cross-fertilization between writing and surgery. If I withdraw from surgery, I would not have another word to write. Having become a writer makes me a better doctor.
[Reply to reporter's question whether he would rather be a full-time writer instead of a surgeon.]

I don’t dawdle. I'm a surgeon. I make an incision, do what needs to be done and sew up the wound. There is a beginning, a middle, and an end.
[On writing.]

I have made many mistakes myself; in learning the anatomy of the eye I dare say, I have spoiled a hatfull; the best surgeon, like the best general, is he who makes the fewest mistakes.

I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give any woman the instrument to procure abortion. … I will not cut a person who is suffering with stone, but will leave this to be done by men who are practitioners of such work.

I would like to see the day when somebody would be appointed surgeon somewhere who had no hands, for the operative part is the least part of the work.

I would never use a long word, even, where a short one would answer the purpose. I know there are professors in this country who “ligate” arteries. Other surgeons only tie them, and it stops the bleeding just as well.

If the love of surgery is a proof of a person’s being adapted for it, then certainly I am fitted to he a surgeon; for thou can’st hardly conceive what a high degree of enjoyment I am from day to day experiencing in this bloody and butchering department of the healing art. I am more and more delighted with my profession.

If we want an answer from nature, we must put our questions in acts, not words, and the acts may take us to curious places. Some questions were answered in the laboratory, others in mines, others in a hospital where a surgeon pushed tubes in my arteries to get blood samples, others on top of Pike’s Peak in the Rocky Mountains, or in a diving dress on the bottom of the sea. That is one of the things I like about scientific research. You never know where it will take you next.

It is necessary that a surgeon should have a temperate and moderate disposition. That he should have well-formed hands, long slender fingers, a strong body, not inclined to tremble and with all his members trained to the capable fulfilment of the wishes of his mind. He should be of deep intelligence and of a simple, humble, brave, but not audacious disposition. He should be well grounded in natural science, and should know not only medicine but every part of philosophy; should know logic well, so as to be able to understand what is written, to talk properly, and to support what he has to say by good reasons.

It is some systematised exhibition of the whale in his broad genera, that I would now fain put before you. Yet is it no easy task. The classification of the constituents of a chaos, nothing less is here essayed. Listen to what the best and latest authorities have laid down.
“No branch of Zoology is so much involved as that which is entitled Cetology,” says Captain Scoresby, A.D. 1820.
“It is not my intention, were it in my power, to enter into the inquiry as to the true method of dividing the cetacea into groups and families. * * * Utter confusion exists among the historians of this animal” (sperm whale), says Surgeon Beale. A. D. 1839.
“Unfitness to pursue our research in the unfathomable waters.” “Impenetrable veil covering our knowledge of the cetacea.” “A field strewn with thorns.” “All these incomplete indications but serve to torture us naturalists.”
Thus speak of the whale, the great Cuvier, and John Hunter, and Lesson, those lights of zoology and anatomy. Nevertheless, though of real knowledges there be little, yet of books there are plenty; and so in some small degree, with cetology, or the science of whales. Many are the men, small and great, old and new, landsmen and seamen, who have at large or in little, written of the whale. Run over a few:— The Authors of the Bible; Aristotle; Pliny; Aldrovandi; Sir Thomas Browne; Gesner; Ray; Linnæus; Rondeletius; Willoughby; Green; Artedi; Sibbald; Brisson; Marten; Lacépède; Bonneterre; Desmarest; Baron Cuvier; Frederick Cuvier; John Hunter; Owen; Scoresby; Beale; Bennett; J. Ross Browne; the Author of Miriam Coffin; Olmstead; and the Rev. T. Cheever. But to what ultimate generalising purpose all these have written, the above cited extracts will show.
Of the names in this list of whale authors, only those following Owen ever saw living whales; and but one of them was a real professional harpooner and whaleman. I mean Captain Scoresby.

It is sometimes asserted that a surgical operation is or should be a work of art … fit to rank with those of the painter or sculptor. … That proposition does not admit of discussion. It is a product of the intellectual innocence which I think we surgeons may fairly claim to possess, and which is happily not inconsistent with a quite adequate worldly wisdom.

It is the surgeon’s duty to tranquillize the temper, to beget cheerfulness, and to impart confidence of recovery.

It ought ... to be understood that no one can be a good physician who has no idea of surgical operations, and that a surgeon is nothing if ignorant of medicine. In a word, one must be familiar with both departments of medicine.

It seeming impossible in any other manner to properly restrict the use of this powerful agent [calomel, a mercury compound, mercurous chloride], it is directed that it be struck from the supply table, and that no further requisitions for this medicine be approved by Medical Directors. ... modern pathology has proved the impropriety of the use of mercury in very many of those diseases in which it was formerly unfailingly administered. ... No doubt can exist that more harm has resulted from the misuse [of this agent], in the treatment of disease, than benefit from their proper administration.
W.A. Hammond, Surgeon General, Washington D.C., 4 May 1863

Let the surgeon take care to regulate the whole regimen of the patient's life for joy and happiness by promising that he will soon be well, by allowing his relatives and special friends to cheer him and by having someone tell him jokes, and let him be solaced also by music on the viol or psaltery. The surgeon must forbid anger, hatred, and sadness in the patient, and remind him that the body grows fat from joy and thin from sadness.

Logic does not pretend to teach the surgeon what are the symptoms which indicate a violent death. This he must learn from his own experience and observation, or from that of others, his predecessors in his peculiar science. But logic sits in judgment on the sufficiency of that observation and experience to justify his rules, and on the sufficiency of his rules to justify his conduct. It does not give him proofs, but teaches him what makes them proofs, and how he is to judge of them.

March 24, 1672. I saw the surgeon cut off the leg of a wounded sailor, the stout and gallant man enduring it with incredible patience without being bound to his chair as usual on such painful occasions. I had hardly courage enough to be present. Not being cut off high enough, the gangrene prevailed, and the second operation cost the poor creature his life.

Men of science, osteologists
And surgeons, beat some poets, in respect
For nature,—count nought common or unclean,
Spend raptures upon perfect specimens
Of indurated veins, distorted joints,
Or beautiful new cases of curved spine;
While we, we are shocked at nature’s falling off,
We dare to shrink back from her warts and blains.

My final word, before I'm done,
Is “Cancer can be rather fun”—
Provided one confronts the tumour
with a sufficient sense of humour.
I know that cancer often kills,
But so do cars and sleeping pills;
And it can hurt till one sweats,
So can bad teeth and unpaid debts.
A spot of laughter, I am sure,
Often accelerates one's cure;
So let us patients do our bit
To help the surgeons make us fit.

My life as a surgeon-scientist, combining humanity and science, has been fantastically rewarding. In our daily patients we witness human nature in the raw–fear, despair, courage, understanding, hope, resignation, heroism. If alert, we can detect new problems to solve, new paths to investigate.

My only wish would be to have ten more lives to live on this planet. If that were possible, I’d spend one lifetime each in embryology, genetics, physics, astronomy and geology. The other lifetimes would be as a pianist, backwoodsman, tennis player, or writer for the National Geographic. … I’d like to keep open the option for another lifetime as a surgeon-scientist.

On Saturday, I was a surgeon in South Africa, very little known ... [and] ... On Monday, I was world renowned.

On the 20th of May 1747, I took twelve patients in the scurvy, on board the Salisbury at sea. Their cases were as similar as I could have them. They all in general had putrid gums, the spots and lassitude, with weakness of their knees. They lay together in one place, being a proper apartment for the sick in the fore-hold; and had one diet common to all, viz, water-gruel sweetened with sugar in the morning; fresh mutton-broth often times for dinner; at other times puddings, boiled biscuit with sugar, &c.; and for supper, barley and raisins, rice and currents, sago and wine, or the like.
Two of these were ordered each a quart of cider a-day. Two others took twenty-five gutta of elixir vitriol three times a-day, upon an empty stomach; using a gargle strongly acidulated with it for their mouths. Two others took two spoonfuls of vinegar three times a-day, upon an empty stomach; having their gruels and their other food well acidulated with it, as also the gargle for their mouth. Two of the worst patients, with the tendons in the ham rigid, (a symptom none of the rest had), were put under a course of sea-water. Of this they drank half a pint every day, and sometimes more or less as it operated, by way of gentle physics. The others had each two oranges and one lemon given them every day. These they eat with greediness, at different times, upon an empty stomach. They continued but six days under this course, having consumed the quantity that could be spared. The two remaining patients, took the bigness of a nutmeg three times a-day, of an electuary recommended by an hospital-surgeon, made of garlic, mustard-seed, rad. raphan. balsam of Peru, and gum myrrh; using for common drink, barley-water well acidulated with tamarinds; by a decoction of which, with the addition of cremor tartar, they were gently purged three or four times during the course.
The consequence was, that the most sudden and visible good effects were perceived from the use of the oranges and lemons; one of those who had taken them, being at the end of six days fit for duty. …
Next to the oranges, I thought the cider had the best effects.

One of my surgical giant friends had in his operating room a sign “If the operation is difficult, you aren’t doing it right.” What he meant was, you have to plan every operation You cannot ever be casual You have to realize that any operation is a potential fatality.

Science affects the average man and woman in two ways already. He or she benefits by its application driving a motor-car or omnibus instead of a horse-drawn vehicle, being treated for disease by a doctor or surgeon rather than a witch, and being killed with an automatic pistol or shell in place of a dagger or a battle-axe.

Science does not have a moral dimension. It is like a knife. If you give it to a surgeon or a murderer, each will use it differently.

Sepsis is an insult to a surgeon.

Surgeon: A man who's always out for his cut.

Surgeons must be very careful
When they take the knife!
Underneath their fine incisions
Stirs the Culprit—Life!

The best surgeon is one that hath been hacked himself.

The British Medical Association is a club of London physicians and surgeons who once a year visit and patronize their professional friends in the country.

The fame of surgeons resembles the fame of actors, who live only during their lifetime and whose talent is no longer appreciable once they have disappeared.

The greatest discoveries of surgery are anaesthesia, asepsis, and roentgenology—and none was made by a surgeon.

The nature of the connexion between the mind and nervous matter has ever been, and must continue to be, the deepest mystery in physiology; and they who study the laws of Nature, as ordinances of God, will regard it as one of those secrets of his counsels ‘which Angels desire to look into.’
[Co-author with William Bowman]

The only weapon with which the unconscious patient can immediately retaliate upon the incompetent surgeon is hemorrhage.

The sick in soul insist that it is humanity that is sick, and they are the surgeons to operate on it. They want to turn the world into a sickroom. And once they get humanity strapped to the operating table, they operate on it with an ax.

The suppression of crime is not entirely a legal question. It is a problem for the physician, the economist and the lawyer. We, as physicians, should encourage the criminologist by lending to him the surgeon, the internist and all of the rest of the resources of medicine, just as we have done in the case of the flea man, the fly man, the mosquito man, the bed-bug man and all the other ologists.

The surgeon is a man of action. By temperament and by training he prefers to serve the sick by operating on them, and he inwardly commiserates with a patient so unfortunate as to have a disease not suited to surgical treatment. Young surgeons, busy mastering the technicalities of the art, are particularly alert to seize every legitimate opportunity to practice technical maneuvers, the more complicated the better.

The surgeon may harden himself whilst performing an operation, for he knows that he is acting for the good of his patient; but if we were intentionally to neglect the weak and helpless, it could only be for a contingent benefit, with an overwhelming present evil.

The surgeon should not love difficult cases and should not allow himself to be tempted to undertake those that are desperate. He should help the poor as far as he can, but he should not hesitate to ask for good fees from the rich.

The wounded surgeon plies the steel
That questions the distempered part;
Beneath the bleeding hands we feel
The sharp compassion of the healer’s art
Resolving the enigma of the fever chart.

There cannot always be fresh fields of conquest by the knife; there must be portions of the human frame that will ever remain sacred from its intrusions, at least in the surgeon's hands. That we have already, if not quite, reached these final limits, there can be little question. The abdomen, the chest, and the brain will be forever shut from the intrusion of the wise and humane surgeon.

There is no better surgeon than a man with many scars.

To be great, a surgeon must have a fierce determination to be the leader in his field. He must have a driving ego, a hunger beyond money. He must have a passion for perfectionism. He is like the actor who wants his name in lights.

We’ve all seen Apollo 13. NASA guys always have the old “plastic bag, cardboard tubing, and duct tape” option to fall back on when the shit hits the fan. Neurosurgeons have no such leeway. What it comes down to is this: if a brain surgeon screws up, it means a multi-million-dollar malpractice suit, but if a rocket scientist screws up, it means a multi-million-dollar hit movie starring Tom Hanks.

Why, in God's name, in our days, is there such a great difference between a physician and a surgeon? The physicians have abandoned operative procedures and the laity, either, as some say, because they disdain to operate with their hands, or rather, as I think, because they do not know how to perform operation. Indeed, this abuse is so inveterate that the common people look upon it as impossible for the same person to understand both surgery and medicine.

You Surgeons of London, who puzzle your Pates,
To ride in your Coaches, and purchase Estates,
Give over, for Shame, for your Pride has a Fall,
And ye Doctress of Epsom has outdone you all.

Dame Nature has given her a doctor's degree,
She gets all the patients and pockets the fee;
So if you don't instantly prove it a cheat,
She'll loll in a chariot whilst you walk the street.
Cautioning doctors about the quack bone-setter, Mrs. Mapp (d. 22 Dec 1737), who practiced in Epsom town once a week, arriving in a coach-and-four.