History of surgery

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.

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.

[3][4] Evidence has been found in prehistoric human remains from Proto-Neolithic[5] and Neolithic times, in cave paintings, and the procedure continued in use well into recorded history (being described by ancient Greek writers such as Hippocrates).

[6] Folke Henschen, a Swedish doctor and historian, asserts that Soviet excavations of the banks of the Dnieper River in the 1970s show the existence of trepanation in Mesolithic times dated to approximately 12000 BCE.

[15] 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.

In the first monarchic age (2700 BCE) the first treatise on surgery was written by Imhotep, the vizier of Pharaoh Djoser, priest, astronomer, physician and first notable architect.

It mentions how to surgically treat crocodile bites and serious burns, recommending the drainage of pus-filled inflammation but warns against certain diseased skin.

Thou shouldst treat it afterwards with honey every day, (and) his relief is sitting until he recovers.Teeth discovered from a Neolithic graveyard in Mehrgarh had shown signs of drilling.

"[30] The Hippocratic Oath,[31] 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.

Works from the Hippocratic corpus include; On the Articulations or On Joints, On Fractures, On the Instruments of Reduction, The Physician's Establishment or Surgery, On Injuries of the Head, On Ulcers, On Fistulae, and On Hemorrhoids.

[35] Galen is also known as "The king of the catgut suture"[36] 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.

[38] Bian Que (Pien Ch'iao) was a "miracle doctor" described by the Chinese historian Sima Qian in his Shiji who was credited with many skills.

[39] 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.

[18] Hunayn ibn Ishaq (809–873) was an Arab Nestorian Christian physician who translated many Greek medical and scientific texts, including those of Galen, writing the first systematic treatment of ophthalmology.

Egypt-born Jewish physician Isaac Israeli ben Solomon (832–892) also left many medical works written in Arabic that were translated and adopted by European universities in the early 13th century.

Abulcasis (936–1013) (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi) was an Andalusian-Arab physician and scientist who practised in the Zahra suburb of Cordoba.

[41][42] 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.

[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.

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.

His Swiss wife and assistant Marie Colinet (1560–1640) improved the techniques for Caesarean Section, introducing the use of heat for dilating and stimulating the uterus during labor.

[51] He was also one of the first to understand the importance of pathology, the danger of the spread of infection and how the problem of inflammation of the wound, bone lesions and even tuberculosis often undid any benefit that was gained from the intervention.

Beginning in the 1840s, European surgery began to change dramatically in character with the discovery of effective and practical anesthetic chemicals such as ether, first used by the American surgeon Crawford Long (1815–1878), and chloroform, discovered by James Young Simpson (1811–1870) and later pioneered in England by John Snow (1813–1858), physician to Queen Victoria, who in 1853 administered chloroform to her during childbirth, and in 1854 disproved the miasma theory of contagion by tracing a cholera outbreak in London to an infected water pump.

American surgeon J. Marion Sims (1813–83) received credit for helping found gynecology, but later was criticized for failing to use anesthesia on enslaved Black test subjects.

The first progress in combating infection in Europe was made in 1847 by the Hungarian doctor Ignaz Semmelweis who noticed that medical students fresh from the dissecting room were causing excess maternal death compared to midwives.

[54] Lister became aware of the work of French chemist and microbiology pioneer, Louis Pasteur, who showed that rotting and fermentation could occur under anaerobic conditions if micro-organisms were present.

[56][57][58] His work was groundbreaking and laid the foundations for a rapid advance in infection control that saw modern antiseptic operating theatres widely used within 50 years.

Lister continued to develop improved methods of antisepsis and asepsis when he realised that infection could be better avoided by preventing bacteria from getting into wounds in the first place.