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The healer who used his hands was known as a chirurgeon, from the Greek kheirourgia, meaning hand (kheir) and work (ergon). Our modern word ‘surgeon’ derives from the same origin. Fighting, hunting, migrating, digging for roots, falling from trees, fleeing predators – the hard life of our ancestors exposed them to endless risk of injury. Tending to wounds is therefore not only the most basic of surgical procedures, but was probably also the first.
Surgery can be an unpredictable profession.
time, I would certainly have taken much less pleasure in it than I do now.
We would be deeply shocked if we found ourselves in an operating theatre in the eighteenth century. The screaming must have been indescribable; blood would have been spattering in all directions, and the stench from searing the stump of an amputated limb would have made us retch. It would have been like something from a horror film. Modern operating
In the seventeenth century Charles-François Félix de Tassy was by no means a novice, but he had never performed an operation to cut open an anal fistula when Louis XIV consulted him about this complaint. So he asked the king to give him six months and first performed the operation on seventy-five patients before daring to try it on the king. I wonder whether my first patients were aware of my comparative lack of experience when I was just beginning as a surgeon.
Some surgical terms may require further explanation. The words ‘incision’ and ‘resection’ come from the Latin and mean literally ‘cut into’ and ‘take away’. ‘Trauma’ comes from Greek and means ‘injury’ or ‘wound’. A trauma can be psychological, in the sense of suffering a trauma after a bad experience, but in surgery it means that something is physically damaged. ‘Indication’ means ‘the reason for an operation’, while a ‘complication’ is an undesired development or a calamity. Other terms can be found in the Glossary at the back of the book.
Jan Jansz. de Doot with his bladder stone and his knife, by Carol van Savoyen, 1655.
For that reason, the gland was called the prostate, based on the Latin pro-status, meaning ‘standing in front of’. The ‘major’
The only other person present during the operation, on 5 April 1651, was his apprentice, who held his scrotum up out of the way. Tulp writes ‘scroto suspenso a fratre uti calculo fermato a sua sinistra (the brother held the scrotum up so that the stone was held in place with his left hand).
This is known as ischaemia. The muscles can do without oxygen for six hours, but the brain only four minutes. Secondly,
Strangely enough, the very first president of the United States, George Washington, died in a similar way, though in his case the loss of blood was caused by his doctors, who also allowed him to suffocate by refusing to perform a tracheotomy. Washington’s final hours are described in detail by
The events of Friday 22 November 1963 would pursue Malcolm Perry for the rest of his life. He had been a surgeon for just two months when the dramatic events unfolded and he had a very busy few days. But it was far from over: Perry was called immediately to the operating theatre to operate on Governor Connally, and two days later he was there again, with his hands in Lee Harvey Oswald’s abdomen, trying to stop arterial haemorrhaging.
Legend has it that the French royal family is directly descended via Charlemagne from Jesus of Nazareth, and therefore from Abraham as well. Christ’s last royal descendant was therefore Louis XVI.
1854, when she married the twenty-three-year-old Emperor Franz Joseph at the age of sixteen, she became both Empress and Queen of the mighty Habsburg Empire, which extended from Russia to Milan and from Poland to Turkey.
The name ‘adrenal’ comes from the location of these two small glands, on top of (Latin ‘ad’) each kidney (Latin ‘ren’). High concentrations of adrenaline therefore flowed through her blood, strengthening the effects of the sympathetic nervous system. This must have given her enough energy to get to the boat on time.
Sisi was the victim of the ‘propaganda of the deed’, a bizarre philosophy associated with anarchism. In that respect, she was in good company: between 1881 and 1913, a series of public figures – including the Russian Tsar Alexander II, the Italian King Umberto I, the French President Sadi Carnot, the Greek King George I and the American President William McKinley were assassinated
Sisinnius died after twenty days in 708 and Theodore II lasted for three weeks in 897. Leo V managed a whole month in 903, Celestine IV only seventeen days in 1241, Pius III twenty-six days in 1503, Marcellus II twenty-two days in 1555, Urban VII twelve days in 1590 and Leo XI twenty-seven days in 1605.
There was also a pope who was a surgeon himself. Pope John XXI was a professor of medicine in his home country of Portugal before being elected to the pontificate in 1276. He must therefore also have been active as a surgeon. During his term
The word ‘bariatric’ comes from the Greek baros (weight) and iater (doctor).
A common weakness among popes throughout the centuries was gluttony.
Charles Dickens described a character with exactly these symptoms in his 1837 novel The Pickwick Papers. Consequently, OSAS is also sometimes referred to as Pickwick syndrome.
Obstructive sleep apnoea syndrome can cause a chronic shortage of oxygen, stimulating the production of red blood cells. This results in an excessively high level of these cells in the blood rather than anaemia, meaning that you should definitely not give the patient a transfusion. Whatever the real cause may have been, Innocent’s death in 1492 marked a fitting end to the dark Middle Ages.
Like a number of other well-known figures from the Renaissance Leo X was homosexual. He suffered continually from fistula and fissures of the anus. That could be seen from the expression on his face when he rode through Rome on a snow-white horse with unprecedented pomp and circumstance on the day of his ordination as pope. His alleged lover was twenty-six-year-old Cardinal Alfonso Petrucci.
It was not so surprising that the Florentine pope had such a low regard for surgeons. Florence was a proverbial hotbed of sodomy. For many years, surgeons were obliged to report the anal complaints of their male patients to the city magistrates so that they – the patients – could be prosecuted.
There is thus a greater chance of a surgical suture in the large intestine leaking than one in the small intestine, and with much more serious consequences.
Theophrastus Bombastus von Hohenheim, one of the most renowned
Pope John Paul II lived to be an old man, but kept his sense of humour. When, shortly after his hip operation, he rose from his stool with considerable difficulty, drawn with pain and stiff as a board, he mischievously and brilliantly quoted Galileo Galilei, mumbling ‘Eppure, si muove!’ – and yet it moves!
Apparently the ankle recovered fully, as he conducted one military campaign after the other until he was finally defeated during a battle near Marathon in Greece. He was none other than Darius the Great, King of Persia, builder of the world’s very first asphalted highway and founder of the city of Persepolis. He called himself ‘the King of Kings’.
After all, as a doctor in Persia you had to comply with the thousand-year-old laws of King Hammurabi of Babylon. Known as the Code of Hammurabi, they have been preserved for posterity on a large pillar of black basalt more than two metres high, which can now be seen in the Louvre in Paris. The code was based on the rules of trade and surgeons would enter into an agreement with their clients: if the treatment was successful, they were paid. If not, they received nothing. If it went wrong, they were called to account – an eye for an eye, a tooth for a tooth – just like everyone else. Article 197
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A precise repositioning of the fractured bones, in such a way that the ankle joint is exactly restored, only really became possible with the invention of the plaster cast in 1851, by Dutch army surgeon Antonius Mathijsen, the discovery of X-rays by Wilhelm Conrad Röntgen in 1895, and the development of a completely new operational technique by the Arbeitsgemeinschaft für Osteosynthesefragen (AO Foundation) in Switzerland in 1958. Today,
osteosynthesis,
The venous valves in our veins, which prevent the blood from flowing in the reverse direction, are a good example. The explanation of how they work may seem a little technical, but with some knowledge of gravity and pressure, they are easy to understand. On the inside of each of our legs, a long vein runs just below
an adult human, during the day, that one small valve in the saphenous arch therefore has to resist the pressure of a column of liquid some 50 centimetres long. That is five times greater than the pressure on any of the other valves in our veins.
So the cause for varicose veins is that one small valve in the saphenous arch is too weak for the job it is supposed to do because, for some mysterious reason, there are no valves in the large veins above it. The obvious question is: why? The answer is staggeringly simple. To find it, we have to go back 3.2 million years, to Lucy, a twenty-five-year-old Australopithecus afarensis. Lucy and the other members of her species were among the first of our ancestors to walk on two legs. Lucy, by walking upright, is at the root of half of modern-day surgical practice. Parts of her skeleton were found
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In the Trendelenburg position, the hydraulic pressure
subcutaneously
endovascularly
Arteries transport the oxygen-rich, bright-red blood from the heart to the furthest edges of the body. Veins collect the blood from the whole body and carry it back to the heart.
Lucy brought humankind even more problems. If she did not happen to have three small blood vessels in her rectum that kept her anus watertight (the haemorrhoidal veins), she would probably have changed her mind after her first few steps and gone back to walking on four legs. The act of defecation has never succeeded in adapting: we still have to bend our hips at 90 degrees to do it. The fact that this now requires much greater pressure leads to typical human problems like haemorrhoids, prolapses and constipation.
In other words, a large part of the work of the surgeon consists of patching up what went wrong when Lucy decided to walk on two legs. Incidentally, Lucy was given a second name, in Ethiopian – Dinqines, which means ‘you are amazing’. Surgeons can agree with that.
Only in 1887 did it become clear that this illness did not have to end in the death of the patient, when Dr Thomas Morton in Philadelphia conducted the first successful operation to
The appendix – more correctly the vermiform (‘worm-shaped’) appendix – is a blind-ended intestinal tube starting from the great bowel near the junction with the small bowel, located in the right lower quadrant of the abdomen. It is less than a centimetre in diameter and some ten centimetres long.
In 1889, American surgeon Charles McBurney described these principles for operating on appendicitis, namely the sooner the operation is performed, the greater the chances of a full recovery, and that it is sufficient to remove the inflamed organ as long as peritonitis has not yet developed. This linked McBurney irrevocably to appendicitis. The spot on the abdomen where the most pain usually occurs is known as McBurney’s point and the incision in the abdominal wall to perform the appendectomy is also named after him. Every surgeon knows immediately what the problem is if a colleague says that a
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We do not know why some people contract appendicitis at a certain moment, while others never do. In the case of Houdini, it was apparently important to
The technique of putting a patient to sleep, or inducing complete unconsciousness is known as general anaesthesia or narcosis (Greek ‘sleep’). The first operation performed under general anaesthesia had, at that time, been performed seven years earlier, on 16 October 1846, at the Massachusetts General Hospital in Boston, United States. A dentist called William Morton had anaesthetised a patient called Edward Abbott, by getting him to inhale ether, diethyl ether to be exact.
She herself described it as ‘… that blessed chloroform, soothing and delightful beyond measure’. The newborn prince was christened Leopold; he was their eighth child and fourth son. Albert was over the moon, though their delight didn’t last long:
precision science. Black surgery coats were replaced by white ones.
Halsted became not only a pioneer of local anaesthesia, but – because the drug they used was cocaine – he also became an addict. Cocaine has long since been replaced in local anaesthesia by derivative drugs that have the same effect locally, but without the stimulating side effects.
Though revolutionary, these methods were, initially, very painful, because of the corrosive effect of disinfectant in the wound and the length of time they took to administer. They could therefore only be applied thanks to the invention of anaesthesia.
But this miracle anaesthetic is not without risks: pop star Michael Jackson became addicted to propofol and died after using it in 2009, because the doctor who administered it to him had not paid sufficient attention to Jackson’s state of health.
