AT THE CUTTING EDGE
Why has the literary world suddenly become obsessed with surgeons? Over the past few years, publishers have haemorrhaged surgeon-memoirs, from Henry Marsh’s Do No Harm to Atul Gawande’s Being Mortal and Paul Kalanithi’s When Breath Becomes Air. But their contemporary tales of slicing open safely-anaesthetised patients in antiseptic operating theatres seem positively cosy when compared to the operations of yore.
Enter Arnold van de Laar, a Dutch surgeon who has written a history of surgery through 28 operations. The chapters span blood-letting to anal fistulas, amputations to pioneering brain surgery, beginning in Ancient Egypt and running through to the present day. The tales have been chosen because the stories are ‘dear to me’, which sets the tone for this utterly eccentric and riveting collection.
Van de Laar takes us back to Amsterdam in the 17th century when bladder stones were as common a complaint as diarrhoea, caused by poor hygiene and a lack of clean drinking water. The operation required to remove the excruciating stones is known as a lithotomy – literally, stone cutting – and it had a mortality rate of about 40%. Which is why the story of the Dutch blacksmith Jan de Doot is all the more remarkable. After years of suffering from a bladder stone and two failed operations to rid himself of it, de Doot decided to operate on himself. He enlisted the help of his assistant to make an incision between the scrotum and the anus. His instruments were not sterile and de Doot knew nothing of anatomy, but he knew where it hurt. That he survived was remarkable: a 1655 portrait by Carel van Savoyen depicts a pained-looking de Doot brandishing a kitchen knife and the offending bladder stone, which is the size and shape of an egg.
Surgery has always required this sort of maverick behaviour. Take, for example, the work of pioneering Scot Robert Liston (1794-1847), who was known in London as ‘the fastest knife in the West End’ (speed was of particular importance before the widespread use of anaesthetic in the latter half of the 19th century).
However, precision was not his forte. His knife once shot out during an operation and hit his assistant’s fingers. Such was the profusion of blood that one spectator dropped dead from shock. Both patient and assistant also died, from gangrene, making it one of the few procedures on record to have resulted in the deaths of three times as many people as were operated on. Liston sounds more like a cowboy than a medic, yet he made several important medical innovations: he devised the ‘bulldog’ forceps that are still used to clamp blood vessels during operations. Under The Knife isn’t a historical study of surgery’s origins so much as a gleeful, gory introduction to some of the most colourful characters to have wielded a scalpel. It’s a shame that van de Laar didn’t include more women: he points out that there have always been respected female surgeons – he just doesn’t seem to find the space to discuss many of them.