Surgery at the Cutting Edge; SHARP ADVICE: Surgeons Have to Show Confidence, If Only to Put Their Patients at Ease

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Byline: Henry Marsh

Blood And Guts: A History Of Surgery by Richard Hollingham BBC Books ? 18.99 . ?17.10 inc p& p (08451550713) . . ...

Iremember some years ago there was a television series about the history of surgery called The Courage To Fail, a title that seemed to emphasise the heroism of surgeons rather than the suffering of patients. I thought it could equally well have been called The Courage To Be Failed Upon.

Blood And Guts is an excellent history of surgery accompanying a new television series on the subject and, as the title suggests, it does not underestimate the violent and bloody nature of its subject.

The practice of surgery has much in common with mountaineering. They both involve great skill and danger, and exhilaration when one is successful. Those who dislike surgeons, of which there are not a few, would say that surgery is mountaineering for cowards since it is not the surgeon's life that is at risk.

However, this highly readable book, full of gripping anecdotes, shows how difficult it can be for surgeons to find the right balance between pioneering experimentation and the ancient Hippocratic rule of 'above all, do no harm'.

It opens with a vivid description of an amputation in 1842, in which a leg is removed in less than 30 seconds without anaesthetic. The swiftness and savagery of the operation was in fact a form of kindness since it was an attempt to minimise the patient's suffering. Yet for all the surgeon's speed and dexterity, such surgery still had a 50 per cent mortality rate due to ignorance of the infections that killed the patients afterwards.

The modern era of surgery began with the discovery of antisepsis and anaesthesia.

This was partly due to the new science of chemistry, with the development of agents such as ether, nitrous oxide and carbolic acid. It was also the result of careful observation and analysis taking precedence over opinion and tradition: surgeons then, as now, tended to be conservative.

It is shocking to learn, for instance, that the Hungarian doctor Ignaz Semmelweis's groundbreaking work on infections in the middle of the 19th Century was at first rejected by the medical profession, even though his introduction of handwashing and sheet-laundering had led to a reduction in the deaths of women after childbirth in hospital from 18 per cent to 1 per cent. …