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Journey of surgery till the Middle Ages
Mankind has been affected with wounds, fractures, and outgrowths since antiquity. Various applicants to heal wounds and fractures have included honey, clay, oils, leaves, sulphur, bandaging and plastering. There are written as well as anthropological evidences of surgical practices in the ancient times, such as trephining of skull, drainage of abscesses, cosmetic reconstructions, amputations, and removal of stones. However many such treatments are a scarce mention in much of medieval medicine. Going under the scalpel did not seem to be a desirable therapy.
Between medieval times, and till the dawn of 20th century releasing “bad humours” from the body was a popular concept, and some surgeries were done with such an intention. Blood-letting was a common surgical practice, using either leeches or by surgical incisions. In medieval Europe, such procedures though ordered by physicians, were performed by barbers. This gave rise to a cadre of first non-physician health-care providers, known as barber-surgeons.
Surgical instruments in use in 16th-17th centuries were crude, and so were their operators. A key reason was the speed with which surgical procedure had to be performed in an awake and distressed person. In absence of anaesthesia and asepsis, all surgical practices were limited by pain, infection and no-go areas such as abdomen, chest and brain.
Surgeons in the pre-anesthesia period.
There are some notable surgeons in pre-1846 era, whose practices changed course of surgical practice. Pierre Fauchard helped evolve dentistry from tooth-pullers to dental-surgeons. He wrote texts on oral pathology, described surgical techniques and even designed newer dental instruments. He is credited today as “father of modern dentistry”.
Daviel Jacques specialised as an ophthalmic surgeon, and revolutionised cataract surgery. Prior to 1747, popular method of cataract surgery was couching – sending opacified lens back into the posterior chamber of eye. He perfected “cataract extraction” leaving the capsule of the lens intact and unharmed.
In 1832, Bretonneau demonstrated that tracheostomy can save lives when larynx is inflamed and obstructed. Before him tracheostomy was considered fatal, and a last resort. Bretonneau was however a physician, who coined the words typhoid and diphtheria.
Dominique Larry was a military surgeon. He pioneered concept of triage, developed first ambulances, and would conduct battlefield surgeries. He is credited as a “modern military surgeon”.
Notable surgeons in the post-anesthesia period
Advent of anaesthesia was a game changer. Surgeons could do operations while patients were calm and asleep. They could spend time, giving respect to the tissues, and preserving function. Surgeries such as hysterectomy, appendicectomy, and oophorectomy were first performed in the decade after introduction of anaesthesia. Joseph Lister and Semmelweis popularised the concept of asepsis and hand washing. Octave Terrillion, introduced boiling or autoclaving of surgical instruments. After introduction of asepsis, surgical mortality declined. This also made various branches of surgery feasible, especially neurosurgery, cardiac surgery, and various abdominal surgeries.
Various surgical advances were made in the 20th century. Harvey Cushing pioneered neurosurgery beginning 1900, Schoffler performed first splenectomy in 1916, first hip transplant took place in 1940, and first successful cardiac surgery in 1952. First Kidney transplant was possible in 1952, and Liver transplant in 1963. Historic timeline of surgery grew, and this advancement in surgical practices rests on the shoulders of bold surgeons, careful anaesthetists, and meticulous asepsis.