Book Review: Under the Knife

Under the Knife: A History of Surgery in 28 Remarkable Operations
Arnold van de Laar
Medicine

Even allowing that Under the Knife is a translation, and even allowing that it's really a collection of essays, this is a book that's unskillfully written and composed. Information is repeated. Chapters come in random order. The prose style is serviceable, no more.

Most irritatingly, the individual chapters themselves are disorganized. The chapter on anesthesia veers off, on the next-to-last-page, into Ignaz Semmelweis The transitioning sentence: "Anaesthesia was a revolution in surgery; the next step was the introduction of hygiene." This diversion lasts for precisely one long paragraph before returning, with no explanation or connection, to chlofoform.

Or take the discussion of vascular surgery, which includes this:

In the twentieth century, the crossectomy was combined with "stripping", a method by which the GSV can be removed subcutaneously completely and in one go. This was--and remained until around 2005--the standard procedure for treating varicose veins, the whole operation taking no more than fifteen minutes per leg. Theodor Billroth, one of the greatest names in the whole history of surgery, was vehemently opposed to varicose vein operations, without bothering to explain why.

What? Where did Billroth come into this? What does his distaste for varicose vein surgery in general have to do with the topic of this paragraph, which is the crossectomy? Nor does Billroth resurface later in the chapter; the next paragraph is about the successor procedure.

These solecisms (and many more) give Under the Knife a random, disconnected quality. You never quite know where a chapter is going, regardless of its title or opening paragraph. The anecdotes about the titular operations are quite interesting, in fact, but van de Laar never figures out how to follow up on them. Look, people, if you're going to write nonfiction, you need to understand that there are rules for doing it--just as there are rules in fiction--and that you violate them at your peril.

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Good biomedical essayists include Lewis Thomas (The Lives of a Cell) and, more tangentially, Loren Eisley and Stephen Jay Gould. For one excellent take on how to write nonfiction well, see Tracy Kidder and Richard Todd's Good Prose: The Art of Nonfiction.