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For other uses of "surgery" or "surgeon", see surgery (disambiguation) and surgeon (disambiguation).
A cardiothoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center.

Surgery (from the Greek [χειρουργική] Error: {{Lang}}: text has italic markup (help) meaning "hand work") is the medical specialty that treats diseases or injuries by operative manual and instrumental treatment. Surgeons may be physicians, dentists, or veterinarians who specialize in surgery.

A surgery can also refer to the place where surgery is performed, or simply the office of a physician, dentist, or veterinarian.

Ancient India

Indian physician Sushruta (c. 600 BC) taught and practiced surgery on the banks of the Ganges in the area that corresponds to the present day city of Benares in Northern India. Much of what is known about Sushruta is contained in a series of volumes he authored, which are collectively known as the Susrutha Samhita. It is the oldest known surgical text and it describes in exquisite detail the examination, diagnosis, treatment, and prognosis of numerous ailments, as well as procedures on performing various forms of plastic surgery, such as cosmetic surgery and rhinoplasty.[1]

In the Sushruta school, the first person to expound Āyurvedic knowledge was Dhanvantari who then taught it to Divodasa who, in turn, taught it to Sushruta, Aupadhenava, Aurabhra, Paushakalāvata, Gopurarakshita, and Bhoja.

Because of his seminal and numerous contributions to the science and art of surgery he is also known by the title "Father of Surgery." The Samhita has some writings that date as late as the 1st century, and some scholars believe that there were contributions and additions to his teachings from generations of his students and disciples. Susrutha is also the father of Plastic Surgery and Cosmetic Surgery since his technique of forehead flap rhinoplasty (repairing the disfigured nose with a flap of skin from the forehead),that he used to reconstruct noses that were amputated as a punishment for crimes, is practiced almost unchanged in technique to this day. This knowledge of plastic surgery existed in India up to the late 18th century as can be seen from the reports published in Gentleman's Magazine (October 1794).

The Susrutha Samhita contains the first known description of several operations, including the uniting of bowel, the removal of the prostate gland, the removal of cataract lenses and the draining of abscesses. Susrutha was also the first surgeon to advocate the practice of operations on inanimate objects such as watermelons, clay plots and reeds; thus predating the modern practice of the surgical workshop by half a millennium.

Ancient Egypt

Researchers have uncovered an Ancient Egyptian mandible, dated to approximately 2650 BC, with two perforations just below the root of the first molar, indicating the draining of an abscessed tooth. Recent excavations of the construction workers of the Egyptian pyramids also led to the discovery of evidence of brain surgery on a labourer, who continued living for two years afterwards.[citation needed]

Ancient Greece

While surgeons are now considered to be specialised physicians, the profession of surgeon and that of physician had different historical roots. For example, Greek tradition was against opening the body, and the Hippocratic Oath warns physicians against the practice of surgery. Specifically, cutting persons laboring under the stone (i.e. lithotomy, an operation to relieve kidney stones) was to be left to such persons as practice [it]. Of course, most knowledge of surgery comes from dissecting bodies, a science which was repulsive to many healers.[citation needed]

Ancient China

Hua Tuo was a famous Chinese physician during the Eastern Han and Three Kingdoms era. He was the first person to perform surgery with the aid of anesthesia, some 1600 years before the practice was adopted by Europeans.[citation needed]

Medieval Europe

Abulcasis (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi) was an Andalusian-Arab physician and scientist who praticised in the Zahra suburb of Cordova. He is considered a great medieval surgeon, whose comprehensive medical texts, combining Middle Eastern and Greco-Roman classical teachings, shaped European surgical procedures up until the Renaissance. He is often regarded as the Father Of Surgery[citation needed]. Patients and students from all parts of Europe came to him for treatment and advice. According to Will Durant, Cordova was in this period the favourite resort of Europeans for surgical operations.

Surgery in Holland (ca. 1690)

By the thirteenth century, many European towns were demanding that physicians have several years of study or training before they could practice. Montpellier, Padua and Bologna Universities were particularly interested in the academic side to Surgery, and by the fifteenth century at the latest, Surgery was a separate university subject to Physics. Surgery had a lower status than pure medicine, beginning as a craft tradition until Rogerius Salernitanus composed his Chirurgia, which laid the foundation for the species of the occidental surgical manuals, influencing them up to modern times.

Europe

Ambroise Paré pioneered the treatment of wounds by gunshots. Among the first modern surgeons were battlefield doctors in the Napoleonic Wars who were primarily concerned with amputation. Naval surgeons were often barber surgeons, who combined surgery with their main jobs as barbers.

In London, an operating theatre or operating room from the day before modern anaesthesia or antiseptic surgery still exists, and is open to the public. It is found in the roof space of St Thomas Church, Southwark, London and is called the Old Operating Theatre.

Development of modern surgery

To make its transition to the modern era the art of surgery had to overcome three major problems that were effectively preventing surgery from progressing to become the widely respected discipline we see today. These three great barriers were:

  • Bleeding
  • Infection
  • Pain

Bleeding

Before modern surgical developments, there was a very real threat that a patient would bleed out on the table during an operation or bleed to death while being attended after an accident or wound. The first real progress in combating bleeding had come when early cultures realized they could close wounds using extremes of heat, a procedure called cauterizing. The early cauterization was successful, but only useable in a limited fashion, highly destructive, and painful, with terrible long term outcomes.

The next real breakthrough to come was the invention of ligatures, something widely believed to have originated with Ambrose Pare during the 16th century. A ligature is a piece of material used to tie closed the end of a cut blood vessel preventing any further bleeding by serving to occlude it. Ligatures form the basis of modern control bleeding, but at the time, they were more of a hazard than a help because the surgeons using them had no concept of infection control.

A final barrier to be overcome was the problem of replacing blood lost. Limiting bleeding is important, but ultimately, a surgeon is fighting a losing battle if blood cannot be replaced, and this final barrier was only conquered when early 20th century research into blood groups allowed the first effective blood transfusions.

Infection

Big holes into sealed internal environments lead to infections, especially if the surgeon is using unsterilised tools, covered in blood and wearing his normal clothes. The first progress in combating infection was made by the Hungarian doctor Semmelweiss who noticed that medical students fresh from the dissecting room were causing excess maternal death compared to midwives. Semmelweiss, despite ridicule and opposition, introduced compulsary handwashing for everyone entering the maternal wards and was rewarded with a plunge in maternal and fetal deaths, however the royal society in the UK still dismissed his advice. The next true progress came when, after reading a paper by Louis Pasteur, the British surgeon Joseph Lister began experimenting with using phenol during surgery to prevent infections. Lister was able to quickly improve infection rates no end, a process that was further helped by his subsequent introduction of techniques to sterilise equipment, have rigorous hand washing and a later implementation of rubber gloves. Lister published his work as a series of articles in The Lancet (March 1867) under the title "Antiseptic Principle of the Practice of Surgery". The work was groundbreaking and laid the foundations for a rapid advance in infection control that saw modern aseptic operating theatres widely used within 50 years (Lister himself went on to make further strides in antisepsis and asepsis throughout his lifetime). The gradual development of germ theory has allowed the final step to be taken to create the highest quality of aseptic conditions in modern hospitals and this has allowed us to (theoretically) perform infection free surgery.

Pain

Anesthesia was discovered by two American dentists, Horace Wells (1815-1848) and William Morton. Before the advent of anesthesia, surgery was a traumatically painful procedure and surgeons were encouraged to be as swift as possible to minimize patient suffering. This also meant that operations were largely restricted to amputations and external growth removals.

Beginning in the 1840s, surgery began to change dramatically in character with the discovery of effective and practical anaesthetic chemicals such as ether and chloroform. In Britain, John Snow pioneered the use of these two anaesthetics. In addition to relieving patient suffering, anaesthesia allowed more intricate operations in the internal regions of the human body. In addition, the discovery of muscle relaxants such as curare allowed for safer applications.

Doctor or Mister?

In the United Kingdom, Australia, South Africa and New Zealand surgeons are distinguished from physicians by being referred to as "Mister." This tradition has its origins in the 18th century, when surgeons were barber-surgeons and did not have a degree (or indeed any formal qualification), unlike physicians, who were doctors with a university medical degree.

By the beginning of the 19th century, surgeons had obtained high status, and in 1800, the Royal College of Surgeons (RCS) in London began to offer surgeons a formal status via RCS membership. The title Mister became a badge of honour, and today only surgeons who are Fellows of the Royal College of Surgeons generally call themselves Mister, Miss, Mrs or Ms in the course of their professional practice. [citation needed]

By contrast, North American physicians and surgeons are always addressed as "Doctor." The title of doctor is represented in a physician and surgeon's name by the title M.D., D.O., D.P.M , D.D.S., or D.M.D. following his/her surname.

Diseases that can be treated by surgery

Common surgical procedures

According to 1996 data from the US National Center for Health Statistics, 40.3 million inpatient surgical procedures were performed in the United States in 1996, followed closely by 31.5 million outpatient operations.

Noted surgeons

For a more complete list, see List of surgeons.

Surgical procedures and techniques

See also

  1. ^ http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2002;volume=48;issue=1;spage=76;epage=8;aulast=Rana
source: https://en.wikipedia.org/w/index.php?title=Surgery&oldid=120092660

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