Review: “Empire of the Scalpel,” by Ira Rutkow

As Rutkow notes at the beginning of his book. It is the reasonable assurance that no one in the industrialized world will escape a disease that requires surgery to effectively treat. I myself would probably be blind in at least one eye (due to retinal detachment), limp (due to a compound ankle fracture).

And possibly be dead (due to urosepsis) if not for help. my fellow surgeons. However, until 150 years ago, Rutkow explains, surgery was limited to external parts of the human body. Such as amputations for injuries. The only internal surgery was occasional bladder raids for bladder stones and a craniotomy. Indeed, millennia-old skulls have been found all over. The planet with intentionally pierced holes that have healed with new bone, meaning the patient survived the procedure. But no one can guess whether the earliest trepanation was done to release a traumatic blood clot from inside the skull or to release the evil spirit responsible for epilepsy or some similar misunderstood disorder.


As Rutkow writes, the emergence of surgery from its barbaric past rested on four pillars—an understanding of anatomy, control of bleeding, anesthesia, and antisepsis. History, however, is not the history of sustainable, rational progress. The surgeon Galen, active in the second century AD, wrote extensively on anatomy. Some of his experience came from treating wounded gladiators, but much of it was based on animal dissection and was simply wrong in relation to human anatomy. His writings were transmitted by the Andalusian physician Abu al-Qasim al-Zahrawi, among others, and became dogma during the Middle Ages.


The first breakthrough came over a thousand years later during the Renaissance and the loosening of the taboo on autopsies. The Flemish physician Andreas Vesalius, the greatest of the early anatomists, performed autopsies on the corpses of executed criminals, often taken secretly from the gallows at night. Surgeons such as Ambroise Pare in France, working with wounds on the battlefield, developed ways to stop bleeding. Such as tying off blood vessels instead of using hot irons and dipping the stump of an amputated limb in boiling oil.

Joseph Lister’s

But the biggest change came in the mid-19th century with the use of ether as an anesthetic and Joseph Lister’s work on antiseptics. This was based on the work of Louis Pasteur showing. That infection is caused by living microbes and not (as previously thought) by odors and dirty air. And yet, as the medical historian David Wootton pointed out in his book Bad Medicine.

The Swiss physician Paracelsus used ether to anesthetize chickens in the 16th century. And Anthony van Leeuwenhoek discovered bacteria using a microscope of his own design (albeit a rather clumsy design). In 17th-century German Hungarian obstetrician Ignaz Semmelweis has shown. That handwashing plays a huge role in the incidence of fatal postpartum infections in women. This was 20 years before the work of Lister and Pasteur. But Semmelweis was fired by his colleagues and died in obscurity. The history of surgery, especially until modern times, is associated with both the innate conservatism of physicians and innovation.

However, it is ultimately a story of triumphant progress. Though not without dark episodes such as the misuse of psychosurgery in the mid-20th century.

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