Term Paper: History of Surgery

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[. . .] F. Greek Medicine

Carola (1992) writes, two Greek scholars, Alcmaeon and Empedocles made their researches using human body dissection and physiology study. From this discovery, they successfully determined the function of the heart to give life to human, and transfer "pneuma" through blood vessels.

When Hippocrates (ca. 460-377 B.C) set the journey of medicine, the modern medicine had advantaged from previous study to relate diseases to more scientific manner, instead of mystical terms.

He studied about the effect of pleurisy and said that pleurisy led to empyema in 20 days and might cause death. After examination and listening to patient's succussion splash, he recommended cutting the bulge on the patient's chest and draining the pus using a tin tube (Warren, 2001).

Two other scientists, Herophilus (ca. 335-280 B.C) and Erasistratus (ca. 310-250 B.C) completed it. By performing dissection on human body Herophilus found the function of brain as the center of intelligence. He also distinguished veins and arteries, and found the nerve system. Erasistratus found that "pneuma" or air is breathed in through the lungs and transported in the arteries.

As described by "The History of Medicine," the Hippocrates principles were taught to physicians in Greece. They were well trained, handling such surgery procedures and codes of medical ethics. Along with the achievement in intellect and arts, the Greek discovered some medical instruments to perform in the theatre. Physicians worked on cataract and stone removal operations, pus drainage from infection, and sutures. Not to mention, wars and athletic contests contributed injuries, or advancement in broken bones treatment. They used the traction method to restore bones dislocations and buttress broken bones to the proper position.

Hippocrates also mentioned the use of rectal speculum (hedrodiastoleus) - now stored in the Claude Moore Health Science Library, UVA - to examine "the ulcerated parts of the bowel" (Klein, 2000).

Hooks were also very common. The blunt one was used for dissection and raising blood vessels, while the sharp one was for raising tissue during excision. This was also useful and tidy to fix and suture the edges of the wounds (Klein, 2000).

Most materials were made of bronze. There was also a kind of medicine chest, portable box substitute to doctor's bag, which was handy to carry surgical instruments like scalpel, probes, and drugs needed for in-house calls.

G. Roman Medicine

The principle of organ structures by Herophilus in Greece was revealed again by Galen (ca. AD 129-199). He was the most famous Roman physician who made a breakthrough by dissecting a monkey to find out the organ functions, considering its similarity to human's. From his experiment, Galen refined the differences of veins and arteries and other structures. He also found that blood runs through the vessel, instead of "pneuma" or air as described before. However he said that "pneuma" entered the lungs and it met the blood in the heart which gave the body the spirit to live and grow (Mayeaux).

This was a very famous era of war and violence, despite the power of the kingdom. Anyway, thanks to the wars, since they allowed surgeons to learn a lot on fixing human injuries craftsmanship. Soldiers from the wars and victims of gladiator combat were the special patients besides usual diseases to treat.

Some ancient Roman surgical instruments were excavated from the House of the Surgeon at Pompeii, now displayed at the Historical Collections and Services of the Health Sciences Library, University of Virginia.

Vaginal speculum was the one survived until the middle of 18th century and even until 20th century. This is a tool to examine the vagina during obstetrics and urinary case, with a screw to open both handles. A bronze tube might also accompany the use of the specula; this would be inserted into rectum, vagina, or nose to prevent unnecessary muscle contraction and also to help channeling the chemical treatments.

Other tool was bone lever to pick bone fractures and extract tooth, and sometimes used in serious foetal cranium injury or "depressed fracture" - to open the skull and remove the part of the bone. Bone drills and bone forceps in variety of sizes were used to make a hole in the injured bone parts and to remove particles from the healthy tissue, including metal chips from weapons. Since bloodletting still believed to be an effective cure, the bloodletting cups were also popular. There was a famous skull surgeon, Aulus Cornelius Celsus.

They still used Greek hooks, mostly in gynecologic purpose. For patients with urinary problems, surgeons might need to employ a 26 cm bronze catheter into the urinary tract. The curved catheter was designed specifically for male and the straight one was for female.

Although not using anesthetics, but Romans had found the useful use of mandragora to reduce one's consciousness. In other case, they might need to hold the patient tight during sections.

Greek and Roman physician mostly used the same kinds of instruments, which means the Roman adapted a lot of the predecessor's knowledge of medicine. The Roman contributed little innovations in surgery.

H. The Dark Ages and the Middle Ages

After the end of the Roman Empire, church became the center of the law and rules. Thus, medicine also came into the monks and clergy's hands. Mayeaux explains, little and almost nothing was improved in medical practice around 400-800 AD. The monks merely based on Galen's theory, which yet was not significantly proven. They only applied medical treatments that worked before to similar cases. Since it was also a religious matter to relate human body and God's rules, dissection of dead body was prohibited.

However, the monks made good records in archiving the medicines and herbs used widely. This encouraged the teaching of medicines too. By the end of the Dark Ages, hospitals and medical schools were established.

Furthermore Mayeaux explains, a scholar, William of Saliceto (1210-1280) had built a school of surgery and the rest was great improvement. He made some recommendations of using knife in surgery after several trials.

Surgeons also started using wine, as primitive antiseptic to clean wounds and minimal anesthetics in surgery, like opium and mandrake soaked into sponges. Thanks to Theodoric, Bishop of Cervia who first escalated the knowledge to public. He also gave friendly approach to public to accept dissection.

Therefore, dissection became popular by the 14th century, as well as traditional medicine, and the art of trepanation.

I. The Renaissance

Since professional medical practitioners were rare and expensive, people turned to barber-surgeons who gained privileges during the Dark Ages as clergy assistant. They did not get enough surgery training and gained experience through the job. However, their presence was essential since the war continued and more victims needed to be treated.

According to Mayeux, amputations even existed in this 16th century. Wounds from gunshot mostly treated using warm or boiling oil to prevent infection, but this procedure sometimes also harmed healthy tissue besides curing the wounds.

One of the barber surgeon, Ambroise Pare (1510-1590) once discovered the use of mixture of eggs, rose oil and turpentine oil to be a good ointment to heal the wounds. He accidentally ran out of hot oil during treatment of an injury, and soon replaced the oil with his own medicine and used a bandage to cover the wounds - an introduction to tourniquet, so that the patient did not suffer from bleeding. The result, it healed better.

As Holt (2001) writes, he began to announce his new assumption that ligature, tying up arteries would prevent blood loss during surgery and patients found better recovery than those of cauterization treatment. The ligature stopped the bleeding and the ointment prevented infection; those sounds like a good combination. Pare did not stop there, as he also performed hernia operation and obstetrics surgery in abnormal delivery.

It had to be a very important turning point in the medicine. In this era, while Galen's principles were still largely used, Andreas Versalius tried to make a progress and improvement. He had a more extensive research in human anatomy, and his findings were a big surprise to the preceding ideas. Two other scientists, Paracelsus and Harvey also supported his finding.

Versalius thought, Galen made several misconceptions in human anatomy since he did not perform the investigation on a human body but on a monkey.

In 1543 he published his research in the Fabricia, the first complete textbook of anatomy, which brought him the title as The Father of Anatomy. He also published "Tabulae Anatomicae" along with drawings and descriptions of human anatomy. Versalius put a fundamental why human cadaver dissection was very important to reveal how human organs really work.

For his persistence, which certainly against the large number of church committee, brought Versalius strong criticism, sabotage, and finally he was required to leave on a pilgrimage to Sinai in 1564 (Holt, 2001).

J. Pathology & Experimental Surgery (18th Century)

According to Schell, Giovanni Morgagni had his "compendium of post-mortem observations, and correlation to clinical disease."

Another famous surgeon from this era was a Scottish born… [END OF PREVIEW]

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