Review: Under the Knife by Arnold Van De Laar

IMG_8505[1]There’s been a wealth of books hitting the shelves lately which have all highlighted the rise in medical non-fiction books. Many of these books have taken the form of memoirs, detailing the personal experiences of doctors and nurses as they face the daily struggles and wider complication of working in a healthcare industry. Whilst I’ve really been enjoying these kinds of books, and I’m still especially eager to get to many more, it was quite refreshing to see a slightly different book arrive on my doorstep.

Under The Knife, a non-fiction book by surgeon Arnold Van De Laar, is no memoir. Under The Knife, as the subtitle clearly states, is ‘the history of surgery in 28 remarkable operations’. The author examines the origins and the development of surgery across the ages, from the very first horrific instances of surgical intervention to the amazing technological advancements we are experiencing today. It takes us on a journey of the human body, exploring the ways things can go wrong and ‘the ingenuity and courage needed to fix them’. All in all, the books blurb interested and slightly repelled me in equal measure – a winning combination!

When I initially started this book I had certain expectations which I was really hopeful the book would deliver upon. I wanted the book to bring these surgical operations to life, to lift them from a text book study and give me all of the gory and repulsive bits in a ‘horrible histories’ type style. Thankfully I was reassured almost instantly with a graphic story which details one man’s attempt in 1651 to seize a knife and cut a four ounce stone out of his own bladder. Similar case studies to this are frequent throughout the book, detailing to us the remarkable history of surgical operations and the brutal attempts made to rectify an illness. This history of surgery is all the better for our narrator, who is himself a surgeon in Amsterdam. This means that alongside the gross yet compelling details, we also get an authentic and intelligent description. This straightforward, quite clinical approach also stops the novel becoming a mere funfair of the bloody history of surgery, providing an intelligent account we can learn from.

Another aspect of the book which I think worked especially well was the very clear and defined structure. The book is split into separate chapters, each one focusing specifically on a different type of surgical operation. From fractures and gangrene, to obesity and anal fistula’s; the subjects approached are all broad and diverse, yet remain linked by this shared history of surgical development. As each topic is discussed we tend to get a step by step view into the operation theatre. Although these details can often be quite unappealing and garish, the authors clinical and knowledgeable viewpoint adds an extra insight into them, even if we still do squirm somewhat at the finder details!

An added element which took me quite by surprise was the wealth of historical details within the chapters. The author clearly has an incredibly amount of information, not only in regards to surgery itself, but also in how the first rudimentary examples of surgery came into being and were later fine-tuned. It was honestly amazing to take a step back and consider how some of these treatments started so long ago, and how barbaric they seem now in comparison to the marvels of modern surgery. The experiments’ and risks which had to be taken in the name of progress are both disturbing and mind-blowing to consider. If anything, this book made me thank my lucky stars that I born into a world where surgery is now so much more commonplace and refined.

These historical elements are further complimented by the wealth of really diverse case studies within the book. We learn about famous celebrities, monarchs, Pope’s and singers, all in the context of these remarkable operations. One of my favourites was actually the chapter on asphyxia, which took a very interesting and in depth look at President Kennedy’s assassination and the injuries he sustained. Like many people I’ve seen the infamous video footage, but I’d never really truly understood the true form of his fatal injuries and the attempts which were made to save his life. These true life examples, although horrific in nature, bring the surgery itself to life and make it much more accessible for someone who does not have a surgical background.

With regards to the medical terminology used, I would say that my experience was pretty mixed. The author does his best to explain the different medical terms, often taking them back to their Greek or Latin root origins. He also does his best to use them in relation to the operations themselves, giving us a contextual background and something to work with in our minds. Even so, I did find some of the words heavy going at times, especially when several new and intricate words are explored in a short span of time. This can make it seem a bit full on at times and slightly confusing, although there is a handy glossary in the back which does improve the reading.

All in all, I was pretty impressed with this book and the successful attempts it’s made to tackle the history of surgery in such a concise manner.  I actually think that one of the greatest accomplishments of this book is the fact that it brings this highly regarded profession into a more accessible realm for the general public. It combines the blood and gore alongside the intricacy and intelligence of the surgical world, creating an insightful and thought provoking read for anyone interesting in surgery!

Publisher: John Murray

Rating: 3.5*/5*

Disclaimer – I was very kindly sent this book in exchange for a review. I will only ever post my own honest opinions and will NOT write a favourable review in exchange for a complimentary book.


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