Surgery is probably no longer the most feared medical procedure. Many of us will go under the surgeon’s knife at some point in our lives. We have come to think of surgery as a safe, painless and reliable method to cure us from illness, but this was not always the case. With no pain control and the risk of infection, surgery used to be painful, horrific and dangerous in roughly equal measure and many people died on the operating table. It was usually the last resort for both patient and practitioner.
Early surgery in the Neolithic and Egyptian periods
The earliest form of surgery was Trephining, which involved cutting a small round hole in the head. It was practised as early as the Neolithic period, for reasons that remain a mystery. There are many theories about the reasons behind this practice. The only thing we know for sure is that some patients survived the procedure, and sometimes even had more than one performed. Later, the Egyptians practised Trephining in an effort to cure migraines – the idea was to ‘let out’ the illness that was causing the headaches.
The discovery of new materials and their effects on Greek surgery
The Ancient Greeks benefited from new materials, such as iron, which they used to make surgical instruments. Greek surgeons could set broken bones, bleed patients, perform amputations and drain the lungs of anyone unfortunate enough to catch pneumonia. Despite this the dangers associated with surgery meant that it remained the last resort, even for notable doctors such as Hippocrates.
The influence of the Greeks and War on Roman surgery
Romans surgeons had ample opportunity to pick up surgical skills at the infamous gladiator schools and during the many wars that Rome inflicted on its neighbours and others further afield. Their surgical instruments were similar to those employed by the Greeks. Turpentine and pitch were used as antiseptics, but internal surgery was still considered too risky. The Romans also performed amputations, Trephining and eye surgery. The most famous surgeon in Rome was Galen, who was surgeon to the Roman emperor.
Al-Zahrawi and Islamic influence on Western medicine
Al-Zahrawi (Albucasis), the famous Islamic surgeon and physician, was highly influential from around 900 CE. He wrote several books detailing subjects such as orthopaedics, military surgery and ear, nose and throat surgery. His books were used extensively for many centuries by Islamic and Western medical scholars.
Surgeons, women, antiseptics and anaesthetics in the Middle Ages
Bleeding was still common in the Middle Ages, but the lack of effective antiseptics and anaesthetics continued to limit the scope of surgery. Some simple anaesthetics such as herbs and alcohol were in use, but they were often so strong that they could kill the patient while the surgeon was still sharpening his or her knife. Women could not become physicians at this time, but surgery, considered a lesser profession, was open to them. Surgeons did not go to university to study, but were apprenticed to practising surgeons to learn through observation.
Medieval barber-surgeons and war
But many surgeons were not surgeons in the modern sense. In fact, most were barbers, who combined small surgical operations with performing bloodletting and tooth extraction. In the medieval period, barber-surgeons travelled around the country. They would take up residence in a castle, treat the occupants and also care for any soldiers who were injured in the many small battles that were undertaken between rival factions.
Paré and new methods of surgery in the 1500s and 1600s
From the 1500s to the middle of the 1600s surgeons experimented with new methods. Cauterising wounds was still popular and helped prevent infection, but some surgeons rejected these established methods in favour of more innovative approaches. In the mid-1500s Ambroise Paré, a French war surgeon, popularised the use of ligatures to control bleeding after amputation. He also used bandages to cover wounds.
The decline of women surgeons
Women continued to train as surgeons throughout the 1500s and 1600s, often treating the poor. In fact they were not pushed out of surgical practice until the 1700s, when surgical training moved to the universities – from which they were banned.
The experience of surgery with newly found pain relief
In the early 1800s the most important talents a surgeon could possess were speed and accuracy. Surgeons were famed for their speed, particularly in amputation. As there was still no effective anaesthetic, they had to perform their procedures quickly and were limited to external tumours, amputation and Trephining. The development of new anaesthetic gases changed the experience of surgery for patient and surgeon. With the patient rendered unconscious, surgery could become more invasive and this also gave the surgeon the opportunity to be both slower and more methodical. The anaesthetic gas ether was first used in 1846 but was soon replaced by chloroform, which was originally used to relieve the pain of childbirth.
Improved surgery in the 19th Century and Emergence of Specialties:
By the beginning of the 1900s surgery was usually less painful and risky, but many patients continued to die from internal infection and blood loss. It was not until the development of safe blood transfusion and antibiotics such as penicillin in the early 1940s that surgery became relatively safe. Surgery became more specialised – surgeons spent many years studying a speciality, such as orthopaedics or cardiac surgery.
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As the 1900s progressed, surgery became more complex. Transplant and replacement surgery became relatively common. Elective surgery – non-life-saving procedures – is now performed regularly and some surgery has been developed principally for cosmetic purposes. Keyhole surgery and microsurgery are used increasingly to minimise exposure to infection and reduce the shock of surgery. While surgery has become safer, it remains a risky business.
Break through in Surgical practices in 20th Century:
Some of the advancements in surgical super or sub-specialties like Cosmetic/plastic surgery, Microvascualar, Eye surgery or Bariatric surgery which are now commonly available for the masses all around the world are briefly discussed as below:
Cosmetic surgery has existed for as long as that anthropologists and historians cannot find any definite beginning. It is known that both the Greeks and the Romans practiced cosmetic surgery. Depictions of cosmetic procedures fixing disfigurements caused by birth, crime punishment, or war have been discovered. These procedures were very minimal and the procedures today have improved a lot.
The wars in the 20th century resulted in so many head and facial feature destruction that the cosmetic surgery gained momentum. Plastic surgery quickly became the starting point for the cosmetic surgery development. In just 2002, about 7 million people went through cosmetic surgery. This is a huge 228% increase from the year 1997, a mere 5 years. The Internet has played a massive role in increasing dissemination of information as well as raising awareness of the people.
Finding ways to correct and improve vision is one of man’s oldest medical challenges. Ancient variations of magnifying glasses paved the way for modern eyeglasses. Customized eyeglass lenses gave scientists the background knowledge to begin making custom contact lenses. As the medical community became more adept at creating means to focus light and images into the human eye, they came to the realization that the eye itself could be changed. The development of the corrective eye surgery has changed the face of ophthalmic medicine forever. When the technology was first developed, corrective eye surgery was only available to the very wealthy. Now, as more ophthalmologists seek the training necessary to perform the procedures, affordable laser eye surgery is available to a large part of the population. As with any business, more service providers create competition, which results in lower price for consumers.
The natural evolution of human beings has helped to eliminate many of our inherent physical weaknesses. Poor eyesight, however, has remained a problem. Perhaps, through the development of refractive lenses and now through corrective eye surgery, we are taking steps to eliminate that weakness on our own.
As surgical tools and procedures continue to improve and obesity rates rise, the medical community can expect greater interest in Bariatric surgery which is now considered as modern tool for weight loss program and greater understanding from the general population. While the methodology has improved, PCPs and surgeons still face the same challenge of educating their patients about the permanent and life-altering ramifications of this procedure. Patient education will take on increasing importance as a higher percentage of the population begins to consider bariatric surgery as a tool for significant weight loss.
According to the NIH’s 1991 Consensus Conference Statement, only surgery has proven effective over the long-term for most patients with clinically severe obesity. With improved surgical methods, more patient education, and effective support systems in place, more Americans are considering surgery as a viable option.
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