History of surgery
Surgery is the branch of medicine that deals with the physical manipulation of a bodily structure to diagnose, prevent, or cure an ailment. Ambroise Paré, a 16th-century French surgeon, stated that to perform surgery is, "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 how to make and handle tools, they have employed their talents to develop surgical techniques, each time more sophisticated than the last; however, until the Industrial Revolution, surgeons were incapable of overcoming the three principal obstacles which had plagued the medical profession from its infancy—bleeding, pain and infection. Advances in these fields have transformed surgery from a risky "art" into a scientific discipline capable of treating many diseases and conditions.
Origins
The first surgical techniques were developed to treat injuries and traumas. A combination of archaeological and anthropological studies offer insight into much earlier techniques for suturing lacerations, amputating unsalvageable 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 people used the quill of a feather attached to an animal bladder to suck out purulent material; the discovery of needles from the Stone Age seems to suggest they were used in the suturing of cuts (the Maasai used needles of acacia 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 bit the edges of the wound and then twisted the insects' neck, leaving their heads rigidly attached like staples.[1]
Trepanation
The oldest operation for which evidence exists is
There is significant evidence of healing of the bones of the skull in prehistoric skeletons, suggesting that many of those that proceeded with the surgery survived their operation.[citation needed] In some studies, the rate of survival surpassed 50%.[9]
Amputation
The oldest known surgical amputation was carried out in
Setting bones
Examples of healed fractures in prehistoric human bones, suggesting setting and splinting have been found in the archeological record.[12] 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 fir was inserted into the cavity of the medulla..."[13] Modern medicine developed a technique similar to this in the 20th century known as medullary fixation.
Anesthesia
Bloodletting
Bloodletting is one of the oldest medical practices, having been practiced among diverse ancient peoples, including the
Antiquity
Mesopotamia
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.[15]
Nevertheless, the Sumerians developed several important medical techniques: in
215. If a physician make a large incision with an operating knife and cure it, or if he open a tumor (over the eye) with an operating knife, and saves the eye, he shall receive ten shekels in money.
217. If he be the slave of some one, his owner shall give the physician two shekels.
218. If a physician make a large incision with the operating knife, and kill him, or open a tumor with the operating knife, and cut out the eye, his hands shall be cut off.
220. If he had opened a tumor with the operating knife, and put out his eye, he shall pay half his value.
Egypt
Around 3100 BCE Egyptian civilization began to flourish when
In the first monarchic age (2700 BCE) the first treatise on surgery was written by Imhotep, the vizier of Pharaoh
On one of the doorjambs of the entrance to the Temple of Memphis there is the oldest recorded engraving of a medical procedure: circumcision and engravings in 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, named after its discoverer Georg Ebers. The Ebers Papyrus, conserved at the
Edwin Smith Papyrus
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 48 case histories.[12][18] The Smith Papyrus describes a treatment for repairing a broken nose,[19] and the use of sutures to close wounds.[20] Infections were treated with honey.[21] For example, it gives instructions for dealing with a dislocated vertebra:
Thou shouldst bind it with fresh meat the first day. Thou shouldst loose his bandages and apply grease to his head as far as his neck, (and) thou shouldst bind it with ymrw. Thou shouldst treat it afterwards with honey every day, (and) his relief is sitting until he recovers.
India
Mehrgarh
Teeth discovered from a Neolithic graveyard in Mehrgarh had shown signs of drilling.[22] Analysis of the teeth shows prehistoric people might have attempted curing toothache with drills made from flintheads.[23][24]
Ayurveda
Sushruta (c. 600 BCE)[25] is considered as the "founding father of surgery". His period is usually placed between the period of 1200 BC – 600 BC.[26] One of the earliest known mention of the name is from the Bower Manuscript where Sushruta is listed as one of the ten sages residing in the Himalayas.[27] Texts also suggest that he learned surgery at Kasi from Lord Dhanvantari, the god of medicine in Hindu mythology.[28] He was an early innovator of plastic surgery who taught and practiced surgery on the banks of the Ganges in the area that corresponds to the present day city of Varanasi in Northern India. Much of what is known about Sushruta is in Sanskrit contained in a series of volumes he authored, which are collectively known as the Sushruta Samhita. It is one of the oldest known surgical texts and it describes in detail the examination, diagnosis, treatment, and prognosis of numerous ailments, as well as procedures on performing various forms of cosmetic surgery, plastic surgery and rhinoplasty.[29]
Greece and the Hellenized world
Surgeons are now considered to be specialized physicians, whereas in the early ancient Greek world a trained general physician had to use his hands (χείρ in Greek) to carry out all medical and medicinal processes including, for example, the treating of wounds sustained on the battlefield, or the treatment of broken bones (a process called in Greek: χειρουργείν).
In
Hippocrates
The
Celsus and Alexandria
Galen
Galen's On the Natural Faculties, Books I, II, and III, is an excellent paradigm of a very accomplished Greek surgeon and physician of the 2nd century Roman era, who carried out very complex surgical operations and added significantly to the corpus of animal and human physiology and the art of surgery.[18][34] He was one of the first to use ligatures in his experiments on animals.[35] Galen is also known as "The king of the catgut suture"[36]
China
In China, instruments resembling surgical tools have also been found in the archaeological sites of Bronze Age dating from the Shang dynasty, along with seeds likely used for herbalism.[37]
Hua Tuo
Middle Ages
Paul of Aegina's (c. 625 – c. 690 AD) Pragmateia or Compendiem was highly influential.[41] Abulcasis Al-Zahrawi of the Islamic Golden Age later repeated the material, largely verbatim.[18]
The Persian physician
In the 9th century the Medical School of Salerno in southwest Italy was founded, making use of Arabic texts and flourishing through the 13th century.
African-born Italian Benedictine monk (Muslim convert) Constantine the African (died 1099) of Monte Cassino translated many Arabic medical works into Latin.
Spanish Muslim physician Avenzoar (1094–1162) performed the first tracheotomy on a goat, writing Book of Simplification on Therapeutics and Diet, which became popular in Europe. Spanish Muslim physician Averroes (1126–1198) was the first to explain the function of the retina and to recognize acquired immunity with smallpox.
Universities such as Montpellier, Padua and Bologna were particularly renowned.
In the late 12th century Rogerius Salernitanus composed his Chirurgia, laying the foundation for modern Western surgical manuals. Roland of Parma and Surgery of the Four Masters were responsible for spreading Roger's work to Italy, France, and England.[18] Roger seems to have been influenced more by the 6th-century Aëtius and Alexander of Tralles, and the 7th-century Paul of Aegina, than by the Arabs.[43] Hugh of Lucca (1150−1257) founded the Bologna School and rejected the theory of "laudable pus".[18]
In the 13th century in Europe skilled town craftsmen called barber-surgeons performed amputations and set broken bones while suffering lower status than university educated doctors. By 1308 the Worshipful Company of Barbers in London was flourishing. With little or no formal training, they generally had a bad reputation that was not to improve until the development of academic surgery as a specialty of medicine rather than an accessory field in the 18th-century Age of Enlightenment.[44]
Guy de Chauliac (1298–1368) was one of the most eminent surgeons of the Middle Ages. His Chirurgia Magna or Great Surgery (1363) was a standard text for surgeons until well into the seventeenth century."[45]
Early modern Europe
There were some important advances to the art of surgery during this period.
The second figure of importance in this era was
Another important early figure was German surgeon
Modern surgery
Scientific surgery
The discipline of surgery was put on a sound, scientific footing during the Age of Enlightenment in Europe (1715–90). An important figure in this regard was the Scottish surgical scientist (in London) John Hunter (1728–1793), generally regarded as the father of modern scientific surgery.[50] He brought an empirical and experimental approach to the science and was renowned around Europe for the quality of his research and his written works. Hunter reconstructed surgical knowledge from scratch; refusing to rely on the testimonies of others he conducted his own surgical experiments to determine the truth of the matter. To aid comparative analysis, he built up a collection of over 13,000 specimens of separate organ systems, from the simplest plants and animals to humans.
Hunter greatly advanced knowledge of
Hunter's student Benjamin Bell (1749–1806) became the first scientific surgeon in Scotland, advocating the routine use of opium in post-operative recovery, and counseling surgeons to "save skin" to speed healing; his great-grandson Joseph Bell (1837–1911) became the inspiration for Arthur Conan Doyle's literary hero Sherlock Holmes.
Other important 18th- and early 19th-century surgeons included
Anesthesia
Beginning in the 1840s, European surgery began to change dramatically in character with the discovery of effective and practical anesthetic chemicals such as
Antiseptic surgery
The introduction of anesthetics encouraged more surgery, which inadvertently caused more dangerous patient post-operative infections. The concept of infection was mostly unknown in Europe until relatively modern times. British medical student, Robert Felkin however learned and later brought knowledge from the 16th century Bunyoro-Kitara kingdoms' medical disinfection practices to Europe, however, due to the prejudices against Africans and their knowledge those medical practices were largely ignored thus resulting in the death of thousands of Europeans. Filkins's travel through the Bunyoro kingdom led him to also witness physicians cleaning women's abdomens with banana alcohol as well as thoroughly washing their hands and tools with the same solution before the surgeries thus showing these African surgeons' knowledge about bacterial infections.
Lister continued to develop improved methods of
In the late 19th century
X-rays
The use of
Modern technologies
In the past century, a number of technologies have had a significant impact on surgical practice. These include
Timeline of surgery and surgical procedures
- c. 31,000 years ago first known amputation. Lived on for another 6–9 yrs.
- c. 5000 BCE. Second known practice of Trepanation in Ensisheimin France.
- c. 3300 BCE. Indus Valley civilization.
- c. 2613–2494 BCE. A jaw found in an Egyptian Fourth Dynasty tomb shows the marks of an operation to drain a pus-filled abscess under the first molar.[30]
- 1754 BCE. The Code of Hammurabi.
- 1600 BCE. The Edwin Smith Papyrus from Egypt described 48 cases of injuries, fractures, wounds, dislocations, and tumors, with treatment and prognosis including closing wounds with sutures, using honey and moldy bread as antiseptics, stopping bleeding with raw meat, and immobilization for head and spinal cord injuries, reserving magic as a last resort; it contained detailed anatomical observations but showed no understanding of organ functions, along with the earliest known reference to breast cancer.
- 1550 BCE. The Ebers Papyrus from Egypt listed over 800 drugs and prescriptions.
- 1250 BCE.
- 600 BCE. Sushruta of India.
- 5th century BCE. Medical schools at Cnidos and Cos.
- 400 BCE. About this year Hippocrates of Cos (460 BCE to 370 BCE) became "the Founder of Western Medicine", insisting on the use of scientific methods in medicine, proposing that diseases have natural causes along with the Four temperaments theory of disease, and leaving the Hippocratic Oath. He "taught that wounds should be washed in water that had been boiled or filtered, and that a doctor's hands should be kept clean, his nails clipped short."[30] He became the first to distinguish benign from malignant breast tumors, advocating withholding treatment for "hidden" cancers, claiming that surgical intervention causes "a speedy death, but to omit treatment is to prolong life."
- 50 CE. About this time Roman physician-surgeon Aulus Cornelius Celsus died, leaving De Medicina, which described the "dilated tortuous veins" surrounding a breast cancer, causing Galen to later give cancer (Latin for crab) its name. He advised against radical mastectomy involving the pectoral muscles, and warned that surgery should only be attempted in the benign stage (first of four).
- 1st/2nd century CE. Soranus of Ephesus wrote a 4-volume treatise on gynaecology.
- 200 CE. About this year Galen died after pioneering the use of catgut for suturing while clinging to Hippocrates Four Temperaments theory, viewing pus as beneficial, and viewing cancer as a result of melancholia caused by an excess of black bile, proven by its frequent occurrence in postmenopausal females, recommending surgical excision of a cancerous breast through healthy tissue to make sure that not "a single root" is left behind, while discouraging ligatures and cautery to allow drainage of black bile.
- 200 CE. About this year Leonidas of Alexandria began advocating the excision of breast cancer via a wide cut through normal tissues like Galen, but recommended alternate incision and cautery, which became the standard for the next 15 centuries. He provided the first detailed description of a mastectomy, which included the first description of nipple retraction as a clinical sign of breast cancer.
- 208 CE. Hua Tuo began using wine and cannabis as an anesthetic during surgery.
- 476 CE. The Fall of Romeended the advance of scientific medical-surgical knowledge in Europe.
- 1162. The Council of Tours banned the "barbarous practice" of surgery for breast cancers.
- 1180. Rogerius published The Practice of Surgery.
- 1214. Hugh of Lucca discovered that wine disinfects wounds.
- 1250. Theodoric Borgognoni, student of Hugh of Lucca broke with Galen and fought pus with dry wound technique (wound cleansing and sutures).
- 1275. William of Salicetbroke with Galen's love of pus and promoted a surgical knife over cauterization.
- 1308. The Worshipful Company of Barbers in London was first mentioned.
- 1350. About this time the Black Death devastated Europe.
- 1453. The Fall of Constantinople caused many scholars to flee to Europe bringing medical-surgical manuscripts with them.
- 1536. Ambroise Parediscovered that cold poultices are better than hot oil.
- 1543. Andreas Vesalius published The Fabric of the Human Body.
- 1721. Lady Mary Wortley Montagu brought the Ottoman practice of inoculationto England using live smallpox virus.
- 1735. Claudius Amyand performed the first successful appendectomy.
- 1773. Bernard Peyrilhe treated breast cancer by radical mastectomy which included both the pectoral muscle and axillary lymph nodes.[62]
- 1775. Percivall Pott discovered that soot caused scrotal cancer in chimneysweeps.
- 1776. John Hunter pioneered artificial insemination.
- 1796. Edward Jenner pioneered smallpox inoculation with cowpox virus.
- 1800. The Royal College of Surgeons of England was founded.
- 1805. Astley Cooper pioneered ligation of arteries.
- 1842. Crawford Williamson Long pioneered ether for anesthesia.
- 1844. Horace Wells pioneered nitrous oxide for anesthesia.
- 1848. James Young Simpson pioneered chloroform for anesthesia.
- 1851. Plaster of pariscast.
- 1852. J. Marion Sims successfully repaired a vesicovaginal fistula.
- 1854. John Snow disproved the miasma theoryof contagion.
- 1879. After becoming the first to diagnose the location based on neurological findings alone, Scottish surgeon brain surgery.
- 1880. German surgeon Ludwig Rehn performed the first thyroidectomy.
- 1882. William Stewart Halsted of Johns Hopkins Hospital performed the first complete radical mastectomy in the U.S., which became the standard treatment.
- 1883. Lawson Tait performed the first successful salpingectomy.
- 1884. After English physician Alexander Hughes Bennett (1848–1901) diagnosed the location based on neurological findings alone, English surgeon Rickman Godlee (1849–1925) completed the first primary (exposed) brain tumor removal.
- 1884. Austrian ophthalmologist Karl Koller first used cocaine as a local anesthetic for eye surgery.
- 1890. German surgeon Themistocles Glück pioneered arthroplasty with a knee replacement and hip replacement using ivory.
- 1891. St. Louis, Missouri surgeon pericardial sacrepair operation.
- 1893. African-American surgeon pericardial sacrepair operation.
- 1895. X-rays.
- 1895. The first successful cardiac surgery was performed by Norwegian surgeon Axel Cappelen. The patient later died of complications, though the autopsy found it was for other reasons, as the wound had been satisfactorily closed.
- 1896. The first successful cardiac surgery without any complications was performed by German surgeon Ludwig Rehn.
- 1900. About this time the Cargile membrane was introduced into surgery.
- 1900. About this time brain surgery.
- 1901. German surgeon Laparoscopic surgeryon dogs.
- 1901. Austrian physician Karl Landsteiner discovered the basic A-B-AB-O blood types.
- 1903. Dutch physician Electrocardiograph.
- 1905. Novocainewas first used as a local anesthetic.
- 1907. Austrian surgeon Hermann Schloffer became the first to successfully remove a pituitary tumor.
- 1910. Swedish physician Hans Christian Jacobaeus performed the first Laparoscopic surgery on humans.
- 1914. Blood transfusion was pioneered.
- 1916. Austrian surgeon Hermann Schloffer performed the first splenectomy operation.
- 1917. Kiwi surgeon Harold Gillies pioneered modern plastic surgeryfor wounded British World War I soldiers.
- 1925. The first open heart surgery by English surgeon Henry Souttar.
- 1929. Werner Forssmann performed the first cardiac catheterization, on himself.
- 1931. The first sex reassignment surgery.
- 1940. The first successful metallic hip replacement surgery.
- 1948. The first successful open heart surgery operations since 1925.
- 1952. The first successful open heart surgery using hypothermia.
- 1953. The first carotid endarterectomy.
- 1954. The first kidney transplant.
- 1955. The first artificial cardiac pacemaker.
- 1955. The first separation operation for conjoined twins.
- 1961. The cochlear implant was invented by William F. House.
- 1961. American surgeon Thomas J. Fogarty invented the Fogarty embolectomy catheter.
- 1962. The first hip replacement surgery via Low Frictional Torque Arthroplasty (LFA) by Sir John Charnley.
- 1963. The first liver transplant was performed by Thomas Starzl et al.
- 1964. The laser scalpelwas invented.
- 1967: The first successful heart transplant by Christiaan Barnard.
- 1967. The first successful coronary artery bypass surgery.
- 1972. The CT scan was perfected.
- 1974. The first Tommy John surgery.
- 1974. The first blunt tunneling (cannula-assisted) Liposuction.
- 1982. The Jarvik-7artificial heart was successfully installed.
- 1983. Robot-assisted surgery began with Arthrobot in Vancouver.
- 1985. The first laparoscopic cholecystectomy by German surgeon Erich Mühe.
- 1985. Positron emission tomography was invented.
- 1987. The first successful heart-lung transplant.
- 1995. Use of adult stem cells in neoregeneration of abdominal wall apponeurosis, used in surgical treatment of incisional hernia. Indian surgeon B.G. Matapurkar.
- 1998. The first Stem Cell Therapy.
- 2000. The da Vinci Surgical System was approved by the FDA.
- 2001. The first self-contained artificial heart, AbioCor.
- 2001. The first remote surgery, using the ZEUS robotic surgical system.
- 2005. The first partial face transplant by French surgeon Jean-Michel Dubernard et al.
- 2008. The first full face transplant by French surgeon Laurent Lantieri et al.
- 2008. The first HIV-to-HIV liver transplant at Groote Schuur Hospital in Cape Town, South Africa.[63]
- 2011. The first successful double leg transplant by Spanish surgeon Pedro Cavadas et al.
- 2012. The first successful mother-daughter womb transplant.
- 2012. The first human hand transplant by surgeons in Leeds, England.
- 2012. The first double arm transplant by surgeons at Johns Hopkins University.
- 2013. The first virtual surgery using Google Glassby surgeons at the University of Alabama, which they call Virtual Interactive Presence in Augmented Reality (VIPAAR).
- 2013. The first growing of a replacement nose on a patient's forehead by surgeons at Imperial College in Fuzhou, China.
- 2014. The first penis transplant by surgeons at Tygerberg Hospital in South Africa.
- 2015. The first skull and scalp transplant by surgeons at MD Anderson Cancer Center and Houston Methodist Hospital in Texas.
- 2016. The first penis transplant (in the United States) by surgeons at Massachusetts General Hospital.[64]
- 2016. The first uterus transplant in the U.S. at Cleveland Clinic.
Notable individuals in the development of surgery
- Sushruta (1200–600 BCE)
- Theodoric Borgognoni (1205–1296)
- William of Saliceto (c. 1210−1277)
- Henri de Mondeville (c.1260–1316)
- Mondino de Luzzi (1275−1326)[18][43]
- Guy de Chauliac (c.1300–1368))[18][65]
- Antonio Benivieni (1443–1502)[18][68][69]
- Paracelsus (1493–1541)[18][70][71]
- Hieronymus Fabricius (1537–1619)[18][74]
- William Clowes (1540–1604)[18][75][76][77]
- Peter Lowe (1550–1612)[18][77][78]
- Richard Wiseman (1621–1676)[18][75][77][79][80]
- William Cheselden (1688–1752)[18][77][81][82][83]
- Lorenz Heister (1683–1758)[18][77][84]
- Percivall Pott (1714–1789)[18][85][86][87][88]
- John Hunter (1728–1793)[18][89][90][91]
- Pierre-Joseph Desault (1744–1795)[18][77][92][93]
- Dominique Jean Larrey (1766–1842)[18][75][77][94][95][96][97]
- Antonio Scarpa (1752–1832)[18][77][98][99]
- Astley Cooper (1768–1843)[18][77][98][100][101]
- Benjamin Bell (1749–1806)[18][102]
- Charles Bell (1774–1842)[18][75][103][104]
- John Bell (1763–1820)[18][75][103][105]
- Erich Mühe (1938–2005)
See also
- History of anatomy
- History of medicine
- Timeline of medicine and medical technology
- History of trauma and orthopaedics
- History of intersex surgery
- Genital reconstructive surgery (disambiguation)
- American Board of Surgery
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- ^ Pott, Percivall; Earle, Sir James (1819). The chirurgical works of Percivall Pott: with his last corrections. Published by James Webster; William Brown, printer. Retrieved 7 December 2012.
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- ^ International Journal of Surgery: Devoted to the Theory and Practice of Modern Surgery and Gynecology. The International Journal of Surgery Co. 1919. p. 392.
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{{cite book}}
: CS1 maint: multiple names: authors list (link) CS1 maint: numeric names: authors list (link) - ^ Cooper, Sir Astley; Green, Joseph Henry (1832). A manual of surgery: founded upon the principles and practice lately taught by Sir Astley Cooper ... and Joseph Henry Green ... Printed for E. Cox. Retrieved 7 December 2012.
- ISBN 9781140774365. Retrieved 7 December 2012.
- ^ a b Garrison, Fielding Hudson (1921). An Introduction to the history of medicine. W.B. Saunders Company. pp. 508–. Retrieved 7 December 2012.
- ^ Bell, John; Bell, Sir Charles; Godman, John Davidson (1827). The anatomy and physiology of the human body. Collins & co. Retrieved 7 December 2012.
- ^ Bell, John (1808). The principles of surgery. Printed for Longman, Hurst, Rees and Orme. Retrieved 7 December 2012.
- ISBN 9783642226960. Retrieved 7 December 2012.
- ISBN 9789054875727. Retrieved 7 December 2012.
- ^ Dupuytren, Guillaume (1847). On the injuries and diseases of bones. Sydenham Society. Retrieved 7 December 2012.
- ISBN 9780930405489. Retrieved 7 December 2012.
- ^ Sims, James Marion (1886). Clinical notes on uterine surgery c. 3. William Wood. Retrieved 7 December 2012.
- ^ Sims, James Marion (1888). The story of my life. D. Appleton and Company. Retrieved 7 December 2012.
Further reading
- F. Gonzalez-Crussi, The Rise of Surgery, in: A Short History of Medicine, New York: The Modern Library 2008
- Thorburn, William (1910). . Manchester: Sherratt & Hughes.
- Gawande, A. (2012). "Two Hundred Years of Surgery". New England Journal of Medicine. 366 (18): 1716–1723. S2CID 39144465.
- Wikidata Q19086319