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2010

A findings of archeologists and medical writings (such as papyrus)

are only the source of knowledge about ancient medicine. The
prehistorical humans, using the most rudimentary surgical
instruments were able to remove splinters, pierce boils or blisters,
treat burns and excise traumatized tissues, bore open a human skull

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3700 BC Some of earliest sources described wound care using fresh

meat, honey, and lint stressing importance of giving the rest for
injured extremity. They used primitive bandages to mummification
of bodies lying the basis for future more definitive wound treatment.

2250 BC Babilonian physicians were able to open purulent cavities

with bronze knives. Wound irrigation was accomplished using the
honey, milk, and plane water. They were able to close wounds using
animal hair or tendons. In the code of Hammurabi the Babylonian
law provided severe penalties for the surgeons whose operations
were unsuccessful. The code of Hammurabi is shown.

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600 BC Chinese used a wine and bread at the care of a wound.

Cosmetic surgery and anesthesia using inhaled opium or autosuggestion were attempted in China.

Ancient India has a rich medical history. Ancient physicians described more than
100 surgical instruments, including scalpels, lancets, scarifies, saws, trocars and
needles. They used maggot therapy (fly larva) to treat wounds, successfully
performed cesarean sections, tooth extractions, etc. Widely renowned for skills in
plastic surgery, introduction of skin pedicled flaps, etc.

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They used maggot therapy to treat wounds

1500-1300 BC Greek civilization is considered as most ancient and

influencing one. It gifted the world with the word "surgery" hyros
(hand)- and urge (action). At the picture the Good Asclepius treats a
patient.

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Approximately 400 years B. C. first systematic description of wounds,

dislocations, fractures, and their treatment was done by Hippocrates.
First definitive explanation of bandaging and dressing. It was him
who introduced the term "desmurgy" desmos - connecting, urge action.

The Corpus Hippocraticum was the collection of knowledge of

ancient Greek civilization precisely describing different types of
wounds, ulcers, injuries, fractions, and their treatment.

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900-800 BC. From the Homeric poems, the Illiad and the Odyssey
that was written roughly 800-700 B.C. (tells about Troy war ) is given
realistic description of battle wounds, arrow and slingshot injuries
and their treatment, etc. At the picture Hector treats Potrocl

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The vase shows wound care (it was built contemporary to

Hippocrates). At that time they were able to make incisions of
purulent wounds, tumors, hemorrhoids, stones, amputations,
venesections (bloodletting), or coagulation of bleeding vessel. There
were stressed an importance of good conditions to wound drainage
and use of boiled water managing the wound.

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Many attention was paid for treatment of fractures and dislocations.

Methods of shoulder dislocation therapy are still used. Very logic
reduction of displaced spinal vertebra using special construction is
shown. Two sticks are used to distort the spine and the lever is used
to reduce vertebra

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One of the most prominent Roman authorities is Aurelius Cornelius

Celsus. He was the encyclopedist of the early first century A. D.
Celsus "De medicine" is the oldest important medical document
after the "Corpus Hippocraticum" It provides cumulative
knowledge of Roman medicine and surgery. At first he described
classical picture of inflammation, etc.

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One of the most famous physicians of the Roman period in second

century A. D. (129-199) was Galen. His views dominated European
medicine for almost 15 centuries, until the time of Renaissance. He
considered that disease was caused by the humors - yellow bile, black
bile, blood and phlegm (although it was described earlier by
Hippocrates). Rases was Persian doctor who at first invented
primitive cast.

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1125 AD The French university was opened. Doctors of Medieval

time used the same approach at treatment as 1000 years ago or even
more shocking. Surgery of the Middle Ages was provided
predominantly by itinerant and barber surgeons.

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Lack of knowledge and ban of surgery by church were most

important obstacles. Anatomy was still shaded, autopsy for education
aim was permitted only twice a year. The picture shows
cardiovascular and muscular systems of those time.

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The procedure of bloodletting is shown which was frequently used

during period between 400 BC till XIX century. At the beginning the
procedure was a common part of treatment accomplished by
surgeons (latter during medieval time was done by barbers).

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Hemostasis by means of heat metal was commonly used to cauterize

wounds (control of bleeding)

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1338 AD Invention of gunpowder, thirst gunshot wounds. 1400 At a

French army the wine was used to irrigate wounds and spider's web
to stop bleeding treating the gun wound

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During the Renaissance, surgery did slowly begin to regain a higher

social position. Most prominent physicians and anatomists were
Vesalius, Fabricius, William Harvey, and Paracelsus. Classification of
wounds dated by 1517 year

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1536 Paracelsus. Considered a pus in the wound as a negative event,

comparing it with the rotted apple justifying necrectomy as a part of
treatment. He blamed bloodletting procedure.

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1543 An anatomy presented by Vesalius broke former views at

Galen's human structure. Created by him practical anatomy atlas for
students at those time was most accurate and complete. Anatomy of
muscular and venous system is shown. But still achievements were
not used fully.

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1536-1545 Ambroise Pare introduced dressing soaked by rose oil and

egg yolk instead of former wound treatment with boiling oil. He
described a debridement (French word) of gunshot wound (not only
incision but excision of necrotic tissues also), ligation of vessels, etc.
Blamed presence of a pus at the wound.

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1597 The method of Italian plasty using migrating flap was

introduced. Presented picture shows device to stabilize the hand
during transfer of the arm's skin at the nose.

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Military time were considered to be the real opportunity for practice

and innovations in surgery. New influx of knowledge was done by
Napoleon wars. 1794-1814 Jean Larrey as a doctor performed more
than 200 amputations daily, stressed an importance of extremities
immobilization.

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Former Immobilization was usually done using wooden boards. 18511855 Flemish surgeon Matise invented plaster cast. Since those time
the modern type has not gain a lot of differences.

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During the nineteenth century the surgeon emerged as

a specialist and a respected medical practitioner. But at the
first half of century the scope of surgery remained limited.
g
treated onlyy simple
p fractures, dislocations and
Surgeons
abscesses and performed amputations technically perfect but
with high mortality rate. They managed to ligate major arteries
for common and accessible aneurysms and made attempts to
excise external tumors, but the abdominal surgery was
virtually unknown.
There were numerous obstacles to the advance of
surgery. Pain, infection, hemorrhage and shock were four of
the most difficult to overcome.

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Narcotic and analgesics agents such as hashish, opium, alcoholic

beverages, mandrake root, or even reduction of blood flow to the
brain to diminish sensibility had been used for thousands of years to
alleviate human pain. 1831 there were introduced three main
anesthetics: ether, nitrous oxide, and chloroform, but without
practical application. Picture shows the common aim of analgesic.

29

The effective use of general anesthesia can be precisely dated to the

1840s. William Morton successfully used ether. It became obvious
that these substances could be applicable to surgical operations.
First successful surgery of vascular tumor under ether anesthesia was
done 1846 by Jon Warren

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Portraits of Morton and others. They gifted the narcosis to humans,

1842,

31

Devices for anesthetic delivery offered by Pirogov (left), and offered

by Morton (right) with latter invention of endotracheal root, etc.

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Thousands of years a different materials were used as a dressing

mostly lint and canvases. Purulent complications (accumulation of
pus) were common after even perfectly performed surgery. Results of
such operations were commonly disappointing. If a patient was
fortunate there was a slow healing process to recovery. And relation
to pus in the wound was unequivocal. Here dressing materials are
shown
h
used
d at the
h time
i
ffrom C
Celsus
l
till
ill XIX century.

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1847-1848 Second crucial step was an introduction of antisepsis as

part of wound treatment. Fillip Shimmelvaise (Hungary surgeon) is
at the picture. He introduced disinfection of hands before taking the
birth care;

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Louis Pasteur (at left) had found responsible for fermentation

microorganisms and developed a germ theory of disease. He showed
that the pus formation and inflammation were caused by living,
multiplying matter. Jousef Lister (English surgeon, at right)
continued his research from practical point of view.

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1867 Introduction of gauze soaked by carbolic acid. 1870 Listers

conception was that everything that was in contact with wound must
be sterile (hand washing, wound and instrument irrigation, air
spraying). He introduced a new suture material known as a catgut
(cat's gut) absorbed by tissues in several weeks.

36

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1870-80 An antiseptic conception had already developed. Special

operating rooms, dressing rooms, their separation, clean and dirty
areas, shaving, cleaning, and other rules were invented.

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Aseptic conception was the necessity of sterilization of instruments

using physical methods

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1876 Johnson was inspired by Listers works and had started

manufacturing dressing materials. Nowadays his company is one of
the most renowned.

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Guillaume Dupuytren was one of the most trained French surgeons

who introduced intestinal suture, wrote a manual of operative
surgery, etc.

40

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In American surgery great contributions for development

of surgery were done by Mc Burney (in honor for this
surgeon the point of maximal tenderness was named,
and now bearing his name) and Murphy (who described
the symptoms of acute cholecystitis).

Kocher sign

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1874 German surgeon Kirsh had introduced a split-thickness skin

graft, special stainless wires (treatment of fractures), etc. Theodor
Billroth, Esmarch 1879 (introduction of tourniquet to stop bleeding
and special device for wound irrigation), Mikulicz, Volkmann,
Bergmann are the famous surgeons who made great contributions in
the history of German abdominal surgery.

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First stapes in neurosurgery were done by Harvey Cushing. He

introduced the practice of sphygmomanometry into the operating
room (beginning of the monitoring during surgical operation). 1895
instruments used to cutting and exploration of tissues

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1836-1840 Pirogov (left) at the period of Russian-Turkey war 1865-66

were done most practical achievements. New methods of gunshot
wound management, amputations, separation of clean and infected
patients, etc.
Vishnevskiy (right) offered many methods of infiltration anesthesia,
active wound care, etc.

44

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Mechnikov (left) had found cell phagocytosis 1882-83 Sclifosovsky

(right) accomplished comparison of carbolic acid and iodine (their
antiseptic efficacy)

45

1878-80 Robert Koch at first described a specific microorganisms

(different species like mycobacterium tuberculosis, staph, etc.)
responsible for different forms of infection.

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1883-84 Kocher (representatives of German school) His surgical

treatment of goiter, earned Kocher to Nobel Prize in 1909, the first
time it was awarded to a surgeon. He also made attention to the
understanding role of the thyroid gland in the body's metabolism.

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1905 William Halsted, an American surgeon, made numerous

important contributions to surgical technique and teaching. He
introduced the use of rubber gloves into the surgery, developed
improved methods for operating on hernias and cancer of the breast.
He took part in the establishing the "surgical residency system",
new program of education provided systematic way of young
surgeons training.

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The discovery of X-rays by Roentgen in 1895. Primary used to bones

and tissues within a few years the use of rays was expanded and
include physiologic studies such as those of swallowing and
intestinal motion.

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Organ transplantation.
Alexis Carrel at period of 1902 till 1912 overcame the problem of
blood supply of transplanted organ. New method of blood vessels
reconnection by means of end-to-end suture was proposed by
Carrel. In honor to that he was awarded the Nobel Prize in 1912.

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The story of modern chemotherapy connected with works of the

British pathologist Alexander Fleming. At 1928 he had discovered
that culture of penicillium was able to suppress multiplication of
staph. Also he had found inhibiting agent and called it lysozyme.
Latter was invented first antibiotic starting antibacterial era.

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One of the prime contributors to the field of cardio-vascular surgery has

been Michael DeBaky. In 1934 he first described a roller pump for extracorporeal
circulation. After this he became a leader in the field of direct surgery for the
treatment of thoracic and abdominal aneurysms including complicated resection
of lesions of the aortic arch. He was the first to perform carotid endarterectomy in
1953 and the use of saphenous vein bypass graft for coronary arteries.

A cariopulmonary
i
l
bypass machine

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Virtual surgeon and virtual surgery computer forecast of

results before and after surgery are not in future.

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