A History of Surgery (review)

Harold Ellis. A History of Surgery. London: Greenwich Medical Media, 2001. xxiii + 264 pp. Ill. $49.95 (1-84110-023-4).

Following in the tradition of George Bankoff's The Story of Surgery (1947), W. J. Bishop's The Early History of Surgery (1960), and Knut M. Haeger's The Illustrated History of Surgery (1988), Harold Ellis's new volume chronologically surveys key developments in surgical practices throughout history. The author, a surgeon by training, is well known for his previous forays into his profession's heritage in works such as Surgical Case-Histories from the Past (1994) and Operations that Made History (1996). In A History of Surgery, Ellis devotes the first nine of sixteen chapters to an overview of surgery from prehistoric times through World War I. Each of these chapters contains brief selections drawn from original sources that are reinforced by the author's narrative. The remaining chapters focus on the growth of surgical specialties, including orthopedic practices, breast surgery, kidney- and bladder-stone operations, thyroid and parathyroid surgeries, thoracic and vascular surgical procedures, and organ transplantation. The closing chapter, "Envoi—Today and Tomorrow," provides a brief introspective look into Ellis's philosophy of surgery.

Most of the book's content is well known to medical historians and to surgeons who have delved, even superficially, into the background of this special handicraft. The photographs—247 in number, many of them in color—have been carefully selected to provide an ideal complement to the individuals and procedures discussed in the text, and an extensive picture index provides helpful, detailed source listings for each illustration. Unfortunately, no similar source listing is provided to support the book's textual narrative, nor are there footnotes. This lack of references to better place Ellis's claims regarding particular eras, individuals, or themes in context severely limits the book's usefulness to readers who wish to explore further particular areas. Some readers will note critically the absence of coverage of key specialties, including neurosurgery, and the author's heavy emphasis upon British surgery.

Ellis's hagiographic work focuses on the pioneers of his profession. His narrative, although comprehensive, emulates a surgeon's precision with its sharp cutting away of humanity, leaving only a bare-bones account. As such, the book often inaccurately represents surgery as a march of progress; the underlying impetus to improve surgical outcomes and the problems with which surgeons grappled are rarely discussed. Such a presentation leaves readers wanting a more complete account of the individuality of the particular surgeons Ellis assembles, as well as an elaboration upon the cultural and professional influences that shaped certain practices to became favored over others.

The most original aspects of Ellis's book appear in his closing chapter. Here, he reflects upon particular changes that have influenced, or are most likely to influence, traditional concepts of surgery and its practice. He portrays surgeons as having "always been quick to adapt to new technology; indeed, they have often been the very first to realise the practical potential of the latest invention" (p. 251). He supports this claim with a discussion of surgeons' quick adoption of Roentgen's X rays for a new look inside the body. After noting that surgeons are "pragmatic, practical, down-to-earth doers rather than thinkers," he acknowledges that they have "a particularly bad record" in prognosticating future events (p. 252). Nevertheless, he describes his own futuristic vision of surgery in the hands of robots. Yet he admits to pitfalls in this path to progress: robots "perform their work mainly on unchanging items and are allowed trial runs in order to get the procedure right," while for surgeons, "every patient is different and trial runs would," he argues, "have difficulty in finding volunteers" (p. 252). In reply to those who argue that surgeons will become increasingly unnecessary, Ellis retorts that as long as "man remains the most unpleasant and most aggressive of all the earth's creatures, there...