3rd year MBBS lecture

1. HISTORY, EVOLUTION AND
SCOPE OF SURGERY

2. Dr. Masrur Akbar Khan
FCPS (Surgery)
Medical Officer
Department of Surgery
Dhaka Medical College Hospital

3. Why do we need to learn
history?

4. DESIRE
To know the origin of the subject

5. WISH
To enquire what has gone before

6. ENTHUSIASM
To discover how current knowledge has been derived
intrinsic to learning and understanding

8. “Historical vignettes simply leave the hard
work of learning and aid the memory,
and it is not unknown for a smattering
of historical knowledge to help in
passing examinations!”
The New Aird’s Companion in Surgical Studies

9. In study of some apparently new
problems we often make progress by
reading work of great men of past
CHARLES H. MAYO, 1865-1939

10. The patient is the centre of the medical universe
around which all our works revolve and
towards which all our efforts trend
J.B. MURPHY, 1857-1916

11. Pre modern age
Science? Let’s see
Up-to middle age
Controlled Treatment is a sin
Before the birth of Christ
Philosophical Imagination

12. Ancient history

13. The craft of surgery is as old as mankind

14. • Drainage of abscess
• Dressing of wound
• Staunching of
hemorrhage
• Setting of fracture
• Trephination of skull
• Amputation of limb
• Circumcision

15. Ancient East

16. The Egyptian IMHOTEP
(2667 - 2648 BCE)
The first physician in history known by name.

17. FIRST DEPICTION OF SURGERY
6th dynasty tomb of Ankh-Ma-Hor

18. THE KAHUN GYNAECOLOGICAL PAPYRUS
Treats women's complaints, including problems with
conception

19. EDWIN SMITH PAPYRUS
Luxor 1862
45 meters long, descriptions of injuries,
wounds, fractures, dislocation and
tumours.

20. CODE OF HAMMURABI
Babylonian 2.5 metres tall pillar engraved with
laws of surgery

21. SHANG DYNASTY (1600-1046 BC)
Written descriptions about disease

23. The first medical
treatise is the
Yellow Emperor's Inner
Canon.

24. • Use of
acupuncture to
manipulate
the Yin and Yang .

25. ATHARVAVEDA
A sacred text of Hinduism dating from the Early Iron Age, is
the first Indian text dealing with medicine

26. • The Atharvaveda also contain prescriptions of
herbs for various ailments.
• The use of herbs to treat ailments would later
form a large part of Ayurveda

27. SUSHRUTA 5th century
Advocated dissection of dead bodies, practice of surgery on
watermelon, amputation, tonsillectomy,
Lithotomy, anal fistulae, rhinoplasty

28. Surgical instrument of Sushruta
Rhinonplasty

31. Ancient Greek and Roman

32. Separation of medicine from magic
History- Examination- Investigation-Rx

33. The Father of Medicine
460-370 BC Greece

37. Roman
medicine

38. Roman surgical instruments

39. Roman surgical instruments

40. Roman surgical instruments

41. Roman surgical instruments

42. Celcus ( Rome)
Described cardinal signs of inflammation

43. Figure from an
ancient text
book of surgery

44. Vaginal speculum excavated from Pompeii

45. Bangladesh

46. The Middle Ages

47. No study of Anatomy and Physiology

48. THEODORIC OF BOLOGNA
Textbook of Surgery(1250 AD)

49. LANFRANC OF MILAN
Wrote “Chirurga Magna” 1450 AD

50. Renaissance
• New wave of scholasticism
• Revival of ancient classical culture
• Burgeoning of scientific enquiry
• Freedom from restriction imposed by religious
views
• Development of evolutionary science

52. Works of Leonardo da Vinci

53. Works of Leonardo da Vinci

54. Works of Leonardo da Vinci

55. Works of Leonardo da Vinci

56. Works of Leonardo da Vinci

57. Works of Leonardo da Vinci

58.  Use of Gun powder in
War field, War field
surgery
 Surgery was
entertained for the sake
of soldiers.

59. Ambroise Pare- military surgeons . He said, “I treated him; God cured him”.
Ambrose Pare( France)--- Father of modern
surgery

61. • Thomas Gale– First ever complete surgical
Text book– 1563
• Barber-Surgeons Company was founded
in 1540 by Henry VIII
• The bodies of four executed criminals
were dissected each year in Barber-
Surgeon’s Hall

62. Henry VIII
Presents the Barber-Surgeons' Company Charterto the
first Master,

63. • Barbers originally aided monks, who
were at the time the traditional
practitioners of medicine and surgery,
because Papal decrees prohibited
members of religious orders themselves
from spilling blood.

64. • In addition to haircutting, hairdressing,
and shaving, barbers performed surgery:
neck manipulation; cleansing of ears and
scalp; draining/lancing of boils, fistulae,
and cysts with wicks; bloodletting and
leeching; fire cupping; enemas; and the
extraction of teeth.

65. • John Hunter– apply experimental methods in
Surgery

66. • Astley Cooper– hernia, dislocation, fracture

67. • Joseph Lister--- Antisepsis—1867

68. • Ignaz Semelweiss– Vienna– 1846– Hand
washing in Obstetrical Practice– reduce 10%
to 1.2%. Disease transmition- criticised by
colleague– mentally ill and died of at age 47.
• Rubber Gloves– William Halstead of Baltimore
1889.

69. • John Hunter– apply experimental methods in
Surgery
• Astley Cooper– hernia, dislocation, fracture
• Joseph Lister--- Antisepsis—1867
• General Anaesthesia—1846– Nitrous oxide–
1799 .
• Inhalation anaesthesia– Ether– 1842– By an
American Medical Student.– William Clark– tooth
extraction.
• 1932- First Intravenous anaesthesia

70. 1842-1889

71. • Ignaz Semelweiss– Vienna– 1846– Hand
washing in Obstetrical Practice– 10% to 1.2%.
• Disease transmits- criticised by colleague–
mentally ill and died of at age 47.
• Rubber Gloves– William Halstead of
Baltimore 1889.
• Lister --- Operation theatre– died in 1912.

72. Best discovery of last 200 years

73. • Mobile phone---------- %
• Computer--------------- %
• DNA ---------------------- %
• Internet----------------- %
• Antibiotics-------------- %
• Antiseptics------------- %
• Sanitation-------------- %
• Aero-plane--------------- %
• Microscope------------ %
• Cloning ----------------- %

74. Hospital

75. Hospital
• Comes from the latin word” Hospices”
• Hospices means where care is providing
• Modern concept of Hospital has been
extended--- where diagnosis, treatment,
management, planning, training, teaching and
also research is ongoing.

81. SIR WILLIAM OSLER, 1849-1919
“To study the
phenomenon of disease
without books is to sail an
uncharted sea, while to
study books without
patients is not to go to sea
at all”

82. Linkage from first class
• Hospital comes from the word--------
• Best scientific discovery of last 200 years------
• Surgery developed best during-----
• Barber surgeons company was established----
• First PG surgery institute------
• Contribution of subcontinent----

83. Surgery

84. Surgery
• Chirurgien
• French word, but comes from Latin
• Greek word “ Chier” meaning hand and
“ ergon” meaning work.
• The Edwin Smith Surgical Papyrus– 3000-
2500 BC.

85. • Theodor Billroth—”The father of Abdominal
Surgery”
• William Halsted– “Father of Breast Surgery”
• First Hepatic Resection– Langenbuch
• Mauret--- 1987---- Lap. Cholecystectomy.
• Parodi----1991--- Robotic surgery.

86. Courvoisier.
He did extensive work on biliary surgery.
He originated his famous Courvoisier’s law.

87. Andreas Vesalius from Padua, Italy (1514 - 1564)
gave the importance of human anatomy in surgery
He gave concept of human dissection in learning anatomy and surgery.
He wrote anatomy book ‘De Humani Coporis Fabrica Libri’.

89. John Hunter (Glasgow, England; 1728–1793) an excellent surgeon of that time wrote
many books on surgery, war wounds.
He had outstanding collections of 13,000 specimens which were present in the
Museum of Royal College of surgeons which was destroyed during World War II by
Nazi bombing.

90. Wilhelm Conrad Roentgen (1845–1923) invented X-rays
(1895) also called as Roentgen rays as basic diagnostic tool.
He got Nobel Prize for the same

91. Bernard von Langenbeck (German 1810–1887) (Fig. 1-14) did lots
of contributions to surgery in technique, precision and instruments.
He did first successful cholecystectomy in 1882.

92. Theodor Billroth (Vienna 1829–1894) (Fig. 1-15) did extensive
work in abdominal surgery. Billroth anastomosis after gastrectomy
is good old popular method.

93. William S Halsted (America 1852–1922) (Fig. 1-13) did extensive
work on surgeries of breast and hernia.

94. Allen oldfather Whipple (1881–1963) (Fig. 1-16) did successful
pancreaticoduodenectomy for pancreatic cancer in 1935.

95. Theodor Kocher (Berne; Switzerland, August 25, 1841–1917) He was
the first surgeon to get Nobel Prize (1909)
He has written Kocher’s textbook of operative surgery in 1892.
Many surgical avenues are after his name—
Kocher’s vein;Kocher’s forceps (has got tooth in the tip); Kocherisation (duodenal
mobilisation); Kocher’s
incision (Right subcostal for open cholecystectomy); Kocher’s
thyroidectomy incision; Kocher’s test

96. • Ambrose Pare( France)--- Father of modern
surgery
• Theodor Billroth—”The father of Abdominal
Surgery”
• William Halsted– “Father of Breast Surgery”
• First Hepatic Resection– Langenbuch
• Mauret--- 1987---- Lap. Cholecystectomy.
• Parodi----1991--- Robotic surgery.

103. Fellowship

104. Surgery in Late 20th
• Transplantation
• Lithotripsy
• Balloon dilatation
• USG Guided Abscess drainage
• Stent insertion

105. Commonest Schedule surgery
• Cholecystectomy ( chole- Gb, Cyst-fluid filled cavity, Ectomy– removal)
• Mastectomy
• Hernia operations
• Hysterectomy
• Tonsillectomy
• Circumcision
• Colectomy
• ----------------
• ----------------

106. Commonest emergency surgery
• Repair of perforation of hollow viscus
• Appendicectomy
• Repair of injury
• Intestinal obstruction
• Caesarean section
• Abscess drainage
• ----------------------
• ----------------------

107. Fibre
optics
Laparoscope
Thoracoscope
Arthoscope
ERCP
EUS
Angiogram
Arteriogram
Lymphangiogram
Cystoscope
Colonoscope
Endoscope

108. Operation theatre

111. Why we need Treatment?
00 25 years
1000 AD 30 years
1900 AD 40 years
2000 AD 60 years
2013AD 70 years
(BBC)

112. Nobel Laureate Surgeons

113. Theodor Kocher Switzerland Thyroid Disease(1909)
Alivar Gullstrand Sweden Ocular (1911)
Alexis Carrel France and USA Vascular Surgery(1912)
Robert Barlmy Austria Vestibular Disease(1914)
Fredrick Banting Canada Insulin(1922)
Walter Hess Switzerland Midbrain (1949)
Werner Forssmann Germany Cardiac catheterization
Charles Huggins USA Oncology
Joseph Murray USA Organ Transplantation
K-71, DMC Bangladesh -------------------------------

114. Surgical procedures-- Vanishing?
• Vagotomy –Gastrojejunostomy
• Gastrorraphy
• Nephropaxy
• Cholecystostomy
• Open prostatectomy
• Lumbar sympathectomy
• ?????????????

115. Nomenclature
• FCPS--- Fellow of the College of Physicians and
Surgeons
• FRCS– Fellow of the Royal college of Surgeons
• MRCS– Members of the Royal College of
Surgeons
• Mchir—Masters of Chirurgens.
• MS– Master of Surgery

116. Surgery Books

124. Surgery in the days to
come will be advanced
by men ( and women)
trained in the methods
and imbued with the
spirit of experimental
research, though it will
no doubt continue to
be practiced to their
profit by those who
are merely craftsmen”
LORD MOYNIHAN

125. What we have learned?
• Surgery started before its conception
• Surgery was a barbarian activity
• Scientific surgery depends on scientific
methods
• Evolution in surgery is a continuous process
( Roads to success is always under construction)
• Scope of surgery is tremendous
• Hospital, surgery, Theater, Books

126. What’s my (your) role in surgery?
• Learn surgery as much as possible
• Practicing surgery best of my level
• Continuous contribution in the field
• Think always how I can contribute as our
ancestor surgeon did for us.

127. So
“Let us start to learn Surgery because it’s the
mankind of future people”