The History of Surgery

8/11/2019 The History of Surgery

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THE HISTORY OF SURGERY

Surgeryis the branch of medicine that deals with the physical manipulation of a bodily structure

to diagnose, prevent, or cure an ailment. Ambroise Par, a 16th century French surgeon, statedthat there were to perform surgery !"o eliminate that which is superfluous, restore that which

has been dislocated, separate that which has been united, #oin that which has been divided and

repair the defects of nature.!

Since humans first learned to ma$e and handle tools, they have employed their talents to develop

surgical techni%ues, each time more sophisticated than the last& however, up until the industrial

revolution, surgeons were incapable of overcoming the three principal obstacles which had

plagued the medical profession from its infancy 'bleeding,painandinfection. Advances in

these fields have transformed surgery from a ris$y !art! into a scientific discipline capable oftreating many diseases and conditions.

Generalities

"he surgical profession has suffered numerous brea$throughs and setbac$s throughout history. (n

general, the surgeon has been considered the technician while the physician )more historically

related to the priest and shaman* was the true healer. +uring the development ofmodern

medicine, both disciplines were taught together and one could obtain the %ualifications to

practice medicine and surgery. A good bit of history, in any case, is intimately related with the

history of general medicine. ew archaeological technologies confirm that the origin ofmedicine coincides with the appearance of modern humans.

[edit]Origins

"he first surgical techni%ues were developed to treat in#uries and traumas. A combination of

archaeological and anthropological studies offer insight into man-s early techni%ues for suturing

lacerations, amputating insalvageable limbs, and draining and cauteriing open wounds. /any

e0amples e0ist some Asian tribes used a mi0 of saltpeter and sulfur that was placed onto wounds

and lit on fire to cauterie wounds& the +a$ota (ndians used the %uill of a feather attached to an

animal bladder to suc$ out purulent material& the discovery of needles from the stone age seem to

suggest they were used in the suturing of cuts )the /aasai used needles of acaciafor the same

purpose*& and tribes in (ndia and South America developed an ingenious method of sealing minor

in#uries by applying termites or scarabs who ate around the edges of the wound and then twisted

the insects nec$ leaving their heads rigidly attached li$e staples.12

[edit]Trepanation

"he oldest operation for which evidence e0ists is trepanation32)also $nown as trepanning,

trephination, trephining or burr hole from 4ree$ and *, in which a hole

isdrilledor scraped into the s$ullfor e0posing the dura materto treat health problems related to

intracranial pressure and other diseases. (n the case of head wounds surgical intervention was

implemented for investigating and diagnosing the nature of the wound and the e0tend 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.5227vidence
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has been found in prehistoric human remains from Proto8eolithic 92andeolithictimes, in cave

paintings, and the procedure continued in use well into recorded history )being described

by ancient 4ree$writers such as:ippocratesamong others*. ;ut of 13< prehistoric s$ulls found

at one burial site in Francedated to 697, < had trepanation holes.62Fol$e :enschen, a

Swedish doctor and historian, asserts that Soviet e0cavations of the ban$s of the +nieper ?iverinthe 1@


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Ha##!ra"i$s %oeitself contains s&ecific legislation reg!lating s!rgeons an #eical

co#&ensation as 'ell as #al&ractice an (icti#$s co#&ensation)

=erossus, a 5rd century =>7 >haldeanphilosopher wrote considerably about the traditional

=abylonian medical techni%ues )principally in the archives of =orsippa* and went on to assert

that the god ;annes taught the Sumerian people all that was to be $nown about civiliation and

that nothing new had been invented. "his assertion seemed hyperbolic until analysis of Sumerian

tablets showed that the /esopotamian civiliation had developed or invented numerous medicaltechni%ues thousands of years before they were re8developed or re8invented by the 7uropeans.citation neee2

Some


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319. (f a physician ma$e a large incision with an operating $nife and cure it, or if he open a

tumor )over the eye* with an operating $nife, and saves the eye, he shall receive tenshe$elsin

money. 316. (f the patient be a freed man, he receives five she$els. 31. (f he be the slave of

some one, his owner shall give the physician two she$els. 31B. (f a physician ma$e a large

incision with the operating $nife, and $ill him, or open a tumor with the operating $nife, and cutout the eye, his hands shall be cut off. 31@. (f a physician ma$e a large incision in the slave of a

freed man, and $ill him, he shall replace the slave with another slave. 33iviliation, even from the

early :arappan periods )c.557*, had $nowledge of medicine and dentistry. "he physical

anthropologist that carried out the e0aminations, Professor Andrea >ucina from the niversity of

/issouri8>olumbia, made the discovery when he was cleaning the teeth from one of the men.Dater research in the same area found evidence of teeth having been drilled, dating bac$ @,


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Pictures of surgery tools atJom ;mbo, 7gypt

Around 517 7gyptian civiliation began to flourish whenarmer, the first Pharaoh of

7gypt, established the capital of/emphis. Kust as cuneiform tablets preserved the $nowledge of

the ancient Sumerians, hieroglyphicspreserved the 7gyptian-s.

(n the first monarchic age )37* the first treaty on surgery was written by (mhotep, the

viier of Pharaoh+#oser, priest, astronomer, physician and first notable architect. So much was

he famed for his medical s$ill that he was deified, becoming the 7gyptian god of medicine.192

;ther famous physicians from the Ancient 7mpire )from 39


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*ee also:,ncient -ree. #eicine

Surgeons are now considered to be specialiedphysicians, whereas in the early ancient 4ree$

world a trained general physician had to use his hands )/01in 4ree$* to carry out all medical

and medicinal processes including for e0ample the treating of wounds sustained in the battle

field, or the treatment of bro$en bones )a process called in 4ree$/0201*. "he:ippocratic

;ath,162written in the 9th century => 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. "he multiple volumes of the :ippocratic corpus12and

the :ippocratic ;athelevated and separated the standards of proper :ippocratic medical conduct

and its fundamental medical and surgical principles from other practitioners of fol$ medicine

often laden with superstitious constructs, andLor of specialists of sorts some of whom would

endeavor to carry out invasive body procedures with dubious conse%uences, such

as lithotomy. 4alen of Pergamum )4ree$345*

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is an e0cellent paradigm of a veryaccomplished 4ree$ surgeon and physician of the ?oman period )3nd century*, who carried out

very comple0 surgical operations and added significantly to the corpus of animal and human

physiology and the art of surgery.

[edit]%hina

:ua "uowas a famous >hinese physician during the 7astern :an and "hree Jingdoms era. :e

was the first person to perform surgery with the aid ofanesthesia, some 16h-iao* was a !miracle doctor! described

by the >hinese historian Mima an in Shi Ki who was credited with many s$ills. Another

boo$, Diei)Dieh "u* describes that =ian Mue conducted a two way e0change of hearts between

people.3


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"he surgeon-s consultation room, a painting by =althasar van den =ossche

Abulcasis )Abu al8Masim Jhalaf ibn al8Abbas Al8Nahrawi* was anAndalusian8Arabphysician

and scientist who practised in theNahrasuburb of>ordoba.:e is considered a great medieval

surgeon, whose comprehensive medical te0ts, combining (slamic medicinewith 4reco8

?omanand (ndian teachings, shaped 7uropean surgical procedures up until the ?enaissance. :eis often regarded as the Father ;f Surgery.332Patients and students from all parts of 7urope came

to him for treatment and advice. According to Eill +urant, >ordoba was in this period the

favorite resort of 7uropeans for surgical operations.

[edit]&estern he#isphere

=y the 15th century, many 7uropean towns were demanding that physicians have several years

of study or training before they could practice./ontpellier,Paduaand =olognaniversities were

particularly interested in the academic side to Surgery, and by the 19th century at the latest,

Surgery was a separate university sub#ect to Physic )/edicine*. Surgery had a lower status thanpure medicine, beginning as a craft tradition until ?ogerius Salernitanuscomposed

his %hir!rgia, which laid the foundation for the species of the occidental surgical manuals,

influencing them up to modern times.

Ambroise Parpioneered the treatment of gunshot wounds. Among the first modern surgeons

were battlefield doctors in theapoleonic Earswho were primarily concerned with amputation.

aval surgeons were oftenbarber surgeons, who combined surgery with their main #obs as

barbers.

(n Dondon, anoperating theatreor operating room from the days beforemodern anaesthesia or antiseptic surgery still e0ists, and is open to the public. (t is found in the

roof space of St "homas >hurch, Southwar$, Dondon and is called the;ld ;perating "heatre.

[edit]Fondations o' #odern srger!

"o ma$e the transition to the modern era, the art of surgery had to solve three ma#or problems

'bleeding,infection, andpain' that effectively prevented surgery from progressing into

modern science.

[edit]Bleeding

=efore 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. "he

first real progress in combating bleeding had come when early cultures realied they could close

wounds using a procedure called cauteriing."he early cauteriation was successful, but only
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usable in a limited fashion, highly destructive, and painful, with very poor long term outcomes.(erification neee2

"he ne0t real brea$through to come was the invention of ligatures, widely believed to have

originated with Abulcasis352 in the 1


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Anesthesia was discovered by two American dentists,:orace Eells)1B19OB* and Eilliam

/orton. =efore the advent of anesthesia, surgery was a traumatically painful procedure and

surgeons were encouraged to be as swift as possible to minimie patient suffering. "his also

meant that operations were largely restricted to amputationsand e0ternal growth removals.

=eginning in the 1B

Documents

The History of Surgery