Of Life and Limb

Patching up scratches and scrapes is a natural part of childhood, but what if stopping a bleeding cut required amputation rather than a Band-Aid? Until quite recently this was the case for mending arterial injuries. When did doctors innovate the ability to fix vascular wounds without it costing patients, literally, an arm and a leg? How did surgeons develop the methods to do so? Why did it take so long for these practices to be adopted as mainstream therapy? As both a surgeon and a historian of medicine, these questions intrigued me powerfully enough to launch the research presented in my book, Of Life And Limb: Surgical Repair of The Arteries in War and Peace, 1880-1960.

Growing up in Norfolk, Virginia, military history was as omnipresent as the roar of Navy jets practicing dogfight maneuvers over the beach. Whether a field trip to Jamestown, haunted by skirmishes between Powhatans and settlers, or a grocery run to a shopping center built atop a Civil War battlefield, I spent my adolescence enmeshed in America’s martial legacy. I entered college planning to major in history while satisfying the requirements for attending medical school and on a lark enrolled in a course on medieval medical history. Serendipitously, I discovered an academic field that melded my intent to practice surgery with my passion for the past. My subsequent research has explored how war and the military has changed the practice of medicine, and particularly surgery. These intellectual pursuits have paralleled my medical training, each endeavor more robust for cross-fertilization from the other.

While popular arguments support the importance of war in medicine’s evolution, much academic scholarship rejects this connection entirely. I consider both extremes reductive and have come to believe that a nuanced study of synergies between combat and healing techniques requires contextualization not just to each war but also to each medical advancement. Having heard that the Korean War gave rise to modern vascular surgery, I decided to investigate further. Preliminary review revealed that a surgeon-scientist named Alexis Carrel had figured out how to sew torn arteries together in the early 20th century. He even received the Nobel Prize for his accomplishments. Confoundingly, however, Carrel’s technique remained obscure, even during global cataclysms like World Wars I and II when soldiers suffered vascular trauma on an immense scale. Then, compounding the mystery, surgeons in the 1950s suddenly began applying Carrel’s approach worldwide. This paradoxical trajectory drove three critical questions that form the core of my book:

1. How did Carrel and his contemporaries create and optimize the novel operation of sewing blood vessels together?

2. Why did no one use Carrel’s method – at the expense of thousands of amputations – for nearly 50 years?

3. What catalysts in the 1950s made the surgical repair of arteries the standard, expected treatment?

I sought answers by exploring military archives, delving into the records of surgical organizations, scouring the medical literature, and interviewing key participants in the process. Of Life and Limb tells the story of what I found. Ultimately, studying the history of vascular surgery will shed light on the broader issue of how surgery changes. Examining that process historically can help us understand how it unfolds and perhaps allow us to expedite surgical improvements in the future.

This guest post is written by Justin Barr, who received his PhD in History from Yale University and his MD from the University of Virginia. He is currently in residency for general surgery at Duke University.