Wednesday, December 18, 2013

A Brief History of Surgery and Surgical Instruments

Long before there were humans, there was illness and injury, and long after we’re gone, illness and injury will persist wherever there is life. Yet archaeological evidence has shown that we have combatted these ills as best we could, given the knowledge we had, for millennia. As far back as the Stone Age, surgical procedures were performed in order to alleviate pain and illness. You might be surprised by how long our earliest medical practices persisted before science transformed the way medicine is practiced today.

Yet as medicine and surgery has evolved, one thing has remained common: proper surgery, the kind that helps and heals, cannot be performed without the right tools. A good surgeon is important, of course, but without the right tools for the job a surgeon can actually cause more harm than good – as has happened again and again throughout history, until recent advancements in surgical techniques. Of course, by ‘recent’ we mean developments in the last 150 years. None of those discoveries in surgical technique could have been possible without the earliest surgeons working to heal others, however.

Ancient Surgery: I Need Surgery Like a Hole in the Head

As far back as the Stone Age, our ancestors practiced trepanation. Trepanation is the practice of cutting open a hole in the skull in order to alleviate pressure on the brain. Blood and/or swelling in the brain can cause massive amounts of pain and even serious and lasting injury. This kind of swelling could be the result of any number of injuries or illnesses, but it is most often a blow to the head that would cause the need for trepanation. Surprisingly, evidence – i.e., the unearthed bodies of ancient man – has shown that some people even survived this procedure, as the bone grew back over the hole in the skull.

The Egyptians displayed detailed knowledge of human anatomy and surgical techniques for the time. You are probably familiar with the mummified remains their civilization left behind; in order to embalm those bodies, principal organs were removed and preserved using embalming tools, such as a three-inch stick used to remove the brain. Probes, saws, forceps, scalpels, and surgical scissors also saw use in the embalming process, as well as in normal surgical procedures.

That’s right, the Egyptians also had some knowledge of how to treat the human body before it died – revolutionary! Clamps, sutures, and cauterization techniques were commonly used, as was honey and willow bark – natural antiseptics. Similarly, the ancient Greeks used wine to bathe wounds, as the alcohol acted to prevent infection.

While the dissection of human bodies was outlawed in ancient Rome, there were nevertheless several surgical instruments developed that continue to be used today, such as the vaginal speculum, which Greek and Roman gynecologists and obstetricians used to diagnose and treat vaginal and uterine disorders. There are records of rectal speculums used in ancient Rome as well, with Hippocrates writing of “… laying the patient on his back and examining the ulcerated part of the bowel by means of the rectal speculum.”

Medieval Surgery: Just How It Sounds

While much of the middle ages saw basic surgery performed by barber-surgeons, who also acted as dentists, the 16th century saw a revolution in surgery as knowledge of anatomy became more advanced, specifically with the publishing of The Fabric of the Human body in 1543 by Andreas Vesalius. With humanity’s improved knowledge of anatomy, surgical techniques advanced considerably.

Subsequently, the development of substantively functional surgical tools became paramount. A flurry of surgical inventions were invented in the following centuries, such as development of sutures and ligatures to stop bleeding, as developed by Ambroise Paré. The discovery of microbes as responsible for infection and disease by Louis Pasteur also led to more sanitary surgical practices throughout the medical world as doctors were encouraged to wash their hands between patients.

Modern Surgery: Oldies But Goodies

Subsequently, Joseph Lister (after whom Listerine is named!) developed carbolic acid as a cleansing and disinfecting agent used to reduce infection by treating instruments and other objects that make contact with the patient. Ernst von Bergmann’s steam sterilization for instruments was a later improvement on this revolution in surgical cleanliness. In the 19th century, methods of anesthesia were developed – such as the discovery of ether – which have helped patients around the world. Meanwhile, surgical instruments themselves continued to evolve, with the advent of more delicate and precise tools like the needle holder.

Today, surgical tools are incredibly advanced, with a range of computerized and robotic tools aiding the surgeon. However, some of the oldest tools at the surgeon’s disposal – the scalpel, the forceps, and so on – continue to be used by surgeons today. As surgical technology continues to evolve and advance, there’s no telling what changes we will see, but one thing is for certain: none of these advances were possible without ancient surgeons laying the groundwork, making mistakes, learning, passing on their expertise to others, and developing new tools to help them solve the surgical problems of their time.


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