Writing in The New England Journal of Medicine, Atul Gawande offers a fascinating historical overview of the surgical profession. It's full of incredible facts and anecdotes. Even after the introduction of anesthesia, for example, it took surgeons a while "to discover that the use of anesthesia allowed them time to be meticulous." Here's Gawande on Robert Liston, a British surgeon who had pioneered a particularly speedy technique for leg amputation; Liston tried out anesthesia for the fist time in 1846, amputating the leg of a butler:
Liston, like many other surgeons, proceeded in his usual lightning-quick and bloody way. Spectators in the operating-theater gallery would still get out their pocket watches to time him. The butler's operation, for instance, took an astonishing 25 seconds from incision to wound closure. (Liston operated so fast that he once accidentally amputated an assistant's fingers along with a patient's leg, according to Hollingham. The patient and the assistant both died of sepsis, and a spectator reportedly died of shock, resulting in the only known procedure with a 300% mortality.)
Liston had suspected that anesthesia, like hynptosim (which had been used, unsuccessfully, to put surgical patients under), was a "Yankee dodge." But "throughout the procedure, [the butler] did not make a sound or even grimace. 'When are you going to begin?' asked the patient a few moments later. He had felt nothing. 'This Yankee dodge beats mesmerism hollow,' Liston exclaimed."
Mass. General in 1941.
Viewed from a high enough altitude, Gawande writes, one of the most surprising things about surgery is how routinized and minimal it's become. Surgery was once a cataclysmic, traumatizing life-event; nowadays, "virtually no one escapes having a condition for which effective treatment requires surgery" (the average American will have seven). That's made possible, in part, because surgeries are less and less invasive. In the last few decades, to choose just one example, "the advent of laparoscopy and thoracoscopy reduced the debilitating, half-meter-long abdominal and chest incisions to a half centimeter."
Perhaps, Gawande suggests, the future might bring truly bloodless surgery: "Scientists are already experimenting with techniques for combining noninvasive ways of seeing into the body through the manipulation of small-scale devices that can be injected or swallowed." Surgery could be next. Much more at The New England Journal of Medicine.
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Joshua Rothman is a graduate student and Teaching Fellow in the Harvard English department, and an Instructor in Public Policy at the Harvard Kennedy School of Government. He teaches novels and political writing.