A focused look into the History of Surgery.pptx

Lecture notes for UG MBBS.

1. Why read history? Those who cannot remember the past are condemned to repeat it. –Santayana. To draw some lessons from history. To find a worthy ideal hero.

2. Introduction It wasn't until the 1900s that the likelihood of surviving surgery was greater than the chance of dying during or immediately after surgery . Surgeons have become less aggressive bacause we are now catching diseases at earlier stages and we have nowother modes like radiotherapy, chemotherapy, monoclonal antibodies etc,

3. Periods of History Prehistory before writing. Ancient history upto 500 BC Middle ages 500 BC to 1500 AD Modern age From 1500 AD Contemporary age

4. Prehistory

5. Prehistory Examples of healed fractures in prehistoric human bones, suggesting setting and splinting have been found in the archeological records. The oldest known surgical amputation was carried out in Borneo about 31,000 years ago. 6,500 B.C.E.:  Skulls found in France show signs of a rudimentary surgery called trepanation, which involves drilling a hole in the skull. In China, instruments resembling surgical tools have also been found in the archaeological sites of Bronze Agedating from the Shang dynasty along with seeds likely used for herbalism

6. Ancient history In  Ninevah archaeologists have discovered bronze instruments with sharpened obsidian resembling modern day scalpels, knives, trephines, etc. The Code of Hammurabi one of the earliest Babylonian code of laws, itself contains specific legislation regulating surgeons and medical compensation as well as malpractice and victim's compensation.

7. Ancient history In 2700 BCE the first treatise on surgery was written by Imhotep . In Memphis Egypt engraving of a surgical procedure: circumcision. 1550 BCE Ebers Papyrus- how to surgically treat crocodile bites and serious burns, recommending the drainage of pus-filled inflammation. The Edwin Smith Papyrus is a  manual for performing traumatic surgery- repairing a broken nose, sutures. 

8. Middle ages In the 13th century in Europe skilled town craftsmen called barber-surgeons performed amputations and set broken bones while suffering lower status than university educated doctors  With little or no formal training, they generally had a bad reputation. development of academic surgery as a specialty of medicine rather than an accessory field in the 18th-century Age of Enlightenment. 1540 C.E.:  English barbers and surgeons unite to form The United Barber-Surgeons Company. These barber-surgeons performed tooth extractions and bloodletting. 1800. The Royal College of Surgeons of England was founded.

9. Modern times The discipline of surgery was put on a sound, scientific footing during the Age of Enlightenment in Europe (1715–90 ) .

10. Problems of surgery Knowledge of Anatomy Bleeding Infection Pain Opening and closing cavities would not be fully resolved until the ending decades of the 19th century . About 100 years ago almost all the surgeries that we are performing today were devised.

11. Problems of surgery: Knowledge of Anatomy Knowledge of Anatomy. Andreas Vesalius (1514-1564) Blood circulation- William Harvey

12. Problems of surgery:Bleeding Hemostasis In ancient times Cauterization with heated metal, boiling oil or both. Later tourniqutes were used. After Harway’s description of blood circulation In 1718,  Jean Louis Petit developed a screw device for occluding blood flow in surgical sites. Ambroise Paré rediscovered ligaure and inveted a precursor of hemostat/ . In 1926, Harvey Cushing and William Bovie collaborated to electric cautery .

13. Problems of surgery: Pain Pain Narcotic and soporific agents, such as hashish, mandrake, and opium, had been used for thousands of years, Nitrous oxide aka laughing gas was tried and rejected later reintroduced for painless labour . Wells , Morton Jackson and warren established inhalational anesthesia.in 1846 Halsted developed local anesthesia James Corning and August Bier developed Spinal anesthesia in 1920.

14. Infection 1847: Semmelweis  proposed the practice of  washing hands  with chlorinated lime solution. 1864: Louis Pasteur proved germ theory of disease. 1867:  British surgeon Joseph Lister publishes  Antiseptic Principle in the Practice of Surgery,  extolling the virtues of cleanliness in surgery. The mortality rate for surgical patients immediately falls.

15. Modern times 1885:  First successful appendectomy performed, in Iowa. 1893:  First successful heart surgery performed, Provident Hospital, Chicago. 1895:  First  X-ray  performed, in Germany. 1896:  First successful heart surgery performed, in Germany. Surgeons repaired a stab wound in the muscle of the right ventricle. 1928:  Antibiotics discovered.

16. Modern times 1940:  First metal hip replacement surgery performed. 1950:  First successful organ transplant The kidney recipient rejected the organ after eight months. 1952:  First successful  heart surgery where the heart was stopped and restarted. 1953:  First successful surgery using a heart-lung bypass machine

17. Modern times 1967:  First heart transplant surgery performed, by South African Christian Barnard. 1975:  First organ surgery performed using  laparoscopic or minimally invasive, technique. 1978:  First "test-tube" baby born using in vitro fertilization. 1982:  Jarvik-7 artificial heart used.

18. Contemporary 1984:  Baby Fae survives 21 days after being transplanted with the heart of a baboon. The first laparoscopic cholecystectomy  by German surgeon Erich Mühe 1985:  First documented robotic surgery. 1999:  First successful hand transplant (previous patients had rejected their grafts). 2001 Telesurgery 2007:  First natural orifice transluminal endoscopic surgery performed. 2008:  Connie Culp has the first near-total full face transplant

19. Contemporary 2013:  A nerve transfer procedure gives a paraplegic patient the ability to move their hands.

20. Our Contribution. 3300 BCE. Trepanation, broken bones, wounds in Indus Valley civilization. Teeth discovered from a Neolithic graveyard in  Mehrgarh  had shown signs of drilling. Sushruta  (c. 600 BCE) is considered as the "founding father of surgery".   Sushruta Samhita  describes in detail the examination, diagnosis, treatment, and prognosis of numerous ailments, as well as procedures on performing various forms of cosmetic surgery, plastic surgery and  rhinoplasty

21. Our Contribution. First Xenotransplant Dhaniram Baruah first heart surgeon in the world to transplant a pig's heart in a human body. 1995. Use of adult stem cells in neoregeneration of abdominal wall apponeurosis , used in surgical treatment of incisional hernia. Indian surgeon B.G. Matapurkar . GV Rao of Hyderabad did first NOTES.in 2007.

22. Heroes of Surgery Father of Surgery- Sushrut . Hippocrates “ the Founder of Western Medicine ” 5th century BC elevated and separated the standards of medical science from superstistions . His surgical works are on Joints, On Fractures Injuries of the Head, On Ulcers, On Fistulae, and On Hemorrhoids. He became the first to distinguish benign from malignant breast tumors,

23. Heroes of Surgery Herophilus of Chalcedon and  Erasistratus of Ceos  were two great Alexandrians who laid the foundations for the scientific study of anatomy and physiology. Developments in ligature ( hemostasis ), lithotomy , hernia operations, ophthalmic surgery, plastic surgery, methods of reduction of dislocations and fractures, tracheotomy, and mandrake as anesthesia. Most of what we know of them comes from  Celsus  and Galen of Pergamum. 

24. Heroes of Surgery Galen  On the Natural Faculties , Books I, II, and III animal and human physiology and the art of surgery. Galen gave cancer (Latin for crab) its name. He was one of the first to use ligatures in his experiments on animals Galen is also known as "The king of the catgut suture. Laudable pus.

25. Heroes of Surgery Andreas Vesalius human anatomy. French army surgeon Ambrose Paré   Developed an emollient of egg yolk, rose oil, and turpentine for gunshot wounds. Brought the resurgence of ligating , “I treated him. God cured him,”

26. Heroes of Surgery John Hunter(1728–1793), generally regarded as the father of modern scientific surgery. Considered greatest surgeon of all times. He brought an empirical and experimental approach to the science.  Aneurysm surgery. First museum of comparative anatomy and pathology in the world.

27. Heroes of Surgery Louis Pasteur germ theory of disease. 1865, Joseph Lister, “ listerism .” Lister recommended antisepsis, or the removal of bacteria from instruments, wounds, and the air above the patient. His process consisted of using carbolic acid as a sterilizing agent, A second important advance by Lister was the development of sterile absorbable sutures. He was able to cut the ends of the ligature short, thereby closing the wound tightly . He developed autoclave. Regarded as father of modern surgery.

28. Heroes of Surgery On October 16, 1846, William T.G. Morton, a Boston dentist, persuaded John Collins Warren , professor of surgery at the Massachusetts General Hospital, to let him administer sulfuric ether to a surgical patient from whom Warren went on to remove a small, congenital vascular tumor of the neck painlessly.

29. Heroes of Surgery  Joseph Bell (1837–1911) became the inspiration for Arthur Conan Doyle's literary hero Sherlock Holmes. Percival Pott   cancer may be caused by an environmental carcinogen after he noticed a connection between chimney sweep's exposure to soot and their high incidence of scrotal cancer.

30. Heroes of Surgery William Stewart Halstead (1852–1922) laid out basic surgical principles for asepsis known as  Halsteads principles Halsted also introduced the latex medical gloves. Developed surgical residency programme . Performed the first complete radical mastectomy in the U.S., which became the standard treatment.

31. Heroes of Surgery Mike Debakey

32. Take home lessons Semmelweis - Don’t ridicule new ideas. Dhaniram Baruah – Don’t be reckless in doing new things . Erich muhe – Don’t be disheartened even if the world is against you.

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