Magazine article The Spectator

'Under the Knife: A History of Surgery in 28 Remarkable Operations', by Arnold Van De Laar - Review

Magazine article The Spectator

'Under the Knife: A History of Surgery in 28 Remarkable Operations', by Arnold Van De Laar - Review

Article excerpt

Powerful memoirs by such eloquent doctors as Oliver Sacks, Atul Gawande, Henry Marsh, Gabriel Weston and Paul Kalanithi have whipped the bed curtains open on a previously secretive profession. Steeped as medicine is in uncomfortable facts about debilitating illness, pain and the stress of treating intractable conditions, it was a subject ripe for exposure.

Under the Knife and Anaesthesia admit to the fallibility of medicine and the responsibilities, flaws and complex emotions of its practitioners. Arnold van de Laar does not rely on personal experience. Instead, he explores the world of surgery through 28 clinical conditions; its historical scope makes for a fascinating book.

Did you know that when Louis XlV was found to be suffering from an anal fistula, his nervous, inexperienced surgeon asked for six months in which to practise on 75 citizens? That Houdini had acute appendicitis at the time of his last performance? That a Dutchman was so frenzied by the agony of his bladder stone that he cut it out himself? In the days before prosthetics, Albert Einstein was saved from near certain death from acute abdominal aortic aneurysm (a swelling of the main artery of the body that precedes rupture) by a surgeon who wrapped the bulging vessel in cellophane. The Shah of Iran's painful death was hastened by his summoning to Egypt a famous American vascular surgeon with no experience in operating on spleens. The surgeon, catastrophically, removed pancreatic tissue along with the spleen. Bob Marley died because he refused to have his big toe with melanoma amputated.

The author's sense of humour is as sharp as his scalpel. He recounts how, when a surgeon famous for speed, accidentally sliced open his assistant's fingers, an onlooker collapsed and died, as did, eventually, the assistant and the patient, so that a single operation resulted in three deaths.

But I have a few quibbles with some of his assertions. Not all bladder stones are caused by infection. The statement that in cardiac tamponade 'the heart will not only beat less frequently but less powerfully' is misleading: when the heart is compressed by fluid in the surrounding sac, it beats furiously fast to try to compensate for the decrease in cardiac output, although slow heart rhythm can occur early and late in the condition. I question Van de Laar's certitude that Houdini's appendix rupture wasn't a result of being punched in the abdomen before he had a chance to tense his abdominal muscles, and query his use of 'ileus' for mechanical bowel obstruction. …

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