History of surgery

Surgeons and Executioners - The History of Operative Treatment
Not only the Homo Sapiens, but already the Neanderthals understood the art of surgery. The skeleton of one of our relatives with an amputated arm bears witness to this, and this patient is 50,000 years old. The following article describes the development of surgical treatment, from the first skull openings several thousand years ago to complex surgery of the present.

contents

• Duties of Surgery
• Cranial operations of the prehistory
• Egyptian surgeons?
• Early amputations and wooden prostheses
• "Where there is pus, must be opened"
• Gladiators under the knife
• Galenos of Pergamon
• Arabs and Persians
• Barbers and Executioners - The Middle Ages
• Surgeons and military surgeons - The early modern era
• The advent of textbooks
• Surgeons become doctors
• Operation succeeded, patient dead
• Rescued limbs
• The modern surgery
• references

Duties of Surgery

The Greek word "cheir urgia" means "to do by hand". Indian doctors cut stones as early as the time of the Vedas and used nasal prostheses, presumably because cutting off their noses was a regular punishment. Duties of surgery It was probably since the Stone Age to breastfeed the blood flow, treat fractures, remove ulcers and stones, as well as cut out purulent wounds.

Archaeological findings show that skulls were apparently opened more than 10,000 years ago. (Image: moomsabuy / fotolia.com)

Cranial operations of the prehistory

"First comes the word, then the remedy and then the knife" (Christian Albert Theodor Billroth (1829-1894), German surgeon).

3,500 BC In ancient times, the ancestors of the Incas practiced the trepanation, opening the skull, and seven out of ten survived the intervention - far more than in the 19th century. Such trepanated skulls can be found even in earlier cultures, down to a gray one Prehistory 12,000 years ago. The bones clearly show that the procedures healed.

The doctors of the Pharaohs in Egypt often trephoned, and the wounds healed regularly. In the Corpus Hippocraticum 300 BC This operation will be mentioned in writing for the first time in Chr.

The scientist Broca proved in the 19th century that cranial surgery with the instruments of the Stone Age was readily possible: he cut freshly dead bone fragments from the skullcap.

Archaeologists today assume that these operations were not cultic, but medical purposes, for example, to eliminate bone splinters or end a headache.

Egyptian surgeons?

Egypt was considered in ancient times as a refuge of medical knowledge. Having learned his craft here, Greek physicians gained a reputation as did Harvard today.

Nevertheless, Egyptologists found little evidence of surgery. Admittedly, Herodotus (circa 490-425 BC) wrote with admiration: "Every doctor treats only one disease ... there are ophthalmologists, ear doctors, dentists, stomach specialists and doctors for certain internal diseases." But there was no question of surgeons.

Even the papyri, the original Egyptian sources, give little information about surgery. However, some texts at least suggest that Egyptian doctors performed surgical procedures.

The Ebers Papyrus, for example, recommends cutting "swelling" with the hemen, ie the doctors' knife. What do you mean with that? Abscesses, blisters or tumors? If it was tumors, then it was about surgical intervention in the body and not just on the surface.

In any case, the Egyptians circumcised the prepuce of boys at puberty. A relief in the necropolis of Saqqara from around 2200 BC. Chr shows a boy. A man clasps his raised hands in front of him, another man squats, rubbing his penis with an object. Underneath it says: "rub vigorously to make it work." A second picture shows how the same man attaches a knife to the child's foreskin.

Mummies prove that almost all adults were circumcised. Presumably, as in the case of Muslims and Jews, this served religious purposes - the Jews may even have taken over the custom from Egypt.

In a lower jaw from Sakkara circa 1500 BC Chr, two parallel holes were found over a root inflammation. These could have been deliberately drilled into it, but it may also be a natural defect. Because thousands of pines of other mummies did not have these holes.

In 1914 Hermann Junker found gold wire on two molars in a mummy made of Sakkara and another find in 1952 strengthened the thesis that Egyptian dentists closed tooth spaces.

The Munich mummy expert Andreas Nerlich found out - with colleagues and in close cooperation with the Egyptological Institute of the University of Heidelberg, the German Archaeological Institute Cairo and the Egyptian Supreme Council of Antiquities - that there is strong evidence of surgery in ancient Egypt.

They examined the skull of a male mummy. The man probably died between 1080 and 714 BC. The scientists inserted an endoscope into the skull through the middle ear, the nasal cavity and an opening in the roof of the nasal cavity.

Scientists were able to show by examining a mummy that in ancient Egypt, apparently surgical procedures were performed. (Image: WitR / fotolia.com)

Computed tomography showed that there was a defect in the bone under intact skin and tissue above the left parietal bone above the left ear. Cause was probably a shock. There was a crack in the skullcap and the bones had reformed. There were no pieces of bone in the damaged and healed region. The meninges and outer skin, however, were intact. A doctor had removed the bone splinters and treated the wound.

Early amputations and wooden prostheses

A mummified foot from the Ramesside period (1305-1080 BC), which the scientists studied, proved to be partially amputated. The entire forefoot had been removed and the wound subsequently healed, as intact skin and soft tissue covered the interface. Not even a scar was visible.

The mummy of a woman contained a wooden prosthesis for the big toe. The stump of the toe was covered with intact skin, obviously there had been no complications. The prosthesis also showed strong signs of wear, which shows that the woman had lived for years after the procedure. The experts discovered calcification of the aorta and small arteries in the affected foot - the woman suffered from arteriosclerosis.

This disease slows down healing processes: the successful operation and precise fitting of the prosthesis testifies to the skills of the physicians involved.

If the Egyptian doctors operated on a larger scale, they knew far better ways to relieve the pain than their descendants in the Middle Ages. They used frankincense, which they imported in quantities from the land of Punt (presumably Yemen and / or Eritrea), smoked it in the infirmaries, and the chemical substances were found in the lungs of mummies. The tetrahydrocannabinol contained in the incense causes euphoria and reduces pain.

The Egyptians also planted poppies in graves, but we do not know if they used opiates as painkillers.

The Papyrus Smith testifies that the Egyptians understood wound healing: "If you examine a man with a cleft lip on his chin that reaches to the bone, then you should palpate his wound. If you find his bone healthy, then you should say: One with a cleft lip on his chin that reaches to the bone has a disease that I will treat. Then you should place two bandages on those gaps; you should combine it with fresh meat on the first day, then treat it with fat, honey, fibers every day, so that he is better. "Nerlich emphasizes that such procedures are also useful for surgical wounds.

The researchers came to the conclusion in 2002 that doctors in ancient Egypt were well able to perform surgical operations. Although there is little direct evidence, according to Nerlich, this is probably due to the fact that the mummies were not examined sufficiently palaeopathologically. In particular, well-healed wounds were difficult to recognize.

"Where there is pus, must be opened"

This sentence of the Greek physician Hippocrates, the founder of rational medicine, shows that the ancient Greeks practiced surgery, because he formulated one of their basic laws.

Physicians in ancient Sparta and Athens removed hemorrhoids and bladder stones, and the knowledge of the ancient Greeks entered the Roman Empire, whose methods in turn formed the basis for Medieval medicine - though much of their knowledge was lost.

Gladiators under the knife

The first known Greek physician in Rome was in the third century BCE. Chr. Archagathus, and he worked as a surgeon, because his practice was called "cutting and burning," which earned him the name Carnifex, meaning an executioner. Archagathus, however, did such a good job that he was 220 BC. Chr received the Roman citizenship.

The ancient Romans knew about surgery very well. They adopted the Greek word cheirourgos and latinized it to surgeon. In the time of Tiberius it refers to a specialist in surgery, namely the Greek Ptolemy.

In the Roman Empire there were specialized healers, stone cutters, star-piercers and tooth-pullers. A good surgeon should be young, have a steady hand and strong nerves. Doctors should generally have surgical knowledge.

In ancient Rome, the injured fighters were operated in a hospital specially built for this purpose. (Image: Fxquadro - fotolia)

Roman doctors used sophisticated apparatus in surgery, including a whole set of scalpels. They knew retractors, needle and thread to close wounds, and they had special tweezers and forceps to remove foreign bodies from injuries.

Simple doctors in the country already had spatulas, probes, scalpels, spoons and bone lifters. Specialists had star needles to pierce the eye lens, Trepane to open the skull, instruments to remove bladder stones, arterial clamps, and forceps.

The scalpels enabled precise cuts, nightshade plants and opium lowered the pain, and the clamps stopped bleeding. However, the Romans knew neither hypodermic syringes and knew nothing about sterile surgical techniques. Although they suspected that diseases were transmitted from person to person, they had no clue about viruses and bacteria.

Meanwhile, the patricians and gladiators in particular enjoyed complicated operations. The training of gladiators took years, and their masters had invested too much to simply let the arena survivors die.

Surgeons operated the injured fighters in a hospital built especially for this purpose. They separated the treatment room and the hospital room, showing that they knew about the spread of disease. The operating rooms lay in the sun, in order to use the daylight as long as possible.

The anatomical knowledge of the Roman physicians was far better than that of the academic physicians of the Middle Ages. They dissected the corpses of executed and killed gladiators.

Although doctors understood surgery, sterile instruments and germs caused by germs, they did not understand anything. Most of the wounded who died from their wounds are responsible for these viruses, bacteria and herds of wounds.

The blood loss could be stopped with the forceps and clamps only for minor bleeding. A bowel perforation was almost always deadly, and Galenos tells us that there is only one gladiator surviving a bowel wound - because his gut was not damaged.

The emperor, with his thumbs down, exposing the defeated gladiator to death, is now considered the symbol of Roman arbitrary cruelty. However, this death blow could also be a mercy, to spare the victim a painful death from suppurated wounds.

Galenos of Pergamon

Galenos of Pergamon lived in Rome and died in AD 200. Although he was referring to Hippocrates' teaching theory, he transformed it as a doctrine of the temperaments and thus built the framework of medicine in Europe to modern times.

Among other things, the doctor treated gladiators and gained his experience of human anatomy. So he found out that wounds on the back of the head could blind those affected, and that the brain moved rhythmically when a skull was split.

Arabs and Persians

The Arabs and Persians took over the heritage of Greco-Roman antiquity as well as the knowledge of the ancient Egyptians, because Egypt became part of the Persian Empire before Christ and after the triumphal march of the Muslims a country of the Islamic empire.

Abu I-Qasim Chalaf ibn al-Abbas az Zahrawi Abulcasis was a famous surgeon. The Arab was born in 936 near Córdoba and died there in 1013 as a court physician of the caliph al-Hakam II.

Abulcasis continued to develop all medicine, but his focus was on surgery. He wrote, "Anyone who wants to exercise them, therefore, must first familiarize themselves with the anatomy, must gain knowledge of the bones, nerves, muscles."

The scholar recommended sponges soaked in mandrake and opium for anesthesia and even developed various instruments. His books represented apparatus for dentistry as well as the setting of blood vessels.

Barbers and Executioners - The Middle Ages

Medieval scholarship was based on Aristotle's tripartite division of general practitioners, theoretical physicians, and medically educated laymen. The Middle Ages distinguished between the surgeon / surgeon, the Physicus or Doctor medicinae and the medically educated layman. Among the last were jugglers like midwives, toothpickers and quacks, executioners and even skinners.

Surgeons had a technical education and often formed their own guild with the bath and barbers. Bader and barbers were usually considered dishonest. The surgeon, unlike Physicus, had a bad reputation.

In 1163, the Council of Tours even prohibited all clergymen from practicing surgical treatment. The doctor was equal to the lesser nobility and clergy, the surgeon stood on the edge of the "respectable" craft, near Gerber and executioner, Bruch- and Steinschneider.

Surgery was not one of the subjects at the university, and anyone who wanted to work as a surgeon gained his knowledge through practical training with another surgeon. Also, their operations rarely led to success. Only in the 18th century was the discipline taught at German universities.

The barbers and barbers not only shaved and cut hair, but they healed fractures and dislocations, veined patients, and put on cupping heads; but they were forbidden to administer medicines.

We can easily imagine what it meant for the sick if the person who treated their fresh wound was not allowed to use any medication. In the 16th century fewer and fewer people went to the bathhouses because of the infectious diseases that were rampant there, and what such conditions meant for the patients requires no imagination.

The disinfection of wounds was unknown until the 19th century. (Image: tibanna79 / fotolia.com)

Surgeons and military surgeons - The early modern era

Military doctors promoted the professional surgical treatment, which later became a subject in the universities. From the 16th century, the ecclesiastical prohibition on dissecting corpses loosened and so the knowledge of the inside of the body increased. The craftsmen were not necessarily bunglers; Dr. Eisenbarth, for example, is still considered a very good doctor.

The first general surgeon was Conrad Holtzendorff (1688-1751). He founded in 1727 the "Collegium medico-chirurgium" to further the field scissors of the army. In addition, under his aegis in Berlin, an army hospital, which later became one of the most famous hospitals in Europe: The Charite.

To put the subject on a professional level was long overdue. Wounding meant unimaginable suffering for soldiers. Every third successful amputee died of exhaustion after surgery. Tetanus, infections and blood loss claimed far more deaths than directly fatal wounds.

Holtzendorff, too, was unable to stem dying in the long term. Until the 19th century, the disinfection of wounds was as unknown as the cause of the inflammation. There were no separate operating rooms, but chairs and tables that dragged employees from one room to the next. The surgeons used cutting knives, stretching instruments, feeding pegs, pliers and spoons.

The advent of textbooks

The lack of social recognition of the surgeons inhibited their professional development; nevertheless, several textbooks by surgeons were published in the early modern period. Johann Schultheiß (1595-1645) published the work "Armamentorium Chirurgicum", 1666 appeared the German edition "Wundarzneyisches Zeug-Hauß".

Schultheiß presented the surgical instruments and methods of his time, including tools that he himself had developed. The textbook explained therapies of tumors, ulcers, wounds, fractures and dislocations. The instruments showed the physician on picture boards.

Pierre Donis (died 1718) published in 1707 "Cours dóperation de Surgery" in which he explained in detail the techniques of operations in ten chapters. The work was considered a standard work, and spread in many editions.

One year later, the textbook by Lorenz Heister (1683-1758) came out with the title "Surgery, in which everything belonging to the Wund Artzney, according to the newest and best kind". It was an encyclopedia that summarized the state of knowledge of the (European) surgery of the time and surgeons used it as a handbook.

Surgeons become doctors

The separation between academic physicians and practical surgeons or medical practitioners who served as assistants lasted until the 18th century. However, more and more doctors criticized the inadequate training of the "barbers" and the catastrophic results of their missing ones, whether real or supposed expertise.

The "general medical edict" for Brandenburg-Prussia in 1725 clearly stated that only graduated physicians were allowed to "curir". As a surgeon, only those who had completed a special school were eligible. Bader first had to undergo an examination, secondly, they were not allowed to call it that way and, thirdly, they could not afford surgical interventions. However, the surgeons still remained assistant doctors, but were now officially higher than the Bader.

In 1811, Prussia abolished the guild system of the Middle Ages and thus also solved the surgery of the barbers. In 1818, Prussia also had freedom of establishment for healing professions.

The "Provisions on the Division and Examination of Medical and Surgeon Staff" set out generally valid examination regulations for all healing professions. The unofficial separation between "practical" rural physicians and "academic" city doctors replaced Prussia with first and second-degree surgeons.

First-class surgeons now had to complete a three-year mix of study and training, perhaps comparable to a modern college. Anatomy, surgery and obstetrics have become part of the curriculum of some universities and additionally subject matter at non-university institutes.

The students learned the anatomy and physiognomy of the human body, and at the end they completed an extensive examination. The doctor confirmed his qualification during a hiking time - only then he was allowed to do the master. The students learned from midwives the obstetrics.

Curricula now included general and special surgery, eye diseases, fractures and dislocations, as well as training on corpses.

During the 19th century, the schools closed, because surgery became more and more a part of regular medical studies. The graduates usually earned a doctorate in medicine.

Operation succeeded, patient dead

Surgical interventions were a life and death game until the 20th century. The danger was less in the surgical methods, namely, the techniques improved enormously until the 19th century - but lacked the knowledge of the causes of infection was missing.

The doctors rarely washed their gowns, which had blood and germs stuck to them. Sepsis developed and nobody knew why. Ignaz Semmelweis recognized in the 19th Century by germs transmitted infections as the cause of childbed fever that at that time many women snatched there and ordered strict hygiene for doctors and nurses. Success proved him right, and the death rate dropped rapidly.

Joseph Lister cleaned hands like carbolic tools, making sure that little germs could harm patients during surgery.

Finally, Louis Pasteur and Robert Koch made sure that tools were disinfected and sterilized and that doctors wore sterile rubber gloves.

Amputations of "diabetic feet" are relatively common. Picture: ittipol - fotolia

Rescued limbs

Until modern times, amputation meant maiming. The doctors on the battlefields amputated as many limbs as possible in the shortest time and could hardly care about plastic surgery. This was partly due to the lack of narcotics - they worked quickly to shorten the duration of the pain - but on the other hand, that they came up with little alternatives to amputee.

But nineteenth-century surgeons formed in anatomy, pathological anatomy, and experimental physiology, finding new ways to treat the most severe wounds. Instead of removing limbs, they also stopped heavy bleeding from the arteries. The goal was to preserve the entire body.

Between 1851 and 1868, experienced surgeons wrote a series of books on surgery that amputated only in extreme emergency: Esmarch "About the Resection after gunshot wounds" (1851), Stromeyer "maxims of martial art" (1855), Pirogov "Basic features of the general war surgery "(1864) and Bernhard von Langenbeck" On the fracture fracture of the joints and their treatment "(1868).

The better education and the new techniques led to unprecedented successes. In the Prussian-French War of 1870/71, at least 18.8% of the wounded were cured from the hospital.

The modern surgery

Today's surgery creates a picture of the inside of the body and operates by the doctor indirectly operating the instruments in front of the screen - until 1850, physicians would probably have believed this to be pure magic.

So-called endoscopes are introduced into the body, starting with Johann von Miuklicu (1850-1905) in Vienna.

Successful brain surgery is the norm today. Although trepanation is one of the oldest surgical practices, it involves operations on the skull and not on the brain.

Only the modern knowledge about the different areas of the brain and their function, a viable anesthesia and comprehensive antisepsis, enabled the surgeons to penetrate into the center of our thinking and feeling.

Surgery is a versatile field and today consists of numerous specialties such as thoracic and visceral surgery. (Image: Syda Productions - fotolia)

John Rickman Godlee (1849-1925) cut a tumor from a brain in 1884. The person concerned died shortly afterwards of meningitis. But already in 1885 Victor Alexander Horsley (1857-1916) successfully removed a brain tumor.

Brain surgery went hand in hand with the development of neurosurgery. Ernst von Bergmann (1836-1907) and Anton von Eiselsberg (1860-1939) did pioneer work here. But the "star" of this discipline was Harvey Cushing (1869-1939). Cushing cut down more than 2,000 brain tumors and most patients survived.

Today, the field of surgery is diversified, and specialists specialize in one area, that is vascular, cardiac, thoracic, pediatric, traumatic, plastic or visceral surgery.

Other disciplines require surgical intervention: gynecology, ear, nose and throat medicine, dermatology, the neuro-
as well as oral and maxillofacial surgery and urology. (Dr. Utz Anhalt, last updated on June 23, 2017)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)

references

Egypt at the time of the Pharaohs. Everyday life and social life. By Eugen Strouhal. Wasmuth Verlag, Tübingen, Berlin 1994. Awakening of the healing arts. The medicine in ancient Egypt. By W. Westendorf. Artemis and Winkler, Zurich 1992.

In the fragile house of the soul. The great odyssey of brain surgery. By Jürgen Thorwald. Droemer-Knaur, Munich 1986.