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As Rutkow observes at the beginning of his book, “there is reasonable certainty that no one in the industrialized world can escape a disease whose effective treatment requires surgical operation.” Without the help of my surgical colleagues, I would probably have gone blind in at least one eye (from retinal detachments), walked with a limp (from a complex ankle fracture), and probably would have died (from urosepsis). But until 150 years ago, as Rutkow explains, surgery was limited to external parts of the human body, such as amputations for trauma. The only internal surgery was for bladder stones and trepanning of the skull with occasional bladder invasion. Indeed, skulls with deliberately drilled holes, healed with new bone, dating back thousands of years, have been found all over the planet, meaning the patient survived the procedure. But there are any guesses as to whether the earliest trepanation was done to release a traumatic blood clot from inside the skull, or to release an evil spirit responsible for epilepsy, or a similar, misunderstood disorder.
As Rutkow wrote, the emergence of surgery from its barbaric past rested on four pillars: understanding of anatomy, control of bleeding, anesthesia, and antisepsis. But the story is not a steady, rational progression. Working in the second century AD, surgeon Galen wrote extensively on anatomy; Some of his experience came from treating injured gladiators, but much of it relied on dissecting animals and was absolutely wrong in terms of human anatomy. His writings were cited to become dogma in the Middle Ages by the Andalusian doctor Abu al-Qasim al-Zehravi, among others.
The first breakthrough came more than a thousand years later, with the Renaissance and the relaxation of taboos about dismembering the dead. The Flemish doctor Andreas Vesalius, the greatest of the early anatomists, performed his dissections on the corpses of executed criminals, often secretly removed from the gallows at night. Like Ambroise Paré in France, surgeons working on battlefield injuries developed ways to control bleeding—for example, instead of using a hot iron and dipping the stump of an amputated limb in boiling oil, they tied off blood vessels.
The biggest change, however, occurred in the mid-19th century with the use of ether as an anesthetic and Joseph Lister’s work on antisepsis. This was based on Louis Pasteur’s work showing that infection is not caused by odors and polluted air (as previously thought) but by living microbes. However, as the medical historian David Wootton points out in his book “Bad Medicine,” the Swiss physician Paracelsus used ether to anesthetize chickens in the 16th century, and Antonie van Leeuwenhoek discovered bacteria using a microscope he had made himself (despite a rather odd design), in the 17th century. . German Hungarian obstetrician Ignaz Semmelweis showed that hand washing makes a big difference in the incidence of postpartum fatal infections in women. This was 20 years before Lister and Pasteur’s work, but Semmelweis was dismissed by his colleagues and died in obscurity. The history of surgery, especially up to the modern age, is as much about innovation as it is about the innate conservatism of doctors.
Ultimately, however, it is a triumphant history of progress, if not dark episodes such as the abuse of psychosurgery in the mid-20th century.
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