Invasion of the Body

Invasion of the Body: Revolutions in Surgery

Nicholas L. Tilney
Copyright Date: 2011
Published by: Harvard University Press
Pages: 432
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  • Book Info
    Invasion of the Body
    Book Description:

    A pioneering organ transplant surgeon narrates in gripping detail the revolutions that have transformed modern surgery, and the turmoil in medical education and health care reform as new capacities to prolong life and restore health run headlong into unsustainable costs. Tilney’s stage is the famous Boston teaching hospital, Brigham and Women's.

    eISBN: 978-0-674-06327-3
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-x)
  3. Introduction
    (pp. 1-6)

    All of us grew up hearing that knives are dangerous. The accidental cuts and punctures we inevitably sustained as children intensified our ingrained fears of pain, bleeding, and infection. Even the word knife carried the potential of danger, mutilation, or death. The media buttressed this instinctive response with endless reports of the implement as a weapon, noting that crimes involving knives account for about one-fifth of the almost million aggravated assaults in the country every year. Despite such formative influences, however, some young doctors enthusiastically choose careers that allow the legal application of a razor-sharp scalpel to the body of...

  4. one Three Operations
    (pp. 7-34)

    Welcome to a representative surgical suite of my teaching hospital. Let us look at three procedures, each performed approximately a half-century apart from the others. These snapshots of surgery over the last one hundred years illuminate the respective differences in the surgeons and their skills, the facilities, the instruments, and those seeking help. The professional staff introduced here are real people. With the exception of Mrs. Turner and a few historical figures, I have changed the names of the patients, although their conditions and operations are as described. Their experiences represent events that occurred routinely in similar hospitals during the...

  5. two The Teaching Hospital
    (pp. 35-51)

    Mrs. Turner walked down the hill from her house to the hospital on the day of her admission. Few people were on the street. A trolley clattered by. Only an occasional motorcar passed as she crossed the road near the recently opened nursing school and toiled up the steep driveway past the entrance lodge toward the Doric columns that embellished the front of the main building. Pulling open the large glass door, she entered the white, wood-paneled central rotunda. Overhead balconies with cast-iron railings led to doctors’ offices. Behind a semicircular mahogany reception desk stood an imposing figure available to...

  6. three Evolution of a Profession
    (pp. 52-74)

    Giles Mullins was a middle-aged butcher who worked during the 1840s at London’s Smithfield meat market in the shadow of the seven-century-old St. Bartholomew’s Hospital. He had become increasingly incapacitated by intense spasms in his lower abdomen, intermittent stoppage of his urinary stream, fever, and bloody urine. In recent months his life had become unbearable.

    Although the incidence of bladder stone has inexplicably declined in the modern world, it was all too common throughout much of human history. The condition occurred so frequently in sixteenth-century France, for instance, that the kings kept court experts in the surgical removal of the...

  7. four Steps Forward and Steps Backward
    (pp. 75-96)

    Although the benefits of operative hygiene gradually became obvious to most practitioners, surgical practices per se were slow to change. During Harvey Cushing’s internship year at the MGH in 1896, for instance, operations consisted predominantly of amputation of damaged limbs, removal of breast cancers, excision of superficial tumors, and minor skin repairs. Spectators in street clothes often entered the operating rooms, and techniques and safeguards now taken for granted were not yet in place. Cushing enjoyed his internship and held several of the faculty in high esteem, but he was less sanguine about the rapid, rough, and imprecise methods of...

  8. five War and Peace
    (pp. 97-127)

    Improvements in the treatment of disease and increasing knowledge of associated basic and applied sciences poured forth in a torrent between the end of World War II and the mid-1980s. The benefits were broad. Public health measures improved. Vaccination against the infectious diseases of childhood became ubiquitous. Precise laboratory assays emerged to enhance diagnosis and provide information about normal and abnormal states. Novel radiological methods allowed the viewing of hitherto inaccessible sites in the body. Differential function of the heart was defined. Some cancers could now be cured. Dialysis began to prolong the lives of patients with nonfunctioning kidneys.


  9. six The Promise of Surgical Research
    (pp. 128-152)

    I had always planned a career as a clinical surgeon, and so my early involvement with the emerging area of kidney transplantation was serendipitous. It was unknown territory. While some organ recipients did relatively well, larger numbers developed problems with which we were completely unfamiliar or which hadn’t even been described. Question after question arose that ranged from the meaning of obscure, obvious, or frightening physical abnormalities to the possible application of emerging data from research laboratories. We had few answers, and many of the patients died. Because scientists in Great Britain were providing much of the basic information on...

  10. [Illustrations]
    (pp. None)
  11. seven Operations on the Heart
    (pp. 153-185)

    Late one winter night in 1971 the nurse in the emergency room of the Peter Bent Brigham Hospital received a call that a man had been shot in the chest. The ambulance had picked him up and was on its way. She immediately paged me from the ward where the intern and I were examining a patient. I was the senior surgical resident in the hospital at the time, in my fifth year of training. We rushed down to the emergency room while she called the cardiac surgeon at home. He said he would be there in half an hour....

  12. eight The Mechanical Heart
    (pp. 186-212)

    John Gibbon Jr., a surgical resident at the MGH in 1931, was typical of those training in prestigious programs at that time. A fourth-generation physician from Philadelphia, he had been educated at Princeton University and Jefferson Medical College. Patrician, tall, spare, and handsome, he was quietly dedicated to his career. One evening the nurses called him urgently to the bedside of a postoperative patient who had suddenly lost consciousness. Her skin, lips, and fingernails were blue, her breathing was labored, her pulse was weakening. She was dying before his eyes from a pulmonary embolus. Despite hours of support with intravenous...

  13. nine The Transfer of Organs
    (pp. 213-239)

    Carmen Esperanza was a 17-year-old high school student when she first became ill. She had amassed good grades, played field hockey, was a cheerleader for the football team, and worked as a counselor at a children’s camp during vacations. She lived with her parents and two sisters. Her future was bright. In the middle of her junior year, however, she developed increasing fatigue, loss of energy, and diminishing appetite. After some weeks she found that her ankles were swelling and that she couldn’t button her skirt. Her urine became dark, and her mother noticed that her eyeballs seemed yellow. Her...

  14. ten Making a Surgeon, Then and Now
    (pp. 240-266)

    Young doctors entering a surgical career soon learn that they have become part of an evolving system in which much of the care they will deliver and many of the operations they will master were developed during their lifetimes, were in their infancy for their parents, and were nonexistent for their grandparents. Indeed, their grandchildren may one day express incredulity about the primitive nature of the strategies and approaches now regarded as state of the art. Less likely to change are both surgeons’ and patients’ expectations that any given procedure will enhance or prolong life. They expect excellent results, minimal...

  15. eleven Shifting Foundations
    (pp. 267-294)

    I recently attended the goodbye ceremony for the graduating senior surgical residents, a yearly event well in keeping with the enduring rituals of academic medicine and its educational precepts. It was held in the hospital amphitheater, the same large, portrait-filled hall I first entered fifty years before and where I had sat through untold numbers of rounds and lectures during my career. Faculty and trainees filled many of the seats in front; spouses and a scattering of parents beamed from the upper rows. An occasional baby made itself heard. The programs were printed on crisp paper. The colored shields of...

  16. twelve Unsolved Challenges
    (pp. 295-322)

    When the Peter Bent Brigham Hospital opened in 1913, the staff performed relatively few operations. These were always under the threat of infection. Diagnostic tools consisted of little more than a determination of numbers of blood cells and chest and abdominal X-rays. Ether was the only anesthetic agent available. Drugs were few. Intravenous support of the ill patient with water and electrolytes was neither used nor understood. Monitoring methods and intensive care did not yet exist. Most cancers could not be cured. Some common procedures were based on false physiological premises. Manipulation of the heart was never considered. The successful...

  17. NOTES
    (pp. 325-344)
    (pp. 345-346)
  19. INDEX
    (pp. 347-358)