The Art of Surgery

Doctors     by Sherwin B. Nuland

The Illustrated History of Medical Pioneers

480 pp.,Illustrated edition by Black Dog and Leventhal, 2008 ....   reviewed by David P. Stern


      "Doctors " is a passionate history of surgery. There is much more to medicine: drugs, vaccines, epidemics and many other side branches, only sketchily covered here, though they probably deserve their own histories and halls of fame. But the evolution of surgery is a fitting framework for tracing all medical history, and Dr. Nuland, a surgeon himself, knows enough stories to stitch together a fascinating narrative. It is a large book, heavy (4.2 lb), beautifully produced in China: savor it slowly, a chapter at a time.

    Dr. Nuland is an experienced writer ("How we Die"), sensitive to nuances of personality ("Lost in America" is a touching account of his growing up) and a developed sense of history. The result is a highly personal account, not at all detached, illustrating his belief that medicine, though heavily relying on science and its methods, is primarily an art.

    Today's educated citizen takes for granted our knowledge of the human body, and rarely appreciates how slow and hesitant was the acquisition of the even the most basic facts about it--e.g. the circulation of blood and the role of microbes in disease. Today's educated citizen might also be surprised at the number of medical problem still unsolved (how do we get headaches, arthritis, cancer? How does the brain work, and interpret what the eye sees?), without realizing that much of today's medicine only emerged in the 19th and 20th century. Nuland goes back to the foundations, to Hippocrates groping in ignorance, to Galen (1st century) who dissected animals (but never human bodies!) and who identified organs with no clear idea of what they did. Also to Vesalius, finally dissecting the dead human and, not having photography available, calling on some of the finest artists of the renaissance to produce careful drawings of what he saw. And to Ambroise Paré, the barber-surgeon who earned skill and knowledge by tending many of the wounded in the religious wars of the 16th century.

    Even today, surgeons still know far too little of what makes the body tick. Imagine yourself in a similar position--given a working computer and asked to figure out its operation, at first without even opening its case. When you finally do open it, you face a bewildering array of wires and encased circuits, and opening these is still not enough: even to trace the circuitry inside "chips" requires a good microscope, and after that you still need to understand what they do. The task facing medical science is not much easier, and one ought to be amazed at the limited headway achieved.

    Progress accelerated in the 1600s with understanding of blood circulation and of the heart, though it remained for some determined men and women in the 20th century to perform heart surgery and save lives of "blue babies." The story of Ignac Semmelweis illustrates the uncertainty of progress. Given an insight--through a fatal incident to a fellow surgeon--of the deadly infection which killed mothers after childbirth, he was prevented by his timid character and lack of writing skills from applying his finding on a wider scale and thus saving thousands of lives. You read of Joseph Lister, the gentle Quaker surgeon of Edinburgh, and of Robert Virchow, pursuing twin goals of improving surgery and bettering society. And about the contested origins of anesthesia, about the sprouting of the first modern American school of medicine in Baltimore, Maryland, and about surgeries made possible only by heart-lung machines and anti-rejection drugs. This book was first published in 1988; had it been written more recently, it would at least cover laparoscopic surgery, remotely conducted through tiny incisions.

    It is a story well told, because the author has an insider's insight and information, has traced history to its details (credit the Yale Historical Medicine Library!) and because his style is personal and engaging. If you have a favorite physician, this book may make an appropriate gift. But first, read it yourself!

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Author and Curator:   Dr. David P. Stern
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Last updated 29 January 2009