History of surgery at glance لمحة عن تاريخ الجراحة

History of Surgery at Glance
Prof . Amer Eltwati Ben Irhuma FRCS
Consultant Surgeon

QuoteQuote
"Nothing will ever be attempted if
all possible objections must first
be overcome."
Samuel Johnson
1709-1784 Author

DefinitionsDefinitions
 Chirurgery =
• Latin, chirurgia, from the Greek,
cheir = hand and ergon = work…
• anglicized to Surgery.

DefinitionsDefinitions
 Medicine:
• The science and/or art of dealing with the
maintenance of health and the prevention,
easing and cure of disease (from Latin mederi,
to heal; medius, middle)
 Physician:
• “A Student of Nature”; A person skilled in the
art of healing (from Latin physi, nature)
 Doctor:
• A learned authoritative teacher (from Latin
docere, to teach); One skilled or specializing in
healing
 Heal:
• To make healthy or whole (from Old English
hal, whole)

IntroductionIntroduction
 The evolution of medicine as a process ofThe evolution of medicine as a process of
trial and error has marked man’s tirelesstrial and error has marked man’s tireless
crusade against the ravages of pestilencecrusade against the ravages of pestilence
and disease.and disease.
 The “history of medicine” deserves theThe “history of medicine” deserves the
attention of medical students andattention of medical students and
practicing physicians alike, butpracticing physicians alike, but
unfortunately has played a minor role inunfortunately has played a minor role in
the medical curriculum to date.the medical curriculum to date.

 Looking back to the history of medicine inLooking back to the history of medicine in
general and surgery in particular is ofgeneral and surgery in particular is of
great important for any surgeongreat important for any surgeon
 Because the luxury and achievements weBecause the luxury and achievements we
enjoys today is an accumulation work ofenjoys today is an accumulation work of
humanity over a thousands of years andhumanity over a thousands of years and
great scarifiesgreat scarifies
 Having said that, it yet along journey toHaving said that, it yet along journey to
go to discover the endless mysteries ofgo to discover the endless mysteries of
health and sickness of human beinghealth and sickness of human being

 The first surgical techniques wereThe first surgical techniques were
developed to treat injuries and traumas.developed to treat injuries and traumas.
 A combination of archaeological andA combination of archaeological and
anthropological studies offer insight intoanthropological studies offer insight into
man's early techniques for suturingman's early techniques for suturing
lacerations, amputating insalvageablelacerations, amputating insalvageable
limbs, and draining and cauterizatinglimbs, and draining and cauterizating
open woundsopen wounds

 Since man first learned to make and handle
tools, they have employed their talents to
develop surgical techniques, each time
more sophisticated than the last; however,
up until the industrial revolution, surgeons
were incapable of overcoming the three
principal obstacles which had plagued the
medical profession from its infancy, namely
:
• bleeding,
• pain
• infection.

 Ambroise Paré, a 16th century French
surgeon stated that there were five
reasons to perform surgery:
• To eliminate that which is superfluous
• To restore that which has been
dislocated
• To separate that which has been united
• To join that which has been divided
• To repair the defects of nature.

Classifications of Surgical InterventionClassifications of Surgical Intervention
 EmergentEmergent – Immediate threat to life or limb– Immediate threat to life or limb
(requires immediate treatment)(requires immediate treatment)
 UrgentUrgent – Urgent threat to life or limb (requires– Urgent threat to life or limb (requires
treatment within a short period of time)treatment within a short period of time)
 ElectiveElective – Does not have to be performed within a– Does not have to be performed within a
short period of time (may be scheduled in theshort period of time (may be scheduled in the
future)future)
 OptionalOptional – Not pathological in the traditional– Not pathological in the traditional
sense (not necessary)sense (not necessary)

Phases of Surgical Care ManagementPhases of Surgical Care Management
 Pre/operative:Pre/operative: prior to initiation ofprior to initiation of
the surgical procedurethe surgical procedure
 Intra/operative:Intra/operative: while procedure iswhile procedure is
being performedbeing performed
 Post/operative:Post/operative: when surgicalwhen surgical
procedure is terminatedprocedure is terminated
Introduction

Ancient MedicineAncient Medicine
 Reflected the apparent belief that disease arose:Reflected the apparent belief that disease arose:
- Vindictive or disagreeing deities- Vindictive or disagreeing deities
- Personal moral failure (punishment)- Personal moral failure (punishment)
- Community's failure to act in a specific or- Community's failure to act in a specific or
desired manner.desired manner.
 The primary focus of Medicine in antiquity was:The primary focus of Medicine in antiquity was:
- Respiratory- Respiratory
- Digestive- Digestive
- Infections- Infections
- Gynecologic disorders- Gynecologic disorders
 Life expectancy was low.Life expectancy was low.
 Cancer and degenerative diseases were notCancer and degenerative diseases were not
relevantrelevant

TrephiningTrephining
 Found throughout Europe in skulls ofFound throughout Europe in skulls of
the Neolithic periodthe Neolithic period
 Therapy based upon supernaturalisticTherapy based upon supernaturalistic
basis of diseasebasis of disease
• To liberate evil spirits (psychosis orTo liberate evil spirits (psychosis or
other mental illness)other mental illness)
• Treat the cause of headaches orTreat the cause of headaches or
epilepsyepilepsy
 Alternative theory:Alternative theory:
• Trephining was developed in areasTrephining was developed in areas
where weapons were in usewhere weapons were in use
• Used to relieve increasedUsed to relieve increased
intracranial pressure following aintracranial pressure following a
blowblow
 Similar proceduresSimilar procedures
• Blood-letting for the purpose ofBlood-letting for the purpose of
allowing "evil spirits" to escapeallowing "evil spirits" to escape
• Finger amputations for religiousFinger amputations for religious
purposespurposes

Mesopotamian and Babylonian SurgeryMesopotamian and Babylonian Surgery
 Code of Hammurabi (2250 B.C.)
- Based upon older Sumerian Law (about
1000 years older)
 Provided specific regulations governing
surgery
- Surgery of the eye- Surgery of the eye
- Surgery of the bladder- Surgery of the bladder
- Drainage and treatment of abscess and- Drainage and treatment of abscess and
infectioninfection

Mesopotamian and Babylonian SurgeryMesopotamian and Babylonian Surgery
 Specific rules related to free men and slavesSpecific rules related to free men and slaves
 Defined the first rules governing malpracticeDefined the first rules governing malpractice
**The fee shall be: "10 shekels of silver for**The fee shall be: "10 shekels of silver for
draining an abscess or preserving the sight of adraining an abscess or preserving the sight of a
gentleman.gentleman.
 If the patient is a slave, then the fee shall be 2If the patient is a slave, then the fee shall be 2
shekels. If opening an abscess shall kill theshekels. If opening an abscess shall kill the
patient, or result in the loss of the eye, then thepatient, or result in the loss of the eye, then the
physician shall have his hand cut off.physician shall have his hand cut off.
 If the patient is a slave, the physician mustIf the patient is a slave, the physician must
replace the slave with a slave."replace the slave with a slave."
 Lawyers followed shortly thereafterLawyers followed shortly thereafter

Egyptian SurgeryEgyptian Surgery

Egyptian SurgeryEgyptian Surgery
 Kahun Papyrus (2000 B.C.)Kahun Papyrus (2000 B.C.)
- Described details relating to gynecologic- Described details relating to gynecologic
surgery and veterinary medicinesurgery and veterinary medicine
 Edwin Smith Papyrus (1600 B.C.)Edwin Smith Papyrus (1600 B.C.)
*Detailed information about diagnosis, examining*Detailed information about diagnosis, examining
the Patient, signs to look for, and specificthe Patient, signs to look for, and specific
"manipulations""manipulations"
*Included descriptions of 48 specific cases, from*Included descriptions of 48 specific cases, from
head and feet, with the majority dealing withhead and feet, with the majority dealing with
head injurieshead injuries
*The use of the knife is never mentioned in*The use of the knife is never mentioned in
these texts.these texts.

Ancient Indian MedicineAncient Indian Medicine
 TheThe SusutraSusutra "Textbook" of Indian Medicine"Textbook" of Indian Medicine
*Ancient Indian physicians were obsessed with*Ancient Indian physicians were obsessed with
classificationclassification
*66 diseases of the oral cavity, 6 of the ear lobe*66 diseases of the oral cavity, 6 of the ear lobe
Surgery was described:Surgery was described:
*Divided into*Divided into incisionincision,, excisionexcision,, scrapingscraping,,
puncturingpuncturing, probing,, probing, extractionextraction,, provokingprovoking
secretionsecretion, and, and suturingsuturing
*Over 100 surgical instruments were described*Over 100 surgical instruments were described
*The hand was the most important instrument*The hand was the most important instrument
 Wine and Hypnotism were used as the firstWine and Hypnotism were used as the first
anestheticsanesthetics

Aztec and Mexican MedicineAztec and Mexican Medicine
 Apparent longstanding medical arts, althoughApparent longstanding medical arts, although
written history is lackingwritten history is lacking
- Pharmacopoeia listed over 1,200 drugs.- Pharmacopoeia listed over 1,200 drugs.
- Surgery was sophisticated- Surgery was sophisticated
**Included suture, embryotomy, other physical**Included suture, embryotomy, other physical
methods.methods.
 WhenWhen CortezCortez arrived in the 16th century, hearrived in the 16th century, he
wrote back to Spain that Physicians were notwrote back to Spain that Physicians were not
needed and did not need to be sent.needed and did not need to be sent.

Chinese MedicineChinese Medicine
 Youngest of the "old" civilization medicalYoungest of the "old" civilization medical
literatureliterature
- Like Indians, overly involved with classification- Like Indians, overly involved with classification
- Pharmacopoeia listed over 1,800 drugs- Pharmacopoeia listed over 1,800 drugs
- The Chinese contributed little to surgery- The Chinese contributed little to surgery
**They believed that surgery was mutilation**They believed that surgery was mutilation
**That mutilation during life would carry over**That mutilation during life would carry over
into death.into death.
 However, they advanced later surgery throughHowever, they advanced later surgery through
their work on acupuncture and acupressuretheir work on acupuncture and acupressure

Greek MedicineGreek Medicine
 Greek medicine focused upon diet, exercise andGreek medicine focused upon diet, exercise and
climate.climate.
- Surgical Procedures were described, but simple- Surgical Procedures were described, but simple
*Cataract and stone removal, abscess drainage,*Cataract and stone removal, abscess drainage,
& suture.& suture.
 HippocratesHippocrates was the most famous authorwas the most famous author
*Contributed a number of books*Contributed a number of books
*Concerned with the description of and natural*Concerned with the description of and natural
history of disease.history of disease.

Roman MedicineRoman Medicine
 The Romans did not contribute primarily toThe Romans did not contribute primarily to
medical knowledge.medical knowledge.
They incorporated Greek influence and physiciansThey incorporated Greek influence and physicians
into their own cultureinto their own culture
Chronicled Greek and Arab works.Chronicled Greek and Arab works.
 GalenGalen was the most famous Roman physicianwas the most famous Roman physician
Developed a diverse and complex series ofDeveloped a diverse and complex series of
diagnostic and therapeutic interventions.diagnostic and therapeutic interventions.
Didn't perform surgery as it was "manual labor".Didn't perform surgery as it was "manual labor".

Islamic medicineIslamic medicine

 TheThe Islamic WorldIslamic World rose to primacy inrose to primacy in
medical science with such thinkers asmedical science with such thinkers as
Ibn SinaIbn Sina ((AvicennaAvicenna),), Ibn NafisIbn Nafis, and, and
RhazesRhazes..
 The first generation of Persian physiciansThe first generation of Persian physicians
was trained at thewas trained at the
Academy of GundishapurAcademy of Gundishapur, where the, where the
teaching hospital was first invented.teaching hospital was first invented.
Rhazes, for example, became the firstRhazes, for example, became the first
physician to systematically use alcohol inphysician to systematically use alcohol in
his practice as a physician.his practice as a physician.

 TheThe Comprehensive Book of MedicineComprehensive Book of Medicine
(Large Comprehensive, Hawi or "al-Hawi"(Large Comprehensive, Hawi or "al-Hawi"
or "The Continence") was written by theor "The Continence") was written by the
Iranian chemistIranian chemist RhazesRhazes (known also as(known also as
RaziRazi), the "Large Comprehensive" was the), the "Large Comprehensive" was the
most sought after of all his compositions.most sought after of all his compositions.
In it, Rhazes recorded clinical cases of hisIn it, Rhazes recorded clinical cases of his
own experience and provided very usefulown experience and provided very useful
recordings of various diseasesrecordings of various diseases

 TheThe MutaziliteMutazilite philosopher and doctorphilosopher and doctor
Ibn SinaIbn Sina (also known as(also known as AvicennaAvicenna in thein the
western world) was another influentialwestern world) was another influential
figure.figure.
 HisHis The Canon of MedicineThe Canon of Medicine, sometimes, sometimes
considered the most famous book in theconsidered the most famous book in the
history of medicine, remained a standardhistory of medicine, remained a standard
text in Europe up until itstext in Europe up until its
Age of EnlightenmentAge of Enlightenment and the renewal ofand the renewal of
thethe IslamicIslamic tradition of scientifictradition of scientific medicinemedicine

 Ibn NafisIbn Nafis (d. 1288) described human(d. 1288) described human
blood circulationblood circulation. This discovery would be. This discovery would be
rediscovered, or perhaps merelyrediscovered, or perhaps merely
demonstrated, bydemonstrated, by William HarveyWilliam Harvey inin 16281628,,
who generally receives the credit inwho generally receives the credit in
Western history.Western history.
 There was a persistent pattern ofThere was a persistent pattern of
Europeans repeating Arabian research inEuropeans repeating Arabian research in
medicine andmedicine and astronomyastronomy, and some say, and some say
physicsphysics, and claiming credit for it., and claiming credit for it.

Abu al-Qasim Al-ZahrawiAbu al-Qasim Al-Zahrawi
(936 - 1013)
 Abu al-Qasim Khalaf bin Abbas Al-Zahrawi (A.D.Abu al-Qasim Khalaf bin Abbas Al-Zahrawi (A.D.
936-1013), known to the West by his Latin name936-1013), known to the West by his Latin name
AlbucasisAlbucasis, was born in Al Zahra’a , six miles, was born in Al Zahra’a , six miles
northwest of Cordoba in Andalusia. He wasnorthwest of Cordoba in Andalusia. He was
simply the greatest Muslim surgeon, withsimply the greatest Muslim surgeon, with
European surgeons of his time coming to regardEuropean surgeons of his time coming to regard
him as a greater authority than even Galen, thehim as a greater authority than even Galen, the
ancient world's acknowledged master. It is clearancient world's acknowledged master. It is clear
from Al-Zahrawi's life history and from hisfrom Al-Zahrawi's life history and from his
writings that he devoted his entire life and geniuswritings that he devoted his entire life and genius
to the advancement of medicine as a whole andto the advancement of medicine as a whole and
surgery in particularsurgery in particular

Abu al-Qasim Al-ZahrawiAbu al-Qasim Al-Zahrawi
(936 - 1013)
 Shoulder dislocation
 Arterial ligation
 Hereditary nature of hemophilia
 Dental devices
 Ectopic pregnancy (lethal)
 Inspection of the uterus, ear,throat

The Dark AgesThe Dark Ages
 The practice of medicine was based upon Galen'sThe practice of medicine was based upon Galen's
(incorrect) reports and theories.(incorrect) reports and theories.
 Medicine was written about by Monks ChronicledMedicine was written about by Monks Chronicled
information, but did not advance knowledgeinformation, but did not advance knowledge
 No understanding of infection or disease processNo understanding of infection or disease process
 Did not advance surgical technique orDid not advance surgical technique or
understanding.understanding.
 Patients with illness were cared for by midwivesPatients with illness were cared for by midwives
and barbers.and barbers.

Dark AgesDark Ages
 AvicennaAvicenna
• 980 – 1037 AD980 – 1037 AD
• Persian philosopherPersian philosopher
• WroteWrote The Canon ofThe Canon of
MedicineMedicine
• Revived Aristotle’sRevived Aristotle’s
theoriestheories

The RenaissanceThe Renaissance

 There were few qualified "Doctors"There were few qualified "Doctors"
Most of care was provided by midwives,Most of care was provided by midwives,
barbers, and lay clergy.barbers, and lay clergy.
*Despite this academic "lack", significant*Despite this academic "lack", significant
advances were made in the understanding ofadvances were made in the understanding of
the basis of disease and anatomic function.the basis of disease and anatomic function.
 Arrival of gunpowder provided new impetusArrival of gunpowder provided new impetus
for increased surgical expertisefor increased surgical expertise

The RenaissanceThe Renaissance (1450 – 1600)(1450 – 1600)
 Began a period ofBegan a period of
renewed interest inrenewed interest in
anatomy and theanatomy and the
etiology of diseaseetiology of disease
 ParacelsusParacelsus andand HarveyHarvey
made significantmade significant
advances in theadvances in the
understanding ofunderstanding of
anatomy, resulting inanatomy, resulting in
the recognition thatthe recognition that
Galen's theories wereGalen's theories were
largely incorrect.largely incorrect.

RenaissanceRenaissance
 ParacelsusParacelsus
• 1493 – 1541 AD1493 – 1541 AD
• Swiss physicianSwiss physician
• Disagreed withDisagreed with
Galen andGalen and
Avicenna, but couldAvicenna, but could
not prove hisnot prove his
theoriestheories
scientificallyscientifically
• Called the Luther ofCalled the Luther of
MedicineMedicine

 VesaliusVesalius 1514 – 15641514 – 1564
 Flemish anatomistFlemish anatomist
 Father of Modern AnatomyFather of Modern Anatomy
 Completed theCompleted the FabriciaFabricia in 1543,in 1543,
a comprehensive textbook ofa comprehensive textbook of
anatomy which remained the definitiveanatomy which remained the definitive
work for centuries.work for centuries.
 Appointed as a surgeon and natomist,Appointed as a surgeon and natomist,
which impacted the field for centuries.which impacted the field for centuries.
 This overcame "taboo" aspects ofThis overcame "taboo" aspects of
dissecting on human cadavers,dissecting on human cadavers,
previously problematic with thepreviously problematic with the
church.church.
 Woodcuts and improved printingWoodcuts and improved printing
allowed dissemination of scholarlyallowed dissemination of scholarly
information.information.

 Ambroise Pare (1510-1590)Ambroise Pare (1510-1590)
An army surgeon who wroteAn army surgeon who wrote
20 books on battle surgery20 books on battle surgery
Contributed important newContributed important new
understanding to care ofunderstanding to care of
gunshot wounds, addinggunshot wounds, adding
ligature and cautery.ligature and cautery.
Replaced previousReplaced previous
(unsuccessful) treatment of(unsuccessful) treatment of
pouring boiling oil onpouring boiling oil on
wounds.wounds.

RenaissanceRenaissance
 William HarveyWilliam Harvey
• 1578 – 16571578 – 1657
• First to accuratelyFirst to accurately
describe circulatorydescribe circulatory
anatomy andanatomy and
physiologyphysiology

 “There is no more
science in surgery
than in butchering,”
 Lord Thurlow
 Parliamentary debate on the
establishment of a Royal College of
Surgeons in 1811
Modern Age

Pathology & ExperimentalPathology & Experimental
Surgery (18th Century)Surgery (18th Century)
 Giovanni MorgagniGiovanni Morgagni::
• Developed modern-dayDeveloped modern-day
clinical pathologyclinical pathology
 De sedius et causus orborumDe sedius et causus orborum......
Compendium of post-mortemCompendium of post-mortem
observations, and correlation toobservations, and correlation to
clinical diseaseclinical disease
*Dealt with diseases commonly*Dealt with diseases commonly
seen by physicians, instead ofseen by physicians, instead of
esoteric diseases previouslyesoteric diseases previously
reported.reported.

Pathology & ExperimentalPathology & Experimental
 John HunterJohn Hunter
 Scottish born surgeon &Scottish born surgeon &
anatomist (born 1728) A pooranatomist (born 1728) A poor
student, but went to work withstudent, but went to work with
his older brother Williamhis older brother William
An excellent dissectionist, usedAn excellent dissectionist, used
his observations to postulatehis observations to postulate
cause and treatment of diseasecause and treatment of disease
Described inflammation as theDescribed inflammation as the
"first principle" of surgery"first principle" of surgery

Anesthesia and AntisepsisAnesthesia and Antisepsis
(19th Century)(19th Century)
 In the early 19th century operations will stillIn the early 19th century operations will still
infrequent In major hospitals, only 1-2infrequent In major hospitals, only 1-2
procedures would be performed on an averageprocedures would be performed on an average
operating day. For tuberculosis, accidents,operating day. For tuberculosis, accidents,
strangulated hernias, abscesses, and aneurysms.strangulated hernias, abscesses, and aneurysms.
 PainPain,, InfectionInfection,, HemorrhageHemorrhage andand ShockShock were thewere the
major obstacles to surgery , As each of thesemajor obstacles to surgery , As each of these
were addressed, the scope and technical ability ofwere addressed, the scope and technical ability of
surgeons was increased.surgeons was increased.

AnesthesiaAnesthesia
 The development of anesthesia
was the most dramatic
development in medicine
• Formerly: Alcohol, mandrake
root, opium, and even
bleeding or reduction of brain
blood flow were used to
decrease pain and sensibility
• In 1842, Crawford Long used
ether to anesthetize patients
for removal of skin tumors,
but did not report it.
• William Morton reported use
of ether 3 years later at the
Massachusetts General
Hospital
• James Simpson reported the
use of chloroform in
Edinburgh the following year..

AntisepsisAntisepsis
 Wound healing in the 19th century was a messWound healing in the 19th century was a mess
(literally) .. Surgeons operated in their street(literally) .. Surgeons operated in their street
clothes, didn't wear gloves or masksclothes, didn't wear gloves or masks
*Some would begin the operation by wiping the*Some would begin the operation by wiping the
scalpel on their bootsscalpel on their boots
 SemmelweisSemmelweis andand HolmesHolmes showed thatshowed that
gynecologic infections were transmitted by hand-gynecologic infections were transmitted by hand-
to-patient contact - Simple handwashing withto-patient contact - Simple handwashing with
antiseptic solutions dramatically reducedantiseptic solutions dramatically reduced
infections. Semmelweis' Viennese colleaguesinfections. Semmelweis' Viennese colleagues
ignored his findingsignored his findings

Joseph ListerJoseph Lister
 Joseph ListerJoseph Lister was born in 1827,was born in 1827,
medical degree in 1852medical degree in 1852
Became a surgeon and aBecame a surgeon and a
member of the staff at themember of the staff at the
Royal Infirmary in EdinburghRoyal Infirmary in Edinburgh
 ListerLister recognized the problemrecognized the problem
of infection on hospital wards,of infection on hospital wards,
and effects on wound healingand effects on wound healing
Was not able to improve theWas not able to improve the
situation in his hospital.situation in his hospital.

Joseph ListerJoseph Lister 1827-19121827-1912
the origination of antiseptic surgerythe origination of antiseptic surgery
 Lister had great success with his patientsLister had great success with his patients
*Depended upon being extremely meticulous*Depended upon being extremely meticulous
*Other surgeons gradually accepted Lister's*Other surgeons gradually accepted Lister's
methods.methods.
 However, their success was variable, based uponHowever, their success was variable, based upon
their attention to detail.their attention to detail.
 Rudolph MatasRudolph Matas (Charity Hospital in New Orleans)(Charity Hospital in New Orleans)
*Reported figures showing a 10-fold increase in*Reported figures showing a 10-fold increase in
the percentage of patients undergoing operationthe percentage of patients undergoing operation
after admission.*Operation was made safer byafter admission.*Operation was made safer by
antisepsis.antisepsis.
 Together, the contribution ofTogether, the contribution of ListerLister andand PasteurPasteur
revolutionized the care of wounds, and therevolutionized the care of wounds, and the
preparation of the patient for surgery.preparation of the patient for surgery.

Louis PasteurLouis Pasteur
 Louis PasteurLouis Pasteur publishedpublished
his "germ theory" ofhis "germ theory" of
disease around 1865disease around 1865
 Lister began using aLister began using a
solution of steam-solution of steam-
sprayed carbolic acid tosprayed carbolic acid to
sterilize instruments,sterilize instruments,
patient's skin, and thepatient's skin, and the
surgeon's skinsurgeon's skin

Surgical TrainingSurgical Training
 Prior to the 19th century,Prior to the 19th century,
surgical training was ansurgical training was an
apprenticeship program,apprenticeship program,
passed from person topassed from person to
person.person.
 LangenbeckLangenbeck (1810-1887)(1810-1887)
established surgicalestablished surgical
trainingtraining
 Training programs includedTraining programs included
surgery, histology andsurgery, histology and
pathology.pathology.
 TrainedTrained KocherKocher andand
BillrothBillroth, two of the most, two of the most
influential surgeons ofinfluential surgeons of
their time.their time.

Some Important Figures in ModernSome Important Figures in Modern
-- William Stewart HalstedWilliam Stewart Halsted
- Wilhelm Roentgen- Wilhelm Roentgen
- Sir Alexander Fleming- Sir Alexander Fleming
- Harvey Cushing- Harvey Cushing
- Theodor Billroth- Theodor Billroth
- Theodor Kocher- Theodor Kocher
- Alexis Carrel- Alexis Carrel
- Alfred Blalock- Alfred Blalock
- Francis Moore- Francis Moore
- Charles Huggins- Charles Huggins
- Joseph Murray- Joseph Murray
- Michael DeBakey- Michael DeBakey

William Stewart HalstedWilliam Stewart Halsted 1852-19221852-1922
 One of the founding member ofOne of the founding member of
the Johns Hopkins Hospital andthe Johns Hopkins Hospital and
Medical SchoolMedical School
 Traveled to Europe to analyze theTraveled to Europe to analyze the
European training system.European training system.
 Defined the need for UniversitiesDefined the need for Universities
and Medical Schools to be unitedand Medical Schools to be united
to train physicians and surgeons.to train physicians and surgeons.
 Created the basis for the modernCreated the basis for the modern
surgical residency, whichsurgical residency, which
provided increasing responsibilityprovided increasing responsibility
and authority to residents.and authority to residents.
 His model is universally followedHis model is universally followed
today, and his trainees moldedtoday, and his trainees molded
modern surgery.modern surgery.

William Stewart HalstedWilliam Stewart Halsted
 In surgical training, revolutionized surgical technique, andIn surgical training, revolutionized surgical technique, and
research .research .
 Introduced the use of rubber gloves to surgery.Introduced the use of rubber gloves to surgery.
 Defined a useful operation for the treatment of breastDefined a useful operation for the treatment of breast
cancer .cancer .
 Described an anatomically correct repair for hernias .Described an anatomically correct repair for hernias .
 Taught and stressed the relationship between surgery andTaught and stressed the relationship between surgery and
physiology .physiology .
 Emphasized careful handling of tissues and meticulousEmphasized careful handling of tissues and meticulous
hemostasis .hemostasis .
 Opened a venue of surgical research at Hopkins which isOpened a venue of surgical research at Hopkins which is
the basis of modern surgical research.the basis of modern surgical research.
 However, his life in Baltimore and later was troubled due toHowever, his life in Baltimore and later was troubled due to
problems with addiction.problems with addiction.

Wilhelm RoentgenWilhelm Roentgen 1845-19231845-1923
 He accidentally discovered the X-ray inHe accidentally discovered the X-ray in
18951895
 It was only a matter of monthsIt was only a matter of months
following the discovery that Roentgenfollowing the discovery that Roentgen
hand and wrist bones could be clearlyhand and wrist bones could be clearly
visualized that clinical applications ofvisualized that clinical applications of
the finding was made .the finding was made .
 Within few years the use of X-ray wasWithin few years the use of X-ray was
expanded to include physiologicalexpanded to include physiological
studies such as those of swallowing andstudies such as those of swallowing and
intestinal motion.intestinal motion.
 Walter B. CannonWalter B. Cannon used fluoroscopy forused fluoroscopy for
this purpose while he was still a medicalthis purpose while he was still a medical
student in 1901 .student in 1901 .

Harvey CushingHarvey Cushing
 Johns Hopkins Surgeon whoJohns Hopkins Surgeon who
worked with Halsted.worked with Halsted.
 Developed the idea of monitoredDeveloped the idea of monitored
anesthesia, andanesthesia, and createdcreated the basisthe basis
for the modern anesthesiafor the modern anesthesia
record.record.
 A pioneer neurosurgeon, whoA pioneer neurosurgeon, who
greatly advanced the treatmentgreatly advanced the treatment
of brain tumors.of brain tumors.
 Developed the "Hunterian"Developed the "Hunterian"
laboratory at Hopkins.laboratory at Hopkins.

Sir Alexander FlemingSir Alexander Fleming
 1921: Described and isolated lysozyme1921: Described and isolated lysozyme
 Began work for an inhibitor of harmfulBegan work for an inhibitor of harmful
bacteriabacteria
 Found a mold that grew on hisFound a mold that grew on his
laboratory cultures of staphylococcuslaboratory cultures of staphylococcus
 The mold inhibited the growth of theThe mold inhibited the growth of the
surrounding bacteriasurrounding bacteria
 PenicillinPenicillin was isolated and began thewas isolated and began the
field of useful antibioticsfield of useful antibiotics

Theodor BillrothTheodor Billroth 1829 - 18941829 - 1894
 Viennese surgeon who wasViennese surgeon who was
a friend and colleague ofa friend and colleague of
Halsted.Halsted.
 He was a pioneerHe was a pioneer
abdominal surgeon, andabdominal surgeon, and
perfected manyperfected many
procedures, includingprocedures, including
gastric resections still usedgastric resections still used
daily in general surgery.daily in general surgery.
 Helped establish theHelped establish the
foundations of academicfoundations of academic
training and universitytraining and university
direction of surgicaldirection of surgical
sciencessciences

Theodor KocherTheodor Kocher 1841 – 19171841 – 1917
 Swiss surgeon whoSwiss surgeon who
was a friend andwas a friend and
colleague of Halstedcolleague of Halsted
and Billrothand Billroth
 Developed safeDeveloped safe
thyroid surgery forthyroid surgery for
goiter which wasgoiter which was
endemic in land-endemic in land-
locked Switzerland.locked Switzerland.
 Received theReceived the NobelNobel
PrizePrize in 1909.in 1909.

Alexis CarrelAlexis Carrel 1873 – 19441873 – 1944
 French surgeon born in Lyon, developedFrench surgeon born in Lyon, developed
fine surgical techniques.fine surgical techniques.
 An experimental surgeon interested inAn experimental surgeon interested in
wound healing, tissue culture ,organwound healing, tissue culture ,organ
transplantationtransplantation
 Perfected the technique for sewingPerfected the technique for sewing
together blood vessels, and repairingtogether blood vessels, and repairing
damaged arteries.damaged arteries.
 Interested in wound healing. A pioneer inInterested in wound healing. A pioneer in
tissue culture and organ transplantation.tissue culture and organ transplantation.
 Received theReceived the Nobel Prize in 1912.Nobel Prize in 1912.

Alfred BlalockAlfred Blalock 1899-19641899-1964
 Vanderbilt trained generalVanderbilt trained general
surgeon who assumed thesurgeon who assumed the
Chair of surgery at JohnsChair of surgery at Johns
Hopkins.Hopkins.
 Conducted detailedConducted detailed
research which describedresearch which described
the pathogenesis of shock.the pathogenesis of shock.
 Also performed the basicAlso performed the basic
research which establishedresearch which established
cardiothoracic surgery.cardiothoracic surgery.
Developed the Blalock-Developed the Blalock-
Taussig shunt for pediatricTaussig shunt for pediatric
patients with structuralpatients with structural
anomalies of the heart.anomalies of the heart.

Francis MooreFrancis Moore
 A Harvard trainedA Harvard trained
physician who spent hisphysician who spent his
career interested incareer interested in
metabolic changes whichmetabolic changes which
occur in patients whooccur in patients who
undergo surgery.undergo surgery.
 His research, published inHis research, published in
the landmark text,the landmark text, thethe
Metabolic Response toMetabolic Response to
Surgery,Surgery, was thewas the
benchmark for the futurebenchmark for the future
of surgical metabolism andof surgical metabolism and
in nutrition for patientsin nutrition for patients
who are unable to eat.who are unable to eat.

Charles HugginsCharles Huggins
 A University of ChicagoA University of Chicago
urologist who discoveredurologist who discovered
the hormonal basis for thethe hormonal basis for the
growth of some cancers.growth of some cancers.
 Described the ability toDescribed the ability to
slow or halt growth ofslow or halt growth of
prostate by removing theprostate by removing the
tissue that produced thetissue that produced the
hormones driving theirhormones driving their
growth.growth.
 Received the Nobel Prize inReceived the Nobel Prize in
1966.1966.

Joseph MurrayJoseph Murray
 Received the NobelReceived the Nobel
Prize in 1990Prize in 1990 for hisfor his
pioneering work inpioneering work in
organ transplantation.organ transplantation.
 His basic researchHis basic research
identified theidentified the
immunologic barrier toimmunologic barrier to
organ transplantation.organ transplantation.
 He performed the firstHe performed the first
successful kidneysuccessful kidney
transplant betweentransplant between
identical twins withidentical twins with
severe kidney disease.severe kidney disease.

Michael DeBakeyMichael DeBakey
 Pioneer in cardiovascularPioneer in cardiovascular
surgery.surgery.
 In 1934, he designed theIn 1934, he designed the
first roller pump, whichfirst roller pump, which
remains the basis for allremains the basis for all
cardiac bypass surgerycardiac bypass surgery
performed today.performed today.
 He is also credited for theHe is also credited for the
development of manydevelopment of many
valuable surgicalvaluable surgical
instruments, and has beeninstruments, and has been
a leader as a spokesmana leader as a spokesman
for medical research.for medical research.

conclusionconclusion
 The thrust has been how we can do more
and more, safely and effectively, to extend
the quantity and quality of life?
 but in the past two decades the emphasis
has shifted to how much less can we do to
achieve our goal of treatment.
 The emerge of Minimal Invasive Surgery .

conclusionconclusion
 Less can be More so long as the
results are same or better:
• Shorter hospital stay, earlier return to
work, fewer transfusions
• Sometimes lower costs
• Recurrence or cure rate equivalent or
better
• Complication rate equivalent or better

History of surgery at glance لمحة عن تاريخ الجراحة

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Ähnlich wie History of surgery at glance لمحة عن تاريخ الجراحة

Ähnlich wie History of surgery at glance لمحة عن تاريخ الجراحة (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

History of surgery at glance لمحة عن تاريخ الجراحة