History of Surgery
Tracey Carpenter
Introduction
• The ability to perform surgery depends on:
– Anatomical information
– Control of pain
– Control of infections
• We have been studying the human body for over 6000 year

• Advances were made in three areas contributing to the progression in the field of surgery.
– Anatomical and physiological knowledge
– Factors affecting the understanding of microbiology
– Development in anesthesia

• Advances in medical science were not linear
• Some were philosophical and others were practical

• Practical issues also influenced medical science.
– Type of experience in anatomical dissection
• – actual vs literary
– Level of chemical knowledge for physiology
Time Line
• 4000 BC Cuneiform Tablets from Nineveh are the earliest found documentation to give anatomical descriptions
• 2500 BC Imhotep wrote an early book on surgery
• 2000 BC
– Code of Hammurabi – medical practice
– Moses – Desert rule of cleanliness
Time Line
• 1500 BC Vedas (Hindu) – Correlated sweet smell of urine with a specific disease
• 1000 BC
– Homer – Provides us a view of military medicine through his writings

• 500 BC Aristotle – Established early scientific mindset
• Herophilos – Father of anatomy; Developed the Doctrine of the Pulse
• Nei Ching – Chinese writing on acupuncture

• Year Zero
– Celsus – Described the signs of inflammation
– Galen – First great anatomist; went unchallenged for 1500 years
• 500 AD – Alexander describe the pump like action of the heart
Historical Fact
• 1200 – 1300
– Surgeons and barbers belong to the same guild, until 1540 when the barbers agreed to confine their practice to dentistry.
– The combined groups were dissolved in 1745 and by 1899 the Royal College of Surgeons of London were chartered.
Time Line
• 1400 AD – Linacre - translated Galen (from year zero) from Greek to Latin
• 1500 AD – Pare - Greatest Surgeon of the 16th century.
– Ligated arteries after amputations
– Cauterized with hot irons and oil
Time Line – cont.
• 1500 AD (cont.)
– Versalius – Father of modern anatomy.
• Challenged Galen openly and correctly
• Performed dissections himself on human cadavers
• Created illustrations for permanent records

• 1850 AD –
– Pasteur – Father of Microbiology
• Pasteurization
– Lister – Developed antiseptic surgical technique
– Billroth – Responsible for advances in surgical procedures, ie Gastrectomy
Time Line
• Halsted – Developed meticulous wound closure
– He also developed the practice of using sterilized rubber gloves for surgical procedures
• Roentgen – Developed the X-ray machine
• 1900 – Cushing – Father of neurosurgery
Time Line
• Lord Berkeley George Moynihan (1865 – 1936)“Surgery has been made safe for the patient; we must now make the patient safe for surgery.”
• Surgery can not be considered safe all the time
• Patient outcome are not always predictable

• “Surgery as we know today is a 20th century phenomenon
Time Line
• 1950
– Cooley –
• Perfected the heart-lung machine.
• Performed 1st heart transplant
• 1st total artificial heart implant
– Debakey – Developed 1st ventricular assist pump
Time Line
• 1980 – Technological revolution began. Endoscopic surgery becomes routine.
• 1990 – Computers age changes surgery.
– Stereotactic surgery
– Virtual reality
– Robotic surgery
Modern Surgery
• Surgery combines the total care of an illness with an intervention (invasive or noninvasive) aspect of treatment.
– Surgical specialization
– Sophisticated diagnostic and imagining techniques
– Minimally invasive equipment
– Collaboration of caregivers and industry
Surgical Categories
• Emergent
• Urgent
• Elective
• Optional
Surgical Specialties
• General Surgery
• OB/GYN
• Orthopedics
• Cardiothoracic
• Peripheral Vascular
• Neurosurgery
• Genitourinary
• Oral & Maxillofacial
• Plastic & Reconstructive
Homework
• Chapter 1
– Read the chapter
– Workbook - Key Terms
• Due by next class