AANS Neurosurgeon | Volume 28, Number 3, 2019

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Under the Knife: Remarkable Stories from the History of Surgery – A Review

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Under the Knife: Remarkable Stories from the History of Surgery
Arnold van de Laar.
John Murray Publishers, London.
2018 (English translation)

Dr. van de Laar, a Dutch laparoscopic surgeon, is a wonderful storyteller with a huge appreciation and knowledge of the origins and modern understanding of the science of surgery. In his book, “Under the Knife”, Dr. van de Laar presents a series of historical, and sometimes gruesome, anecdotes recounting the evolution of surgery from its literal barbaric origins to the refined practices of today. These anecdotes serve to draw the reader in and set a framework to cover the scientific subject matter common to all surgical disciplines such as diagnosis and indications for surgery, biological basis of wound healing and complications.

Dr. van de Laar also ‘pulls back the curtain’ on the early days of surgery, sharing what many fellow surgeons take for granted, but few of the lay public understand –

“surgeons were often treated with great respect, even awe, portrayed as heroes who, in the face of adversity and appalling working conditions, tried to save patients with their scalpels. But this image is often distorted. Surgeons were often indifferent, naïve, unclean, clumsy and bent only on money or fame.”

Van de Laar writes in the same vein as Mary Roach (Bonk, Stiff, Gulp, Grunt), picking a subject that we often take for granted, highlighting some of the lesser-known and popularized facts, thus appealing to a broad audience. I was pleasantly surprised to learn of the early history of female surgeons which is left out of most textbooks. Women were trained as surgeons as early as the 13th century in Italy and in France, permitted to take over their husband’s practice after his death. Both practices were laid to waste by the Middle Ages, and it was centuries until the resurrection of female surgeons. Dr. van de Laar writes with a quick and satiric wit, moving easily from the tragedy of indications for castration over the years (providing sopranos for the opera to ‘treating’ homosexuality) to listing the top 10 fictional surgeons from books and movies.  

The book was translated from the original Dutch, and its readability suffers at moments due to differences in culture and idiomatic structures of speech. Nonetheless, I think most surgeons would enjoy this relatively thorough and insightful reflection on the history of the surgical sciences.

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