HISTORY OF SURGERY ”The history of surgery is the history of the last 100 years, which started in 1846 with the discovery of nacrosis and the possibility of no-pain operation. Everything, which was before, is just a night of ignorance, pain and barren groping in the dark.” (Bertrand Gosset, 1956)

Classification• 1.pre historic• 2. antiquity---Egypt --Middle east ---india ----- china 3. Greek & Roman---Homer,Hippocrates,

-----cesus & Alexandria

4. ISLAMIC MIDDLE AGES ---9th---12th 5. Medieval Europe===400-1400 AD

6.Renaissance to early modern period

16 th -18 th century7.19 th century ==rise of

modern surgery8. 20th century 1st world war ----------------2nd

world war------------post world war II----MODERN

SURGERY--

Celsus Library ( Celcius Library)Celsus LibraryThis library is one of the most beautiful structures in Ephesus. It was built in 117 A.D. It was a monumental tomb for Gaius Julius Celsus Polemaeanus, the governor of the province of Asia; from his son Galius Julius Aquila. The grave of Celsus was beneath the ground floor, across the entrance and there was a statue of Athena over it. Because Athena was the goddess of the wisdom.

The scrolls of the manuscripts were kept in cupboards in niches on the walls. There were double walls behind the bookcases to prevent the them from the extremes of temperature and humidity. The capacity of the library was more than 12,000 scrolls. It was the third richest library in ancient times after the Alexandra and Pergamum.

Celsus Library ( Celcius Library)Celsus LibraryThis library is one of the most beautiful structures in Ephesus. It was built in 117 A.D. It was a monumental tomb for Gaius Julius Celsus Polemaeanus, the governor of the province of Asia; from his son Galius Julius Aquila. The grave of Celsus was beneath the ground floor, across the entrance and there was a statue of Athena over it. Because Athena was the goddess of the wisdom.

The scrolls of the manuscripts were kept in cupboards in niches on the walls. There were double walls behind the bookcases to prevent the them from the extremes of temperature and humidity. The capacity of the library was more than 12,000 scrolls. It was the third richest library in ancient times after the Alexandra and Pergamum.

GALEN

Greatest Physician of the Roman Empire Galen was the greatest physician of ancient Rome. Whereas Hippocrates laid the foundation of Greek Medicine, Galen further developed its theory and practice, and carried Greco-Roman medicine to its zenith.Galen Claudius Galenus, or Galen, was born in Pergamum, an old Greek city on the Aegean coast of Asia Minor, or present day Turkey, in the year 130 A.D. Pergamum was an ancient center of learning and medicine, having an Asclepion and a famous library that second only to the one in Alexandria.

HISTORY OF SURGERY IS DIVIDED IN TO THREE PERIODS

HippocratesPhysicianHippocrates of Cos or Hippokrates of Kos, was an ancient Greek physician of the Age of Pericles, and is considered one of the most outstanding figures in the history of medicine. WikipediaBorn: C, Kos, GreeceDied: 371 BC, Larissa, GreeceHippocratesPhysicianHippocrates of Cos or Hippokrates of Kos, was an ancient Greek physician of the Age of Pericles, and is considered one of the most outstanding figures in the history of medicine. WikipediaBorn: 460 BC, Kos, GreeceDied: 371 BC, Larissa, GreeceNationality: GreekBooks: On Ancient Medicine, Hippocratic writings, moreChildren: Thessalus, DracoParents: Praxitela, HeraclidesNationality: GreekBooks: On Ancient Medicine, Hippocratic writings, moreChildren: Thessalus, DracoParents: Praxitela, Heraclides

Period 1 :-primaeval time to middle of the 19 th century

Period 2:- it lasted from 1846 to 1960s

Period 3 :-it lasted from the sixties until now days.

(P-1 ) Period of Ignorance & Pain

a) a) Primaeval time

• This can be considered as

• pre Hippocratic time

• This can be considered as Ancestors of primitive humans not staying in any houses,

• Not having knowledge of healing.

b)Hippocratic time• 5th century B.C.• Founder of Rational

Empiric Therapy• He treated the patients ,• Teached the students,• Described his experience

in ''Corpus Hippocraticum"

• Technique of bandaging, treating fractures ,dislocations,trepanation etc.

PERIOD 1

• c)In the middle ages,• Many factors were responsible for

slow development of medicine. They are---

• 1) ecclesiastical dogmas:-----prevented the development of medicine in Europe

• 2) " WILL OF GOD".• 3) MONKS WORD FINAL.• 4) QUAKES• 5) • IT WAS A BIG SACRIFICE FROM THE

SIDE OF THE SUFFERER.• Many theories were established

earlier were disproved by –FLAMAND—Anatomist & surgeon—born in Bruxelles.

• He only used animals for experiments. And approved similarities and differences in living organisms.

IN 1543 –PUBLISHED ( in BASEL)" De humani corporis fabrica"Auther –Andreas vesalius (1514:1564)Who teached at university of Padua.

Sir Alexander Fleming was born at Lochfield near Darvel in Ayrshire, Scotland on August 6th, 1881. He attended Louden Moor School, Darvel School, and Kilmarnock Academy before moving to London where he attended the Polytechnic. He spent four years in a shipping office before entering St. Mary's Medical School, London University. He qualified with distinction in 1906 and began research at St. Mary's under Sir Almroth Wright, a pioneer in vaccine therapy. He gained M.B., B.S., (London), with Gold Medal in 1908, and became a lecturer at St. Mary's until 1914. He served throughout World War I as a captain in the Army Medical Corps, being mentioned in dispatches, and in 1918 he returned to St.Mary's. He was elected Professor of the School in 1928 and Emeritus Professor of Bacteriology, University of London in 1948. He was elected Fellow of the Royal Society in 1943 and knighted in 1944.

Early in his medical life, Fleming became interested in the natural bacterial action of the blood and in antiseptics. He was able to continue his studies throughout his military career and on demobilization he settled to work on antibacterial substances which would not be toxic to animal tissues. In 1921, he discovered in «tissues and secretions» an important bacteriolytic substance which he named Lysozyme. About this time, he devised sensitivity titration methods and assays in human blood and other body fluids, which he subsequently used for the titration of penicillin. In 1928, while working on influenza virus, he observed that mould had developed accidently on a staphylococcus culture plate and that the mould had created a bacteria-free circle around itself. He was inspired to further experiment and he found that a mould culture prevented growth of staphylococci, even when diluted 800 times. He named the active substance penicillin.

Sir Alexander wrote numerous papers on bacteriology, immunology and chemotherapy, including original descriptions of lysozyme and penicillin. They have been published in medical and scientific journals.

Fleming, a Fellow of the Royal College of Surgeons (England), 1909, and a Fellow of the Royal College of Physicians (London), 1944, has gained many awards. They include Hunterian Professor (1919), Arris and Gale Lecturer (1929) and Honorary Gold Medal (1946) of the Royal College of Surgeons; Williams Julius Mickle Fellowship, University of London (1942); Charles Mickle Fellowship, University of Toronto (1944); John Scott Medal, City Guild of Philadelphia (1944); Cameron Prize, University of Edinburgh (1945); Moxon Medal, Royal College of Physicians (1945); Cutter Lecturer, Harvard University (1945); Albert Gold Medal, Royal Society of Arts (1946); Gold Medal, Royal Society of Medicine (1947); Medal for Merit, U.S.A. (1947); and the Grand Cross of Alphonse X the Wise, Spain (1948).

Period 1 CT

• INFECTION AT SSI WAS THE RULE• PRINCIPLES OF SEPSIS & ANTISEPSIS -NOT EXISTING.

• AUTOPSIES WERE BIG SHOW IN EVERY TOWN.—using own instruments ,which were also used for surgery.

• LETHAL INFECTIONS WERE PLENTY.• DURING THE SIEGE OF DAMVILLIERS IN 1552 "Ambroise Pare"(1510-1590)—used vascular clamp and he is the first ,to apply the ligature to manage the bleeding.

1200—1500PRE-ROMAN AGES.---ROMAN AGES.

Period 2• FROM THE DISCOVERY OF NARCOSIS (1846)

- UNTILTHE 1960s. In 1772,---Joseph Priestley(1733-1804) a British scientist ,discovered the laughing gas (N2O),

In 1800 ---,Humphry Davy (1778-1829 ) , a British chemist-found N2O is suitable for Anaesthesia.

Horace Wells –(1815-1848), an American Dentist used nitrous oxide during dental extraction in 1844.

On 16/10/1846 -william MORTON (1819-1868) an American Dentist narcotized apatient with Ether. (Ether day)---1st public demo in Boston.

• ETHER –C-Jackson---chemist –discovered the ether. Other chemist Morton helped him.

• How ether was given to 1st patient ?—BULB ---

• PATIENT DECLARED –He had no pain during operation ,this WAS THE BEGINNING OF new era in treating surgical patient.

• In 1847 Oliver Holmes -conception of anaesthesia.

He served as President of the Society for General Microbiology, he was a Member of the Pontifical Academy of Science and Honorary Member of almost all the medical and scientific societies of the world. He was Rector of Edinburgh University during 1951-1954, Mary's.

In his younger days he was a keen member of the Territorial Army and he served from 1900 to 1914 as a private in the London Scottish Regiment.

Dr Fleming died on March 11th in 1955 and is buried in St. Paul's Cathedral.From Nobel Lectures, Physiology or Medicine 1942-1962, Elsevier Publishing Company, Amsterdam, 1964 This autobiography/biography was written at the time of the award and first published in the book series Les Prix Nobel. It was later edited and republished in Nobel Lectures. To cite this document, always state the source as shown above. 

Sir Alexander Fleming Born: 6 August 1881, Lochfield, ScotlandDied: 11 March 1955, London, United KingdomAffiliation at the time of the award: London University, London, United KingdomPrize motivation: "for the discovery of penicillin and its curative effect in various infectious diseases"Field: anti-bacterial agents, bacteriology, biochemistryPrize share: 1/3

Freeman of many boroughs and cities and Honorary Chief Doy-gei-tau of the Kiowa tribe. He was also awarded doctorate, honoris causa, degrees of almost thirty European and American Universities.

In 1915, Fleming married Sarah Marion McElroy of Killala, Ireland, who died in 1949. Their son is a general medical practitioner.

Fleming married again in 1953, his bride was Dr. Amalia Koutsouri-Voureka, a Greek colleague at St.

In 1847, Ignác Semmelweis (1818–1865), a Hungarian obstetrician, introduced the compulsory hand:washing with chlorinated lime to prevent the puerperal fever. It was obligatory for all doctors, medical students, as well as the nurse staff. Thereafter, the mortality rate of women, who were in labour, decreased from 30% to 1%. It unambiguously proved that decomposing organic matter on the specialists’ hands, who made the examinations and treatments, propagated the mortal disease.

In 1847,Kolletschka, who was a professor of forensic medicine, died in sepsis following an injury during an autopsy. Based on the report of autopsy of Kolletschka, Semmelweis determined that his septic clinical picture was similar to those seen in autopsies of women who died in puerperal fever. He recognized the common cause: The corpusles from the dead body could enterinto the blood stream. Semmelweis had to face many rejections when he introduced the effectiveness of hand disinfectioning.

The Hungarian surgeon, János Balassa (1814:1868) was the first one in Hungary who applied ether narcosis. He was 28 years old when they nominated him as the head of the department of the Surgical Diseases. He was a professor of surgery, obstetrics and ophthalmology. He established and made internationally known the independent Hungarian Surgery by his multi:faceted surgical works and publications. He took part in the preparation of the universities educational reform and in the organization of modern surgical education. He worked out numerous operative procedures. He established the urological surgery. He performed a large number of urinary bladder incisions and the disintigration of the stones. He applied new methods in the field of the plastic (reconstructive) surgeries. His written works are of great importance in abdominal hernias and plastic surgeries. He set up the Medical Weekly Journal in 1857, which is the fifth one among the oldest medical journals all over the world and also a

9part of the Hungarian Cultural Heritage. He was contemporary with the Pál Bugát (1793:1865), who created many (medical) words and so the main parts of those words which are used nowdays in the medical literature are orginating from him.

1860. Louis Pasteur (1822–1895) worked out the “germ theory”. He also assumed that microscopic particles, which are originated from the surrounding tissues, cause wound infection and pus formation.

• 1861. Sándor Lumnitzer (1821:1892), a Hungarian surgeon, effectively dealed with the plastic surgery. He was an excellent traumathologist and introduced many technical innovations.

1867. Sir Joseph Lister (1827:1912), who was a professor of surgery in Glasgow, based on the “germ theory” of Louis Pasteur introduced the disinfectioning processes in surgery. He believed that even in the case of a complicated fracture there is only a need to inject a material into the wound which can kill the septic germs. Lister found the carbolic acid (phenol) as an effective material for this purpose. In the operating theatre Lister sprayed carbolic acid onto the operative area, onto the instruments and bandages, and even onto the air. His ”antiseptic theory” revolutionized the surgery, since the surgeons were incapable of managing the wound infection until that time. Hümér Hültl (1868:1940) played an important role in the spread of the antiseptic surgery in Hungary.

1878. Emil Theodor Kocher (1841:1917), a Swiss surgeon, edited his book about the surgical removal of goitres. He paid more attention to the courses of the vessels than his ancestors. He avoided the injury to the recurrent laryngeal nerve.He also saved the neck muscles resulting to good cosmetic results. In 1909 he was awarded the Nobel Prize for his work on the thyroid gland.

1879. Jules Émile Péan (1830:1898), a French surgeon, resected the stomach partially due to a pyloric cancer and then sewed the remaining part to the duodenum. 1881. Theodor Billroth (1829:1894), an Austrain surgeon, performed the first successful gastrectomy.The patient survived the intervention.He carried out the first oesophageal resection and the first total laryngectomy. In his experiments, he developed the optimal methods for surgical treatment of the cancers of the bladder and intestines.He applied the statistical analysis in medicine.

1886. Gustav Adolf Neuber (1850:1932), a surgeon from Kiel, applied the aseptic treatment of wounds aimfully to prevent the infections. 1886. Ernst von Bergmann (1836:1907), a surgeon whointroduced the gas sterilization of the instruments in his clinic in Berlin. This was a determinate step towards the aseptic system of work.

1889. Charles McBurney (1845:1913) was an American surgeon. Hisclassic report on early operative interference in cases of appendicitis waspresented before the New York Surgical Society in its scientific session. He described that in 99% of cases the symptoms of inflammation are originated from the right lower part of the abdomen (i.e. from the appendix). He determined the area of greatest abdominal pain which is the exact place of the typical muscle guarding (nowdyas, known as McBurney’s point). Later, he set forth in another paper 10the incision that he used in cases of appendicitis,now called McBurney’s incision

1895. Wilhelm Conrad Röntgen (1845:1923), who was aGerman physicist, discovered the X:ray which revolutionized the patient treatment. In 1901, he was awarded the Nobel Prize in Physics

1896. William S. Halsted (1852:1922) was a surgeon at the Johns Hopkins Medical School, who developed the surgical rubber gloves.In 1890 heasked the Goodyear Rubber Company to manufacture thin surgical gloves for his chief scrub nurse (and his later wife) Caroline Hampton) who was suffering of dermatitis due to useof disinfectants. Joseph C. Bloodgood (1867:1935), who was Halsted’s student, initiated the rutine use of surgical gloves in 1896. This method reduced the incidence of the dermatitis, as well as the number of the postoperative wound infections.

• 1900. Hunter initiated the use of surgical mask. Du

• ring sterile intervention, all participants

• use paper or textile cap : which covers their whole

• hair: as well as surgical mask.

• 1901. Karl Landsteiner (1868:1943), an Austrian pat

• hologist, who discovered the blood

• groups and described the ABO and Rh systems. He was

• awarded the Nobel Prize in 1930.

1902. Imre Ullmann (1861:1937) was born in Pécs. He

• studied and worked in Vienna from • 1880. Then he visited Pasteur in Paris and made exp

• eriments there. At the Vienna Surgical • Society he reported the first case of renal autotra

• nsplantation in which the kidney was placed • in the the neck of a dog. He did not use any vascul

• ar suture. He sewed the ureter onto the • skin. The kidney was functioning for five days. Lat

• er, he stopped his researches in this field • but his results stimulated Carrel.

1902. Alexis Carrel (1873:1944), a French surgeon, developed and published a technique for the end:to:end anastomosis of blood vessels. Thus, he created the surgical basis of the cardiovascular surgery and organ transplantation. He took sewing lessons in Lyon to develop his technique. In 1904, he joined the American physician Charles Guthrie in Chicago. They transplanted vessels, thyroid gland, parathyroid gland, ovarium, tescicle and heart. Carrel was awarded the Nobel Prize for Physiology and Medicinein 1912.

1902. Georg Kelling (1866:1945) the word ”laparoscopy” was used by him which is a Greek word: αραπαλ, meaning soft tissue, and κσcοωεπ meaning inspection. 1904. Ferdinand Sauerbruch (1875:1951) was a surgeon in Berlin. His main professional field was the thoracic: and lung surgery, especially the surgeries of alterartions due to tuberculosis. In the Congress of German Surgical Society he demonstrated the pressure equalizing process invented by him.

1907. Gyula Dollinger (1849:1937) was a surgeon, who founded the Hungarian Surgical Society. 1907. Hümér Hütl (1868:1940). According to the Hungarian surgical belief, Victor Fischer (an ingenious designer of surgical instruments) wasthe inventor of the first surgical stapler that was used by Hümér Hütl. In 1924 Aladár Petz (1889:1953) designed this device further. The Petz:stapler spreaded world:wide as a rutine instrument and became the prototype for future GI staplers.

Conrad Ramstedt (1867:1963) was a surgeon from Munster. In 1912, Ramstedt described a new technique to save the life of the infants suffering from spastic hypertrophic pyloric stenosis.

• 1923. With the support of the Charite in Berlin, th

• ey opened the Institute of Medical

• Cinematography. They put a camera above the operati

• ng table which was electrically directed

• and could make films from operations. These medical

• films primarily demonstrated the

• operative techniques.

1914. William T. Bovie developed an innovative method. His electrosurgical unit let the high frequency alternating current pass through the bodyallowing it to cut or coagulate (electrocautery).

• 1931. Rudolf Nissen (1896:1981) was a German surgeo

• n. He was the first who performed a

• pulmonectomy in a patient who was suffering from br

• onchiectasia. He also developed the

• method of fundoplication of the stomach.

• 1938. János Veres (1903:1979) was a pulmonologist i

• n Kapuvár. In order to prevent injuries • of the lung while getting through the thoracic wall

• , Veres used his own new, special, spring:• loaded needle to create safely an artificial pneumo

• thorax which was a technique for treatment • of the tuberculosis at that time. The instrument (V

• eres:needle) is spreaded world:wide in • creating pneumoperitonuem during laparoscopy.

1944. Alfred Blalock (1899:1964) was an American heart surgeon in Baltimore. In the Johns Hopkins Hospital, he performed the first successfuloperation on a cyanotic infant (”blue:baby”), who had a syndrome of tetralogy of Fallot.

• 1950. Richard H. Lawler (1896:1982) was an American

• surgeon in Chicago. He performed • the first kidney allotransplantation. He used a cad

• aver’s kidney without application of any • immunsuppression. The transplanted kidney functione

• d well at the begining, but they had to • reoperate the patient 10 months later, when they fo

• und a shrunken and pale kidney graft.

1954. Joseph E. Murray (1919: ) performed the world's first successful renal transplantation between the identical twins at the Peter Bent Brigham Hospital in Boston. He wasawarded the Nobel Prize in 1990.His surgical technique is – with minor modifications – still used.

1958. Pope Pius XII (1876:1958) said that doctors could not define the death: ”within the competence of the Church to define death”. This produced an ambivalent opinion in the public: ”You are dead when your doctor says you are”. In 1966, the French Medical Academy for the first time used the irreversible injury to the brain as a factor to establish (determine) the death instead of the cardiac standstill.

III. Period: From the 1960s

1962. András Németh performed the first kidney transplantation in Szeged. 1967. Christiaan Neething Barnard (1922:2001) performed the world's first human heart transplant operation in Cape Town, South Africa. The donor heart came from a 24:year:old woman, who had been killed in a road accident .The recipient was the 54:year:old Louis 12Washkansky. The operation took 3 hours. Washkansky survived the operation and lived for eighteen (18) days when he died due to a severe infection.

• 1985. Erich Mühe (1938:2005) performed the first la

• paroscopic cholecystectomy in

• Böblingen. That time, the German surgical society d

• egradated the method as the ”keyhole

• surgery

• 1998. Friedrich:Wilhelm Mohr (1951: ) using the Da

• Vinci surgical robot performed the first

• robotically assisted cardiac bypass in the Leipzig

• Heart Centre (Germany).

1990. Kiss Tibor performed the first laparoscopic cholecystectomy in Hungary (Pécs).

• 2001. In New York Jacques Marescaux used the Zeus r

• obot to perform a laparoscopic

• cholecystectomy on a 68 year old woman in Strasbour

• g (France)

2004. They started to perform the NOTES (Natural Orifice Transluminal Endoscopic Surgery) interventions with the use of flexible endoscopes in animal models. The human use of the technique promises the reduction of postoperative pain (no pain surgery), the decrease in possibilty for adhesion, and the elimination of postoperative abdominal hernias. It also leads to an incisionless or no scar surgery.