Throughout his existence, man has been an aggressive animal and has always been the subject of violence; contusions, fractures, dislocations, impalements, eviscerations, and so on. The earliest surgeons were no doubt those men and women who showed particular interest and skill in dealing with the injuries. Long before written records existed, we have to rely on the only available evidence, obtained from ancient skeletons, to learn something of the diseases which afflicted primitive man and of the earliest surgical endeavours. Archaeologists have unearthed evidence of arthritis, bone infections, and bone tumours from the earliest times. Fractures, of course, are obvious, and splints of wood and of bark recovered from excavations from tombs of the Fifth Dynasty in Egypt have been dated at approximately 2450 bc. However — remarkably and inexplicably — the earliest major surgery of which we have undoubted evidence is trephination of the skull, which dates back to at least 5000 bc in the Stone Age period. Not only did these primitive surgeons, using no more than crude flint or stone instruments, actually bore holes through the skull, but undoubtedly a proportion at least of their patients survived. We know this because about half of the skulls that have been excavated show evidence of healing around the edges of the bone defect. Others show that repeated operations had been performed. Moreover, this procedure was performed in widely different areas of the world. Trephined skulls have been excavated in Western Europe (including England), North Africa, Asia, the East Indies, and New Zealand. In the New World, evidence has been found of the operation in Alaska and down through the Americas to Peru.
There are many unanswered questions about this remarkable operation. There might be a single trephine defect or up to seven in number. Size could vary from a tiny hole to two or more inches in diameter. The operation was performed on men, women, and children. Did this operation, which is today regarded as a sophisticated procedure to be done by an expert neurosurgeon, arise spontaneously in numerous centres throughout the world, or did knowledge of the operation spread gradually from centre to centre? Why was the operation performed? In many cases it was undoubtedly carried out because of injury to the skull. This is particularly so in Peruvian skulls, where fractures in the region of the trephine were commonly found. Among the ancient Peruvians large clubs of wood and stone, and also hatchets have been excavated — reason enough for the production of serious skull injuries. In many other examples, however, there is no evidence of skull injury, and evidence that the operation was repeated at intervals of time. We can only guess that it might have been performed in patients who suffered from mental illness, intractable headache, or epilepsy in order to let out the demon which had possessed the patient — belief in such demons is still held in some primitive races.
To perform safe and effective surgical operations, four major hurdles had to be overcome:(i) The surgeon has to have an effective knowledge of the anatomy of the body.(ii) He must be able to control haemorrhage effectively, whether this is the result of trauma or follows his own surgical incision.(iii) Effective pain relief is necessary in order to spare the patient the agonies of the knife: the development of anaesthesia. Without this, the patient will only submit to the surgeon when his symptoms are intolerable, and then will only allow the shortest and quickest procedure to be carried out.(iv) There must be effective control of infection of the wound, both by the prevention of the access of bacteria (antiseptic and aseptic surgery) and by having the means of killing bacteria which have already invaded the tissues (antibiotics).
These four barriers were successfully overcome over a period of many centuries.
Appreciation of the body's anatomyIn the centuries before an understanding of human anatomy, surgical procedures were necessarily both limited and crude. The major advance was the introduction of human dissection in the European medical schools in the sixteenth century. An important landmark was the publication of the first comprehensive and fully illustrated textbook of human anatomy by Andreas Vesalius in 1543. Surgeons were now at least familiar with the location and relationships of anatomical structures, which enabled them, for example, to expose injured blood vessels and to appreciate what structures might be injured in deep body wounds. Of course, the scope of their endeavours was still seriously limited by the other three problems listed above.
Control of haemorrhageFor centuries, major haemorrhage from injured blood vessels was controlled by pressure or by the application of the cautery iron — what amounts to a red-hot poker. Not only was this inefficient but, of course, it was also horrifyingly painful. The alternative of tying the damaged vessel with a ligature had been employed by various surgeons dating back to Celsus, a Roman medical author in the first century ad. A great advance was made by the French surgeon Ambroise Paré (1510–90) — a contemporary of Vesalius, and who actually met him once in consultation; he taught that ligation of blood vessels was safer and far kinder in major operations, especially in amputations. From then on, the control of haemorrhage became a safer and more accurate procedure.
Relief of painThe agonizing pain of surgical procedures, whether to deal with a major wound, a fractured bone, an amputation, or removal of a tumour, was a major obstacle to the development of surgery. Surgeons would attempt to stupefy the patient with alcohol, opium, or morphia, but with little effect. It was the discovery of the anaesthetic properties of ether by William Morton (1811–68), a dentist in Boston, in 1846, and of chloroform by Sir James Young Simpson (1811–70) of Edinburgh, in the following year, that at last allowed the surgeon to carry out his procedures painlessly and in an unhurried manner under general anaesthesia.
Control of infectionInfection, the fourth in our list of problems, was the greatest impediment to surgical progress and the last to be conquered. Over the centuries, the wounds which surgeons were tending, either as a result of injury or inflicted by themselves on their patients, would swell, redden, and suppurate with the discharge of pus. Indeed, this was regarded as the normal process of wound healing. The patient often became severely ill from the general manifestations of infection — fever, rigors, and toxaemia — and was very likely to die when this occurred. Nowadays, of course, we know that both the local and the general effects of infection are due to bacterial contamination of the wound. It was Louis Pasteur (1822–95) who proved conclusively that putrefaction of milk, urine, meat, and wine was due to bacteria and not merely to exposure to the air. It was the genius of Joseph Lister (1827–1919), the professor of surgery in Glasgow, to realize that it was these bacteria, carried into the wound, which resulted in the suppuration, pus, gangrene, and other dreaded complications which plagued the surgical wards of those days. It was obviously impossible to kill microbes in the wound by means of heat as Pasteur had shown in his experiments, so Lister developed chemical methods to destroy the bacteria, initially carbolic acid. Lister's first operation using this antiseptic method was in 1865, and he was soon able to show that major surgery could be performed with what had virtually never been seen before: healing without infection. The next stage was to progress beyond killing the bacteria that reached the wound to the prevention of contamination by eliminating bacteria from the operating theatre — aseptic surgery, with steam sterilization of instruments, dressings, and gowns, and the other rituals of the modern operating theatre.
Since the days of Lister, the dream had been to discover an agent that would kill the bacteria that spread through the body, without damaging the patient, as well as dealing with local contamination of the wound. It was Howard Florey, Ernst Chain, and their team in Oxford who succeeded in extracting penicillin in 1941. Its effects in both the prevention and the treatment of wound sepsis were dramatic and heralded the onset of today's ‘antibiotic era’.
The conquest of pain, haemorrhage, and infection, together with today's detailed knowledge of the anatomy and physiology of the human body and its derangements under pathological conditions, has opened the way to the extraordinary burgeoning of surgery in the past century or so, with advances being made in the past decades in what seems like geometrical progression. Only some aspects of this vast subject can be chosen here to illustrate this theme.
Abdominal surgeryAbdominal cancers are common and serious problems, and were among the first conditions to be dealt with in the post-Lister period. In 1881, Theodor Billroth (1829–94) carried out the first successful resection of a carcinoma of the stomach, soon to be followed by successes in dealing with cancers of the large bowel, kidney, and other structures. Abdominal emergencies, previously almost invariably fatal, were soon shown to be curable by surgery. Removal of the appendix for acute appendicitis, repair of perforated peptic ulcers, and removal of the ruptured spleen after trauma all became routine procedures.
Cardiac surgeryIt was long thought that even touching the heart would be fatal, and it was not until 1897 that Ludwig Rehn (1849–1930) performed the first successful repair of a wound of the heart. Henry Souttar (1875–1964) made a considerable advance in 1925 when he passed his finger through the wall of the heart to dilate a stenosed mitral valve, an operation that was popularized by Harken in 1948. However, to perform careful procedures on the open heart itself under direct vision, the heart must be put out of circulation and stopped. This required the development of an effective pump oxygenator, which was developed successfully by Gibbon in the US and Melrose in London, allowing the first successful operation with this technique to be carried out by Lillehei in 1956. It was now possible to repair complicated congenital anomalies of the heart, replace diseased and defective valves (either with artificial valves or using pig or human cadaver valves preserved by freeze-drying), and, most commonly of all, to perform bypass operations on occluded coronary arteries, using either a superficial vein taken from the leg or an artery from the front of the ribs. This procedure, the coronary artery bypass graft, is now performed in tens of thousands of patients each year.
Minimal access surgeryRefinement in fibreoptic technology and engineering have produced instruments which are used for so-called ‘keyhole’ surgery. Fine tools can be passed into the abdominal and chest cavities so that many operations which previously required major incisions can now be performed through quite small puncture wounds. This is particularly well established in gynaecological surgery and in operations upon the gall bladder, and techniques are being devised for similar operations on other organs. This technology also involves the development of instruments to pass along every tube in the body, for example to remove obstructions in the oesophagus, bile ducts, bowel, prostate, and major blood vessels. Many procedures on joints — for example, removal of a torn cartilage from the knee — can now be performed safely, using these minimal access techniques.
See also anaesthesia, general; anatomy; dissection.
COLIN BLAKEMORE and SHELIA JENNETT. "surgery." The Oxford Companion to the Body. 2001. Encyclopedia.com. (August 24, 2016). http://www.encyclopedia.com/doc/1O128-surgery.html
COLIN BLAKEMORE and SHELIA JENNETT. "surgery." The Oxford Companion to the Body. 2001. Retrieved August 24, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O128-surgery.html
surgery, branch of medicine concerned with the diagnosis and treatment of injuries and the excision and repair of pathological conditions by means of operative procedures (see also anesthesia; medicine; radiology).
In prehistoric times, sharpened flints and other sharp-edged devices were used to perform various surgical operations. Circumcision and other ritualistic operations were later performed with similar instruments. There are indications that in Neolithic times saws of stone and bone were used to perform amputations. Nearly all major operations were performed by the ancient Hindus nearly a thousand years before the advent of Greek medicine. Knowledge of the use of soporific potions to alleviate the pain caused by surgery can be traced to remote antiquity.
The early Greeks and Romans practiced surgery with great skill and with such cleanliness that infection of surgical and other wounds was relatively uncommon. Their cleanliness and their use of boiled water or wine for irrigating wounds was probably suggested by Hippocrates, a competent surgeon and diagnostician of that time. Other notable early surgeons were Erasistratus and Herophilus of the medical school at Alexandria, and Galen, whose numerous treatises were long influential.
The surgical and sanitary techniques employed by the Greeks and Romans were lost with the decline of their civilizations. During the Middle Ages in Europe there was a marked regression in surgical knowledge, and postoperative infection was common. Surgical practice soon fell into the hands of the unskilled and uneducated: the barber-surgeon, who performed the usual functions of a barber as well as surgical operations, became a common figure, especially in England and France. It was not until the 18th cent. that surgery began to reach a professional level. There were, nevertheless, notable figures in early surgery, among them Guy de Chauliac in the 14th cent., and in the 16th cent. Ambroise Paré, who developed sutures and ligatures to stop bleeding and sew up wounds.
The Birth of Modern Surgery
With the introduction of antiseptic methods, surgery entered its modern phase. Louis Pasteur established the fact that microbes are responsible for infection and disease. Using this knowledge, Dr. Ignaz Semmelweis reduced postpartum infections (puerperal sepsis) in the wards of Vienna's lying-in hospitals by urging doctors to wash their hands between patients. In the 1860s Joseph Lister introduced the use of carbolic acid as a cleansing and disinfecting agent, and his results in reducing infection were dramatic. It was found later that the carbolic acid spray that Lister used to cleanse the air about the patient was unnecessary, but the antiseptic treatment of instruments and other articles in contact with the patient continued until antisepsis was gradually replaced by the aseptic methods employed in modern hospitals. Before the discovery of antisepsis by Lister, about 80% of surgical patients contracted gangrene.
Ernst von Bergmann is credited with introducing steam sterilization under pressure for treating instruments and all other medical equipment used for a surgical patient. William Stewart Halsted, the famous surgeon at Johns Hopkins Hospital, introduced sterile rubber gloves when the hands of his fiancée became irritated from constant washings and antiseptics. The development of methods of anesthesia, especially the discovery in the 1840s of the value of ether, has also been of immeasurable value.
Surgery in the Twentieth Century
In the 20th cent., surgery has benefited from an improved understanding of the causes of shock and its treatment; knowledge of blood group typing and transfusion techniques; understanding of blood clotting and the use of anticoagulants; and the development of antibiotics to control infection and analgesics to control pain. Surgical instruments have developed along with modern technology and are now sophisticated, meticulously designed devices. Electrically powered surgical instruments are invaluable for cautery and for separating hard tissues such as bone with minimal damage. Surgical stapling instruments, first developed in the Soviet Union, can join blood vessels or other tissues in less than half the time required by hand stitching. New medical glues, surgical tapes, and even zippers now enable surgeons to close some wounds effectively without stitches. With the development of X-ray techniques and fluoroscopy and, later, CAT scans and magnetic resonance imaging (MRI), surgery gained valuable diagnostic instruments. Some operations are now being conducted inside specially adapted MRI devices, allowing the surgeon to have live images for guidance during operations. Holograms can be created using data from MRI and other diagnostic instruments and are beginning to be used in the operating room to give surgeons a three-dimensional image of the area to be operated upon, and models created using 3D printers may be used in preparing for complex surgeries.
Cryogenic, or supercooled, probe beams have been used to precisely remove tissues and abnormal growths. Ultrasound techniques, using very-high-frequency sound waves, are used to break up kidney stones and are employed in brain and inner-ear operations, which require great precision and control. They are also used to scan the pregnant uterus, a process that, unlike X-ray scanning, does not endanger the fetus. Medical lasers, which produce amplified monochromatic light waves in a very narrowly focused beam, have become useful tools in various forms of surgery, notably that of the eye, and are now commonly used to remove or "spot-weld" tissues.
The heart-lung machine made open-heart surgery possible by taking over the blood-pumping and breathing functions of these organs during operations. Hypothermia, or cold surgery, by which the body is cooled to lower the rate of metabolism, thus reducing the need for oxygen, has made long operations, especially those involving transplantation, possible. Other recent transplantation advances include procedures involving the liver, lungs, pancreas, bone marrow, and the kidney. The first human heart transplant was performed in 1967 by South African surgeon Christiaan Barnard. The usefulness of transplantation is currently limited by the fact that drugs must be used constantly to halt the body's rejection of foreign tissue.
New techniques in orthopedic surgery (see also orthopedics) have also been introduced, including the use of cementing substances to unite bones destroyed by tumor and the replacement of joints with metal or plastic devices. Plastic surgery and reconstructive surgery have made enormous strides, and microsurgery is making severed or injured limbs usable.
A trend toward less invasive surgery and shorter hospital stays began in the 1980s. By 1995 more than 56% of all surgical procedures in the United States were done on an outpatient basis, without an overnight stay in a hospital. Endoscopic surgery, using small incisions and tiny instruments attached to fiber-optic viewing devices (see endoscope), has been used in place of more traditional procedures for gall-bladder surgery, and it has been used on the fetus in the womb to correct life-threatening birth defects before birth. Angioplasty is frequently used to circumvent or postpone the need for coronary artery bypass.
See O. H. and S. D. Wangensteen, The Rise of Surgery (1979); R. Selzer, Confessions of a Knife (1979); A. S. Earle, Surgery in America (1965, rev. ed. 1983); R. M. Youngson, The Surgery Book (1993); N. L. Tilney, Invasion of the Body (2011).
"surgery." The Columbia Encyclopedia, 6th ed.. 2016. Encyclopedia.com. (August 24, 2016). http://www.encyclopedia.com/doc/1E1-surgery.html
"surgery." The Columbia Encyclopedia, 6th ed.. 2016. Retrieved August 24, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1E1-surgery.html
Surgery is the treatment of disease or injury by cutting into the body to repair or remove the injured or diseased body part. Surgery is usually performed by surgeons in the operating room of a hospital or clinic.
Surgery has been performed since ancient times. The earliest surgical operations were circumcision (removal of the foreskin of the penis) and trepanation (cutting a hole in the skull for the release of pressure or "demons"). Stone Age skulls bearing holes from trepanning have been found around the world. The ancient Egyptians practiced surgery as early as 2500 b.c. using sharp instruments made of copper. The ancient Hindus of India excelled at surgery, performing tonsillectomies, plastic surgery, and removal of bladder stones and cataracts (a clouding of the lens of the eye). The Greeks and Romans used a variety of instruments, including forceps, knives, probes, and scalpels, to operate on wounds and amputate limbs.
During the Middle Ages (400–1450), medical knowledge slowed, and those performing operations, called barber-surgeons, often possessed little education or skill. Without knowledge of antisepsis (techniques to prevent infection), surgery was extremely risky and often resulted in complications or death of the patient.
After the Middle Ages, efforts were made to elevate the status of surgery to a level of some prestige and professionalism. Instrumental in this effort was the great French surgeon Ambroise Paré (1517–1590). Paré introduced the use of ligature (material such as thread or wire) for the tying of blood vessels to prevent excessive bleeding during amputations. His medical writings, which include information on anatomy and discussion of new surgical techniques, greatly influenced his fellow barber-surgeons and advanced the surgical profession.
Era of modern surgery
The era of modern surgery began in the nineteenth century with the introduction of anesthesia (techniques to lessen pain), antiseptic methods, and sterilization of instruments. The discovery of the X ray in 1895 gave surgeons an invaluable diagnostic tool. X rays are a form of radiation that can penetrate solids and are used to generate images of bones and other tissues. Diagnoses using X rays were followed by diagnoses using ultrasound, computerized axial tomography (CAT) scanning, and magnetic resonance imaging (MRI).
Words to Know
Anesthesia: Method of decreasing sensitivity to pain in a patient so that a medical procedure may be performed.
Barber-surgeon: Name given to often unskilled and uneducated persons who practiced surgery during the Middle Ages.
Computerized axial tomography (CAT scan): An X-ray technique in which a three-dimensional image of a body part is put together by computer using a series of X-ray pictures taken from different angles along a straight line.
Endoscope: Instrument for examining internal body cavities or organs.
Laser: A device that sends out a high-intensity beam of light.
Ligature: Material such as thread used to tie a blood vessel or bind a body part.
Magnetic resonance imaging (MRI): A technique for producing computerized three-dimensional images of tissues inside the body using radio waves.
Trepanation: The removal of a circular piece of bone, usually from the skull.
Ultrasound: A diagnostic technique that uses sound waves to produce an image.
X ray: A form of electromagnetic radiation that can penetrate solids that are used to generate images of bones and other tissues.
Surgery advances in the twentieth century include techniques for performing blood transfusions, brain and heart operations (such as bypass surgery and valve replacement), organ transplantation, microsurgery, and laser surgery. Microsurgery allows surgeons to perform precise, delicate operations on various body structures while viewing the surgical area through a microscope. Lasers, high-intensity beams of light focused at targeted tissues, are used to treat eye disorders, break up kidney stones and tumors, and remove birthmarks, wrinkles, and spider veins.
Some types of surgery that previously required extensive cutting through body tissue can now be accomplished using less invasive techniques. Endoscopic surgery is a method of operating on internal body structures, such as knee joints or reproductive organs, by passing an instrument called an endoscope through a body opening or tiny incision. Tiny surgical instruments and a miniature video camera, allowing viewing of the area to be operated on, are attached to the endoscope.
Plastic surgery, including cosmetic surgery, has flourished in the twentieth century. Plastic surgery is the reconstruction or repair of damaged
tissue due to injury, birth defects, severe burns, or diseases such as cancer. Cosmetic surgery is increasingly popular for both men and women and includes facelifts, breast enlargement and reduction, nose reshaping, and liposuction (removal of fat from tissues).
A dramatic advance in recent years is fetal surgery, in which procedures such as blood transfusions or correction of a life-threatening hernia (rupture) or urinary tract obstruction are performed on the unborn fetus while the mother is under general anesthesia.
[See also Plastic surgery ]
"Surgery." UXL Encyclopedia of Science. 2002. Encyclopedia.com. (August 24, 2016). http://www.encyclopedia.com/doc/1G2-3438100620.html
"Surgery." UXL Encyclopedia of Science. 2002. Retrieved August 24, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3438100620.html
See also 266. MEDICAL SPECIALTIES .
- Medicine. removal of part of the body by surgery.
- excision or amputation.
- Obsolete, cautery.
- the act of cauterization, or burning away of dead tissue.
- a surgical perforation or puncture.
- Archaic. surgery.
- the breaking of a bone into small pieces. See also 52. BONES .
- a surgical instrument for opening a hole in the skull.
- a surgical technique using freezing to destroy tissue.
- any form of plastic surgery of the skin, as skin grafts.
- surgery of the vagina.
- repair or restoration of part of the body by plastic surgery.
- the surgical practice of bone-grafting.
- a serrated instrument for bone surgery.
- 1. the dissection or anatomy of bones.
- 2. the cutting of bones as part of a surgical operation. —osteotomist, n.
- the branch of surgery dealing with the replacement of missing limbs or organs with artificial substitutes. — prosthetic, adj.
- an obsession with surgery.
- the process of suture.
- surgical excision of part of the vas deferens, the duct which carries sperm from the testes, performed as a form of male contraception.
- the process of surgically grafting tissue from a lower animal onto the human body. —zooplastic, adj.
"Surgery." -Ologies and -Isms. 1986. Encyclopedia.com. (August 24, 2016). http://www.encyclopedia.com/doc/1G2-2505200399.html
"Surgery." -Ologies and -Isms. 1986. Retrieved August 24, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-2505200399.html
sur·ger·y / ˈsərjərē/ • n. (pl. -ger·ies) 1. the branch of medicine concerned with treatment of injuries or disorders of the body by incision or manipulation, esp. with instruments: cardiac surgery. ∎ such treatment, as performed by a surgeon: he had surgery on his ankle. 2. Brit. a place where a doctor, dentist, or other medical practitioner treats or advises patients. ∎ [in sing.] an occasion on which such treatment or consultation occurs: Doctor Bailey had finished his evening surgery.
"surgery." The Oxford Pocket Dictionary of Current English. 2009. Encyclopedia.com. (August 24, 2016). http://www.encyclopedia.com/doc/1O999-surgery.html
"surgery." The Oxford Pocket Dictionary of Current English. 2009. Retrieved August 24, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O999-surgery.html
"surgery." World Encyclopedia. 2005. Encyclopedia.com. (August 24, 2016). http://www.encyclopedia.com/doc/1O142-surgery.html
"surgery." World Encyclopedia. 2005. Retrieved August 24, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O142-surgery.html
"surgery." A Dictionary of Nursing. 2008. Encyclopedia.com. (August 24, 2016). http://www.encyclopedia.com/doc/1O62-surgery.html
"surgery." A Dictionary of Nursing. 2008. Retrieved August 24, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O62-surgery.html
"surgery." Oxford Dictionary of Rhymes. 2007. Encyclopedia.com. (August 24, 2016). http://www.encyclopedia.com/doc/1O233-surgery.html
"surgery." Oxford Dictionary of Rhymes. 2007. Retrieved August 24, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O233-surgery.html