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How People First Arrived in the Americas

[MUSIC PLAYING]pamela paulIs the story we learned about people crossing a land bridge to the Americas all wrong? Jennifer Raff will be here to talk about her best-selling book, “Origin: A Genetic History of the Americas.” How has the practice of surgery changed over time? Ira Rutkow will join us to talk about his latest book, “Empire of the Scalpel.”Alexandra Alter will be here to talk about what’s going on in the publishing world. Plus, my colleagues and I will talk about what we’re reading. This is the Book Review podcast from The New York Times. It’s March 11. I’m Pamela Paul.[MUSIC PLAYING]Jennifer Raff joins us now from Lawrence, Kansas. She is an associate professor of anthropology at the University of Kansas, and her new book is called “Origin: A Genetic History of the Americas.” Jennifer, thanks for being here.jennifer raffThank you so much for having me on.pamela paulSo this is a book that challenges the prevailing theory about how people first came to and settled in the Americas. I think many of us have a kind of vague notion that there was a land bridge between Siberia and Alaska, and that people crossed it X thousand years ago, and not much more than that. So if you could give a backdrop about what exactly the prevailing theory has been, and then we can talk about why it is possibly, or probably, wrong.jennifer raffSo the story that you may have learned in school, at least if you’re my age or older, is this fantastic story of this group of intrepid big-game hunters who raced across the Bering land bridge and down a corridor that had opened up through the glacial ice mass along the Canadian Rocky Mountains and peopled the Americas relatively recently, just 13,000 years ago, give or take. And along the way, they developed this very distinctive archaeological tradition, which we call Clovis, after the town in New Mexico, the city in New Mexico, where the first Clovis point— which is this beautiful, bifacially flaked, fluted spear point— was found.And these Clovis peoples, which we sometimes call them, appear to have been everywhere in North America all at once. They just appear in the archaeological record very rapidly around 13,000 years ago. And for a long time in the 20th century, that was taken as evidence of the very first peoples in the Americas. Since then, over the last couple of decades, actually, archaeologists have found more and more evidence that people were actually present in North and South America before Clovis.And genetics has played an important part in this story, as well. I think that it’s funny because a lot of my colleagues are like, well, of course we know that Clovis wasn’t first. But I think that the average person, who may not be as steeped in the archaeological literature, they may not know that this story is not quite right. And my hope was that I could update them on the latest scientific findings and give them a better picture of what we think today.pamela paulWho originated the Clovis theory? And what was it based on? What was the evidence for that, other than the spearheads?jennifer raffThe major evidence for it was the proximity of these spear points to large animals, these large, extinct megafauna, these fantastic creatures that lived in North America at the end of the Pleistocene. And South America, too, I should say. These include the mastodons and the glyptodons and, you know, extinct bison.These Clovis points, these spear points, were found in direct association with these extinct animals, now extinct animals. And so archaeologists came to this idea that perhaps these first peoples were big-game hunters who had been following these large herds of creatures, and that’s how they made their way into North America. It’s a really interesting idea, but it hasn’t quite held up.pamela paulWho originated the theory?jennifer raffWell, it’s been a number of archaeologists over the years have added to this idea, but certainly they were non-Native archaeologists, I should say, European-descended archaeologists, who came up with this idea gradually, looking at stone tool typologies and figuring out a chronological sequence gradually.pamela paulAnd just to get a better sense of the history of how these earlier theories came about, when did Americans become interested in the origins of human life on this continent? How long was it studied, and were there key figures who led that research?jennifer raffInterest in the origin of Native Americans has been going on since the very first settlers arrived in the continents from Europe and realized that Native Americans, these people were not in the Bible. They were not described in the Bible. And that was very disturbing to these settlers, who had, of course, a biblical worldview that all the races of man were descended from the sons of Noah. And they could not fit Native Americans into that worldview very easily. And so as a result, they came up with a whole list of possibilities for who they could be and a whole mythology around who the makers of— previous evidence of civilization— who had created that.So for example, the incredible mounds that one finds throughout the Eastern woodlands that are burial mounds— they’re effigy mounds in the shapes of animals— these were thought by Europeans to have been made by somebody other than the ancestors of present-day Native Americans because, in their minds, so-called, as they would say, Indians were not sophisticated enough to create the incredible artwork and monumental architecture that they were seeing in the lands that they were conquering. And so they came up with this mythology. And it was “anybody but Native Americans made these.”So they attributed them to Phoenicians. They attributed these different cultures that they saw to ancient Irish sailors or to the lost tribe of Israel— so anybody that they could think of who was not Native themselves. And among this mythology that they developed came this distinct idea that present-day Native Americans must have wiped out this lost race.And unfortunately, that idea, which we call the Myth of the Mound Builder, has persisted to this day in a number of alternative history ideas. So if you watch certain programs on TV or you read certain books, you’ll find strains of this mound builder myth persisting into today. And it has contributed to not only the erasure of present-day Indigenous peoples, but also the conception of them as peoples of the past, people who are extinct or are living only in the past. And it’s an extremely damaging and harmful narrative.pamela paulWhat do we now make of the bridge theory and of Clovis? How does that fit into what we now believe to have happened?jennifer raffBroadly speaking, there are several perspectives on the peopling of the Americas right now, and which one that you favor depends on what kinds of evidence that you prioritize. So there is a group of archaeologists which still maintains that people arrived in the Americas rather late, so maybe just before 14,000 years ago, and that they crossed over the land bridge. It’s a little bit more nuanced and complex than the old Clovis first theory, but there are some commonalities between it.And then on the complete opposite extreme, there’s another very small group of archaeologists who interpret the evidence as showing that people were present in the Americas very early, some claim even as early as 130,000 years ago. This is a bit of an extreme edge. I would not say that many archaeologists agree on that model. But I would say by far the majority of archaeologists and geneticists like myself interpret the evidence from both archaeology and genetics that showing that people were present in the Americas by 16,000 to 17,000 years ago, or perhaps even as early as 25,000 years ago, depending on which sites that you find to be plausible.And in these models, Beringia is one candidate— the Bering land bridge is not just a land bridge, but it is a candidate for a homeland. This is an area that is twice the size of Texas, or it would have been at the height of the last glacial maximum, when a lot of the ocean was bound up in these massive ice sheets that covered North America. And this land connection, this really large area, has been shown through paleoclimactic reconstructions to have in certain areas, especially along the southern coast of the central part of the Bering land bridge, to have a really decent climate relative to other places during the last glacial maximum.And so it’s one plausible candidate for a place where people may have stayed for a prolonged period of time during this climactic event, during which we see genetic variants that are characteristic and unique to the first peoples of the Americas. They evolved during this period of isolation. And so that’s one place where that may have happened. We’re still looking for strong archaeological evidence of it, but it’s a very good working hypothesis.pamela paulWhat is the Kelp Highway hypothesis?jennifer raffThe Kelp Highway hypothesis is this hypothesis that was developed based upon the observation that one of the most plausible routes south of the ice sheets into the rest of the Americas was by boat along the West Coast. And it rests upon a couple of pieces of evidence, one of them being early sites, early archaeological sites seen along the coast, another one being that the ice sheets melted earlier along the West Coast, so as early, perhaps, as about 17,000 years ago, and opened up a route for travel.pamela paulWhen you say the West Coast, meaning the West Coast of North, Central and South America.jennifer raffYes. The major barrier would have been in North America. This ice sheet covered most of Canada and most of northern United States. And so getting past that ice sheet would have been a challenge, and it would have been possible earlier if one took a boat along the West Coast of North America, rather than through an interior route.And then finally, the Kelp Highway hypothesis rests also upon the observation that marine resources would have been plentiful along the coast, providing people with a known set of resources to which they may have been already adapted. And it would have facilitated travel very quickly both southward and perhaps back northward, as people were exploring and returning back to their families farther north, up and down the coastline.pamela paulHow do we get to these new theories? I mean, some of it, you mentioned genetics, but let’s start with linguistics. What role does linguistics play in explaining how people got here?jennifer raffLinguistics is really important for revealing relationships between populations, between cultural exchanges. And it can be used as a tool to reconstruct the past, but only up to a certain point. At some point in the distant past, languages and the sharing of languages becomes so complex and so muddled that, as I understand it, not being a linguist myself, but there is somewhat of a barrier to using linguistics for the very, very distant past.But certainly when we look at linguistic diversity presence in Indigenous peoples of the Americas, it’s extremely high. There is an extraordinary amount of linguistic diversity in populations in North America and South America. And that suggests a very long period of time in which people have been living here.pamela paulAll right, you’re not a linguist, but you are a geneticist. So what role has genetics played in updating these theories?jennifer raffIn recent years, the ability to obtain complete genomes from ancient ancestors has really given us new insights, extraordinary new insights into the histories not only of individuals and populations, but also of our ancestors globally. So we know that anatomically modern Homo sapiens, humans who look like us, interbred and had children with other kinds of humans, like Neanderthals and Denisovans, and that this interbreeding has profoundly shaped the history of our species.In the Americas, what we have seen is that we can reconstruct population histories over very long periods of time so that we can now identify the populations who originally gave rise to the ancestors of Native Americans. And we can identify extremely important evolutionary events in that process, going back starting about 26,000 years ago. So we can use genetics to identify biological histories and to characterize biological histories, and even identify populations which we had no idea existed based on archaeology alone.pamela paulSpeaking of archaeology, I’m trying to figure out the numbers here, because the earlier theory was that people came to the Americas 13,000 years ago. You said that many geneticists now believe, and anthropologists, believe that it’s more like 16,000 to 17,000 years ago, and possibly as early as 25,000 years ago. What does this mean, that they found 22,000-year-old human footprints in New Mexico? How could it possibly be only 13,000 or even 16,000 years if we have that archaeological evidence?jennifer raffThat is a wonderful question, and it is something which the field is now grappling with and trying to understand. I should say that not all archaeologists find that date for these footprints in New Mexico to be reliable, that they have questions about the dating method used for these footprints. And the discussion about that is still ongoing.But for those archaeologists who do find that date plausible, they are now trying to interpret it in light of the fact that the majority of other sites in the Americas that are pretty well accepted range from about 15,000 to maybe 16,900 years ago. So what can account for that major time gap, and how can one square that with genetic evidence, which generally supports a major migration occurring just before the formation of these sites? I don’t have a great answer to that, unless we can say perhaps there were people here before or perhaps our models are simply wrong and we need to go back and rethink what we’re looking at and how we square the archaeological evidence with the genetic evidence.pamela paulAll right, I want to stay on these footprints for a minute because, for those who haven’t read the book, where are these footprints in New Mexico? When did we discover them, and how did we date them to 22,000 years ago? And then also, if people think that the dating wasn’t done accurately, have we not tried other methods? Are there other ways of trying to figure out a better number?jennifer raffSo these footprints are found at the White Sands site in New Mexico, and specifically at Locality Two. This is in the White Sands park in New Mexico, and it is extraordinary. I haven’t had a chance to go out there to see it for myself, but if you look at the photographs of these, they show you just extraordinary stories of individuals walking along this landscape. And in some places, you see mastodons crossing over these footprints.There were major animals using this area. And you see really poignant things, like a mother putting— well, I assume it was a mother, maybe it was a father, I don’t know— putting a child down on the ground for a few minutes before picking them up again and continuing on with their day. You can see all these things in footprints and these trackways. And they were dated by means of seeds that were found embedded in the footprints. And they used radiocarbon dating on these, which is a pretty standard method.Unfortunately, the controversy is that these seeds sometimes, because of their nature, return a date that’s older than what their actual age is. And so archaeologists are currently in discussions about that. The ones who have done this research have accounted for, they say, that potential problem.And I want to stress that the research that’s going on at White Sands is ongoing. This is by no means the end of the story. And I’m sure that they will be employing other methods as soon as it is feasible. But for now, I would say that it is quite controversial, but a lot of archaeologists are saying, well, we find ourselves persuaded by this evidence. The dating has actually been careful. They have accounted for this potential problem. And we now need to turn our attention to the question of if people were at this site 20,000 to 22,000 years ago, how did they get there and who were they?pamela paulAll right, here’s one very big final question, which is, what difference does it make if it’s 13,000 years, if it’s 16,000 years, if it’s 25,000 years ago that people came and populated North and South and Central America? What does it mean for our understanding of our history?jennifer raffI think there’s a couple of answers to that question. On one level, we want to be accurate, right? We want to understand what actually happened in the past. And we need to take our egos out of the equation, and be open and receptive to all kinds of evidence in order to reconstruct the history as accurately as possible. Unfortunately, it’s very, very tempting as a scientist to get caught up and fall in love with your own models, and it is a struggle to avoid doing that. I certainly struggled with that in writing this book.But it matters also because the narrative of Indigenous peoples as recent has a lot of implications for them. It has been used as an argument that, well, Indigenous peoples are just another recent immigrant to these continents, and therefore they have— you know, insert what you want to put there. Like, no claim to the lands, or not a strong claim to their ancestral sovereignty. And I think that, in speaking with my Indigenous colleagues, they find that very hurtful. And it’s also inaccurate. It’s also scientifically inaccurate to say that they’ve only been here a short period of time.Indigenous peoples have, many of them have their own histories about how they came to these lands. In some cases, these histories say that they have been here forever, that they emerged from the land. And one can take that literally or metaphorically. But it is certainly important to respect all kinds of knowledge— traditional knowledge, for want of a better term, Western scientific approaches. And that’s something that I’ve tried to do in the writing of this book, and I know a lot of my colleagues are trying to do as well, in their research.But I think it really boils down to this: What is the accurate story? What can we say, based on different kinds of evidence— archaeological, genetic, linguistic, traditional knowledge? Is there one story that we can reconstruct from all these different ways of looking at the past, all these different kinds of evidence? And I think that we have not quite gotten there yet. We keep finding evidence that shows people here earlier and earlier. And I think that’s one of the things that makes it so exciting to be a researcher working in this field today.pamela paulAll right, well it sounds like we still don’t know all the answers, but “Origin: A Genetic History of the Americas” offers an important update and corrective. Jennifer, thank you so much for being here.jennifer raffThank you so much, Pamela.pamela paulJennifer Raff’s new book, again, is called “Origin: A Genetic History of the Americas.”[MUSIC PLAYING]Ira Rutkow joins us now from Baltimore. He is the author of numerous books, including “The History of Surgery in the United States: 1775 to 1900,” “Seeking the Cure,” “James A. Garfield” and “Bleeding Blue and Gray.” His latest book is “Empire of the Scalpel: The History of Surgery.” Ira, thanks for being here.ira rutkowOh, thank you for inviting me.pamela paulI’m going to start with a really basic question. Just how do we define surgery?ira rutkowSurgery is simply defined as the manual art of doing something with your hands in the process of treating a patient. It’s a very simple definition, which has been present for thousands of years. It’s, of course, changing currently, in terms of who does surgery, what is surgery, how do you define surgery, how do you define surgeons. That is all undergoing a major transformation right now, which I write about in the book.pamela paulWell, I would love to hear more about that. I mean, why? What is it that is undergoing redefinition, and why?ira rutkowWell, everything is definitional in the world of surgery nowadays, meaning how do you define who a surgeon is. In the past, somebody like me, who trained back in the 1970s, went through a formal process, seven years, in my case, at a place, Johns Hopkins, where you had surgical training. I spent time in a laboratory. My laboratory was the library at Johns Hopkins, doing research. So we were all defined by the actual specialty that we went into, meaning, in my case, general surgery. But there’s orthopedic surgery, plastic surgery, cardiac surgery. Those are precise definitions that existed back then.But in today’s world, we’re beginning to see more and more practitioners who are not necessarily trained in orthopedic surgery or urology, but are defined as surgeons. For instance, a dermatologic surgeon. He is trained as a dermatologist, but they use the word “surgeon” within there. So it’s sort of like he is a surgeon, she is a surgeon, but are they a surgeon in terms of the actual, precise definition of what a surgeon once was. And that is all going through a change.pamela paulWhy are they adding surgeon? Because they are doing things that are more like surgical procedures? And they’re adding it even though they’re not technically trained as a surgeon?ira rutkowThat is the essence of the question of what’s going on today, now.pamela paulBecause it sounds kind of like marketing.ira rutkowIt is, absolutely. And I could give you my reasons why. Whether they’re the right ones and correct, I can’t tell you. I can say a lot of it deals with the entire process of what a surgeon was for the last 5,000 years.There was a dividing line in surgery between individuals who worked with their hands and the thinkers. Now, we’re talking going back to the age of ancient Egypt and ancient Greece. People always looked down upon individuals who worked with their hand. They were called surgeons. They did the manual arts.But the thinkers, the thinkers of the time were very demeaning towards surgeons. And that attitude lasted literally for thousands of years, probably up through the 20th century, that individuals who worked with their hand were considered inferior. There were the thinkers versus the doers, the scholars versus the non-scholars.Well, what’s happened is that, beginning in the 20th century, all of a sudden, surgeons got— the remuneration was greater. They were becoming more socially powerful. They started assuming the presidencies of all major organizations, back then the AMA, whatever it might have been. And they were all-powerful during the course of the beginning of the 20th century.And over the course of time, that power translated into more money and people beginning to pay more for the art of surgery, meaning something that was done with their hands. And that all goes up to the present, the 21st century, where you’re beginning to see that people who do things with their hands, for instance a gastroenterologist who does colonoscopy with their hands, or a dermatologic surgeon, they get paid at a higher rate for doing those manual operations than what they were in the past. And so it becomes very difficult to say what is surgery, what isn’t surgery.pamela paulIsn’t there some kind of regulation? Doesn’t the American Medical Association or, I don’t know, some other representative body of people— because to become what I think of as an actual surgeon, you really do need a lot of additional school and training that’s expensive and arduous and time-consuming.ira rutkowSo I’m laughing because that is the essence of why I wrote the book. The reason I wrote the book was, for many of my past books, they were discrete ideas. I had an idea about “Bleeding Blue and Gray,” which was medicine during the Civil War; I wrote about medicine during the Civil War. “James Garfield” is a biography. I wrote about James Garfield. But this book was really something that evolved over the course of 50 years, five decades of my surgical training and surgical practice.There are two factors involved with how this arose and what happened. One was that I was dismayed, over the course of my surgical practice, at how little patients understood about the whys and wherefores of what a surgeon did or how a surgeon became a surgeon. They didn’t understand board certification. They didn’t understand the years, the arduousness of what went into surgical training. Again, in my case, it was seven years after medical school.Similarly, I was shocked at how, as I became interested in history, even though I was a surgeon, that when I spoke to my colleagues, you would ask them simple questions— when did anesthesia come about? when did Lister discover antisepsis?— more importantly, for a surgeon in today’s world, when the board started— if I asked a surgeon when was the Orthopedic Board started, they would look at me incredulous, and they would have no idea. So I felt that it was important to write a book for the trade that the average person out there could read this book and understand what a surgeon was, who they were, why they did what they did, and how did they get there. Similarly, for surgeons, they could understand the history of their profession.pamela paulLet’s go back in time now. When were the earliest surgeries, and who performed them? What kind of training, if any, did they have?ira rutkowThat is a fascinating question. And I write about it at the very beginning of the book because the first operations were done by cavemen during the Stone Age. Now, what are we talking about? There were trephinations. Trephination was the removal of a piece of the skull, for whatever the reason— probably back then, it was for spiritual reasons. Perhaps the patient had mental illness. They thought that if they removed a piece of the skull, that would remove the evil demons within the brain.So trephination is an operation where they take out part of the skull. Obviously, they didn’t have scalpels, but they might have rubbed the skull with a stone or a sharpened flint. And they would take out part of the skull, and they would be looking at the brain. And these patients survived. It’s hard to imagine that these patients survived.So the earliest operations were done by Stone Age cavemen. Everything has a beginning, a birth from which its story emerges. For surgery, the prehistoric surgeons, they really represent the Big Bang of surgery’s evolutionary tree. And much of that ancestor’s DNA— that’s what you’re asking me about, that determines who we are, our DNA with our ancestors— well, vestiges of the Stone Age surgeon’s surgical essence, his authority, his derring do, his psyche, his positive attitude, the skills that they had, they course through every surgeon’s body in today’s world. And so we’re looking at a 5,000-year-old continuum. And surgeons of today, when you go see a surgeon today, you have to understand that the knowledge that they are using on you was learned over centuries.pamela paulWhat did surgery look like in ancient Rome, for, say, Galen in the second century?ira rutkowNot something that you and I would recognize, and not something that you and I would like to undergo. Understand that there are four elements of a surgical operation that need to be present for the operation to be successful. Now, what are those four elements?One is an understanding of anatomy. That’s the first. We have to understand the ability to stop blood flow, because if blood is flowing all over the place, the surgeon can’t see where they’re going. Then you have to have anesthesia, and you have to have antisepsis. Without those four things, if they stand apart, the surgical operation cannot exist, at least successfully.So when you ask me about ancient Rome or about ancient Greece— or you don’t need to go back that far, you can go back to the 18th century— all of those elements were not in place. For instance, the study of human anatomy by Vesalius did not occur until the 16th century. That is when human anatomy finally began to be understood. The ability to stop blood flow was something that a man by the name of Paré did, also in the 16th century.So in the 16th century, we knew anatomy, we knew blood flow. But there’s only one problem. They were still doing operations, but they had no ability to have anesthesia and no ability to have antisepsis. So patients would suffer, obviously, from the pain, and they would die from infection after the operation.pamela paulWell, let’s pause for a moment there because you’ve written a book about medicine during the Civil War. And for many people who’ve not studied it, maybe their one exposure to it is that scene in “Gone With the Wind,” where amputations are taking place without any anesthetic. So they were doing them. They were extraordinarily painful, obviously. But did most people survive those kinds of very brutal basic surgeries?ira rutkowWell, the Civil War is a sort of a turning point in the history of surgery, to the extent that anesthesia was available. Anesthesia was developed in 1846, at Harvard, by the way, up in Boston. So ether anesthesia was available. Was it used in all the operations during the Civil War? I would say obviously not, because not everybody was trained in it. Some were, some weren’t.But even if they did the operation— amputation, for instance, whatever it might be, of the arm or the leg— under anesthesia, the patient woke up. They had no pain medicines to give them. And the patient would invariably develop an infection. The stump would become infected. The patient would develop sepsis. And in many instances, a higher percentage than you and I want to know about, would die.pamela paulYou mentioned another major development that one needed in order to conduct a successful surgery, which is antisepsis. And that’s obviously, presumably, a big part of the subject of your book on James Garfield. So for those who have not read that book, or, for example, Candice Millard’s “Destiny of the Republic,” which is a great narrative history of Garfield’s assassination, what happened when Garfield was shot? And what did we learn, just not in time?ira rutkowJames Garfield was a fascinating turning point in American surgery, and surgery in the world, for that matter. Now, what happened? Garfield is shot. It’s 1881. He’s shot in the back. And immediately, immediately surgeons are called. They surround him, and they start putting their fingers into the bullet hole, which is in his back. And the reason is because they want to see if they can feel the bullet. Can they find the bullet? There were no X-rays. There were no MRIs. That stuff didn’t exist.pamela paulAnd they didn’t do even basic handwashing at that time?ira rutkowNo. And this is what people don’t realize. And it gets a little queasy, but we’ll discuss it because it’s fascinating. So back then, if the surgeon came on horseback or if the surgeon was driving his wagon with horses, they had reins.They had those reins. They would pick them up in their hands. Now, they tied the reins to a post. The reins fell on the street, on the dirt. And what’s over the dirt? Horse manure. So they would pick up the reins. They would come. They didn’t know about handwashing.So when that surgeon put his fingers into that hole, his finger probably had bacteria from horse manure and other things on it. So the surgeons were actually introducing an infection into Garfield’s back. And over the course of about two to three months, Garfield did exactly what you would expect. He developed a massive abscess inside his abdomen. They were unable to treat it because they didn’t know how to treat it. And in the end, he died from sepsis.Now, having said all of this, there was a big divide in American surgery at the time. This is 1881. But five years prior, Joseph Lister had come to the United States. Lister was the discoverer of antisepsis. And he began to preach his message. Do not do things like putting your hands into a wound before you wash them with an antibiotic solution. You must wash your hands and the instruments at all times.Well, some surgeons believed him, some surgeons didn’t believe him. And I’ve written about this any number of times, Lister’s trip to America in 1876. The surgeons who treated Garfield were older, as you would expect. To treat the president of the United States, they were not going to have a younger surgeon there. And the older surgeons did not believe Lister.The younger surgeons did. And there was this line in the sand divide between the younger surgeons and the older surgeons. The oldest surgeons were treating the man. The man died from it. And what happened in 1881 was the American world of surgery saying, aha, we need to listen to Lister. You need to understand what’s going on about antisepsis. And that is what happened.And from 1881 on, people began to believe in antisepsis. And that is when surgery became surgery. Surgery was not surgery before the time of Lister. Yes, they had anesthesia. Yes, they knew about anatomy. But every time they operated on somebody, the patient would die from sepsis.pamela paulHas the history of surgery been a sort of steady, relentless progress and move forward, especially with regard to those four major areas you mentioned, or have there been setbacks along the way?ira rutkowThere are always setbacks in any profession, but in general, the course of surgery has been a steady progress as we continue into today. You have to keep in mind that the experiences of a surgeon is really one which reflects the experiences of all of the surgeons that went before him or her. And that’s sort of guided my career, to understand the history of what was going on. And although people might not listen to certain things, they might disagree, which is human nature— sometimes you agree with something, sometimes you don’t agree with something— but in truth, the progress in surgery was linear. It did continue. And it continues into today’s world.pamela paulHas technology accelerated the rate of change in the exponential sense that it has accelerated change in so many other fields?ira rutkowYes. And I write about transformations in surgery. There have been transformations in surgery. Obviously, the beginning of anesthesia is an amazing transformation in the evolution of surgery, as is antisepsis. And I write that, in today’s world, there’s been another major transformation, which perhaps isn’t evident because we haven’t had the time to look back at it and to really discuss it and realize its impact, but the ability to do smaller operations through a laparoscope or to use the technology of robotic surgery, and the presence of same-day surgery.Before, to have a hernia operation, for instance, you were in the hospital for four or five days. Afterwards, you were in immense pain and discomfort, and it was a difficult recovery. In today’s world, a hernia operation, both either through a laparoscope or through a small incision, you go home an hour or two after the operation, and in a matter of a week or so, you’re back doing what you want. So this is a major transformation in surgery, the ability to do operations through much smaller incisions. And with the same-day aspect, it’s changed everything.pamela paulAll right, I have two final questions, both looking towards the future. You mentioned robotic surgery. Are we looking at a future where it’s not even human beings doing the surgery? Is this something robots and A.I.-assisted machines are going to do in lieu of human surgeons?ira rutkowSo the answer is that I don’t know, but I am willing to make a prediction. I would say that, in the future, robotic surgery will take over many of the areas of surgery. But what does that mean? Well, someone needs to code the robot, someone needs to do programming the robot, and somebody needs to be around if something goes wrong with the robot.So I think that, in the end, humans will be there running the robots. Whether the humans will be there conducting the actual surgery, I would say that probably, as we go forward, that they will not be doing the actual surgery, that robots, along with A.I. and all sorts of things that are happening, will be able to conduct a more efficient operation.pamela paulAll right, so speaking of efficiency, my last question is from very much a patient’s perspective, which is that some people might ask, with all of this excellent progress, with this possible outsourcing to robots, why isn’t surgery getting any less expensive? Why would it not become more efficient for patients in terms of price?ira rutkowI think that involves all of the socioeconomics that exist in the world of modern American medicine, medicine in the world, for that matter, is that things exponentially are getting more expensive. Even though the operations might be more efficient, the technology is more expensive. For instance, a hernia done through an incision where you don’t have laparoscopic equipment, it costs less than what it would if you were doing it with equipment. Why surgeons use a particular operation, it’s what they feel comfortable with and what they feel a patient will do better with.I don’t see how things are going to decrease in cost. There’s virtually nothing in the world right now that is costing less. Things tend to cost more. And I think that you’re beginning to see that in surgery, in medicine as a whole. And that is where we’re going right now. I can’t tell you 100 years from now what it’s going to be, but I certainly can say that, in the immediate future, the costs, I don’t think, are going to be going down. If anything, they’re going to be going up.pamela paulAll right, so faster, easier, less painful, less invasive, but alas, probably more expensive is the future.ira rutkowYes, like many things in life. You’re enjoying it more, you’re having a better experience, but it’s costing you more to enjoy the experience. So yes.pamela paulBut as you said, probably much more of a pleasant experience than having surgery anytime earlier than the 20th century, with some gorier details in your book. Ira, thank you so much for being here.ira rutkowNo, thank you. I appreciate the opportunity.pamela paulIra Rutkow’s new book is called “Empire of the Scalpel: The History of Surgery.”[MUSIC PLAYING]john williamsAlexandra Alter joins me now with news from the publishing world. Hi, Alexandra.alexandra alterHi, John.john williamsSo you broke some news this week about a real giant of American literature.alexandra alterYes, there was some very exciting news this week from Knopf. They have the first Cormac McCarthy novel in 16 years. It’s been 16 years since he published “The Road,” which became a huge best seller, won a Pulitzer, and devastated me and millions of others readers. If anyone hasn’t read it, it’s this extremely bleak, post-apocalyptic novel about a father and son.So there’s been a lot of speculation in the Cormac McCarthy hive, which I’ve discovered while reporting this is very active on Reddit. There’s a whole— many sub-Reddits devoted to his work. And people have been waiting for the next novel, which he’s been hinting at for many years. It’s called “The Passenger.”So when they announced that he had a novel coming out, I think people who had been following closely knew that he had this book called “The Passenger.” The big surprise was that it’s not one, but two novels that he’s written, and they are interconnected. So this fall, one month apart, Knopf is going to release his books, “The Passenger,” and a second companion novel, “Stella Maris.”And these are very unusual books for him. You know, he’s very well known for his books set in the West, in the Southwest, in the South. His books are often extremely violent, possibly even masculine. They’re often focused on vengeance, and bloodshed, and good and evil. And he’s got a very distinctive prose style. He shuns punctuation and quotation marks. So he’s a giant, obviously, of American literature. But he’s known for this particular style of his.And these books sound quite different. For one thing, “Stella Maris” has a female protagonist, Alicia Western, who is a doctoral candidate in mathematics and is a genius who is also having a psychotic breakdown. And the first novel, “The Passenger,” is largely the story of her brother Bobby Western.These siblings, based on what I’ve read from the material the publisher provided, they are kind of obsessed with one another, in love with one another. And their father was a physicist who worked on the atom bomb, so they’re both tortured by their family legacy of mass violence.john williamsUtter destruction.alexandra alterUtter destruction. So— so these aren’t going to be light reads. And, you know, the themes of death, and destruction, and good and evil, that he’s always plumbed in his work are certainly being realized in these books as well. But what is quite different, I think, is how directly he is approaching some of these other abstract ideas that have always obsessed him, from what I’ve read of his work and his interests.He’s long been interested in things like the history of mathematics and physics and complexity theory. And he’s a trustee at the Santa Fe Institute, which is this theoretical studies institute in Santa Fe. And he surrounds himself with physicists and mathematicians and scientists, and sort of steeps himself in a lot of these big ideas. And apparently, through these characters, particularly through Alicia Western, he takes on a lot of these esoteric interests of his.The one thing we do know about these books is that they have been decades in the making. There was, I think, a reference to “The Passenger” in correspondence from McCarthy in 1980.john williamsWow.alexandra alterAnd then more recently he referenced working on a book about a woman. In a very rare interview that he gave to The Wall Street Journal in 2009, he said he’d been planning to write about a woman for 50 years and had never felt like he was competent enough to do it, but he felt like he had to try at some point. So it’s been known to scholars and close followers of McCarthy’s that he had this big project. I think the surprise is the form that it’s taken.And I should mention another unusual thing about “Stella Maris,” which is the shorter, companion novel. It unfolds entirely as a medical transcript between Alicia Western and her doctor at a psychiatric institute.john williamsOh, wow.alexandra alterSo it’s this very different, formal approach that he’s taken.john williamsThat sounds quite different.alexandra alterI’m eager to read it. I haven’t yet.john williamsSo nearing 90, Cormac McCarthy is semi-confidently writing about a woman in the form of a hallucinatory transcript.alexandra alterYou got it. That’s the summary, yes.john williamsOK. So we’ll look for that. “The Passenger” comes out on October 25th and “Stella Maris” comes out on November 22nd, so not quite at the same time, but not a long wait between the two. And maybe we’ll have you back at that point. And maybe we’ll— maybe we’ll try to get Cormac to talk to you on the podcast.alexandra alterThat would be amazing.john williamsThanks for breaking the news, Alexandra.alexandra alterThanks for having me. [MUSIC PLAYING]pamela paulJoining me now to talk about what we’re reading, my colleagues John Williams and Liz Egan. Hey, guys.john williamsHey, Liz. Hey, Pamela.liz eganHi, Pamela. Hi, John.pamela paulLiz, it’s been a while since you’ve been on. Tell us what you’re reading.liz eganI am reading a wonderful book that I just started— actually, I’m listening to it. It’s called “The Days of Afrekete,” and it’s by Asali Solomon, who teaches writing at Haverford. This is her third book. She’s written one other novel and one collection of short stories, neither of which I’ve read or listened to.This is a book that’s a modern take on Mrs. Dalloway. And it’s set in Philadelphia, in a neighborhood called Mount Airy. And it begins with a woman getting ready for a dinner party. And the woman’s name is Liselle. And her husband— she’s Black, and her husband, Winn, who is white, has just lost a primary bid to unseat a longtime state representative. And the party is meant to be a celebration of the end of his campaign.And unbeknownst to many of the guests, Winn is about to be indicted. And so we see the party preparations in full swing, and the guests arriving, and Liselle dealing with her frustrating teenage son. And at the same time, we’re having flashbacks to Liselle’s college days with a girlfriend, who she still is thinking about.Eventually, I know I’ll see some of the action from Selena, the girlfriend’s, perspective. But so far, it’s a really great look at the life that this woman is living versus the life she expected and the gap between the two. And it’s full of tension and excitement and disappointment. And it’s just so far really incredibly beautiful.pamela paulAll right, since you mentioned that you are listening to this book, I have to bring up a subject that came up in conversation at an actual party earlier this week with one of our erstwhile colleagues Frank Bruni. And it was a conversation that I actually found kind of frightening, because you and Frank were one-upping each other in terms of how fast you listen to audiobooks. You now have to reveal all.liz eganWell, this book I’m listening to at 1.2, which is only slightly faster than it’s being read. Because I really love the voice of the narrator. Her name is Karen Chilton. The last book that she narrated that I listened to was “On Juneteenth,” by Annette Gordon-Reed, which I know you enjoy also, Pamela. But I really love the sound of her voice, so I’m not speeding her up too much.When I’m not loving the sound of the voice, and I just want to kind of get through a story, I will go up as high as 1.8, which is kind of like listening to Alvin and the Chipmunks, but it works for me. How about you guys?pamela paulOh, I am like a baby listener. No, when I listen at 1.5, I get— I get really like rattled.john williamsDizzy.pamela paulYeah, yeah. What about you, John?john williamsI don’t listen to books really. The only time I tried, it was so long ago, it’s like a different century now, almost— I think literally, maybe. I had read “The Accidental Tourist,” and then I saw that John Malkovich narrated it. And I— at the time, I was like a big Malkovich fan.pamela paulBack in the era of books on tape.john williamsYeah, exactly, very much. So I put the cassette into the car player. And I was driving around. And I just— because I was driving, I just couldn’t keep my attention. I would find that two minutes went by and I just had forgotten what was going on, like the way you listen to a song and you sing the first verse, but then you’re just driving automatically and unconsciously, and then the song is over.So I can’t really pay attention to a narrative while I do things like that. And I really prefer to read on paper when I’m at home or on the subway or anywhere else really.pamela paulYou know what, John, I’m actually with you. Liz is very upset.liz eganI’m the odd man out, but I have to say during the pandemic, I have really discovered my love of audiobooks, because I love to read while I’m walking, it’s great. John, tell us what you’re reading.john williamsI’m reading another Iris Murdoch novel. I talked a couple of weeks ago on the podcast about “The Black Prince.” And so I’ve continued my education in her, reading— I think this is my fifth novel by her now, called “A Word Child.” And it was published in 1975, a couple of years after “The Black Prince.”And like that book, it has a very strong first person narrator, a guy named Hilary. And you feel, from page one, just very immersed in his voice and his vibrancy, even if he’s a bit— more than a bit— curmudgeonly. It’s kind of like the feeling of being trapped in a web, all of her books, I think. Except instead of being eaten by a spider, you’re about to have a delightful literary experience. It’s like a safe web.And so I made the mistake last time of only quoting a few aphoristic lines. And I’m going to read a— slightly, just a few sentence paragraph, to give you a sense of her voice at gallop. And then talk a little bit about her reception at the time she wrote, which I’m finding really fascinating. So this is the narrator, Hilary, who was an illegitimate child, as they said at the time, and has kind of a chip on his shoulder about the world. And claims to be— he keeps claiming that he’s a violent person in ways that you don’t really see yet, but I imagine are going to play out in the course of the book. And so here, he’s talking about this couple who invite him over for dinner from time to time. And their last name is Impiatt.And so he says, “As I may sometimes seem in what follows to mock the Impiatts, let me here make it clear once and for all that I thoroughly like them both, as we often do those whom we mock. I thought they were decent people and I admired them because they were happily married, quite a feat in my estimation.“Of course, this latter achievement is not always totally endearing. The assertion made by a happy marriage often alienates, and often is at least half consciously intended to alienate the excluded spectator. The brightness of the Impiatt hearth made me feel sometimes like a slinking, sniffing wolf. And they, the happy ones, liked to have a wolf about, liked to glimpse him now and then from the window and hear his hungry howling.“How rarely can happiness be really innocent and not triumphant? Not an insult to the deprived? How offensive it can be, the natural, instinctive showing off of decent happy people.”liz eganOh, I love that.john williamsThere’s this very intense, as you can tell, observation and rhythm to the prose. And she just maintains that over hundreds of pages, which is incredible. And I’m also reading her personal letters, very slowly. They came out probably four or five years now ago. It’s called “Living on Paper: Letters From Iris Murdoch, 1934-1995.”And I’m really going back and also reading contemporaneous reviews of her work. Because I do think even though she’s incredibly well known, and I think respected, there’s been kind of a renaissance of her reputation in the last however many years.And when you go back, to especially the ‘70s, it seems like these very smart critics— here’s a review of “A Word Child” from The Times in 1975, and it was written by David Bromwich, a very smart guy, still around, still reviewing, and he says plenty of nice things about it, but he frames it all in this kind of skeptical and disappointed tone.Here’s the opening of his review. “This is Iris Murdoch’s 17th novel, almost one a year since “Under the Net.” And it raises the old, bewildering questions about her status as a writer. Anything she sets her hand to seems distinctive.You could not possibly confuse her with any other novelist. But take all the separate volumes, set them alongside each other, and they do not look strikingly individual. Tricks, characters, whole turns of the plot may be carried over from one book to the next. One begins to worry about this magical disposition of elements.”And this is a common thing. He later calls the story kind of schematic, because Murdoch was a philosopher and she did like to set these big themes in motion, sometimes embodied in characters, and let these ideas about God and romance and ethics play out through her very busy plots.But from my perspective— and I was going to say I don’t mean this as an insult to contemporary fiction, but maybe I do— it’s just remarkable to me, reading her books, that you would do anything except exult in their brilliance and their charm. The fact that her reputation was always in play on some level really amazes me as a fan of her work. But anyway, so that’s a little sort of critical sidebar. Pamela, what are you reading these days?pamela paulI’m going to talk about two books that I’ve read recently. One is by someone who’s been a guest on this podcast. And the other one was recommended to me by you, John— or maybe I just saw you reading it out of the corner of my eye.So the first one is “The True American: Murder and Mercy in Texas,” by Anand Giridharadas. And I have been meaning to read this book forever, it feels like. I remember when my husband read it, and he was really taken with it, and then it just was on the bookshelf for a long time. And it moved over to my more urgent area of my bookshelf. And I finally read it a couple of weeks ago. And it’s just a really great book. I can’t recommend it highly enough.The subtitle has the word mercy in it. And so it reminds me of “Just Mercy,” which I’ve talked about also on the podcast, Bryan Stevenson’s book about his advocacy on behalf of death row prisoners. And mercy is just a concept that I feel like is a little bit absent in our merciless culture, so it interests me.And the specific story of this book is about a man named Raisuddin Bhuiyan. And he was a Bangladeshi immigrant to America, who was well-educated, middle class. He’d been an Air Force officer in Bangladesh. Comes over and ends up, as so often is the case, working at a job that pays a lot less and requires many fewer skills than he actually has, which is he works at a gas station shop in Dallas, in a mini mart.And one day in October of 2001, a man named Mark Stroman, who is in and out of prison a little bit, ne’er-do-well, dabbling, occasionally addicted to drugs, white man in Texas. And Stroman shoots Bhuiyan. He also shoots two other South Asian men working in mini markets and kills both of them. And it’s about these two men and how they got to this point.Bhuiyan survives and he ends up, as implied in the title, deciding to forgive his attempted murderer. So it’s a book about the justice system. It’s obviously about race and prejudice in America. It’s about 9/11. But I think most of all, it’s really about what the title says, which is both of these people felt like they were true Americans. So you’re looking at these very different ways and what it means to be an American.Is an American an ambitious, aspiring citizen immigrant who is trying to work himself up and achieve the American dream? Or is a true American a person who is born and raised in Texas, always lived there, believes that he is defending his country’s honor in revenge for the attacks of 9/11?And one of the things that I loved about the book is that while it feels like a very black and white case of right and wrong, the portrayals of the characters are very empathetic and evenhanded and nuanced. And that’s also something I feel like is really rare in our culture these days.The other book I read is the book that you recommended, John. I actually— I can’t remember— I remember seeing it on your desk and I think I asked you about it. It’s called “The Examined Life: How We Lose and Find Ourselves,” by Stephen Grosz. And it also has a blurb on the cover from one of my favorite writers and critics working today, which is Andrew Solomon. And he says, “impossible to put down.”I actually asked Andrew about it afterwards. And he knows the author, Stephen Grosz, who is a psychoanalyst based in London, although I believe he is— he is American, or he was born in America. And it’s these very short chapters, these case studies of people that he has treated, looked at in a way— kind of a thematic way, in terms of what they can tell you about humanity, really.I mean, the chapter titles alone are the kind of things that make you want to read it. So he has a few different sections of the book. And one section is called “Beginnings.” One is called “Telling Lies.” One is called “Loving.” So I’m just going to tell you a few chapter titles. One is “How Praise Can Cause a Loss of Confidence.”Another is “On Not Being in a Couple,” “A Passion for Ignorance,” “How Paranoia Can Relieve Suffering and Prevent a Catastrophe.” So you read these— just these chapter titles, I mean, to me, it’s like— it’s just like candy.john williamsWhat’s funny is that right now you’re reminding me of when you talked about the Michael Schur book and those chapter titles about the trolley problem and things like that, because you’re reading a lot of books with very hooky things that really grab your attention and go, wait a minute, I want to know more about this.I think I picked that up because— it might have been a review. I think Michiko Kakutani reviewed it for The Times. It might have been her review that did it. But that’s kind of a genre that I’m generally interested in if it’s well done. I like Adam Phillips’s books. And Andrew Solomon, it’s not surprising to me that he likes it.My memory of it— it was a while ago now— is that the short chapters were very good, and I was into the book, and I wondered if it was just my cup of tea. And then in the last maybe 20 percent of the book, something about either the cases he was looking at or the way that they reflected the earlier cases in the book gave it all a sudden changed momentum and coherence that felt even more powerful to me.So that I kind of really liked it through the first half, but didn’t know if I would recommend it to people. And then I’m sure I pushed it on you and a few others.pamela paulLet’s run down the titles again.john williamsI’m reading “A Word Child,” by Iris Murdoch.liz eganI am reading “The Days of Afrekete,” by Asali Solomon.pamela paulAnd I read Anand Giridharadas’s “The True American: Murder and Mercy in Texas,” and “The Examined Life: How We Lose and Find Ourselves,” by Stephen Grosz.[MUSIC PLAYING]Remember there’s more at And you can always write to us at I write back; not right away, but I do. The Book Review podcast is produced by the great Pedro Rosado from HeadStepper Media, with a major assist from my colleague John Williams. Thanks for listening. For The New York Times, I’m Pamela Paul.

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