A gathering of knives in Wuhan

Knives” is slang for surgeons, so I’m referring to a meeting, conference, or congress of surgeons.

I recently attended an Asian congress in cardiothoracic surgery—surgery of the heart and lungs—in Wuhan, the capital of Hubei province in central China. Wuhan, the political and manufacturing hub of China, is home to over 11 million people and is China’s seventh most-populous city.

Historically, Wuhan was the headquarters of the Wuchang uprising which ended China’s last imperial dynasty in 1911. It was thrust into international consciousness when a citywide lockdown was imposed in January 2020, due to the COVID-19 pandemic.

Wuhan has been hosting international meetings to make the city more open and inclusive, and to send out signals of its international competitiveness with a resilient economy.

When I visited the 1,000-bed Huoshenshan (meaning Fire God Mountain) hospital, built in a record 10 days by 7,000 workers during the early days of the pandemic, I was told that it had been converted into a nursing facility. This temporary hospital closed on April 15, 2020, after a little over two months in operation as community transmission had stopped in China. I also learned that the seafood market where the pandemic supposedly started was permanently closed.

Medicine in China has progressed from the era of barefoot doctors in rural Chinese villages in the 1970s, to surgical feats like the world’s first transplant of a genetically altered pig liver into a human, and the world’s first double-lung transplant for end-stage lung disease brought about by COVID-19.

China has two of the world’s largest lung transplant programs, one in Wuxi People’s Hospital in Jiangsu province, and another in the 155-year-old Second Affiliated Hospital of the Zhejiang University School of Medicine in Hangzhou. While China is catching up with the West, this progress has been shadowed by controversy.

The elephant in the room is, of course, the use of organs from executed prisoners, which made China a pariah in the international transplant community. Scientific articles were denied publication in peer-reviewed medical journals, and Chinese transplant doctors had difficulty presenting their work in international medical conferences.

To address this, Chinese authorities came up with the Hangzhou Resolution of October 2013, which resolved to end “donation by execution” and promote ethical and internationally recognized practices of organ donation and transplantation. The resolution also called for transparency in organ donation through a computerized waitlist of potential transplant recipients regardless of gender, social status, and religious beliefs. Furthermore, it rejects foreign patients seeking to undergo transplantation in China.

During the last 40 years, China was able to lift 800 million people out of poverty, with health care and medical services also improving in its wake. In big urban hospitals and universities, small armies of Ph.D.s work in narrow fields of basic medical sciences, including research in cancer biology and genetics.

This leads us to the question: Why has China not produced another Nobel Prize laureate in medicine or physiology? (China has only one in this category). That is another matter altogether.

Back to why surgeons are called “knives,” a reference to the scalpel, one of the earliest surgical instruments that evolved from flint or volcanic glass cutting implements during the Stone Age, to its present modern version of tempered steel.

“He who wishes to be a surgeon should go to war,” wrote the Greek physician Hippocrates in the 4th century BC. During the Middle Ages in Europe, barber surgeons accompanied soldiers into battle and took care of the injured. The barber’s pole, with a helix of red and white, and sometimes blue, dates back to the Middle Ages: red representing blood, and white symbolizing the bandages used to staunch bleeding.

Wars taught early surgeons surgical techniques like amputations and wound closure. With the invention of gunpowder in China, surgeons learned a whole new way of dealing with traumatic gunshot injuries.

In fact, the modern ambulance was an innovation of a surgeon in Napoleon’s army: the so-called “flying ambulances” to rapidly transport injured soldiers for treatment, thereby improving the organization of field hospitals, the forerunner of the modern mobile army hospital units.

Surgeons are descendants of guilds, or medieval association of craftsmen or barber-surgeons and merchants in the pursuit of a common goal. They met and compared notes, a practice carried into the modern era. Congresses of transplant surgeons, heart surgeons, abdominal surgeons—these serve as formal and informal exchanges of knowledge, advances, and tips in the profession, the present simply repeating the past.

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Jose Luis J. Danguilan is a thoracic surgeon and is the former executive director of the Lung Center of the Philippines.