Book Review: Under the Knife

Under the Knife: The History of Surgery in 28 Remarkable Operations, by Arnold van de Laar, offers an eye watering, riveting, always accessible account of surgical techniques and development from biblical times through to the present day. The operations detailed focus on well known names – figureheads, tyrants and celebrities – as well as the medical practitioners who pioneered new practices, mostly without anaesthetic. Along the way technical terms commonly used by doctors are explained.

With the benefit of hindsight the unhygienic conditions that prevailed for so long may horrify, as will recurring treatments such as blood letting. For centuries surgeons and doctors were regarded separately, each developing their skills but rarely working together. Progress was sometimes accidental with a key observation or new practice ridiculed by peers until accepted by a high profile patient.

“in the Middle Ages common sense was obscured by tradition. Rather than looking at the results of their actions, our medieval forefathers would follow what some great predecessor had written in an ancient book.”

The Hippocratic Oath, historically taken by medical students as a step towards qualifying as a doctor, used to contain the line ‘I will not cut for stone’, implying that such dangerous practices as lithotomy – stone cutting – should be left to experts. The first operation detailed in the book involves a Dutch man who ignored this advice and, in desperation, cut out his own bladder stone at home. It was larger than a chicken’s egg and somehow he survived. The formation of such stones is explained as is the more standard operation to remove them and how this has changed over the years. Bladder stones are caused by bacteria. What was once an everyday complaint is now rare.

Treatment for asphyxia – problems with breathing – is then explored by detailing treatment of a very famous patient following a shooting – President John F. Kennedy. As we know he did not survive, following in the footsteps of the first president of the United States, George Washington, who suffocated after his doctors refused to perform a tracheotomy – a cut into the windpipe to allow air into the lungs. This and similar treatments are described along with when and why they may be needed.

Further chapters cover other common complaints: wound healing, including reasons for circumcision; shock, which in medical terms means a failure of the blood’s circulatory system; obesity and its complications, recurrent amongst popes over the years; fracture; varicose veins and other problems caused when our ancestors decided to walk on two legs; peritonitis, which killed Harry Houdini; narcosis and the introduction of anaesthetics for which Queen Victoria was thankful; gangrene; aneurysm; castration; hernia; stroke and more.

Bob Marley died because his religion forbade him from accepting required treatment. Alan Shepard became the fifth man to walk on the moon thanks to a placebo. Lenin suffered multiple strokes throughout his life, the causes and effects of which likely contributed to making him the tyrant he became, although he may have been felled due to lead poisoning from a bullet that remained in his body following a shooting years previously.

As well as detailing key operations, methods of diagnosis are discussed along with complications that can arise due to surgical error. Successful surgeons can become much sought after, especially by those willing and able to pay. Michael DeBakey was one such man in the twentieth century. Described as a maestro by his famous patients he enjoyed to the full his reputation and fame. Nevertheless he dismissed an assistant’s concern during an operation and did not follow through when the patient, the deposed Shah of Iran, developed worrying post operative symptoms which ultimately led to the former leader’s death.

“great surgeons can sometimes make a mistake. Complications are, after all, part and parcel of operations and the risk of problems can never be counted out, no matter how great you are.”

Each of the twenty-eight chapters offers a fascinating insight into surgical developments and subsequent treatment. They are written with sympathy and wit in a style that enables lay readers to understand and learn more about doctor’s reasoning, vernacular and limitations.

For anyone interested in little known medical issues suffered by the famous over the centuries, in how their own body functions and the work of those who may be called upon to keep it going, this is a well structured, digestible, recommended read.

My copy of this book was provided gratis by the publisher, John Murray, via Bookbridgr

2 comments on “Book Review: Under the Knife

  1. I’ve been hearing about this one, it sounds great but I think I’m going to be too squeamish to read it myself! Excellent review.

    • Jackie Law says:

      Thanks. It is very well structured so easy to read without dumbing down. Surgeries were bloody and must have been excruciating for the patient but it offers a fascinating insight into their development.

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