EMPIRE OF THE SCALPEL

A veteran surgeon and historian of American medicine charts the development of effective surgery.

Rutkow, who has written multiple books about surgery, offers both useful historical context and deserved recognition to the key figures. The author notes that the first evidence of surgery goes back millennia—there are skulls from the Neolithic period with holes in them caused by a method called trephination, which relieves dangerous pressure on the brain—but he also acknowledges that for centuries, surgery was a last-resort procedure, almost as likely to kill the patient as save them. In fact, some of the early surgeons were barbers, presumably because they owned sharp blades. Rutkow sets out the parameters for successful surgery as we now know it: a profound knowledge of anatomy, a capacity to stem blood loss, access to anesthesia, and a precise understanding of infection and how to combat it. He shows how each of these elements has been addressed and provides biographical sketches of the physicians and researchers responsible. Modern developments such as X-rays and blood typing helped to turn surgery into a more exact science, reflected in increasing professionalization and specialization in the field. The first kidney transplant, in 1954, was a remarkable achievement, marking the way ahead for operations of increasing complexity. Rutkow also adds some vignettes about his own surgical experiences, which gives the book an added dimension of personal connection. The author avoids jargon, arguing against the idea of surgeons as a quasi-priestly elite and emphasizing that surgery is, ultimately, about saving lives rather than building reputations. In the concluding section, he examines the impact of robots, 3-D organ printing, and artificial intelligence systems on surgical practices, changes that will require new skills from surgeons. These advancements are all positive, writes Rutkow, but a knowledge of history provides a crucial element of humility for the profession and understanding for the public.

A fascinating, well-rendered story of how the once-impossible became a daily reality.