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A review by lpm100
Under the Knife: A History of Surgery in 28 Remarkable Operations by Arnold van de Laar
informative
medium-paced
5.0
Book Review
"Under The Knife"
5/5 stars
Of the book:
-309 pages of prose/29 chapters
≈11 pps/chapter
-62 references (exactly 31 books and exactly 31 journal articles)
-A glossary
-A good index
This is a brilliant book, and I recommend that it be read in conjunction with "Complications," by Atul Gawande.
It is just what it claims to be, which is: a brief history of surgery with a narrative are constructed by the history of 28 specific surgeries.
There are some pictures, but absolutely no graphs or diagrams.
It really has the feel of being written by a surgeon, because there are absolutely no wasted words in this book.
I'm also not clear whether or not it was originally written in English, but if it was: this Dutchman has an impressive command of the English language. His prose is so clear and engaging.
One of the central observations of this book is/has been/will be very much lost on most people, but: It is not sufficient to reason your way to what works; experiments have to actually be conducted, and hypotheses falsified.
In the case of surgeons, this means that a lot of people must die in botched procedures before it can be figured out what actually does work.
And it is amazing how long it took for surgery to reach the state that it has today.
Overarching thoughts:
1. "WOW! This author really/ REALLY does not like the Catholic Church / pontiff / papacy."
He finds a way to blowtorch pontiffs at some length.
Ch.5: Obesity/gluttony; witch hunts; draining patients of their blood so that they could give transfusions to corpulent popes; obesity caused obstructive sleep apnea; selling indulgences; continual anal fistulas and fissures from WAY too much receptive butt sex (Leo X).
Ch.6: Dementia (but, he referred to John Paul II as a "demented old man" instead of as a "dementia patient.")
2. I've heard a number of my relatives say on many occasions / independently of each other: "Damn! White people are so nasty."
And I had just thought that was a mean-spirited stereotype...... Until I read this book's documentation of appalling European filth (by a European, no less).
i. Louis XIV didn't have any teeth left by the time he was 40;
ii. He didn't take more than one shower in 72 years on the throne; and, he received visitors and held court on the toilet. (It appears that's where LBJ got his inspiration.)
iii. (p.142) The hygiene standards in Europe all the way up until probably past the time of Pasteur were ABSOLUTELY APPALLING
And this is not the first time I've read something like: "Washing or changing your clothes daily was not done in the 17th century. There was a good reason why wigs, perfume, and toilet waters were so popular. They were necessary to disguise the unwashed hair and the stench of the body and clothing."
How could people be romantically intimate with odors like that? Unless they been naturally selected to just not care about odors.
*******
There are so many good observations, that I will just give a selected listing of the most interesting points:
1. The author reevaluates the autopsy of JFK and shows that a "magic bullet" is not necessary to explain that President's death. (And that you could save yourself 3 hours of life watching the Oliver Stone documentary.)
2. Way back when, circumcision was a procedure of diabolical brutality. (These days, it's no more complicated than clipping a fingernail.)
3. Surgery involves three essential things: i. Tending to wounds; ii. Draining pus; iii. Treating fractures.
4. A lot of the surgical techniques that have been learned in the past century or so have only become needful as a result of increasing lifespan: arterial sclerosis was not something that doctors had experience with a century ago because patients didn't live that long.
5. Several centuries ago, surgery was an itinerant profession. (The mortality rate was very high and if your patient died you might want to skip town before his family got ahold to you.)
6. Out of the 305 pontiffs, the 5-year survival rate was only 54%. I think the shortest Pope was in office for 33 days.
7. (p.79) The red and white pole outside of a barber shop has its origin in the habit of hanging out blood splattered bandages so the people would know that a barber was also a surgeon. (Incidentally, Noah Gordon wrote an entire book about traveling barber surgeons.)
8. "No cure, no pay" has been legally changed to a surgeons being obligated to provide "duty of care." (p.82).
9. Walking upright has created a lot of work for (orthopedic) surgeons: varicose veins, hemorrhoids, broken hips, hernias.
10. Anesthesia was introduced to us in 1846. With diethyl ether.
11. Who knew? St Martin is an island that has been divided between a Dutch and French half for about 4 centuries now. (And everybody speaks English.)
Also, Italy as we know it just came into existence since 1870. Before, it was divided between France, the Papal States, and various other spheres. (Giuseppe Garibaldi was the one that unified the state.)
12. (p.117) The pirate with a peg leg is a cinema archetype, but in historical reality: a lot of them used to be seamen that had an amputation in the line of duty and could not return to service. They could have been beggars on land or pirates on the sea.
13. Bob Marley's death was a Darwin award. It seems that his cancer started out only in his toe, and it could have been eliminated by amputation of the toe. But for Rastafarianism.
14. Three types of surgical treatment: conservative, expectative, and invasive.
15. The course of X is Y days. If X has not happened by then, then it will not happen.
16. Hernias (protrusions) are actually of many types. (Umbilical. Diaphragmatic. Incisional. Femoral. Groin.)
And not everything that is referred to as a hernia actually is.
17. Biological age≠calendar age
18. Most problems with surgery occur after the fact, and never on the table.
19. The fast track / short stay approach has only been popular since 2004. But, really it has always been true that people need to get up and start moving as soon as possible after a surgery.
20. Several centuries ago, normal citizens could buy tickets to watch the Royal Family eat. Queen Caroline was so fat that she couldn't even turn over without the help of her servants. (p.208)
21. VI Lenin may have had a reason to have been so insane and despotic. Seems that it was a result of being shot and lead poisoned.
Second order thoughts:
1. Surgery is a nearly 100% empirical profession.
a. It is interesting how long it took before demanding empirical evidence became a common way of thinking. (The Four Humors were something that were not disprovable. )
b. By dint of its being empirical, all surgical knowledge proceeds by trial and error: some patients just have to die so you know what NOT to do.
c. There are SO many treatments that were empirically false that had been swept into the dustbin of history. (That should make people a little bit more humble in present times.)
2. Because surgery is so empirical / hit or miss/trial and error, the best thing you can do is not put yourself in a position to have to see the surgeon. Because you really have almost no idea what you are getting when you go under anesthesia (and that is in terms of the skills of the surgeon, to say nothing of procedures that don't have a long track record).
Eat less, exercise more, and don't smoke.
3. There is a shaky discussion ("Diagnosis" chapter) about the philosophical distinction between physicians and surgeons, and therefore a more general discussion of aspects of epistemology. (I really believe that the author confuses deductive and inductive reasoning, and that he would have made a more clear argument if he included ABDUCTIVE reasoning, which is actually nearly all of what physicians use.)
a. The Scientific Method, à la Karl Popper, combined both inductive and deductive reasoning less than a century ago.
b. Physicians come up with diagnoses as a result of process of elimination/exclusionary diagnoses/working diagnoses. What is "true" is least likely to be *untrue*.
4. European royalty has been extremely weird for centuries: Houses that are intermarrying, inbreeding, and exchanging members while their populations are at war with each other. As far back as the 1700s, "The Royal Family spoke French to each other and incomprehensible English with a German accent in public." (p.210).
The Windsor Family of the United Kingdom used to be "Saxe-Coburg-Gotha" up until just a century ago.
****
Verdict: Strongly recommended.
Good quote (p.208): "For a patient with symptoms that you cannot explain, there is no better cure than to wait."
New vocabulary:
Intermittent claudication
Arthrosis
Gorget
Lithotomy
raspatory
Basso continuo
Busier (job title, p.217)
ordure
Mors in tabula
"Under The Knife"
5/5 stars
Of the book:
-309 pages of prose/29 chapters
≈11 pps/chapter
-62 references (exactly 31 books and exactly 31 journal articles)
-A glossary
-A good index
This is a brilliant book, and I recommend that it be read in conjunction with "Complications," by Atul Gawande.
It is just what it claims to be, which is: a brief history of surgery with a narrative are constructed by the history of 28 specific surgeries.
There are some pictures, but absolutely no graphs or diagrams.
It really has the feel of being written by a surgeon, because there are absolutely no wasted words in this book.
I'm also not clear whether or not it was originally written in English, but if it was: this Dutchman has an impressive command of the English language. His prose is so clear and engaging.
One of the central observations of this book is/has been/will be very much lost on most people, but: It is not sufficient to reason your way to what works; experiments have to actually be conducted, and hypotheses falsified.
In the case of surgeons, this means that a lot of people must die in botched procedures before it can be figured out what actually does work.
And it is amazing how long it took for surgery to reach the state that it has today.
Overarching thoughts:
1. "WOW! This author really/ REALLY does not like the Catholic Church / pontiff / papacy."
He finds a way to blowtorch pontiffs at some length.
Ch.5: Obesity/gluttony; witch hunts; draining patients of their blood so that they could give transfusions to corpulent popes; obesity caused obstructive sleep apnea; selling indulgences; continual anal fistulas and fissures from WAY too much receptive butt sex (Leo X).
Ch.6: Dementia (but, he referred to John Paul II as a "demented old man" instead of as a "dementia patient.")
2. I've heard a number of my relatives say on many occasions / independently of each other: "Damn! White people are so nasty."
And I had just thought that was a mean-spirited stereotype...... Until I read this book's documentation of appalling European filth (by a European, no less).
i. Louis XIV didn't have any teeth left by the time he was 40;
ii. He didn't take more than one shower in 72 years on the throne; and, he received visitors and held court on the toilet. (It appears that's where LBJ got his inspiration.)
iii. (p.142) The hygiene standards in Europe all the way up until probably past the time of Pasteur were ABSOLUTELY APPALLING
And this is not the first time I've read something like: "Washing or changing your clothes daily was not done in the 17th century. There was a good reason why wigs, perfume, and toilet waters were so popular. They were necessary to disguise the unwashed hair and the stench of the body and clothing."
How could people be romantically intimate with odors like that? Unless they been naturally selected to just not care about odors.
*******
There are so many good observations, that I will just give a selected listing of the most interesting points:
1. The author reevaluates the autopsy of JFK and shows that a "magic bullet" is not necessary to explain that President's death. (And that you could save yourself 3 hours of life watching the Oliver Stone documentary.)
2. Way back when, circumcision was a procedure of diabolical brutality. (These days, it's no more complicated than clipping a fingernail.)
3. Surgery involves three essential things: i. Tending to wounds; ii. Draining pus; iii. Treating fractures.
4. A lot of the surgical techniques that have been learned in the past century or so have only become needful as a result of increasing lifespan: arterial sclerosis was not something that doctors had experience with a century ago because patients didn't live that long.
5. Several centuries ago, surgery was an itinerant profession. (The mortality rate was very high and if your patient died you might want to skip town before his family got ahold to you.)
6. Out of the 305 pontiffs, the 5-year survival rate was only 54%. I think the shortest Pope was in office for 33 days.
7. (p.79) The red and white pole outside of a barber shop has its origin in the habit of hanging out blood splattered bandages so the people would know that a barber was also a surgeon. (Incidentally, Noah Gordon wrote an entire book about traveling barber surgeons.)
8. "No cure, no pay" has been legally changed to a surgeons being obligated to provide "duty of care." (p.82).
9. Walking upright has created a lot of work for (orthopedic) surgeons: varicose veins, hemorrhoids, broken hips, hernias.
10. Anesthesia was introduced to us in 1846. With diethyl ether.
11. Who knew? St Martin is an island that has been divided between a Dutch and French half for about 4 centuries now. (And everybody speaks English.)
Also, Italy as we know it just came into existence since 1870. Before, it was divided between France, the Papal States, and various other spheres. (Giuseppe Garibaldi was the one that unified the state.)
12. (p.117) The pirate with a peg leg is a cinema archetype, but in historical reality: a lot of them used to be seamen that had an amputation in the line of duty and could not return to service. They could have been beggars on land or pirates on the sea.
13. Bob Marley's death was a Darwin award. It seems that his cancer started out only in his toe, and it could have been eliminated by amputation of the toe. But for Rastafarianism.
14. Three types of surgical treatment: conservative, expectative, and invasive.
15. The course of X is Y days. If X has not happened by then, then it will not happen.
16. Hernias (protrusions) are actually of many types. (Umbilical. Diaphragmatic. Incisional. Femoral. Groin.)
And not everything that is referred to as a hernia actually is.
17. Biological age≠calendar age
18. Most problems with surgery occur after the fact, and never on the table.
19. The fast track / short stay approach has only been popular since 2004. But, really it has always been true that people need to get up and start moving as soon as possible after a surgery.
20. Several centuries ago, normal citizens could buy tickets to watch the Royal Family eat. Queen Caroline was so fat that she couldn't even turn over without the help of her servants. (p.208)
21. VI Lenin may have had a reason to have been so insane and despotic. Seems that it was a result of being shot and lead poisoned.
Second order thoughts:
1. Surgery is a nearly 100% empirical profession.
a. It is interesting how long it took before demanding empirical evidence became a common way of thinking. (The Four Humors were something that were not disprovable. )
b. By dint of its being empirical, all surgical knowledge proceeds by trial and error: some patients just have to die so you know what NOT to do.
c. There are SO many treatments that were empirically false that had been swept into the dustbin of history. (That should make people a little bit more humble in present times.)
2. Because surgery is so empirical / hit or miss/trial and error, the best thing you can do is not put yourself in a position to have to see the surgeon. Because you really have almost no idea what you are getting when you go under anesthesia (and that is in terms of the skills of the surgeon, to say nothing of procedures that don't have a long track record).
Eat less, exercise more, and don't smoke.
3. There is a shaky discussion ("Diagnosis" chapter) about the philosophical distinction between physicians and surgeons, and therefore a more general discussion of aspects of epistemology. (I really believe that the author confuses deductive and inductive reasoning, and that he would have made a more clear argument if he included ABDUCTIVE reasoning, which is actually nearly all of what physicians use.)
a. The Scientific Method, à la Karl Popper, combined both inductive and deductive reasoning less than a century ago.
b. Physicians come up with diagnoses as a result of process of elimination/exclusionary diagnoses/working diagnoses. What is "true" is least likely to be *untrue*.
4. European royalty has been extremely weird for centuries: Houses that are intermarrying, inbreeding, and exchanging members while their populations are at war with each other. As far back as the 1700s, "The Royal Family spoke French to each other and incomprehensible English with a German accent in public." (p.210).
The Windsor Family of the United Kingdom used to be "Saxe-Coburg-Gotha" up until just a century ago.
****
Verdict: Strongly recommended.
Good quote (p.208): "For a patient with symptoms that you cannot explain, there is no better cure than to wait."
New vocabulary:
Intermittent claudication
Arthrosis
Gorget
Lithotomy
raspatory
Basso continuo
Busier (job title, p.217)
ordure
Mors in tabula