Review: “Empire of the Scalpel,” by Ira Rutkow

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As Rutkow observes at the start of his guide, it’s a “cheap certainty that nobody within the industrialized world will escape having an sickness for which efficient remedy requires a surgical treatment.” I personally would most likely be blind in a minimum of one eye (from retinal detachments), stroll with a limp (from a fancy ankle fracture) and presumably be lifeless (from urosepsis) if not for the assistance of my surgical colleagues. But till 150 years in the past, as Rutkow explains, surgical procedure was restricted to the exterior elements of the human physique, reminiscent of amputations for trauma. The one inside surgical procedure was the occasional foray into the bladder for bladder stones and trepanning of the cranium. Certainly, skulls have been discovered all around the planet, courting again 1000’s of years, with intentionally made holes that had healed over with new bone, that means that the affected person survived the process. However it’s anyone’s guess as as to if the earliest trepanning was accomplished to launch a traumatic blood clot from contained in the cranium, or to launch an evil spirit liable for epilepsy or some related, misunderstood dysfunction.

As Rutkow writes, the emergence of surgical procedure from its barbaric previous rested on 4 pillars — the understanding of anatomy, the management of bleeding, anesthesia and antisepsis. The story, nonetheless, will not be one among regular, rational progress. The surgeon Galen, working within the second century A.D., wrote extensively on anatomy; a few of his expertise got here from treating wounded gladiators however a lot of it was based mostly on dissecting animals, and was merely mistaken with respect to human anatomy. His writings have been handed down by the Andalusian doctor Abu al-Qasim al-Zahrawi, amongst others, to change into dogma within the Center Ages.

The primary breakthrough got here greater than a thousand years later with the Renaissance, and the relief of taboos about dissecting the lifeless. The Flemish doctor Andreas Vesalius, the best of the early anatomists, carried out his dissections on the corpses of executed criminals, usually eliminated surreptitiously from the gallows at night time. Surgeons reminiscent of Ambroise Paré in France, engaged on battlefield accidents, established methods of controlling bleeding — tying off blood vessels, for example, slightly than utilizing red-hot irons and plunging the stump of an amputated limb into boiling oil.

However the biggest change got here within the mid-Nineteenth century, with the usage of ether as an anesthetic, and Joseph Lister’s work on antisepsis. This was based mostly on Louis Pasteur’s work exhibiting that an infection was brought on by dwelling microbes, and never (as had been beforehand thought) by smells and foul air. And but, because the medical historian David Wootton has identified in his guide “Unhealthy Drugs,” the Swiss doctor Paracelsus was utilizing ether to anesthetize chickens within the sixteenth century and Antonie van Leeuwenhoek had found micro organism, utilizing a microscope of his personal making (though of slightly an ungainly design), within the seventeenth century. The German Hungarian obstetrician Ignaz Semmelweis confirmed that hand-washing made an enormous distinction to the incidence of deadly postnatal infections in girls. This was 20 years earlier than Lister’s and Pasteur’s work, but Semmelweis was dismissed by his colleagues and he died in obscurity. The historical past of surgical procedure, particularly till the fashionable period, is as a lot about docs’ innate conservatism as it’s about innovation.

It’s, nonetheless, in the end a historical past of triumphant progress — though not with out darkish episodes, such because the abuse of psychosurgery in the midst of the twentieth century.

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