History of Surgery
Tibor F. Tihanyi History of Surgery periods of development • 1st. Period: from the beginnings till the middle of the 19th. century • 2nd. Period: from the discovery of anaesthesia till the middle of the 20th century • 3rd. Period: from the 1960’s going on today History of Surgery 1st.period • Ancient civilisation: – characterised by superstition and religious beliefs – treating war injuries in Egypt – plastic surgery in India (nose reconstruction) – collection of medical knowledge in China, pain relief by opiates Primitive tribes Ancient civilizations Egypt-Imhotep Mesopotamia-Hamurapi India- Shushrata History of Surgery 1st.period • Antique civilisation: – Greeks: Hippocrates- medical ethics - oath, the four humours of the body. Asclepions the first hospitals – Romans: Celsus in the 1st. Galenus in the 2nd century a.c. GREEKS
Hippocrates ROMANS Celsus Galenus History of Surgery 1st.period • Middle Ages: – The dark period of early Christianity – Preservation of the antique knowledge through the Arabic culture - Middle East, Alexandria, South of Spain – Avicenna
The Islamic World History of Surgery 1st.period
• The XIII-XIVth. Century – Appearance of the first Universities - Medical schools of Solerno, Bologna, Montpellier – great endemic diseases (bubonic plaque, leprosy, syphilis) • The Renaissance: – Anatomic studies by Leonardo da Vinci, Vesalius The „Plaque”
The University Spread of bubonique plaque Paracelsus and The XVIth C The „Surgeon” Ambroise Paré The ART and Science History of Surgery 1st.period
• Scientific revolution in the 17-18th. Century – Discovery of America - expansion of vision. World trade - colonisation – Discovery of the microscope – Fine anatomical structures – Cell as the unit of living organisms – scientific bases of physiology The XVIIth. C Robert Hook’s „CELL”
Treatments
And instruments in XVIIth. The XVIIth. Century History of Surgery 2nd.period • Technical achievements of surgery • Great surgeons of Europe- Dupuytren, Billroth, Kocher, Moynihan, Balassa and United States - Halsted, Mayo brothers • Discovery of X-ray (Roentgen, Curie) • Blood groups by Landsteiner -1900 (ABO) • Fluid replacement , treatment of shock • EHRLICH - Salvarsan, DOMAGK - Sulfonamides, FLEMMING –Penicillin (1929) • ANTIBIOTICS used from 1940 History of Surgery 2nd.period
• Industrial revolution of the 19th century • Discovery of ether, nitrous oxide, chloroform • Basics of physiology - cellular pathology of Virchow Virchoff and the „Cellular Pathology”
Medical students
First abdominal operation in 1809 Developement of Instrumentation
Nitze 1879
O’Dwyer 1880 History of Surgery 2nd.period • Turn-point in surgery -> ANAESTHESIA • H.Wells (dentist) used laughing gas-1845 • T.G.Morton (dentist) used sulphuric ether - 1846 - first operation in Boston • Local anaesthesia with cocaine The Anaesthesia
1844 Horace Wells- Nitrousoxide
1846 William Morton-sulphuric ether (Boston, John C Warren operated )
James Simpson – chloroform History of Surgery 2nd.period • ANTISEPSIS – Semmelweis contagiousness of puerperal sepsis – Lister surgical disinfection with carbolic acid – Pasteur-discovery of micro-organisms - heat treatment – Koch - discovery of pathogenic bacteria Antisepsis Discovery of the Microorganisms Ehrlich Nobel prize for immunologic studies - Salvarsan Domagk - Sulfonamides Flemming - Penicillin
X-ray Among the first and greatest
Theodor Billroth
Baron Dupuytren Lord Moynihan „Classique” Surgeons Pirogov
Development of amputation techniques, rapid operation with less trauma Father of Military Surgery: Sorting of the casualty according to the severity of the injury at the Battle of Sevastopol Great Hungarian surgeons
Gyula Dollinger
János Balassa
Hüttl Hümér Aladár Petz History of Surgery 3rd.period • HI-TECH in surgery from the 1960’s – new technologies, fine instrumentation, computerisation – new imaging techniques (US, CT, MRI) – flexible endoscopy revolutionised diagnostics – new surgical materials, implants – development of immunology - organ transplantation History of Surgery 3rd.period • Increasing costs of diagnosis and treatment lead to rationalisation of procedures • New term: Minimal Invasive Surgery – interventional endoscopy and ultrasonography – Minimal Access Surgery – Shortened hospital stay - outpatient surgery • High specialisation
History of Surgery Future Perspectives
• Surgery will rely more and more on high technology, methods will change - Telerobots, virtual reality • Development of pharmaceuticals will change therapy - many diseases will come out from the scope of surgery • Specialisation will be even higher • Interventional endoscopy-radiology and surgery might be incorporated • Artificial organs developed