On January 22nd, 1913, a Mary Agnes Turner was the first patient admitted to the newly completed Peter Bent Brigham Hospital in Boston. After the birth of her first child the veins in her legs had begun to swell, and long hours on her feet as a maid only made things worse. By 1913, at age 45, her varicose veins had become so bothersome that she sought help. Her doctors at the Brigham planned an operation to strip her varicose veins, still a new procedure at the time. Medical personnel attending to the operation were clad in the newly conceived cotton face mask. In a brand new wooden operating room Turner was rendered unconscious through the use of ether, dripped onto gauze across her face. Using the newly introduced razor-blade scalpel and techniques developed just a few years earlier, doctors stripped segments of the veins by running a cable down their lengths and removing them forcefully. Turner was stitched up with catgut and silk, and discharged after ten days of postoperative care.
By 1965 the Brigham had grown to 300 beds. A stocky, muscular, 68-year-old Joseph Costello was admitted to treat a dangerously widened aorta. Relatively few procedures had been performed in the new field of vascular reconstruction, but the risks of operating on Costello were considered overshadowed by the consequences of inaction. Radio-opaque dye was injected into his aorta and an X-ray taken at the exact right moment to produce an image of the arterial tree. Costello’s aorta was seen to contain an aneurysm the width of a fist. Costello was sedated and wheeled to the very room where Turner’s operation had occurred, now with tiled walls and linoleum floor. A catheter was run to his bladder, a tube to his nose, and various intravenous lines were set. An electric knife opened Costello’s abdomen, and the aneurysm was isolated, clamped, removed, and replaced by a synthetic woven tube graft. His abdominal wall was closed in layers, the five-hour procedure ended successfully, and Costello was discharged ten days later.
At the same hospital in 2007, Shirley Laverne sought treatment for morbid obesity, an emerging and rather unexpected health problem. At 37 Laverne weighed nearly 350 pounds. An obvious candidate for gastric bypass surgery, in which the size of the stomach is drastically reduced, she went through an extensive series of information sessions and consultations before the course was set. She then was evaluated by a psychiatrist, dietitian, cardiologist, and radiologist, along with her physician and surgeon. On operating day, in a pristine room on a stainless steel table custom-built for morbidly obese patients, Laverne was fitted with pneumatic boots that could be pulsed to prevent blood clotting. She was rendered unconscious nearly instantly, catheterized, tubed, intravenously lined, and connected to an automatic respiratory unit. The procedure was conducted via laparoscopy, the training-intensive, minimally invasive technique of inserting instruments through relatively small incisions rather than opening the entire operating field. Five incisions were made for implements and a camera, and the surgeon watched a feed from the camera on a television monitor. He used stapling devices to isolate a small gastric pouch, restored intestinal continuity, and closed the incisions. Blood loss was minimal, the postoperative course was smooth, and three years later Laverne weighed 140 pounds.
These three surgeries, conducted at roughly fifty-year intervals, demonstrate much of the advancement covered by Dr. Nicholas L. Tilney in his new book, Invasion of the Body: Revolutions in Surgery. The names of the second two patients have been changed, but the rest of their stories are true. Tilney himself assisted on the 1965 operation recounted here. The book is filled with detail, anecdotes, and shocking facts, jumping back in time to share the practices of the earliest Greek physicians, seventeenth century itinerant practitioners, surgeons of Victorian London, and the battlefield procedures of the American Civil War, among many other historical moments.
Tilney’s focus is on the teaching hospital, and on the milestones that have let surgery leap forward: the discovery and development of anesthesia and asepsis, of standards for care and caution, the introduction of antibiotics, insulin, and modern pharmaceuticals. Tilney’s story isn’t just a linear march of progress, though. He also highlights the unfortunate state of managed health care in America, and isn’t shy about expressing his misgivings over some of the recent reforms to medical education.
We spoke with Dr. Tilney about some of the surgical advances that are explored in Invasion of the Body:
