Origins

The first surgical techniques were developed to treat injuries and traumas. A combination of archaeological and
anthropological studies offer insight into man's early techniques for suturing lacerations, amputating unsalvageable
limbs, and draining and cauterizing open wounds. Many examples exist: some Asian tribes used a mix of saltpeter
and sulfur that was placed onto wounds and lit on fire to cauterize wounds; the Dakota people used the quill of a
feather attached to an animal bladder to suck out purulent material; the discovery of needles from the stone age
seem to suggest they were used in the suturing of cuts (the Maasai used needles of acacia for the same purpose);
and tribes in India and South America developed an ingenious method of sealing minor injuries by applying termites
or scarabs who ate around the edges of the wound and then twisted the insects' neck, leaving their heads rigidly
attached like staples.[1]

Trepanation
The oldest operation for which evidence exists is trepanation[2] (also known as trepanning, trephination, trephining or
burr hole from Greek and ), in which a hole is drilled or scraped into the skull for exposing
the dura mater to treat health problems related to intracranial pressure and other diseases. In the case of head
wounds, surgical intervention was implemented for investigating and diagnosing the nature of the wound and the
extent of the impact while bone splinters were removed preferably by scraping followed by post operation
procedures and treatments for avoiding infection and aiding in the healing process. [3][4] Evidence has been found in
prehistoric human remains from Proto-Neolithic[5] and Neolithic times, in cave paintings, and the procedure
continued in use well into recorded history (being described by ancient Greek writers such as Hippocrates). Out of
120 prehistoric skulls found at one burial site in France dated to 6500 BCE, 40 had trepanation holes. [6] Folke
Henschen, a Swedish doctor and historian, asserts that Soviet excavations of the banks of the Dnieper River in the
1970s show the existence of trepanation in Mesolithic times dated to approximately 12000 BCE.[7] The remains
suggest a belief that trepanning could cure epileptic seizures, migraines, and certain mental disorders.[8]
There is significant evidence of healing of the bones of the skull in prehistoric skeletons, suggesting that many of
those that proceeded with the surgery survived their operation. [citation needed] In some studies, the rate of survival
surpassed 50%.[9]

Setting bones[edit]
Examples of healed fractures in prehistoric human bones, suggesting setting and splinting have been found in the
archeological record.[10] Among some treatments used by the Aztecs, according to Spanish texts during the conquest
of Mexico, was the reduction of fractured bones: "...the broken bone had to be splinted, extended and adjusted, and
if this was not sufficient an incision was made at the end of the bone, and a branch of fir was inserted into the cavity
of the medulla..."[11] Modern medicine developed a technique similar to this in the 20th century known as medullary
fixation.

Anesthesia[edit]
Main articles: History of general anesthesia and History of tracheal intubation

Bloodletting[edit]
Hirudo medicinalis. Leeches for bloodletting

Bloodletting is one of the oldest medical practices, having been practiced among diverse ancient peoples, including
the Mesopotamians, the Egyptians, the Greeks, the Mayans, and the Aztecs. In Greece, bloodletting was in use
around the time of Hippocrates, who mentions bloodletting but in general relied on dietary techniques. Erasistratus,
however, theorized that many diseases were caused by plethoras, or overabundances, in the blood, and advised
that these plethoras be treated, initially, by exercise, sweating, reduced food intake, and
vomiting. Herophilus advocated bloodletting. Archagathus, one of the first Greek physicians to practice in Rome,
practiced bloodletting extensively. The art of bloodletting became very popular in the West, and during
the Renaissance one could find bloodletting calendars that recommended appropriate times to bloodlet during the
year and books that claimed bloodletting would cure inflammation, infections, strokes, manic psychosis and more.[12]

Antiquity[edit]
Mesopotamia[edit]
The Sumerians saw sickness as a divine punishment imposed by different demons when an individual broke a rule.
For this reason, to be a physician, one had to learn to identify approximately 6,000 possible demons that might
cause health problems. To do this, the Sumerians employed divining techniques based on the flight of birds, position
of the stars and the livers of certain animals. In this way, medicine was intimately linked to priests, relegating surgery
to a second-class medical specialty.[13]
Nevertheless, the Sumerians developed several important medical techniques: in Ninevah archaeologists have
discovered bronze instruments with sharpened obsidian resembling modern day scalpels, knives, trephines, etc.
The Code of Hammurabi, one of the earliest Babylonian code of laws, itself contains specific legislation regulating
surgeons and medical compensation as well as malpractice and victim's compensation: [14]

215. If a physician make a large incision with an operating knife and cure it, or if he open a tumor (over the eye) with
an operating knife, and saves the eye, he shall receive ten shekels in money.
217. If he be the slave of some one, his owner shall give the physician two shekels.
218. If a physician make a large incision with the operating knife, and kill him, or open a tumor with the operating
knife, and cut out the eye, his hands shall be cut off.
220. If he had opened a tumor with the operating knife, and put out his eye, he shall pay half his value.

Egypt[edit]
See also: Egyptian medical papyri
Pictures of surgery tools at Kom Ombo, Egypt

Around 3100 BCE Egyptian civilization began to flourish when Narmer, the first Pharaoh of Egypt, established the
capital of Memphis. Just as cuneiform tablets preserved the knowledge of the ancient
Sumerians, hieroglyphics preserved the Egyptian's.
In the first monarchic age (2700 BCE) the first treaty on surgery was written by Imhotep, the vizier of
Pharaoh Djoser, priest, astronomer, physician and first notable architect. So much was he famed for his medical skill
that he was deified, becoming the Egyptian god of medicine. [15] Other famous physicians from the Ancient Empire
(from 2500 to 2100 BCE) were Sachmet, the physician of Pharaoh Sahure and Nesmenau, whose office resembled
that of a medical director.[citation needed]
On one of the doorjambs of the entrance to the Temple of Memphis there is the oldest recorded engraving of a
medical procedure: circumcision and engravings in Kom Ombo, Egypt depict surgical tools. Still of all the
discoveries made in ancient Egypt, the most important discovery relating to ancient Egyptian knowledge of medicine
is the Ebers Papyrus, named after its discoverer Georg Ebers. The Ebers Papyrus, conserved at the University of
Leipzig, is considered one of the oldest treaties on medicine and the most important medical papyri. The text is
dated to about 1550 BCE and measures 20 meters in length. The text includes recipes, a pharmacopoeia and
descriptions of numerous diseases as well as cosmetic treatments. It mentions how to surgically treat crocodile bites
and serious burns, recommending the drainage of pus-filled inflammation but warns against certain diseased skin.
Edwin Smith Papyrus[edit]
Main article: Edwin Smith Papyrus
Plates vi and vii of the Edwin Smith Papyrus (around the 17th century BC), among the earliest medical texts

The Edwin Smith Papyrus is a lesser known papyrus dating from the 1600 BCE and only 5 meters in length. It is a
manual for performing traumatic surgery and gives 48 case histories. [10][16] The Smith Papyrus describes a treatment
for repairing a broken nose,[17] and the use of sutures to close wounds.[18] Infections were treated with honey.[19] For
example, it gives instructions for dealing with a dislocated vertebra:
Thou shouldst bind it with fresh meat the first day. Thou shouldst loose his bandages and apply grease to his head
as far as his neck, (and) thou shouldst bind it with ymrw . Thou shouldst treat it afterwards with honey every day,
(and) his relief is sitting until he recovers.

India[edit]
Archaeologists made the discovery that the people of Indus Valley Civilization, even from the early Harappan
periods (c. 3300 BCE), had knowledge of medicine and dentistry. The physical anthropologist that carried out the
examinations, Professor Andrea Cucina from the University of Missouri-Columbia, made the discovery when he was
cleaning the teeth from one of the men. Later research in the same area found evidence of teeth having been
drilled, dating back 9,000 years to 7000 BCE.[20]
Sushruta (c. 600 BCE)[21] is considered as the "founding father of surgery". His period is usually placed between the
period of 1200 BC - 600 BC.[22] One of the earliest known mention of the name is from the Bower Manuscript where
Sushruta is listed as one of the ten sages residing in the Himalayas. [23][23] Texts also suggest that he learned surgery
at Kasi from Lord Dhanvantari, the god of medicine in Hindu mythology.[24] He was an early innovator of plastic
surgery who taught and practiced surgery on the banks of the Ganges in the area that corresponds to the present
day city of Varanasi in Northern India. Much of what is known about Sushruta is in Sanskrit contained in a series of
volumes he authored, which are collectively known as the Sushruta Samhita. It is one of the oldest known surgical
texts and it describes in detail the examination, diagnosis, treatment, and prognosis of numerous ailments, as well
as procedures on performing various forms of cosmetic surgery, plastic surgery and rhinoplasty.[25]

Greece and the Hellenized world[edit]

See also: Ancient Greek medicine
Engraving of Hippocrates by Peter Paul Rubens, 1638.

Surgeons are now considered to be specialized physicians, whereas in the early ancient Greek world a trained
general physician had to use his hands ( in Greek) to carry out all medical and medicinal processes including for

example the treating of wounds sustained on the battlefield, or the treatment of broken bones (a process called in
Greek: ).
In The Iliad Homer names two doctors, the two sons of Asklepios, the admirable
physicians Podaleirius and Machaon and one acting doctor, Patroclus. Because Machaon is wounded and
Podaleirius is in combat Eurypylus asks Patroclus to cut out this arrow from my thigh, wash off the blood with warm
water and spread soothing ointment on the wound."[26]
Hippocrates[edit]
The Hippocratic Oath,[27] written in the 5th century BC provides the earliest protocol for professional conduct and
ethical behavior a young physician needed to abide by in life and in treating and managing the health and privacy of
his patients. The multiple volumes of the Hippocratic corpus[28] and the Hippocratic Oath elevated and separated the
standards of proper Hippocratic medical conduct and its fundamental medical and surgical principles from other
practitioners of folk medicine often laden with superstitious constructs, and/or of specialists of sorts some of whom
would endeavor to carry out invasive body procedures with dubious consequences, such as lithotomy. Works from
the Hippocartic corpus include; On the Articulations or On Joints, On Fractures, On the Instruments of
Reduction, The Physician's Establishment or Surgery, On Injuries of the Head, On Ulcers, On Fistulae, and On
Hemorrhoids.[16]
Celsus and Alexandria[edit]
Herophilus of Chalcedon and Erasistratus of Ceos were two great Alexandrians who laid the foundations for the
scientific study of anatomy and physiology.[29]Alexandrian surgeons were responsible for developments in ligature
(hemostasis), lithotomy, hernia operations, ophthalmic surgery, plastic surgery, methods of reduction of dislocations
and fractures,tracheotomy, and mandrake as anesthesia. Most of what we know of them comes
from Celsus and Galen of Pergamum (Greek: )[16][30]
Galen[edit]
Galen's On the Natural Faculties, Books I, II, and III, is an excellent paradigm of a very accomplished Greek
surgeon and physician of the 2nd century Roman era, who carried out very complex surgical operations and added
significantly to the corpus of animal and human physiology and the art of surgery.[16][30] He was one of the first to
use ligatures in his experiments on animals.[31] Galen is also known as "The king of the catgut suture"[32]

China[edit]
In China, instruments resembling surgical tools have also been found in the archaeological sites of Bronze
Age dating from the Shang Dynasty, along with seeds likely used for herbalism.[33]
Hua Tuo[edit]
Woodblock printing by Utagawa Kuniyoshi of Hua Tuo

Hua Tuo (140208) was a famous Chinese physician during the Eastern Han and Three Kingdoms era. He was the
first person to perform surgery with the aid of anesthesia, some 1600 years before the practice was adopted by
Europeans.[34]Bian Que (Pien Ch'iao) was a "miracle doctor" described by the Chinese historian Sima Qian in
his Shiji who was credited with many skills. Another book, Liezi (Lieh Tzu) describes that Bian Que conducted a two
way exchange of hearts between people.[35] This account also credited Bian Que with using general anaesthesia
which would place it far before Hua Tuo, but the source in Liezi is questioned and the author may have been
compiling stories from other works.[36]Nonetheless, it establishes the concept of heart transplantation back to around
300 CE.

Middle Ages[edit]
Paul of Aegina's c. 625 c. 690) Pragmateia or Compendiem was highly influential.[37] Abulcasis repeats the
material, largely verbatim.[16]
Hunayn ibn Ishaq (809873) was an Arab Nestorian Christian physician who translated many Greek medical and
scientific texts, including those of Galen, writing the first systematic treatment of ophthalmology.
Persian physician Muhammad ibn Zakariya al-Razi (854925), "the Islamic Hippocrates" advanced experimental
medicine, pioneering ophthalmology and founding pediatrics.
In the 9th century the Medical School of Salerno in southwest Italy was founded, making use of Arabic texts and
flourishing through the 13th century.
Egypt-born Jewish physician Isaac Israeli ben Solomon (832892) left many medical works written in Arabic that
were translated and adopted by European universities in the early 13th century.
Persian physician Ali ibn Abbas al-Majusi (d. 994) worked at the Al-Adudi Hospital in Baghdad, leaving The
Complete Book of the Medical Art, which stressed the need for medical ethics and discussed the anatomy and
physiology of the human brain.
Abulcasis (9361013) (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi) was an Andalusian-Arab physician and
scientist who practised in the Zahra suburb of Cordoba. He is considered a great medieval surgeon, though he
added little to Greek surgical practices.[16] His works on surgery were influential.[37][38]

Persian physician Avicenna (9801037) wrote The Canon of Medicine, a synthesis of Greek and Arab medicine that
dominated European medicine until the mid-17th century.
African-born Italian Benedictine monk (Muslim convert) Constantine the African (died 1099) of Monte
Cassino translated many Arabic medical works into Latin.
Spanish Muslim physician Avenzoar (10941162) performed the first tracheotomy on a goat, writing Book of
Simplification on Therapeutics and Diet, which became popular in Europe.
Spanish Muslim physician Averroes (11261198) was the first to explain the function of the retina and to recognize
acquired immunity with smallpox.
In Europe, universities such as Montpellier, Padua and Bologna were particularly renowned.
In the late 12th century Rogerius Salernitanus composed his Chirurgia, laying the foundation for modern Western
surgical manuals. Roland of Parma and Surgery of the Four Masters were responsible for spreading Roger's work to
Italy, France, and England.[16] Roger seems to have been influenced more by the 6th-century Atius and Alexander
of Tralles, and the 7th-century Paul of Aegina, than by the Arabs.[39] Hugh of Lucca (11501257) founded the
Bologna School and rejected the theory of "laudable pus". [16]
In the 13th century in Europe skilled town craftsmen called barber-surgeons performed amputations and set broken
bones while suffering lower status than university educated doctors. By 1308 the Worshipful Company of Barbers in
London was flourishing. With little or no formal training, they generally had a bad reputation that was not to improve
until the development of academic surgery as a specialty of medicine rather than an accessory field in the 18thcentury Age of Enlightenment.[40]
Guy de Chauliac (12981368) was one of the most eminent surgeons of the Middle Ages. His Chirurgia
Magna or Great Surgery (1363) was a standard text for surgeons until well into the seventeenth century." [41]
The Black Death (c. 1350) followed by the Renaissance decimated the population of Europe while weakening the
Church and freeing scholars to seek wisdom from the Byzantine and Muslim worlds.

Early modern Europe[edit]

Andreas Vesalius (15141564)

Ambroise Par (c. 15101590), father of modern military surgery.

Wilhelm Fabry (15401634), father of German surgery

There were some important advances to the art of surgery during this period. Andreas Vesalius (15141564),
professor of anatomy at the University of Padua was a pivotal figure in the Renaissance transition from classical
medicine and anatomy based on the works of Galen, to an empirical approach of 'hands-on' dissection. His
anatomic treatise De humani corporis fabrica exposed many anatomical errors in Galen and advocated that all
surgeons should train by engaging in practical dissections themselves.
The second figure of importance in this era was Ambroise Par (sometimes spelled "Ambrose" (c. 1510 1590) [42]),
a French army surgeon from the 1530s until his death in 1590. The practice for cauterizing gunshot wounds on the
battlefield had been to use boiling oil, an extremely dangerous and painful procedure. Par began to employ a less
irritating emollient, made of egg yolk, rose oil and turpentine. He also described more efficient techniques for the
effective ligation of the blood vessels during an amputation.
Another important early figure was German surgeon Wilhelm Fabry (15401634), "the Father of German Surgery",
who was the first to recommend amputation above the gangrenous area, and to describe a windlass (twisting stick)
tourniquet. His Swiss wife and assistant Marie Colinet (15601640 improved the techniques for Caesarean Section,
introducing the use of heat for dilating and stimulating the uterus during labor. In 1624 she became the first to use a
magnet to remove metal from a patient's eye, although he received the credit.

Modern Surgery[edit]
Scientific surgery[edit]
John Hunter (17281793), father of modern scientific surgery

Benjamin Bell (17491806) by Sir Henry Raeburn. c1780

The discipline of surgery was put on a sound, scientific footing during the Age of Enlightenment in Europe (1715
89). An important figure in this regard was the Scottish surgical scientist (in London) John Hunter (17281793),
generally regarded as the father of modern scientific surgery.[43] He brought an empirical and experimental approach
to the science and was renowned around Europe for the quality of his research and his written works. Hunter
reconstructed surgical knowledge from scratch; refusing to rely on the testimonies of others he conducted his own

surgical experiments to determine the truth of the matter. To aid comparative analysis, he built up a collection of over
13,000 specimens of separate organ systems, from the simplest plants and animals to humans.
Hunter greatly advanced knowledge of venereal disease and introduced many new techniques of surgery, including
new methods for repairing damage to the Achilles tendon and a more effective method for applying ligature of
the arteries in case of an aneurysm.[44] He was also one of the first to understand the importance of pathology, the
danger of the spread of infection and how the problem of inflammation of the wound, bone lesions and
even tuberculosis often undid any benefit that was gained from the intervention. He consequently adopted the
position that all surgical procedures should be used only as a last resort. [45]
Hunter's student Benjamin Bell (17491806) became the first scientific surgeon in Scotland, advocating the routine
use of opium in post-operative recovery, and counseling surgeons to "save skin" to speed healing; his greatgrandson Joseph Bell (18371911) became the inspiration for Arthur Conan Doyle's literary hero Sherlock Holmes.
Percivall Pott (17141788), engraved from an original picture by Nathaniel Dance-Holland, National Library of Medicine, Images
from the History of Medicine.

Other important 18th- and early 19th-century surgeons included Percival Pott (17141788), who first
described tuberculosis on the spine and first demonstrated that a cancer may be caused by an
environmental carcinogen after he noticed a connection between chimney sweep's exposure to soot and their high
incidence of scrotal cancer. Astley Paston Cooper (17681841) first performed a successful ligation of the
abdominal aorta. James Syme (17991870) pioneered the Symes Amputation for the ankle joint and successfully
carried out the first hip disarticulation. Dutch surgeon Antonius Mathijsen invented the Plaster of Paris cast in 1851.

Anesthesia[edit]
Crawford Long (18151878)

James Young Simpson (18111870)

John Snow (18131858)

Modern pain control through anesthesia was discovered in the mid-19th century. Before the advent of anesthesia,
surgery was a traumatically painful procedure and surgeons were encouraged to be as swift as possible to minimize
patient suffering. This also meant that operations were largely restricted to amputations and external growth
removals.
Beginning in the 1840s, surgery began to change dramatically in character with the discovery of effective and
practical anaesthetic chemicals such as ether, first used by the American surgeon Crawford Long (18151878),
and chloroform, discovered by James Young Simpson (18111870) and later pioneered in England by John
Snow (18131858), physician to Queen Victoria, who in 1853 administered chloroform to her during childbirth, and
in 1854 disproved the miasma theory of contagion by tracing a cholera outbreak in London to an infected water
pump.[46] In addition to relieving patient suffering, anaesthesia allowed more intricate operations in the internal
regions of the human body. In addition, the discovery of muscle relaxants such as curare allowed for safer
applications. American surgeon J. Marion Sims (181383) received credit for helping found Gynecology, but later
was criticized for failing to use anesthesia on African test subjects.

Antiseptic surgery[edit]
Joseph Lister, pioneer of antiseptic surgery.

The introduction of anesthetics encouraged more surgery, which inadvertently caused more dangerous patient postoperative infections. The concept of infection was unknown until relatively modern times. The first progress in
combating infection was made in 1847 by the Hungarian doctor Ignaz Semmelweis who noticed that medical
students fresh from the dissecting room were causing excess maternal death compared to midwives. Semmelweis,
despite ridicule and opposition, introduced compulsory handwashing for everyone entering the maternal wards and
was rewarded with a plunge in maternal and fetal deaths, however the Royal Society dismissed his advice.
Until the pioneering work of British surgeon Joseph Lister in the 1860s, most medical men believed that chemical
damage from exposures to bad air (see "miasma") was responsible for infections in wounds, and facilities for
washing hands or a patient's wounds were not available.[47] Lister became aware of the work of French chemist Louis
Pasteur, who showed that rotting and fermentation could occur under anaerobic conditions if micro-organisms were
present. Pasteur suggested three methods to eliminate the micro-organisms responsible for gangrene: filtration,
exposure to heat, or exposure to chemical solutions. Lister confirmed Pasteur's conclusions with his own
experiments and decided to use his findings to develop antiseptic techniques for wounds. As the first two methods
suggested by Pasteur were inappropriate for the treatment of human tissue, Lister experimented with the third,
spraying carbolic acid on his instruments. He found that this remarkably reduced the incidence of gangrene and he
published his results in The Lancet. [48] Later, on 9 August 1867, he read a paper before the British Medical
Association in Dublin, on the Antiseptic Principle of the Practice of Surgery, which was reprinted in The British

Medical Journal.[49][50][51] His work was groundbreaking and laid the foundations for a rapid advance in infection control
that saw modern antiseptic operating theatres widely used within 50 years.
Lister continued to develop improved methods of antisepsis and asepsis when he realised that infection could be
better avoided by preventing bacteria from getting into wounds in the first place. This led to the rise of sterile
surgery. Lister instructed surgeons under his responsibility to wear clean gloves and wash their hands in 5% carbolic
solution before and after operations, and had surgical instruments washed in the same solution. [52] He also
introduced the steam steriliser to sterilize equipment. His discoveries paved the way for a dramatic expansion to the
capabilities of the surgeon; for his contributions he is often regarded as the father of modern surgery.[53] These three
crucial advances - the adoption of a scientific methodology toward surgical operations, the use of anaesthetic and
the introduction of sterilised equipment - laid the groundwork for the modern invasive surgical techniques of today.
In the late 19th century William Stewart Halstead (18521922) laid out basic surgical principles for asepsis known
as Halsteads principles. Halsted also introduced the latex medical glove. After one of his nurses suffered skin
damage due to having to sterilize her hands with carbolic acid, Halsted had a rubber glove that could be dipped in
carbolic acid designed.

X-rays[edit]
Wilhelm Roentgen (18451925)

The use of X-rays as an important medical diagnostic tool began with their discovery in 1895 by
German physicist Wilhelm Rntgen. He noticed that these rays could penetrate the skin, allowing the skeletal
structure to be captured on a specially treated photographic plate.

Modern technologies[edit]
In the past century, a number of technologies have had a significant impact on surgical practice. These
include Electrosurgery in the early 20th century, practical Endoscopy beginning in the 1960s, and Laser
surgery, Computer-assisted surgery and Robotic surgery, developed in the 1980s.

Timeline of surgery and surgical procedures[edit]

B.C.E.-

c. 5000 BCE. First known practice of Trepanation in Ensisheim in France.

c. 3300 B.C.E. Trepanation, broken bones, wounds in Indus Valley Civilization.

c. 26132494 BCE. A jaw found in an Egyptian Fourth Dynasty tomb shows the marks of an operation to
drain a pus-filled abscess under the first molar.[26]

2580 BCE Khufu heard stories of Dedi's feats of surgery; Dedi re-attaches the severed head of a goose with
magic.[26]

1754 BCE The Code of Hammurabi.

1600 BCE The Edwin Smith Papyrus from Egypt described 48 cases of injuries, fractures, wounds,
dislocations, and tumors, with treatment and prognosis including closing wounds with sutures, using honey and
moldy bread as antiseptics, stopping bleeding with raw meat, and immobilization for head and spinal cord
injuries, reserving magic as a last resort; it contained detailed anatomical observations but showed no
understanding of organ functions, along with the earliest known reference to breast cancer.
1550 BCE The Ebers Papyrus from Egypt listed over 800 drugs and prescriptions.
1250 BCE Asklepios and his sons Podaleirius and Machaon were reported by Homer as battlefield
surgeons.[26] He also reported arrowheads cut out; styptics; administration of sedatives and bandaging of
wounds with wool.[26]

600 BCE Sushruta of India.

5th century BCE Medical schools at Cnidos and Cos.

400 BCE About this year Hippocrates of Cos (460 BCE to 370 BCE) became "the Founder of Western
Medicine", insisting on the use of scientific methods in medicine, proposing that diseases have natural causes
along with the Four temperaments theory of disease, and leaving the Hippocratic Oath. He "taught that wounds
should be washed in water that had been boiled or filtered, and that a doctor's hands should be kept clean, his
nails clipped short."[26] He became the first to distinguish benign from malignant breast tumors, advocating

withholding treatment for "hidden" cancers, claiming that surgical intervention causes "a speedy death, but to
omit treatment is to prolong life."
---C.E.-

50. About this time Roman physician-surgeon Aulus Cornelius Celsus died, leaving De Medicina, which
described the "dilated tortuous veins" surrounding a breast cancer, causing Galen to later give cancer (Latin for
crab) its name. He advised against radical mastectomy involving the pectoral muscles, and warned that surgery
should only be attempted in the benign stage (first of four).
1st/2nd century CE. Soranus of Ephesus wrote a 4-volume treatise on gynaecology.

200. About this year Galen died after pioneering the use of catgut for suturing while clinging to Hippocrates
Four Temperaments theory, viewing pus as beneficial, and viewing cancer as a result of melancholia caused by
an excess of black bile, proven by its frequent occurrence in postmenopausal females, recommending surgical
excision of a cancerous breast through healthy tissue to make sure that not "a single root" is left behind, while
discouraging ligatures and cautery to allow drainage of black bile.

200. About this year Leonidas of Alexandria began advocating the excision of breast cancer via a wide cut
through normal tissues like Galen, but recommended alternate incision and cautery, which became the standard
for the next 15 centuries. He provided the first detailed description of a mastectomy, which included the first
description of nipple retraction as a clinical sign of breast cancer.

208. Hua Tuo began using wine and cannabis as an anesthetic during surgery.

476. The Fall of Rome ended the advance of scientific medical-surgical knowledge in Europe.

1162. The Council of Tours banned the "barbarous practice" of surgery for breast cancers.

1180. Rogerius published The Practice of Surgery.

1214. Hugh of Lucca discovered that wine disinfects wounds.

1250. Theodoric Borgognoni, student of Hugh of Lucca broke with Galen and fought pus with dry wound
technique (wound cleansing and sutures).

1275. William of Salicet broke with Galen's love of pus and promoted a surgical knife over cauterization.

1308. The Worshipful Company of Barbers in London was first mentioned.

1350. About this time the Black Death devastated Europe, spurring the Renaissance, in which learning from
the Byzantine and Muslim worlds was sought out.

1453. The Fall of Constantinople caused many scholars to flee to Europe bringing medical-surgical
manuscripts with them.

1536. Ambroise Pare discovered that cold poultices are better than hot oil.

1543. Andreas Vesalius published The Fabric of the Human Body.

1721. Lady Mary Wortley Montagu brought the Ottoman practice of inoculation to England using live
smallpox virus.

1735. Claudius Amyand performed the first successful appendectomy.

1775. Percivall Pott discovered that soot caused scrotal cancer in chimneysweeps.

1776. John Hunter pioneered artificial insemination.

1796. Edward Jenner pioneered smallpox inoculation with cowpox virus.

1800. The Royal College of Surgeons of England was founded.

1800. About this time French surgeon Bernard Peyrilhe became the first to experimentally transmit cancer to
an animal by injecting breast cancer cells.

1805. Astley Cooper pioneered ligation of arteries.

1842. Crawford Williamson Long pioneered ether for anesthesia.

1844. Horace Wells pioneered nitrous oxide for anesthesia.

1848. James Young Simpson pioneered chloroform for anesthesia.

1851. Antonius Mathijsen invented the Plaster of paris cast.

1852. J. Marion Sims successfully repaired a vesicovaginal fistula.

1854. John Snow disproved the miasma theory of contagion.

1879. After becoming the first to diagnose the location based on neurological findings alone, Scottish
surgeon William Macewen (18481924) performed the first successful non-primary (trephined) brain tumor
removal, pioneering brain surgery.
1880. German surgeon Ludwig Rehn performed the first thyroidectomy.
1882. William Stewart Halsted of Johns Hopkins Hospital performed the first complete radical mastectomy in
the U.S., which became the standard treatment.
1883. Lawson Tait performed the first successful salpingectomy.
1884. After English physician Alexander Hughes Bennett (18481901) diagnosed the location based on
neurological findings alone, English surgeon Rickman Godlee (18491925) completed the first primary
(exposed) brain tumor removal.

1884. Austrian ophtalmologist Karl Koller first used cocaine as a local anesthetic for eye surgery.

1890. German surgeon Themistocles Glck pioneered arthroplasty with a knee replacement and hip
replacement using ivory.

1891. St. Louis, Missouri surgeon Henry C. Dalton performed the first successful pericardial sac repair
operation.

1893. African-American surgeon Daniel Hale Williams of Chicago performed the second
successful pericardial sac repair operation.

1895. Wilhelm Roentgen discovered X-rays.

1895. The first successful cardiac surgery was performed by Norwegian surgeon Axel Cappelen. The patient
later died of complications, though the autopsy found it was for other reasons, as the wound had been
satisfactorily closed.

1896. The first successful cardiac surgery without any complications was performed by German
surgeon Ludwig Rehn.

1900. About this time the Cargile membrane was introduced into surgery.

1900. About this time Harvey Cushing began pioneering brain surgery.

1901. German surgeon Georg Kelling performed the first Laparoscopic surgery on dogs.

1901. Austrian physician Karl Landsteiner discovered the basic A-B-AB-O blood types.

1903. Dutch physician Willem Einthoven invented the Electrocardiograph.

1905. Novocaine was first used as a local anesthetic.

1907. Austrian surgeon Hermann Schloffer became the first to successfully remove a pituitary tumor.

1910. Swiss physician Hans Christian Jacobaeus performed the first Laparoscopic surgery on humans.

1914. Blood transfusion was pioneered.

1916. Austrian surgeon Hermann Schloffer performed the first splenectomy operation.

1917. Kiwi surgeon Harold Gillies pioneered modern plastic surgery for wounded British World War I
soldiers.

1925. The first open heart surgery by English surgeon Henry Souttar.

1929. Werner Forssmann performed the first cardiac catheterization, on himself.

1931. The first sex reassignment surgery.

1940. The first successful metallic hip replacement surgery.

1948. The first successful open heart surgery operations since 1925.

1952. The first successful open heart surgery using hypothermia.

1953. The first carotid endarterectomy.

1954. The first kidney transplant.

1955. The first artificial cardiac pacemaker.

1955. The first separation operation for conjoined twins.

1961. The cochlear implant was invented by William F. House.

1961. American surgeon Thomas J. Fogarty invented the Fogarty embolectomy catheter.

1962. The first hip replacement surgery via Low Frictional Torque Arthroplasty (LFA) by Sir John Charnley.

1963. The first liver transplant was performed by Thomas Starzl et al.

1964. The laser scalpel was invented.

1967: The first successful heart transplant by Christiaan Barnard.

1967. The first successful coronary artery bypass surgery.

1972. The CT scan was perfected.

1974. The first Tommy John surgery.

1974. The first blunt tunneling (cannula-assisted) Liposuction.

1982. The Jarvik-7 artificial heart was successfully installed.

1983. Robot-assisted surgery began with Arthrobot in Vancouver.

1985. The first laparoscopic cholecystectomy.

1985. Positron emission tomography was invented.

1987. The first successful heart-lung transplant.

1998. The first Stem Cell Therapy.

2000. The da Vinci Surgical System was approved by the FDA.

2001. The first self-contained artificial heart, AbioCor.

2001. The first remote surgery, using the ZEUS robotic surgical system.

2005. The first partial face transplant by French surgeon Jean-Michel Dubernard et al.

2008. The first full face transplant by French surgeon Laurent Lantieri et al.

2011. The first successful double leg transplant by Spanish surgeon Pedro Cavadas et al.

2012. The first successful mother-daughter womb transplant.

2012. The first human hand transplant by surgeons in Leeds, England.

2012. The first double arm transplant by surgeons at Johns Hopkins University.

2013. The first virtual surgery using Google Glass by surgeons at the University of Alabama, which they call
Virtual Interactive Presence in Augmented Reality (VIPAAR).

2013. The first growing of a replacement nose on a patient's forehead by surgeons at Imperial College in
Fuzhou, China.

2014. The first penis transplant by surgeons at Tygerberg Hospital in South Africa.
2015. The first skull and scalp transplant by surgeons at MD Anderson Cancer Center and Houston
Methodist Hospital in Texas.

2016. The first penis transplant (in the United States) by surgeons at Massachusetts General Hospital. [54]

2016. The first uterus transplant in the U.S. at Cleveland Clinic.

2016. The first HIV-to-HIV liver transplant at Johns Hopkins.[55]

Notable individuals in the development of surgery [edit]

See Wiki article List of surgeons.

Sushruta (1200600 BCE)

Theodoric Borgognoni (12051296)

William of Saliceto (c.12101277)

Henri de Mondeville (c.12601316)

Mondino de Luzzi (12751326)[16][39]

Guy de Chauliac (c.13001368))[16][56]

John of Arderne (13061390)[16][57][58]

Antonio Benivieni (14431502)[16][59][60]

Paracelsus (14931541)[16][61][62]

Ambroise Pare (15101590)[16][63][64]

Hieronymus Fabricius (15371619)[16][65]

William Clowes (15401604)[16][66][67][67][68]

Peter Lowe (15501612)[16][68][69]

Richard Wiseman (16211676)[16][66][68][70][71]

William Cheselden (16881752)[16][68][72][73][74]

Lorenz Heister (16831758)[16][68][75]

Percivall Pott (17141789)[16][76][77][78][79]

John Hunter (17281793)[16][80][81][82]

Pierre-Joseph Desault (17441795)[16][68][83][84]

Dominique Jean Larrey (17661842)[16][66][68][85][86][87][88]

Antonio Scarpa (17521832)[16][68][89][90]

Astley Cooper (17681843)[16][68][89][91][92]

Benjamin Bell (17491806)[16][93]

Charles Bell (17741842)[16][66][94][95]

John Bell (17631820)[16][66][94][96]

Baron Guillaume Dupuytren (17771835)[16][97][98][99]

James Marion Sims (18131883)[16][66][100][101][102]

Joseph Lister (18271912)[16][53][68][103]

A BRIEF HISTORY OF SURGERY

By Tim Lambert
Ancient Surgery
In the stone age some adults had holes cut in their skulls. At least sometimes
people survived the 'operation' because the bone grew back. We do not know the
purpose of the 'operation'. Perhaps it was performed on people with head injuries
to release pressure on the brain.
The Egyptians did have some knowledge of anatomy from making mummies. To
embalm a dead body they first removed the principal organs, which would
otherwise rot.
However Egyptian surgery was limited to such things as treating wounds and
broken bones and dealing with boils and abscesses. The Egyptians used clamps,
sutures and cauterization. They had surgical instruments like probes, saws,
forceps, scalpels and scissors.
They also knew that honey helped to prevent wounds becoming infected. (It is a
natural antiseptic). They also dressed wounds with willow bark, which has the
same effect.
The Ancient Greeks bathed wounds with wine. (The alcohol helped to prevent
infection).
In the Roman Empire techniques of surgery were dominated by the ideas of
Galen. He was interested in anatomy. Unfortunately by his time dissecting human
bodies was forbidden. So Galen had to dissect animal bodies including apes.
However animal bodies are not the same as human bodies and so some of
Galen's ideas were quite wrong.
Unfortunately Galen was a very influential writer. For centuries his writings
dominated medicine.
After the fall of the Roman Empire in the West surgery, along with other crafts,
declined in Western Europe. However ideas about anatomy and techniques of
surgery were kept alive by the Arabs and in the 12th and 13th centuries they
returned to Europe.

Meanwhile in India surgeons were highly skilled. They were pioneers of plastic
surgery. Because people were often punished by having their nose cut off an
operation to reconstruct the nose (rhinoplasty) was common.
Surgery in the Middle Ages
In Europe in the 13th century a new type of craftsmen emerged in towns. He (or
she because not all were male) was the barber-surgeon. They cut hair, they
pulled teeth and they performed simple operations such as amputations and
setting broken bones.
From the mid-14th century the church allowed some dissections of human bodies
at medical schools. However Galen's ideas continued to dominate medicine and
surgery.
Surgery in the 16th Century
In the 16th century surgery did become a little more advanced. Leonardo Da
Vinci (1452-1519) dissected some human bodies and made accurate drawings of
what he saw.
However the Tudor greatest surgeon was Andreas Vesalius (1514-1564). He did
many dissections and realized that many of Galen's ideas were wrong. In 1543
he published a book called The Fabric of the Human Body. It contained accurate
diagrams of a human body.
Vesalius's great contribution was to base anatomy on observation not on the
authority of writers like Galen.
Another great surgeon was Ambroise Pare. In the 16th century surgeons poured
hot oil onto wounds. However in 1536 during the siege of Turin pare ran out of
oil. He made a mixture of egg yolk, rose oil and turpentine and discovered it
worked better than oil. Pare also designed artificial limbs.
In the 16th century syringes were used to irrigate wounds with wine.
In the 18th century surgery did make some progress. The famous 18th century
surgeon John Hunter (1728-1793) is sometimes called the Father of Modern
Surgery. He invented new procedures such as tracheotomy.
In 1792 a Frenchman named Dominique-Jean Larrey created the first ambulance
service for wounded men.
Surgery in the 19th Century
In the 19th century surgery was greatly improved by the discovery of anesthetics.
As early as 1799 the inventor Humphrey Davy (1778-1829) realized that inhaling
ether relieved pain. Unfortunately decades passed before it was actually used as
an anesthetic in an operation 1842.

James Simpson (1811-1870), who was Professor of Midwifery at Edinburgh

University, began using chloroform for operations in 1847.
In 1884 cocaine was used as a local anesthetic. From 1905 Novocain was used.
Surgery became much more advanced in the 19th century. In 1865 Joseph
Lister (1827-1912) discovered antiseptic surgery, which enabled surgeons to
perform many more complicated operations. Lister prevented infection by
spraying carbolic acid over the patient during surgery. German surgeons
developed a better method. The surgeons hands and clothes were
sterilized before the operation and surgical instruments were sterilized with super
heated steam. Rubber gloves were first used in surgery in 1890. Anesthetics and
antiseptics made surgery much safer. They allowed far more complicated
operations.
In 1883 Robert Lawson Tait removed the fallopian tube of a woman suffering an
ectopic pregnancy saving her life.
In 1895 Wilhelm Roentgen discovered x-rays. That brought great benefits to
surgery.
Surgery in the 20th Century
In the 20th century surgery made great advances. The most difficult surgery was
on the brain and the heart. Both of these developed rapidly in the 20th century.
The first pacemaker was made in 1958. The first heart transplant was performed
in 1967 by Christiaan Barnard. The first artificial heart was installed in 1982. The
first heart and lung transplant was performed in 1987.
The laser was invented in 1960. In 1964 it was used in eye surgery for the first
time.
Meanwhile in 1960 the first hip replacement surgery was performed. In 1962 a
boy had his arm severed but surgeons managed to reattach it. That was the first
time a limb was successfully reattached.
In the late 20th century one of the most exciting developments in surgery was
keyhole surgery. In 2008 a laser was used in keyhole surgery to treat brain
cancer.

A modern hospital in Portsmouth

Surgery in the 21st Century
In the 21st century surgery continued to advance. In 2005 the first face transplant
was performed. The first leg transplant took place in 2011 and the first womb
transplant was carried out in 2012.