2. Surgery
• Surgery (from the Greek: χειρουργική
cheirourgikē (composed of χείρ, "hand", and
ἔργον, "work"), via Latin: chirurgiae, meaning
"hand work") is an ancient medical specialty
that uses operative manual and instrumental
techniques on a patient to investigate and/or
treat a pathological condition such as disease
or injury, to help improve bodily function or
appearance or to repair unwanted ruptured
areas (for example, a perforated ear drum).
12. surgery of the ancient world
• Mesopotamia
• Berossus, a 3rd-century BCE Assyrian philosopher
wrote considerably about the traditional
Babylonian medical techniques (principally in the
archives of Borsippa) and went on to assert that
the god Oannes taught the Sumerian people all
that was to be known about civilization and that
nothing new had been invented. This assertion
seemed hyperbolic until analysis of Sumerian
tablets showed that the Mesopotamian
civilization had developed or invented numerous
medical techniques thousands of years before
they were re-developed or re-invented by the
Europeans.
13. • Some 4000 BCE the Sumerian civilization was
established in Mesopotamia between the Tigris and
Euphrates rivers, creating the oldest form of
writing, cuneiform. Of the 30,000 or so cuneiform
tablets that have been discovered, about 800 of
them deal with medical themes (one of these being
the first prescription known to have been written).
The name of the first surgeon is Urlugaledin, from
the 4000 BCE, whose personal seal depicts two
knives encircled by medicinal plants. This seal is
now housed in the Louvre.
14. • 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.
16.
17.
18. Hammurabi's Code itself
contains specific
legislation regulating
surgeons and medical
compensation as well as
malpractice and victim's
compensation.
19. • Egypt
• Around 3100 BCE Egyptian civilization began to flourish when
Narmer, the first Pharaoh of Egypt, established the capital of
Memphis. Just as cuneiform tablets preserved the knowledge
of the ancient Sumerians, hieroglyphics preserved the
Egyptian's.
• In the first monarchic age (2700 BCE) the first treaty on
surgery was written by Imhotep, the vizier of Pharaoh Djoser,
priest, astronomer, physician and first notable architect. So
much was he famed for his medical skill that he was deified,
becoming the Egyptian god of medicine.[15] Other famous
physicians from the Ancient Empire (from 2500 to 2100 BCE)
were Sachmet, the physician of Pharaoh Sahure and
Nesmenau, whose office resembled that of a medical director
surgery of the ancient world
20.
21.
22.
23. • 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 University of Leipzig, is considered one of the
oldest treaties on medicine and the most important
medical papyri. The text is dated to about 1550 BCE
and measures 20 meters in length. The text includes
recipes, a pharmacopoeia and descriptions of
numerous diseases as well as cosmetic treatments. It
mentions how to surgically treat crocodile bites and
serious burns, recommending the drainage of pus-filled
inflammation but warns against certain diseased skin.
26. • India
• Archaeologists made the discovery that the
people of Indus Valley Civilization, even from the
early Harappan periods (c. 3300 BCE), had
knowledge of medicine and dentistry. The
physical anthropologist that carried out the
examinations, 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 to 7000 BCE.
surgery of the ancient world
27. • Sushruta (c. 600 BCE other dates range from 1000
BCE to 900 CE) 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 Benares 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
Sushrutha Samhita. It is the oldest known surgical
text 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.
32. surgery of the Middle Ages
• 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. He is considered a great
medieval surgeon, though he added little to Greek surgical
practices.[16] His works on surgery were influential.
• In Europe, the demand grew for surgeons to formally study for
many years before practicing; universities such as Montpellier,
Padua and Bologna were particularly renowned. Hugh of Lucca
(1150−1257) founded the Bologna School and rejected "laudable
pus". 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."
33. • In the 15th century, Rogerius Salernitanus
composed his Chirurgia, laying the foundation for
modern Western surgical manuals. Barber-
surgeons 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. Basic surgical principles for asepsis
etc., are known as Halsteads principles. 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.[38]
Roland of Parma and Surgery of the Four Masters
were responsible for spreading Roger's work to
Italy, France, and England.
35. History of aseptic and antiseptics
• The first "antiseptic" methods can be found in many
descriptions of work of doctors in ancient times. In 500
years BC in India it was known that smooth healing of
wounds possibly only after their careful cleaning of foreign
matters. In Ancient Greece Hippocrates surely covered an
operational field with pure fabric, during operation used
only boiled water. In traditional medicine within several
centuries for antiseptics used to myrrh, an incense, a
camomile, a wormwood, an aloe, a dogrose, alcohol,
honey, sugar, sulfur, kerosene, salt, etc. However
purposeful, intelligent actions of surgeons according to the
prevention of purulent complications began much later —
only in the middle of the XIX century.
36. • Ignaz Semmelweis suggested to process before
internal research hands chloric lime and
achieved phenomenal results: at the beginning of
1847 the postnatal lethality owing to
development of sepsis made 18,3%, in the
second half of year decreased to 3%, and the
next year — to 1,3%. However Zemmelveys
wasn't supported, and persecution and indignity
which he suffered, led to that the obstetrician
was placed in a psychiatric clinic, and then, on a
twist of fate, in 1865 died of sepsis owing to the
felon which developed after wound of a finger
during performance of one of operations.
38. • Nikolay Ivanovich Pirogov didn't create the
integral doctrine about antiseptics, but he was
close to that. N. I. Pirogov applied in some cases
to treatment of wounds antiseptics — silver
nitrate, chloric lime, zinc sulfate, wine and
camphor alcohols.
39. • Nikolay Ivanovich Pirogov tried to solve
organizationally a problem of prevention of
surgical infections, demanding the structure of
"special office" for infectious patients. He
formulated one of the main postulates of
modern antiseptics: principle of division of
streams into "pure" and "purulent" patients
40. Nikolay Pirogov in 1870
Born in 25 November
1810
Moscow, Russian Empire
Died in5 December 1881
(aged 71)
Vishnya, Russian Empire
(now Vinnytsia, Ukraine)
41. History of general anesthesia
• Attempts at producing a state of general anaesthesia can be traced
throughout recorded history in the writings of the ancient Sumerians,
Babylonians, Assyrians, Egyptians, Greeks, Romans, Indians, and Chinese.
During the Middle Ages, scientists and other scholars made significant
advances in the Eastern world, while their European counterparts also
made important advances.
• The European Renaissance saw significant advances in anatomy and
surgical technique. However, despite all this progress, surgery remained a
treatment of last resort. Largely because of the associated pain, many
patients with surgical disorders chose certain death rather than undergo
surgery. Although there has been a great deal of debate as to who
deserves the most credit for the discovery of general anaesthesia, it is
generally agreed that certain scientific discoveries in the late 18th and
early 19th centuries were critical to the eventual introduction and
development of modern anaesthetic techniques.
42. • Two enormous leaps occurred in the late 19th
century, which together allowed the transition to
modern surgery. An appreciation of the germ
theory of disease led rapidly to the development
and application of antiseptic techniques in
surgery. Antisepsis, which soon gave way to
asepsis, reduced the overall morbidity and
mortality of surgery to a far more acceptable rate
than in previous eras. Concurrent with these
developments were the significant advances in
pharmacology and physiology which led to the
development of general anaesthesia and the
control of pain.
43. • In the 20th century, the safety and efficacy of
general anaesthesia was improved by the routine
use of tracheal intubation and other advanced
airway management techniques. Significant
advances in monitoring and new anaesthetic
agents with improved pharmacokinetic and
pharmacodynamic characteristics also
contributed to this trend. Finally, standardized
training programs for anaesthesiologists and
nurse anaesthetists emerged during this period.
45. Blood type
• The two most significant blood group systems were discovered by
Karl Landsteiner during early experiments with blood transfusion:
the ABO group in 1901 and in co-operation with Alexander S.
Wiener the Rhesus group in 1937. Development of the Coombs
test in 1945, the advent of transfusion medicine, and the
understanding of ABO hemolytic disease of the newborn led to
discovery of more blood groups, and now 33 human blood group
systems are recognized by the International Society of Blood
Transfusion (ISBT), and across the 33 blood groups, over 600
different blood group antigens have been found; many of these
are very rare or are mainly found in certain ethnic groups. Blood
types have been used in forensic science and were formerly used
to demonstrate impossibility of paternity (e.g., a type AB man
cannot be the father of a type O infant), but both of these uses are
being replaced by genetic fingerprinting, which provides greater
certainty.
46. Karl Landsteiner
Born June 14, 1868
Baden bei Wien, near
Vienna,
Austria-Hungary
Died June 26, 1943
(aged 75)
New York City
48. Modern surgery
• The discipline of surgery was put on a sound, scientific
footing during the Age of Enlightenment in Europe. An
important figure in this regard was the English surgical
scientist, John Hunter, generally regarded as the father
of modern scientific surgery. 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.
49. Painted by John Jackson,
1813, after Sir Joshua
Reynolds, 1786
Born 13 February 1728
Long Calderwood near East
Kilbride,
Scotland
Died 16 October 1793 (aged
65)
London, England
50. • He greatly advanced knowledge of venereal
disease and introduced many new techniques of
surgery, including new methods for repairing
damage to the Achilles tendon and a more
effective method for applying ligature of the
arteries in case of an aneurysm. 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. He consequently adopted the
position that all surgical procedures should be
used only as a last resort.
52. • Other important 18th and early 19th century
surgeons included Percival Pott (1713 -1788)
who described tuberculosis on the spine and first
demonstrated that a cancer may be caused by an
environmental carcinogen - (he noticed a
connection between chimney sweep's exposure
to soot and their high incidence of scrotal cancer.
Astley Paston Cooper (1768-1841) first
performed a successful ligation of the abdominal
aorta, and James Syme (1799-1870) pioneered
the Symes Amputation for the ankle joint and
successfully carried out the first hip
disarticulation.
53. Exhibit room of the
Hunterian
Museum in 1853,
housing the
collection of John
Hunter,
a father of modern
surgery.
54. • Modern pain control through anesthesia was discovered in
the mid-19th century. Before the advent of anesthesia,
surgery was a traumatically 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 external growth
removals. Beginning in the 1840s, surgery began to change
dramatically in character with the discovery of effective
and practical anaesthetic chemicals such as ether, first used
by the American surgeon Crawford Long, and chloroform,
discovered by James Young Simpson and later pioneered by
John Snow, physician to Queen Victoria.[26] In addition to
relieving patient suffering, anaesthesia allowed more
intricate operations in the internal regions of the human
body. In addition, the discovery of muscle relaxants such as
curare allowed for safer applications.
55. Description of surgical procedure
• Location
• At a hospital, modern surgery is often done in an operating theater
using surgical instruments, an operating table for the patient, and
other equipment. The environment and procedures used in surgery
are governed by the principles of aseptic technique: the strict
separation of "sterile" (free of microorganisms) things from
"unsterile" or "contaminated" things. All surgical instruments must be
sterilized, and an instrument must be replaced or re-sterilized if it
becomes contaminated (i.e. handled in an unsterile manner, or
allowed to touch an unsterile surface). Operating room staff must
wear sterile attire (scrubs, a scrub cap, a sterile surgical gown, sterile
latex or non-latex polymer gloves and a surgical mask), and they must
scrub hands and arms with an approved disinfectant agent before
each procedure. There is moderate-quality evidence that usage of
two layers of gloves compared to single gloving during surgery
reduces perforations and blood stains on the skin, indicating a
decrease in percutaneous exposure incidents.
