History of surgery
Encyclopedia
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
is the branch of medicine that deals with the physical manipulation of a bodily structure to diagnose, prevent, or cure an ailment. Ambroise Paré
Ambroise Paré
Ambroise Paré was a French surgeon. He was the great official royal surgeon for kings Henry II, Francis II, Charles IX and Henry III and is considered as one of the fathers of surgery and modern forensic pathology. He was a leader in surgical techniques and battlefield medicine, especially the...
, a 16th century French surgeon, stated that there were to perform surgery: "To eliminate that which is superfluous, restore that which has been dislocated, separate that which has been united, join that which has been divided and repair the defects of nature."
Since humans first learned to make and handle tools, they have employed their talents to develop surgical techniques, each time more sophisticated than the last; however, up until the industrial revolution
Industrial Revolution
The Industrial Revolution was a period from the 18th to the 19th century where major changes in agriculture, manufacturing, mining, transportation, and technology had a profound effect on the social, economic and cultural conditions of the times...
, surgeons were incapable of overcoming the three principal obstacles which had plagued the medical profession from its infancy — bleeding
Bleeding
Bleeding, technically known as hemorrhaging or haemorrhaging is the loss of blood or blood escape from the circulatory system...
, pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
and infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
. Advances in these fields have transformed surgery from a risky "art" into a scientific discipline capable of treating many diseases and conditions.
Generalities
The surgical profession has suffered numerous breakthroughs and setbacks throughout history. In general, the surgeon has been considered the technician while the physician (more historically related to the priest and shaman) was the true healer. During the development of modern medicine, both disciplines were taught together and one could obtain the qualifications to practice medicine and surgery. A good bit of history, in any case, is intimately related with the history of general medicine. New archaeological technologies confirm that the origin of medicine coincides with the appearance of modern humans.Origins
The first surgical techniques were developed to treat injuries and traumas. A combination of archaeological and anthropological studies offer insight into man's early techniques for suturing lacerations, amputating insalvageable limbs, and draining and cauterizing open wounds. Many examples exist: some Asian tribes used a mix of saltpeter and sulfur that was placed onto wounds and lit on fire to cauterize wounds; the Dakota Indians used the quill of a feather attached to an animal bladder to suck out purulent material; the discovery of needles from the stone age seem to suggest they were used in the suturing of cuts (the Maasai used needles of acaciaAcacia
Acacia is a genus of shrubs and trees belonging to the subfamily Mimosoideae of the family Fabaceae, first described in Africa by the Swedish botanist Carl Linnaeus in 1773. Many non-Australian species tend to be thorny, whereas the majority of Australian acacias are not...
for the same purpose); and tribes in India and South America developed an ingenious method of sealing minor injuries by applying termites or scarabs who ate around the edges of the wound and then twisted the insects neck leaving their heads rigidly attached like staples.
Trepanation
The oldest operation for which evidence exists is trepanationTrepanation
Trepanning, also known as trephination, trephining or making a burr hole, is a surgical intervention in which a hole is drilled or scraped into the human skull, exposing the dura mater in order to treat health problems related to intracranial diseases. It may also refer to any "burr" hole created...
(also known as trepanning, trephination, trephining or burr hole from Greek
Greek language
Greek is an independent branch of the Indo-European family of languages. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. Its writing system has been the Greek alphabet for the majority of its history;...
τρύπανον and τρυπανισμός), in which a hole is drill
Drill
A drill or drill motor is a tool fitted with a cutting tool attachment or driving tool attachment, usually a drill bit or driver bit, used for drilling holes in various materials or fastening various materials together with the use of fasteners. The attachment is gripped by a chuck at one end of...
ed or scraped into the skull
Human skull
The human skull is a bony structure, skeleton, that is in the human head and which supports the structures of the face and forms a cavity for the brain.In humans, the adult skull is normally made up of 22 bones...
for exposing the dura mater
Dura mater
The dura mater , or dura, is the outermost of the three layers of the meninges surrounding the brain and spinal cord. It is derived from Mesoderm. The other two meningeal layers are the pia mater and the arachnoid mater. The dura surrounds the brain and the spinal cord and is responsible for...
to treat health problems related to intracranial pressure and other diseases. In the case of head wounds surgical intervention was implemented for investigating and diagnosing the nature of the wound and the extend of the impact while bone splinters were removed preferably by scraping followed by post operation procedures and treatments for avoiding infection and aiding in the healing process. Evidence has been found in prehistoric human remains from Proto-Neolithic and Neolithic
Neolithic
The Neolithic Age, Era, or Period, or New Stone Age, was a period in the development of human technology, beginning about 9500 BC in some parts of the Middle East, and later in other parts of the world. It is traditionally considered as the last part of the Stone Age...
times, in cave painting
Cave painting
Cave paintings are paintings on cave walls and ceilings, and the term is used especially for those dating to prehistoric times. The earliest European cave paintings date to the Aurignacian, some 32,000 years ago. The purpose of the paleolithic cave paintings is not known...
s, and the procedure continued in use well into recorded history (being described by ancient Greek
Ancient Greece
Ancient Greece is a civilization belonging to a period of Greek history that lasted from the Archaic period of the 8th to 6th centuries BC to the end of antiquity. Immediately following this period was the beginning of the Early Middle Ages and the Byzantine era. Included in Ancient Greece is the...
writers such as Hippocrates
Hippocrates
Hippocrates of Cos or Hippokrates of Kos was an ancient Greek physician of the Age of Pericles , and is considered one of the most outstanding figures in the history of medicine...
among others). Out of 120 prehistoric skulls found at one burial site in France
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
dated to 6500 BCE, 40 had trepanation holes. Folke Henschen, a Swedish doctor and historian, asserts that Soviet excavations of the banks of the Dnieper River
Dnieper River
The Dnieper River is one of the major rivers of Europe that flows from Russia, through Belarus and Ukraine, to the Black Sea.The total length is and has a drainage basin of .The river is noted for its dams and hydroelectric stations...
in the 1970s show the existence of trepanation in Mesolithic
Mesolithic
The Mesolithic is an archaeological concept used to refer to certain groups of archaeological cultures defined as falling between the Paleolithic and the Neolithic....
times dated to approximately 12000 BCE. The remains suggest a belief that trepanning could cure epileptic seizures, migraines, and mental disorders.
Many prehistoric and premodern patients had signs of their skull structure healing, suggesting that many of those that proceeded with the surgery survived their operation. In some studies the rate of survival surpassed 50%.
Setting bones
Among some treatments used by the Aztecs, according to Spanish texts during the conquest of Mexico, was the reduction of fractured bones: "...the broken bone had to be splinted, extended and adjusted, and if this was not sufficient an incision was made at the end of the bone, and a branch of firFir
Firs are a genus of 48–55 species of evergreen conifers in the family Pinaceae. They are found through much of North and Central America, Europe, Asia, and North Africa, occurring in mountains over most of the range...
was inserted into the cavity of the medulla
Bone marrow
Bone marrow is the flexible tissue found in the interior of bones. In humans, bone marrow in large bones produces new blood cells. On average, bone marrow constitutes 4% of the total body mass of humans; in adults weighing 65 kg , bone marrow accounts for approximately 2.6 kg...
..." Modern medicine developed a technique similar to this in the 20th century known as medullary fixation.
Bloodletting
Mesopotamia
Mesopotamia is a toponym for the area of the Tigris–Euphrates river system, largely corresponding to modern-day Iraq, northeastern Syria, southeastern Turkey and southwestern Iran.Widely considered to be the cradle of civilization, Bronze Age Mesopotamia included Sumer and the...
ns, the Egyptians
Ancient Egypt
Ancient Egypt was an ancient civilization of Northeastern Africa, concentrated along the lower reaches of the Nile River in what is now the modern country of Egypt. Egyptian civilization coalesced around 3150 BC with the political unification of Upper and Lower Egypt under the first pharaoh...
, the Greeks, the Mayans, and the Aztecs. In Greece, bloodletting was in use around the time of Hippocrates, who mentions bloodletting but in general relied on dietary techniques. Erasistratus
Erasistratus
Erasistratus was a Greek anatomist and royal physician under Seleucus I Nicator of Syria. Along with fellow physician Herophilus, he founded a school of anatomy in Alexandria, where they carried out anatomical research...
, however, theorized that many diseases were caused by plethoras, or overabundances, in the blood, and advised that these plethoras be treated, initially, by exercise, sweating, reduced food intake, and vomiting. Herophilus advocated bloodletting. Archagathus, one of the first Greek physicians to practice in Rome, practiced bloodletting extensively and gained a most sanguinary reputation. The art of bloodletting became very popular in the West
Western world
The Western world, also known as the West and the Occident , is a term referring to the countries of Western Europe , the countries of the Americas, as well all countries of Northern and Central Europe, Australia and New Zealand...
, and during the Renaissance
Renaissance
The Renaissance was a cultural movement that spanned roughly the 14th to the 17th century, beginning in Italy in the Late Middle Ages and later spreading to the rest of Europe. The term is also used more loosely to refer to the historical era, but since the changes of the Renaissance were not...
one could find bloodletting calendars that recommended appropriate times to bloodlet during the year and books that claimed bloodletting would cure inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
, infections, stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
s, manic psychosis and more.
Mesopotamia
Berossus
Berossus was a Hellenistic-era Babylonian writer, a priest of Bel Marduk and astronomer writing in Greek, who was active at the beginning of the 3rd century BC...
, a 3rd century BCE Chaldea
Chaldea
Chaldea or Chaldaea , from Greek , Chaldaia; Akkadian ; Hebrew כשדים, Kaśdim; Aramaic: ܟܐܠܕܘ, Kaldo) was a marshy land located in modern-day southern Iraq which came to briefly rule Babylon...
n philosopher wrote considerably about the traditional Babylonian medical techniques (principally in the archives of Borsippa) and went on to assert that the god Oannes taught the Sumerian people all that was to be known about civilization and that nothing new had been invented. This assertion seemed hyperbolic until analysis of Sumerian tablets showed that the Mesopotamian civilization had developed or invented numerous medical techniques thousands of years before they were re-developed or re-invented by the Europeans.
Some 4000 BCE the Sumerian civilization was established in Mesopotamia between the Tigris
Tigris
The Tigris River is the eastern member of the two great rivers that define Mesopotamia, the other being the Euphrates. The river flows south from the mountains of southeastern Turkey through Iraq.-Geography:...
and Euphrates
Euphrates
The Euphrates is the longest and one of the most historically important rivers of Western Asia. Together with the Tigris, it is one of the two defining rivers of Mesopotamia...
rivers, creating the oldest form of writing, cuneiform. Of the 30,000 or so cuneiform tablets that have been discovered, about 800 of them deal with medical themes (one of these being the first prescription known to have been written). The name of the first surgeon is Urlugaledin, from the 4000 BCE, whose personal seal depicts two knives encircled by medicinal plants. This seal is now housed in the Louvre
Louvre
The Musée du Louvre – in English, the Louvre Museum or simply the Louvre – is one of the world's largest museums, the most visited art museum in the world and a historic monument. A central landmark of Paris, it is located on the Right Bank of the Seine in the 1st arrondissement...
.
The Sumerians saw sickness as a divine punishment imposed by different demons when an individual broke a rule. For this reason, to be a physician, one had to learn to identify approximately 6,000 possible demons that might cause health problems. To do this, the Sumerians employed divining techniques based on the flight of birds, position of the stars and the livers of certain animals. In this way, medicine was intimately linked to priests, relegating surgery to a second-class medical specialty.
Nevertheless, the Sumerians developed several important medical techniques: in Ninevah archaeologists have discovered bronze instruments with sharpened obsidian resembling modern day scalpels, knives, trephines, etc. Hammurabi's Code
Code of Hammurabi
The Code of Hammurabi is a well-preserved Babylonian law code, dating to ca. 1780 BC . It is one of the oldest deciphered writings of significant length in the world. The sixth Babylonian king, Hammurabi, enacted the code, and partial copies exist on a human-sized stone stele and various clay...
itself contains specific legislation regulating surgeons and medical compensation as well as malpractice and victim's compensation:
India
Archaeologists made the discovery that the people of Indus Valley CivilizationIndus Valley Civilization
The Indus Valley Civilization was a Bronze Age civilization that was located in the northwestern region of the Indian subcontinent, consisting of what is now mainly modern-day Pakistan and northwest India...
, even from the early Harappan periods (c. 3300 BCE), had knowledge of medicine and dentistry. The physical anthropologist that carried out the examinations, Professor Andrea Cucina from the University of Missouri-Columbia, made the discovery when he was cleaning the teeth from one of the men. Later research in the same area found evidence of teeth having been drilled, dating back 9,000 years to 7000 BCE.http://news.bbc.co.uk/1/hi/sci/tech/4882968.stm
Sushruta (c. 600 BCE) taught and practiced surgery on the banks of the Ganges in the area that corresponds to the present day city of Benares in Northern India
North India
North India, known natively as Uttar Bhārat or Shumālī Hindustān , is a loosely defined region in the northern part of India. The exact meaning of the term varies by usage...
. Much of what is known about Sushruta is in Sanskrit
Sanskrit
Sanskrit , is a historical Indo-Aryan language and the primary liturgical language of Hinduism, Jainism and Buddhism.Buddhism: besides Pali, see Buddhist Hybrid Sanskrit Today, it is listed as one of the 22 scheduled languages of India and is an official language of the state of Uttarakhand...
contained in a series of volumes he authored, which are collectively known as the Susrutha Samhita. It is the oldest known surgical text and it describes in exquisite detail the examination, diagnosis, treatment, and prognosis of numerous ailments, as well as procedures on performing various forms of plastic surgery
Plastic surgery
Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand...
, such as cosmetic surgery and rhinoplasty
Rhinoplasty
Rhinoplasty , also nose job, is a plastic surgery procedure for correcting and reconstructing the form, restoring the functions, and aesthetically enhancing the nose, by resolving nasal trauma , congenital defect, respiratory impediment, and a failed primary rhinoplasty...
.
In the Sushruta school, the first person to expound Āyurvedic knowledge was Dhanvantari
Dhanvantari
Dhanvantari is an Avatar of Vishnu from the Hindu tradition. He appears in the Vedas and Puranas as the physician of the gods , and the god of Ayurvedic medicine...
who then taught it to Divodasa who, in turn, taught it to Sushruta, Aupadhenava, Aurabhra, Paushakalāvata, Gopurarakshita, and Bhoja.
Because of his seminal and numerous contributions to the science and art of surgery, Sushruta is also known by the title "Father of Surgery". The Samhita has some writings that date as late as the 1st century, and some scholars believe that there were contributions and additions to his teachings from generations of his students and disciples. Susrutha is also the father of Plastic Surgery and Cosmetic Surgery since his technique of forehead flap rhinoplasty (repairing the disfigured nose with a flap of skin from the forehead),that he used to reconstruct noses that were amputated as a punishment for crimes, is practiced almost unchanged in technique to this day. This knowledge of plastic surgery existed in India up to the late 18th century as can be seen from the reports published in Gentleman's Magazine (October 1794).
The Sushruta Samhita
Sushruta Samhita
The Sushruta Samhita is a Sanskrit text, attributed to one Sushruta, foundational to Ayurvedic medicine , with innovative chapters on surgery....
contains the first known description of several operations, including the uniting of bowel, the removal of the prostate gland, the removal of cataract lenses and the draining of abscesses. Susrutha was also the first surgeon to advocate the practice of operations on inanimate objects such as watermelons, clay plots and reeds; thus predating the modern practice of the surgical workshop by half a millennium.
Egypt
Narmer
Narmer was an ancient Egyptian pharaoh of the Early Dynastic Period . He is thought to be the successor to the Protodynastic pharaohs Scorpion and/or Ka, and he is considered by some to be the unifier of Egypt and founder of the First Dynasty, and therefore the first pharaoh of unified Egypt.The...
, the first Pharaoh of Egypt, established the capital of Memphis
Memphis, Egypt
Memphis was the ancient capital of Aneb-Hetch, the first nome of Lower Egypt. Its ruins are located near the town of Helwan, south of Cairo.According to legend related by Manetho, the city was founded by the pharaoh Menes around 3000 BC. Capital of Egypt during the Old Kingdom, it remained an...
. Just as cuneiform tablets preserved the knowledge of the ancient Sumerians, hieroglyphics preserved the Egyptian's.
In the first monarchic age (2700 BCE) the first treaty on surgery was written by Imhotep, the vizier of Pharaoh Djoser
Djoser
Netjerikhet or Djoser is the best-known pharaoh of the Third dynasty of Egypt. He commissioned his official, Imhotep, to build the first of the pyramids, a step pyramid for him at Saqqara...
, priest, astronomer, physician and first notable architect. So much was he famed for his medical skill that he was deified, becoming the Egyptian god of medicine. Other famous physicians from the Ancient Empire (from 2500 to 2100 BCE) were Sachmet, the physician of Pharaoh Sahure
Sahure
- Etymology :Sahure's birth name means "He who is Close to Re". His Horus name was Nebkhau.- Biography :Sahure was a son of queen Neferhetepes, as shown in scenes from the causeway of Sahure's pyramid complex in Abusir. His father was Userkaf. Sahure's consort was queen Neferetnebty. Reliefs show...
and Nesmenau, whose office resembled that of a medical director.
On one of the doorjambs of the entrance to the Temple of Memphis there is the oldest recorded engraving of a medical procedure: circumcision
Circumcision
Male circumcision is the surgical removal of some or all of the foreskin from the penis. The word "circumcision" comes from Latin and ....
and engravings in Kom Ombo
Kom Ombo
Kom Ombo or Ombos or Latin: Ambo and Ombi – is an agricultural town in Egypt famous for the Temple of Kom Ombo...
, Egypt depict surgical tools. Still of all the discoveries made in ancient Egypt, the most important discovery relating to ancient Egyptian knowledge of medicine is the Ebers Papyrus
Ebers papyrus
The Ebers Papyrus, also known as Papyrus Ebers, is an Egyptian medical papyrus dating to circa 1550 BC. Among the oldest and most important medical papyri of ancient Egypt, it was purchased at Luxor, in the winter of 1873–74 by Georg Ebers...
, named after its discoverer Georg Ebers
Georg Ebers
Georg Moritz Ebers , German Egyptologist and novelist, discovered the Egyptian medical papyrus, of ca. 1550 BCE, named for him at Luxor in the winter of 1873–74...
.
The Ebers Papyrus, conserved at the University of Leipzig
University of Leipzig
The University of Leipzig , located in Leipzig in the Free State of Saxony, Germany, is one of the oldest universities in the world and the second-oldest university in Germany...
, is considered one of the oldest treaties on medicine and the most important medical papyri
Medical papyri
Egyptian medical papyri are ancient Egyptian texts written on papyrus which permit a glimpse at medical procedures and practices in ancient Egypt. The papyri give details on disease, diagnosis, and remedies of disease, which include herbal remedies, surgery, and magical spells. It is thought there...
. The text is dated to about 1550 BCE and measures 20 meters in length. The text includes recipes, a pharmacopoeia and descriptions of numerous diseases as well as cosmetic treatments. It mentions how to surgically treat crocodile bites and serious burns, recommending the drainage of pus-filled inflammation but warns against certain diseased skin.
The Edwin Smith Papyrus is a lesser known papyrus dating from the 1600 BCE and only 5 meters in length. It is a manual for performing traumatic surgery and gives surprisingly accurate advice given the time. For example, it gives instructions for dealing with dislocated vertabra:
Greece
Surgeons are now considered to be specialized physicianPhysician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s, whereas in the early ancient Greek world a trained general physician had to use his hands (χείρ in Greek
Greek language
Greek is an independent branch of the Indo-European family of languages. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. Its writing system has been the Greek alphabet for the majority of its history;...
) to carry out all medical and medicinal processes including for example the treating of wounds sustained in the battle field, or the treatment of broken bones (a process called in Greek: χειρουργείν). The Hippocratic Oath
Hippocratic Oath
The Hippocratic Oath is an oath historically taken by physicians and other healthcare professionals swearing to practice medicine ethically. It is widely believed to have been written by Hippocrates, often regarded as the father of western medicine, or by one of his students. The oath is written in...
, written in the 5th century BC provides the earliest protocol for professional conduct and ethical behavior a young physician needed to abide by in life and in treating and managing the health and privacy of his patients. The multiple volumes of the Hippocratic corpus
Hippocratic Corpus
The Hippocratic Corpus , or Hippocratic Collection, is a collection of around 60 early Ancient Greek medical works strongly associated with the physician Hippocrates and his teachings...
and the Hippocratic Oath
Hippocratic Oath
The Hippocratic Oath is an oath historically taken by physicians and other healthcare professionals swearing to practice medicine ethically. It is widely believed to have been written by Hippocrates, often regarded as the father of western medicine, or by one of his students. The oath is written in...
elevated and separated the standards of proper Hippocratic medical conduct and its fundamental medical and surgical principles from other practitioners of folk medicine often laden with superstitious constructs, and/or of specialists of sorts some of whom would endeavor to carry out invasive body procedures with dubious consequences, such as lithotomy
Lithotomy
Lithotomy from Greek for "lithos" and "tomos" , is a surgical method for removal of calculi, stones formed inside certain hollow organs, such as the kidneys , bladder , and gallbladder , that cannot exit naturally through the urinary system or biliary tract...
. Galen
Galen
Aelius Galenus or Claudius Galenus , better known as Galen of Pergamon , was a prominent Roman physician, surgeon and philosopher...
of Pergamum (Greek: Γαληνός) is an excellent paradigm of a very accomplished Greek surgeon and physician of the Roman period (2nd century), who carried out very complex surgical operations and added significantly to the corpus of animal and human physiology and the art of surgery.
China
Hua TuoHua Tuo
Hua Tuo was an ancient Chinese physician who lived during the late Han Dynasty and Three Kingdoms era of Chinese history. The Records of Three Kingdoms and Book of Later Han record Hua as the first person in China to use anesthesia during surgery. He used a general anesthetic combining wine with a...
was a famous Chinese physician during the Eastern Han and Three Kingdoms era. He was the first person to perform surgery with the aid of anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
, some 1600 years before the practice was adopted by Europeans.
Bian Que (Pien Ch'iao) was a "miracle doctor" described by the Chinese historian Qima Nan in Shi Ji who was credited with many skills. Another book, Liezi
Liezi
The Liezi is a Daoist text attributed to Lie Yukou, a circa 5th century BCE Hundred Schools of Thought philosopher, but Chinese and Western scholars believe it was compiled around the 4th century CE.-Textual history:...
(Lieh Tzu) describes that Bian Que conducted a two way exchange of hearts between people. This account also credited Bian Que with using general anaesthesia which would place it far before Hua Tuo, but the source in Liezi is questioned and the author may have been compiling stories from other works. Nonetheless, it establishes the concept of heart transplantation back to around 300 CE.
Eastern hemisphere
Córdoba, Spain
-History:The first trace of human presence in the area are remains of a Neanderthal Man, dating to c. 32,000 BC. In the 8th century BC, during the ancient Tartessos period, a pre-urban settlement existed. The population gradually learned copper and silver metallurgy...
. He is considered a great medieval surgeon, whose comprehensive medical texts, combining Islamic medicine
Islamic medicine
In the history of medicine, Islamic medicine, Arabic medicine or Arabian medicine refers to medicine developed in the Islamic Golden Age, and written in Arabic, the lingua franca of Islamic civilization....
with Greco-Roman and Indian teachings, shaped European surgical procedures up until the Renaissance. He is often regarded as the Father Of Surgery. Patients and students from all parts of Europe came to him for treatment and advice. According to Will Durant
Will Durant
William James Durant was a prolific American writer, historian, and philosopher. He is best known for The Story of Civilization, 11 volumes written in collaboration with his wife Ariel Durant and published between 1935 and 1975...
, Cordoba was in this period the favorite resort of Europeans for surgical operations.
Western hemisphere
By the 13th century, many European towns were demanding that physicians have several years of study or training before they could practice. MontpellierMontpellier
-Neighbourhoods:Since 2001, Montpellier has been divided into seven official neighbourhoods, themselves divided into sub-neighbourhoods. Each of them possesses a neighbourhood council....
, Padua
Padua
Padua is a city and comune in the Veneto, northern Italy. It is the capital of the province of Padua and the economic and communications hub of the area. Padua's population is 212,500 . The city is sometimes included, with Venice and Treviso, in the Padua-Treviso-Venice Metropolitan Area, having...
and Bologna
Bologna
Bologna is the capital city of Emilia-Romagna, in the Po Valley of Northern Italy. The city lies between the Po River and the Apennine Mountains, more specifically, between the Reno River and the Savena River. Bologna is a lively and cosmopolitan Italian college city, with spectacular history,...
Universities were particularly interested in the academic side to Surgery, and by the 15th century at the latest, Surgery was a separate university subject to Physic (Medicine). Surgery had a lower status than pure medicine, beginning as a craft tradition until Rogerius Salernitanus
Rogerius (physician)
Rogerius , also called Rogerius Salernitanus, Roger Frugard, Roger Frugardi, Roggerio Frugardo, Rüdiger Frutgard and Roggerio dei Frugardi, was a Salernitan surgeon who wrote a work on medicine entitled Practica Chirurgiae around 1180...
composed his Chirurgia, which laid the foundation for the species of the occidental surgical manuals, influencing them up to modern times.
Ambroise Paré
Ambroise Paré
Ambroise Paré was a French surgeon. He was the great official royal surgeon for kings Henry II, Francis II, Charles IX and Henry III and is considered as one of the fathers of surgery and modern forensic pathology. He was a leader in surgical techniques and battlefield medicine, especially the...
pioneered the treatment of gunshot wounds.
Among the first modern surgeons were battlefield doctors in the Napoleonic Wars
Napoleonic Wars
The Napoleonic Wars were a series of wars declared against Napoleon's French Empire by opposing coalitions that ran from 1803 to 1815. As a continuation of the wars sparked by the French Revolution of 1789, they revolutionised European armies and played out on an unprecedented scale, mainly due to...
who were primarily concerned with amputation
Amputation
Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for...
. Naval surgeons were often barber surgeon
Barber surgeon
The barber surgeon was one of the most common medical practitioners of medieval Europe - generally charged with looking after soldiers during or after a battle...
s, who combined surgery with their main jobs as barbers.
In London
London
London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...
, an operating theatre
Operating theatre
An operating theater was a non-sterile, tiered theater or amphitheater in which students and other spectators could watch surgeons perform surgery...
or operating room from the days before modern anaesthesia or antiseptic
Antiseptic
Antiseptics are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction...
surgery still exists, and is open to the public. It is found in the roof space of St Thomas Church
St Thomas Church
St Thomas Church, Southwark, London, England. The first church was part of the original St. Thomas' Hospital which was located to the area around the present St Thomas Street, from the infirmary at St Mary Overie priory in 1212. The hospital was therefore also an Augustinian house. The hospital/...
, Southwark, London and is called the Old Operating Theatre
Old Operating Theatre
The Old Operating Theatre Museum and Herb Garret is a museum of surgical history and one of the oldest surviving operating theatres. It is located in the garret of St Thomas's Church, Southwark, on the original site of St Thomas' Hospital....
.
Foundations of modern surgery
To make the transition to the modern era, the art of surgery had to solve three major problems — bleedingBleeding
Bleeding, technically known as hemorrhaging or haemorrhaging is the loss of blood or blood escape from the circulatory system...
, infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
, and pain — that effectively prevented surgery from progressing into modern science.
Bleeding
Before modern surgical developments, there was a very real threat that a patient would bleed to death on the table during an operation or while being attended after an accident or wound. The first real progress in combating bleeding had come when early cultures realized they could close wounds using a procedure called cauterizingCauterization
The medical practice or technique of cauterization is the burning of part of a body to remove or close off a part of it in a process called cautery, which destroys some tissue, in an attempt to mitigate damage, remove an undesired growth, or minimize other potential medical harmful possibilities...
. The early cauterization was successful, but only usable in a limited fashion, highly destructive, and painful, with very poor long term outcomes.
The next real breakthrough to come was the invention of ligature
Ligature (medicine)
In surgery or medical procedure, a ligature consists of a piece of thread tied around an anatomical structure, usually a blood vessel or another hollow structure to shut it off. With a blood vessel the surgeon will clamp the vessel perpendicular to the axis of the artery or vein with a hemostat,...
s, widely believed to have originated with Abulcasis in the 10th century and improved by Ambroise Paré
Ambroise Paré
Ambroise Paré was a French surgeon. He was the great official royal surgeon for kings Henry II, Francis II, Charles IX and Henry III and is considered as one of the fathers of surgery and modern forensic pathology. He was a leader in surgical techniques and battlefield medicine, especially the...
in the 16th century. A ligature is a piece of material used to tie closed the end of a severed blood vessel
Blood vessel
The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...
to prevent further bleeding. Ligatures form the basis of modern bleeding control, but at the time, they were more of a hazard than a help because the surgeons using them had no concept of infection control.
Another barrier to be overcome was the problem of replacing blood lost. Limiting bleeding is important, but ultimately, a surgeon is fighting a losing battle if blood cannot be replaced, and this final barrier was only conquered when early 20th century research into blood groups allowed the first effective blood transfusion
Blood transfusion
Blood transfusion is the process of receiving blood products into one's circulation intravenously. Transfusions are used in a variety of medical conditions to replace lost components of the blood...
s.
The ultimate problem, however, was for the medical profession to recognize that blood loss was a major threat to the survival of the patient. In fact, doctors would typically bleed patients. Bloodletting
Bloodletting
Bloodletting is the withdrawal of often little quantities of blood from a patient to cure or prevent illness and disease. Bloodletting was based on an ancient system of medicine in which blood and other bodily fluid were considered to be "humors" the proper balance of which maintained health...
was used to treat almost every disease and it was thought to prevent infection. Before surgery blood was removed to prevent inflammation. Before amputation it was customary to remove a quantity of blood equal to the amount believed to circulate in the limb that was to be removed. The practice was abandoned only in the late 19th century.
Available at: https://tspace.library.utoronto.ca/handle/1807/17628 Groves developed his aseptic technique because he considered surgical infections to be transmitted by fluids as he knew typhoid was spread. The gradual development of germ theory has allowed the final step to be taken to create the highest quality of aseptic conditions in modern hospitals, allowing modern surgeons to perform nearly infection-free surgery.
Pain
Anesthesia was discovered by two American dentists, Horace WellsHorace Wells
Horace Wells was an American dentist who pioneered the use of anaesthesia in dentistry, specifically nitrous oxide .-Life:...
(1815–48) and William Morton
William Morton
William Morton may refer to:* William T.G. Morton , American dentist, the first to use ether anesthesia* William Morton , American boxer, see Boxing at the 1955 Pan American Games* William Morton , Scottish cricketer...
. Before the advent of anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
, surgery was a traumatically painful procedure and surgeons were encouraged to be as swift as possible to minimize patient suffering
Suffering
Suffering, or pain in a broad sense, is an individual's basic affective experience of unpleasantness and aversion associated with harm or threat of harm. Suffering may be qualified as physical or mental. It may come in all degrees of intensity, from mild to intolerable. Factors of duration and...
. This also meant that operations were largely restricted to amputation
Amputation
Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for...
s and external growth removals.
Beginning in the 1840s, surgery began to change dramatically in character with the discovery of effective and practical anaesthetic chemicals such as ether
Diethyl ether
Diethyl ether, also known as ethyl ether, simply ether, or ethoxyethane, is an organic compound in the ether class with the formula . It is a colorless, highly volatile flammable liquid with a characteristic odor...
and chloroform
Chloroform
Chloroform is an organic compound with formula CHCl3. It is one of the four chloromethanes. The colorless, sweet-smelling, dense liquid is a trihalomethane, and is considered somewhat hazardous...
. In Britain, John Snow
John Snow (physician)
John Snow was an English physician and a leader in the adoption of anaesthesia and medical hygiene. He is considered to be one of the fathers of epidemiology, because of his work in tracing the source of a cholera outbreak in Soho, England, in 1854.-Early life and education:Snow was born 15 March...
pioneered the use of these two anaesthetics. In addition to relieving patient suffering, anaesthesia allowed more intricate operations in the internal regions of the human body. The further discovery of muscle relaxant
Muscle relaxant
A muscle relaxant is a drug which affects skeletal muscle function and decreases the muscle tone. It may be used to alleviate symptoms such as muscle spasms, pain, and hyperreflexia. The term "muscle relaxant" is used to refer to two major therapeutic groups: neuromuscular blockers and spasmolytics...
s such as curare
Curare
Curare is a common name for various arrow poisons originating from South America. The three main types of curare are:* tubocurare...
also facilitated safer applications.
Timeline of surgical procedures
- cCircaCirca , usually abbreviated c. or ca. , means "approximately" in the English language, usually referring to a date...
. 1900 Cargile membraneCargile membraneA Cargile membrane was a sterile membrane prepared from the peritoneum of the ox, and used in abdominal surgery to interpose between raw surfaces and thus prevent the formation of adhesions...
employed by surgeons. - 1967: First successful heart transplant.
Notable individuals in the development of surgery
- Harvey CushingHarvey CushingHarvey Williams Cushing, M.D. , was an American neurosurgeon and a pioneer of brain surgery, and the first to describe Cushing's syndrome...
- William Williams KeenWilliam Williams KeenWilliam Williams Keen was the first brain surgeon in the United States. He also saw Franklin Delano Roosevelt when his paralytic illness struck, and worked closely with six American presidents.-Biography:...
- William Stewart HalstedWilliam Stewart HalstedWilliam Stewart Halsted was an American surgeon who emphasized strict aseptic technique during surgical procedures, was an early champion of newly discovered anesthetics, and introduced several new operations, including the radical mastectomy for breast cancer...