A Short History of Surgery

Thousands of surgeries are performed every day on virtually every part of the human body. Although surgery has existed since prehistoric times, most of the things that people consider a normal part of surgery, such as anaesthesia, sterility and a careful procedure that is not unduly rushed, are all products of inventions and discoveries of the late nineteenth and twentieth centuries. Up until that time, surgery was dogged by religious bans and mysticism and often conducted by untrained tradesmen rather than physicians. The word surgery is an Anglicization of the Latin chirurgia which comes from the Greek words chier (meaning hand) and ergon (meaning work).

Prehistoric surgery

Neolithic and Mesolithic peoples are known to have performed trephination (also called trepanation). This procedure involves the boring of a small hole through the skull to expose the underlying brain matter. This is no small feat when you are armed with only stone tools and absolutely no anaesthetics.  Based on skeletal findings and cave paintings, it would seem that they also performed amputations.

Ancient civilizations

Hundreds of pre-Incan Peruvian mummies (ca. 2000 BC) also show evidence of trephination. The Aztecs (1325-1521) treated broken bones by placing straight pieces of wood in the marrow of the bone to align and splint it. This is not that different from modern treatments for severely broken bones.

Many civilizations, including the Babylonians, Egyptians, Chinese, Indians and Sumerians, were known to perform surgery. The Chinese were the first to use any form of anaesthetic, which they made by mixing opium with water (ca. 300 BC). They are also known to have conducted heart transplants (ca. AD 300 ) and at least one caesarean section that both mother and child survived (ca. AD 225 ). They have been performing castrations since 1000 BC.

Many modern medical terms come from the ancient Greek and Roman civilizations. It was during this time that science began to have a bigger influence on medicine, with mysticism and religion moving into the background. Surgery was still mainly performed by tradesmen at this point. The Macedonians were the first to begin to elevate surgery above the trades. The Muslims would carry this tradition forward and develop the first hospitals. Abul Qasim (AD 936-1013) wrote the first text devoted to surgery during that time and is often considered the father of surgery.

Middle Ages

The Christian Church firmly felt that illness and disease were caused by God and moved surgery back to the domain of barbers, the occasional academic surgeon and charlatans. Priests and monks were the primary healers in these cultures, and the Church banned them from performing surgery.

The Renaissance saw a rebirth of interest in anatomy, which led to the development of surgical pathology as a field of study. The development of gun powder also caused a dramatic increase in the need for military surgeons. But it wasn’t until Ambroise Pare (1510-1590), that surgeons began to take on a respected role; Pare treated four successive kings during his career.

From 1600-1900 there were many developments in fields such as chemistry, anatomy and pathology. Inventions such as the microscope led to histology, cytology, microbiology, bacteriology and other advances in medical knowledge. Add to that the invention of the stethoscope, the thermometer, and the sphygmomanometer (blood pressure monitor) and medicine began to move toward a more recognizable state. However, there was still no anaesthesia, and many were reluctant to undergo surgery unless absolutely necessary. Due to the lack of anaesthetic, most surgeries were performed as quickly as possible. This led to many accidental injuries, including the case where a surgeon cut off the finger of an assistant during surgery. The assistant and patient both died, as did a spectator that went into shock, resulting in 300 percent mortality for a surgical procedure. Soporifics such as alcohol, opium, hashish and mandrake were used, but their effects tended to be short-lived and made speed a necessity.

The 19th and 20th centuries

By 1853, chloroform and ether were in use as anaesthetics and things really began to change.This meant surgeons no longer had to rush through surgery, and far fewer patients died from accidents occurring during the surgery. Although more people were willing to undergo surgery, infection remained a serious problem that killed many patients. Joseph Lister was the first one to use a spray of carbolic acid as an antiseptic during surgery. While this increased patient survival rates, many patients and staff suffered from reactions to the acid. Nurses began wearing rubber gloves to protect their hands from the acid. At around the same time, it was shown that the patient`s infections shared the same germs as could be found on their surgeon`s hands. This led to the sterilization of the operating room and equipment, with aseptic procedures being put in place to protect the patient.

While this caused a strong decrease in the number of infections patients experienced, it did not help the complications that came from blood loss during surgery. Random blood transfusions were attempted, but this increased the number of deaths until blood typing was discovered. During WWI, sodium citrate came into use to prevent blood from clotting, and the ability to store donated blood for long periods of time became possible. By WWII, when penicillin was discovered and treatment of internal infections without surgery became possible, the surgical room had begun to resemble what most people associate with an operating room.

In 1950, William Bigelow performed the first open heart surgery. Two years later, the first kidney transplant occurred, and fifteen years after that Christian Barnaard completed the first heart transplant. Changes and successes came hard and fast for the balance of the twentieth century. Then, in the 1990s, keyhole techniques, using endoscopes and ultrasound scanning, allowed surgeons to decrease the invasiveness of many surgeries.

The field has come a long way since prehistoric days. While modern surgical tools are shining examples of technology, there remains the need to cut the body open to cure it, so perhaps there is still a ways yet to go.