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

As Rutkow observes firstly of his e-book, it’s a “cheap certainty that nobody within the industrialized world will escape having an sickness for which efficient therapy requires a surgical treatment.” I actually would in all probability be blind in at the very least one eye (from retinal detachments), stroll with a limp (from a posh 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, resembling amputations for trauma. The one inner surgical procedure was the occasional foray into the bladder for bladder stones and trepanning of the cranium. Certainly, skulls have been discovered everywhere in the planet, courting again 1000’s of years, with intentionally made holes that had healed over with new bone, which means that the affected person survived the process. However it’s anyone’s guess as as to if the earliest trepanning was completed to launch a traumatic blood clot from contained in the cranium, or to launch an evil spirit answerable 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, nevertheless, is just not certainly one of regular, rational progress. The surgeon Galen, working within the second century AD, wrote extensively on anatomy; a few of his expertise got here from treating wounded gladiators however a lot of it was primarily based on dissecting animals, and was merely flawed with respect to human anatomy. His writings have been handed down by the Andalusian doctor Abu al-Qasim al-Zahrawi, amongst others, to grow to be 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 eliminated of executed criminals, usually surreptitiously from the gallows at night time. Surgeons resembling Ambroise Paré in France, engaged on battlefield accidents, established methods of controlling bleeding — tying off blood vessels, as an example, quite than utilizing red-hot irons and plunging the stump of an amputated limb into boiling oil.

However the best change got here within the mid-Nineteenth century, with using ether as an anesthetic, and Joseph Lister’s work on antisepsis. This was primarily based 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 e-book “Dangerous 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 quite a clumsy design), within the seventeenth century. The German Hungarian obstetrician Ignaz Semmelweis confirmed that hand-washing made a large 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, nevertheless, in the end a historical past of triumphant progress — though not with out darkish episodes, such because the abuse of psychosurgery in the course of the twentieth century.

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