1.history development and future of surgery c

8/8/2019 1.History Development and Future of Surgery c

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Professor Panna Lal Saha

Professor of Surgery & HeadDepartment of Surgery

BGC Trust Medical CollegeChittagong

History of surgery


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This includes

The first surgery for which there is evidence-

trepanning (Neolithic era)

The middle ages, the development of scientific

approaches to the big three problems,

bleeding, infection and pain in the 16th century

onwards

The development of modern surgery and

techniques thereafter


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History of surgeryIt covers the development of

invasive and non-invasivemedical procedures from

prehistoric to modern times


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The

ancient

world


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Trepanation

The evidence available for the oldest

surgery is trepanation ( also known astrepanning, trephination, trephining,

burrhole) in which a hole is drilled or

scraped into the skull, thus exposing

the dura mater in order to treat health

problems related to intracranial

pressure and other diseases


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Neolithic times

Evidence found in prehistoric human from

remains from neolithic times, in cave

paintings, and the procedure continued in

use well into recorded history

Out of 120 skulls found at one burial site in

France dated to 6500 BC, 40 hadtrepanation hole.


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Neolithic times

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 structures healing;

suggesting that many of those thatproceeded with the surgery survived their

operation


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Ancient

India


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In modern day Pakistan, archeologist made the

discovery that the people of Indus valley

civilization, even from early Harappan period 3300BC had knowledge of medicine and dentistry.

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.

Indian physician Sushurata (600 BC) taught andpracticed surgery on the banks of Ganges in the that

corresponds to the present day city of Benares in

Northern India.


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Much of what is known about Sushrutha iscontained in a series of volumes he authored, whichare collectively known as the Susrutha Samhita. It isthe oldest known surgical text and it describes inexquisite detail the examination, diagnosis,treatment, and prognosis of numerous ailments, as

well as procedures on performing various forms of plastic surgery, such as cosmetic surgery andrhinoplasty

In the Susrutha school, the first person to expound

Ayurvedic knowledge was Dhanvantari who thentaught it to Divodasa who, in turn, taught it toSusrutha, Anupadhenava, Aurabhra, Paushakalavata,Gopurarakshita, and Bhuja


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Because ofhis seminal and numerous contributions

to the science and art of surgery, Susrutha is also

known by the title Fat

her of Surgery

The Samhita has some writings that date as late as

the 1st century, and some scholars believes that there

contributions and additions to his teachings from the

generations ofhis students and disciples

Susrutha is also the father of plastic surgery and

cosmetic surgery since his technique of forehead

flap rhinoplasty, that he used to reconstruct nosesthat were amputated as a punishment for crimes, is

practiced almost unchanged in technique to this

days.


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Ancient

Egypt


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Researchers have uncovered an Ancient

Egyptian mandible, gated to approximately

2650 BC, with two perforations just belowthe root of first molar, indicating the draining

of an abscessed tooth

Recent excavations of the construction

workers of the Egyptian pyramids also led to

the discovery of evidence of brain surgery on

a laborer, who continued living for two years

afterwards


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Ancient

Greece


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While surgeons are now considered to be

specialized physicians, the profession of

surgeon and the physician had differenthistorical roots. For example, Greek tradition

was against opening the body, and

Hippocrates oath warns physicians against practice of surgery. Specifically, cutting

persons laboring under the stone was to be left

to such persons as practice. Of course, mostknowledge of surgery comes from dissecting

bodies, a science which was repulsive to many

healers


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Ancient

Ch

ina


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Hua Tuo was a famous Chinese physician

during the Eastern Han and Three kingdom

era. He was the first person to surgery with the

aid of anaesthesia, some 1600 years before the

practice was adopted by Europeans.


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Ancient

Islamic

world


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Abulcasis (Abul al-Qasim Khalaf ibn al-Abbas Al-

Zahrawi) was a Andalusian-Arab physician and

scientist who practiced in t

he Za

hra suburb ofCordoba. He is considered a great medieval surgeon,

whose comprehensive medical texts, combining

Islamic medicine and Greco-Roman teachings,

shaped European surgical procedures up until theRenaissance.

He is often regarded as the father of surgery.

Patients and students from all parts of Europe cameto him for treatment and advice. According to Will

Durant, Cordoba was in this period the favourite

resort of Europeans for surgical operations.


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Surgery in

Western

Euro e


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By the thirteen century, many European towns were

demanding that physicians have several years of

study or training before they could practice.Montpellier, Padua and Bologna Universities were

particularly interested in the academy side of

surgery, and by the fifteenth century at the latest,

surgery was a separate University subject to physics.

Surgery had a lower status than pure medicine,

beginning as a craft tradition until RogeriusSalernitanus composed his Chirurgia, which laid the

foundation for the species of the occidental surgical

manuals, influencing them upto modern times.


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Ambroise Pare pioneered the treatment of gunshot wounds. Among the first modern

surgeons were battlefield doctors in the Napoleonic Wars who were primarily

concerned with amputation. Naval surgeonswere often barber surgeons, who combined

surgery with their main jobs as barbers.

In London, an operating theatre or operatingroom from the days before modern anaesthesia

or antiseptic surgery still exists, and is open topublic. It is found in roof space of St ThomasChurch, Southwark, London and is called the

old operating theatre.


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Foundationsof modernSurgery


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To make its transitions to the modern era the

art of surgery had to solve three major problems that effectively prevented surgery

from progressing into the modern science.

These were :

Bleeding

Pain

Infection


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Bleeding&

Surgery


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Before modern surgical developments, there was avery real threat that a patient would bleed to deathon the table during an operation or while being

attended after an accident or wound. The first real progress in combating bleeding had come whenearly cultures realized they could close woundsusing extremes of heat, a procedure calledcauterizing.

The next real breakthrough to come was theinventions of ligatures, widely believed to have

originated with Ambrose Pare during the 16th

century. A ligature is a piece of material used to tieclosed the end of a severed blood vessel to preventfurther bleeding.


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Ligatures form the basis of modern bleeding control,

but at the time , they were more of a hazard than ahelp because the surgeon using them had no concept

of infection control.

A final 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 can not be replaced, and this final barrier was

only conquered when early 20th century research

into blood groups allowed the first effective blood

transfusions.


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Infection&

Surgery


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The first progress in combating infection was made

in 1847 by the Hungarian doctor Ignas Semmelweiswho noticed that medical students fresh from the

dissecting room were causing excess maternal death

compared to midwives.

Semmelweis, despite ridicule and opposition,

introduce compulsory hand washing for everyone

entering the maternal wards and was rewarded with

a plunge in maternal and fetal deaths. However in

Royal Society in UK still dismissed his advice.


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The next true progress came when, after reading apaper by Louis Pasteur, the British surgeon Joseph

Lister began experimenting with phenol in

postoperative wound to prevent infections. Listerwas able to quickly reduce infection rates, a

reduction that was furtherhelped by his subsequent

introduction of techniques to sterilize equipment,

have rigorous hand washing and a later implementation of rubber gloves.


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Lister published his work as a series of articles in

the Lancet (1867) under the title Antiseptic principleof the practice of surgery. The work was

groundbreaking and laid the foundations for a rapid

advance in infection control that saw modern aseptic

operating theatres widely used within 50 years. 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, allowingmodern surgeons to perform nearly infection free

surgery


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Pain&

Surgery


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Anaesthesia was discovered by two American

dentist, Horace Well and William Morton. Before

the advent of anaest

hesia, surgery was atraumatically painful procedure and surgeons were

encouraged to be as swift as possible to minimize

patient suffering. This also meant that operations

were largely restricted to amputations and externalgrowth removals.

Beginning in 1840s, surgery began to change

dramatically in character with the discovery ofeffective and practical anaesthetic chemicals such as

ether and chloroform. In Britain, John Snow

pioneered the use of these two anaesthetics.


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1.history development and future of surgery c

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