Under the Knife - A History of Surgery in 28 Remarkable Operations (2018)
Author: Arnold Van De Laar
Most nations in the world are forever looking out to keep their brains within their boundaries. Brains, besides economics, are the main ingredients of nation-building. For this, it needs the services of the top five professional vocations - architects, accountants, engineers, maybe lawyers and doctors.
Critical thinking and thinking outside the box are pre-requisites to unshackle the chains of poverty. Ironically, doctors are not expected to be too creative. They are merely expected to conform and follow the precedence as set by their seniors. No patients want to be treated by a 'cowboy'. New ventures can only be under the purview of peers of high standings. Misadventures stemming from unconventional, novel and experimental modalities will implore the wrath of the society, not praises for innovations.
This book is a collection of about 28 kinds of surgeries and a little of history associated with them. It goes as far back as to a time when analgesia was a long shot of brandy or chewing on some roots. And the removal of bladder stones meant cutting through the highly sensitive and vascular perineal region unanaesthetised and the area was to be left unsutured. Sutured had not been invented yet.
Jan De Vaat, a Dutch surgeon, had the dubious honour of operating on his own bladder stone. The lithotomy position, used by most gynaecological patients, got its name from these operations as it was in that position bladder stones were removed (lith - stone, otomy - cut).
It brings to the time when JFK was brought to the casualty unit in a Dallas hospital after being shot. The surgeon on-call had to perform a tracheostomy to create an airway, but the President succumbed to hypoxia due to a torn trachea and massive blood loss. JFK may have been saved if he had an airway secured within the 8-minute critical window. Probably that is why now an ambulance with a medical team accompanies any of the President's entourage to institute immediate treatment. A similar situation befell upon George Washington. He had a nasty throat infection for which an age-old practice of blood-letting was established instead of tracheostomy. He lost 2.5 litres of blood in 16 hours.
The practice of mandatory circumcision probably arose from Abraham's phimosis. The scriptures made mention of Abraham having painful erections; hence coitus was avoided, and Sarah remained childless. He sliced off the tight prepuce with a stone, and he was relieved of his misery. Sarah soon conceived. King Louis XVI probably suffered the same ailment, but he was relieved by ointments.
Many of the medical conditions here are explained in simple terms for the general public to follow the discussions. Empress Sisi of Austria's ability to witness a stab wound on her chest was due to the tamponade by her corset.
Obesity was an issue even during the early years of the Papacy. Of course, Popes were old when they were ordained. Nevertheless, the 5-year survival rate of Popes is 54%. Many died soon after installed. The lingering rumour is the allegation of foul play, but lifestyles diseases and obesity predominate.
Pope Paul John II was not so lucky with bullets. He once was shot in the abdomen and ended up with a temporary colostomy. He ceremoniously visited his assailant in prison.
Hammurabi had laid down a code for practising physicians. The patient cannot be charged if he is not cured of his ailment. The author relates the story of King Darius, who had an ankle fracture. Egyptians used to have great doctors, it seems, and one of their doctors supposedly treated it.
Many of the general surgeons' jobs revolve around the fact that we are biped. Ever since Lucy, our first ancestor, started walking erect, homo sapiens have to deal with varicose veins, inguinal hernia, haemorrhoids, disc prolapse, genital prolapse as well as hip and knee problems. Incidentally, Lucy is named such because of the song that was playing in the background when her fossils were excavated - Lucy in the Sky of Diamond.
Even though most people think Houdini died underwater, drowning after failing to escape from a locked chest, his cause of death is actually perforated appendicitis with peritonitis.
A dentist in Boston is credited with the honour of administering ether anaesthesia for a surgeon to operate a patient with neck tumour. The surgeon, so impressed with the technique, uttered the historical line, "Gentlemen, this is no humbug." Their European cousins, the British, thought otherwise. That was until the grand multiparous Queen Victoria, in 1847, a year later, had chloroform offered to her by John Snow. The follow-up was not all okay. Queen Victoria suffered postnatal depression, of course not related to anaesthesia. Biblical scholarly were quick to condemn the act as going against Nature as the scriptures state that women must endure labour pains.
With the royal seal established in medicine, other branches of medicine soon gain traction. The importance of handwashing, donning of gloves, hygiene and epidemiology were appreciated.
Because of the nature of human activities and the absence of antibiotics, gangrene was a common occurrence those days. The need for amputation was appreciated.
It is often said that one can train a monkey to perform surgeries. Still, the true mark of a surgeon is in his ability to deduce a diagnosis based on the clinical observations and to deal with complications if it should arise. Saying that history has shown that even experienced surgeons are guilty of running into trouble and failing to identify complications. A case in point was when pioneering vascular, Michael DeBakey, was requested to perform a splenectomy on the leukaemia-inflicted deposed Shah of Persia. A subphrenic abscess developed to be thought of a little bit too late even though the telltale signs were evident for all to elucidate. The monarch succumbed to the complications following the repeat surgery.
Even though the need and safety of surgery are established, some patients still refuse surgical procedures on personal grounds. Bob Marley rejected the idea of losing his big toe even though he was diagnosed with malignant melanoma. His religion, Raftarianism, is against losing body parts. He succumbed to metastasis.
Hippocrates had noted that cutting open the abdomen is always fatal, but we have come a long way doing safe laparotomies, laparoscopies and many abdominoplasties. Gynaecologists started the ball rolling with minimally invasive surgery with visualisation of pelvic organs. There is an interesting description of Einstein and his problem with a dissecting aortic aneurysm. Nissen, famous for his fundoplication surgery for acid reflux, wrapped his aneurysm with simple cellophane paper, which was to spur scarring around the vessel.
Castration remains one of the most frequent surgeries performed in the history of mankind. Maybe the word 'rib' in ancient scriptures somehow denotes the part of the penile 'bone'. In other words, a woman is a castrated male - God made Eve from Adam's rib!
This surgical operation is more than just a medical procedure. It has power-play and political implications. In the imperial courts of China, eunuchs play an essential role in handling affairs of the royal household. They were loyal and efficient workers. They were not mere servants but hold a very subtle unseen control of power in the kingdom.
During the barbaric tyranny of fanatic Islamic tribes, castration was mainstream. It remained a sure way to put cessation to the lineage of their non-believing conquests. And their subjects made good slave material to spur the economy. Even in recent times, chemical castration was instituted to homosexuals. Alan Turing was one such victim. Prostatic cancer is probably the only bona fide indication for castration of unaffected testes.
The place of placebo is firmly rooted in the holistic management of an ailing patient. Alan B Shepard, the first American to fly into space failed to partake in Apollo 11 lunar mission because of vestibular dysfunction. A dubious procedure of unproven value was done on him. In 1971, he finally landed on the last lunar landing through Apollo 14.
An interesting coincidence happened when JFK's assassin, Lee Harvey Oswald, was treated by the same surgeon who treated JFK. He succumbed to the single bullet that pierced his abdomen, injuring many vital blood vessels. In his dying moment, the medical team try to whisper to him to spill the beans whether he was indeed the shooter, but he took the secret with him to the grave.
The first medical prosthesis was probably that for a patient with tuberculosis of the shoulder. It was made from hardened paraffin but failed miserably as the bone was still infected with T.B.
From the misadventures of Lenin who suffered from multiple strokes and paralysis, we appreciated the need for smooth laminar flow in the carotids.
Kocher, a doyen in general surgery, was a pioneer in gastric surgery together with Billroth and Halstead. Kocher was the first surgeon to be awarded the Nobel Prize and has many things named after him - instruments, incisions, signs, manoeuvres, points of references and even a crater on the moon. Ironically, he died after thyroid surgery.
What started as an operation on an electric eel in an Amsterdam zoo, electricity finally evolved to be used as a means to coagulate and cut tissues.
The book ends with pop culture references to the job in many famed Hollywood productions. From female surgeon, Dr Helena Russel in Space:1999 to Robot Surgeons in Star Wars, making surgeons superfluous to software (HAL 9000) overriding human commands in Kubrik's 2001:Space Odyssey and doctors reduced to corpuscle size to perform minimally invasive procedures in Fanstatic Voyage, many of the things that were considered to be in the domain of science fiction are now becoming mainstream.
(P.S. Just a tongue-in-the-cheek statement. The book failed to mention the contribution of other nations in the development of surgical skills and techniques. Maybe it is ignorance. The British, with the privilege of eavesdropping and spy watching on their subjects, discovered of an Indian peasant performing rhinoplasty on a British soldier was cut off by Tipu Sultan's Army.
Critical thinking and thinking outside the box are pre-requisites to unshackle the chains of poverty. Ironically, doctors are not expected to be too creative. They are merely expected to conform and follow the precedence as set by their seniors. No patients want to be treated by a 'cowboy'. New ventures can only be under the purview of peers of high standings. Misadventures stemming from unconventional, novel and experimental modalities will implore the wrath of the society, not praises for innovations.
This book is a collection of about 28 kinds of surgeries and a little of history associated with them. It goes as far back as to a time when analgesia was a long shot of brandy or chewing on some roots. And the removal of bladder stones meant cutting through the highly sensitive and vascular perineal region unanaesthetised and the area was to be left unsutured. Sutured had not been invented yet.
Jan De Vaat, a Dutch surgeon, had the dubious honour of operating on his own bladder stone. The lithotomy position, used by most gynaecological patients, got its name from these operations as it was in that position bladder stones were removed (lith - stone, otomy - cut).
It brings to the time when JFK was brought to the casualty unit in a Dallas hospital after being shot. The surgeon on-call had to perform a tracheostomy to create an airway, but the President succumbed to hypoxia due to a torn trachea and massive blood loss. JFK may have been saved if he had an airway secured within the 8-minute critical window. Probably that is why now an ambulance with a medical team accompanies any of the President's entourage to institute immediate treatment. A similar situation befell upon George Washington. He had a nasty throat infection for which an age-old practice of blood-letting was established instead of tracheostomy. He lost 2.5 litres of blood in 16 hours.
The practice of mandatory circumcision probably arose from Abraham's phimosis. The scriptures made mention of Abraham having painful erections; hence coitus was avoided, and Sarah remained childless. He sliced off the tight prepuce with a stone, and he was relieved of his misery. Sarah soon conceived. King Louis XVI probably suffered the same ailment, but he was relieved by ointments.
Many of the medical conditions here are explained in simple terms for the general public to follow the discussions. Empress Sisi of Austria's ability to witness a stab wound on her chest was due to the tamponade by her corset.
Obesity was an issue even during the early years of the Papacy. Of course, Popes were old when they were ordained. Nevertheless, the 5-year survival rate of Popes is 54%. Many died soon after installed. The lingering rumour is the allegation of foul play, but lifestyles diseases and obesity predominate.
Pope Paul John II was not so lucky with bullets. He once was shot in the abdomen and ended up with a temporary colostomy. He ceremoniously visited his assailant in prison.
Hammurabi had laid down a code for practising physicians. The patient cannot be charged if he is not cured of his ailment. The author relates the story of King Darius, who had an ankle fracture. Egyptians used to have great doctors, it seems, and one of their doctors supposedly treated it.
Many of the general surgeons' jobs revolve around the fact that we are biped. Ever since Lucy, our first ancestor, started walking erect, homo sapiens have to deal with varicose veins, inguinal hernia, haemorrhoids, disc prolapse, genital prolapse as well as hip and knee problems. Incidentally, Lucy is named such because of the song that was playing in the background when her fossils were excavated - Lucy in the Sky of Diamond.
Even though most people think Houdini died underwater, drowning after failing to escape from a locked chest, his cause of death is actually perforated appendicitis with peritonitis.
A dentist in Boston is credited with the honour of administering ether anaesthesia for a surgeon to operate a patient with neck tumour. The surgeon, so impressed with the technique, uttered the historical line, "Gentlemen, this is no humbug." Their European cousins, the British, thought otherwise. That was until the grand multiparous Queen Victoria, in 1847, a year later, had chloroform offered to her by John Snow. The follow-up was not all okay. Queen Victoria suffered postnatal depression, of course not related to anaesthesia. Biblical scholarly were quick to condemn the act as going against Nature as the scriptures state that women must endure labour pains.
With the royal seal established in medicine, other branches of medicine soon gain traction. The importance of handwashing, donning of gloves, hygiene and epidemiology were appreciated.
Because of the nature of human activities and the absence of antibiotics, gangrene was a common occurrence those days. The need for amputation was appreciated.
It is often said that one can train a monkey to perform surgeries. Still, the true mark of a surgeon is in his ability to deduce a diagnosis based on the clinical observations and to deal with complications if it should arise. Saying that history has shown that even experienced surgeons are guilty of running into trouble and failing to identify complications. A case in point was when pioneering vascular, Michael DeBakey, was requested to perform a splenectomy on the leukaemia-inflicted deposed Shah of Persia. A subphrenic abscess developed to be thought of a little bit too late even though the telltale signs were evident for all to elucidate. The monarch succumbed to the complications following the repeat surgery.
Even though the need and safety of surgery are established, some patients still refuse surgical procedures on personal grounds. Bob Marley rejected the idea of losing his big toe even though he was diagnosed with malignant melanoma. His religion, Raftarianism, is against losing body parts. He succumbed to metastasis.
Hippocrates had noted that cutting open the abdomen is always fatal, but we have come a long way doing safe laparotomies, laparoscopies and many abdominoplasties. Gynaecologists started the ball rolling with minimally invasive surgery with visualisation of pelvic organs. There is an interesting description of Einstein and his problem with a dissecting aortic aneurysm. Nissen, famous for his fundoplication surgery for acid reflux, wrapped his aneurysm with simple cellophane paper, which was to spur scarring around the vessel.
Castration remains one of the most frequent surgeries performed in the history of mankind. Maybe the word 'rib' in ancient scriptures somehow denotes the part of the penile 'bone'. In other words, a woman is a castrated male - God made Eve from Adam's rib!
This surgical operation is more than just a medical procedure. It has power-play and political implications. In the imperial courts of China, eunuchs play an essential role in handling affairs of the royal household. They were loyal and efficient workers. They were not mere servants but hold a very subtle unseen control of power in the kingdom.
During the barbaric tyranny of fanatic Islamic tribes, castration was mainstream. It remained a sure way to put cessation to the lineage of their non-believing conquests. And their subjects made good slave material to spur the economy. Even in recent times, chemical castration was instituted to homosexuals. Alan Turing was one such victim. Prostatic cancer is probably the only bona fide indication for castration of unaffected testes.
The place of placebo is firmly rooted in the holistic management of an ailing patient. Alan B Shepard, the first American to fly into space failed to partake in Apollo 11 lunar mission because of vestibular dysfunction. A dubious procedure of unproven value was done on him. In 1971, he finally landed on the last lunar landing through Apollo 14.
An interesting coincidence happened when JFK's assassin, Lee Harvey Oswald, was treated by the same surgeon who treated JFK. He succumbed to the single bullet that pierced his abdomen, injuring many vital blood vessels. In his dying moment, the medical team try to whisper to him to spill the beans whether he was indeed the shooter, but he took the secret with him to the grave.
The first medical prosthesis was probably that for a patient with tuberculosis of the shoulder. It was made from hardened paraffin but failed miserably as the bone was still infected with T.B.
From the misadventures of Lenin who suffered from multiple strokes and paralysis, we appreciated the need for smooth laminar flow in the carotids.
Kocher, a doyen in general surgery, was a pioneer in gastric surgery together with Billroth and Halstead. Kocher was the first surgeon to be awarded the Nobel Prize and has many things named after him - instruments, incisions, signs, manoeuvres, points of references and even a crater on the moon. Ironically, he died after thyroid surgery.
What started as an operation on an electric eel in an Amsterdam zoo, electricity finally evolved to be used as a means to coagulate and cut tissues.
The book ends with pop culture references to the job in many famed Hollywood productions. From female surgeon, Dr Helena Russel in Space:1999 to Robot Surgeons in Star Wars, making surgeons superfluous to software (HAL 9000) overriding human commands in Kubrik's 2001:Space Odyssey and doctors reduced to corpuscle size to perform minimally invasive procedures in Fanstatic Voyage, many of the things that were considered to be in the domain of science fiction are now becoming mainstream.
(P.S. Just a tongue-in-the-cheek statement. The book failed to mention the contribution of other nations in the development of surgical skills and techniques. Maybe it is ignorance. The British, with the privilege of eavesdropping and spy watching on their subjects, discovered of an Indian peasant performing rhinoplasty on a British soldier was cut off by Tipu Sultan's Army.
 |
On 9 October 1794, an operation to replace the nose,
at that point no longer practised in the West, was
reported in the Gentleman's Magazine. Cowasjee,
a Mahratta, who had served in the British army as
a bullock driver was captured by Tipu Sultan and
mutilated by having his nose and one of his hands
cut off. The nose was replaced from a flap of skin
brought down from the forehead to cover the
mutilated nose, an operation thought to have been
practised for centuries in India.
|
No comments:
Post a Comment