Principles & History of Surgery

Prof.Dr.
Hasan Besim
PRİNCİPLES AND HİSTORY

OF SURGERY
1
 One of the oldest branches of medicine
 Disorders which cannot be treated medically and
needs surgical/invasive intervention
 Cherios: Hand
 Ergon: Work
2
 Since humans first learned to make and
handle tools, they have employed their
talents to develop surgical techniques, each
time more sophisticated than the last;
 The three principal obstacles which had
plagued the medical profession from its
infancy
 Bleeding
 Pain
 Infection
 Advances in these fields have transformed
surgery from a risky "art" into a scientific
discipline capable of treating many diseases
and conditions.
The Extraction of the Stone of Maddness
3
Hieronymous Bosch.
TREPANATİON
 Trepanning, also known as trepanation,
trephination, trephining or making a burr hole
(the verb trepan derives via Old French via Medieval
Latin.
 It is a surgical intervention in which a hole is drilled
or scraped into the human skull, exposing the

dura mater to treat health problems related to
intracranial diseases.
4
DENTAL PRACTİCES
 7000 BC Mehgarh Pakistan
 2650 BC Ancient Egypt
5
ANCİENT EGYPT
 The Edwin Smith papyrus is an instructional text for treatment of

trauma in the upper half of the body. This text and the Ebers papyrus
allow for a greater understanding of Ancient Egyptian surgical
procedures
 Needles, stiches,, other instruments
 Trephining, tracheostomy, and circumcision
 Almost all of the evidence that exhibits surgical procedures is related
to trauma
 Mummification, autopsy
6
ANCİENT GREECE
 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
7
HİPPOCRATES
 The Hippocratic Oath, written in the 5th

century BC provides the earliest protocol for
professional conduct and ethical behavior a
young physician
8
ARAB – ISLAMİC SURGERY
 Albucasis (936-1013) WROTE 30
SURGICAL TEXTS PUBLISHED IN Latin
as Liber Alzaharavii de Chirurgia.
 Includes operations for bladder stone,
eye diseases, wound cauterisation,

sutures, treatment of fractures...
 200 illustrations of surgical
instruments
 The knife took second place to
therapies like pharmacy, bloodletting

and cupping
9
HİSTORİCAL TURKİSH SURGERY
 Serefeddin Sabuncuoglu 15th Century (1385-
1470) Ottoman Surgeon in Amasya
 (Cerrahiyetu ‘l-Haniye =Imperial Surgery)
 It was the first illustrated surgical atlas and the
last major medical encyclopedia from the Islamic

world
 It was largely based on Al-Zahrawi's Al-Tasrif, but
Sabuncuoglu introduced many innovations of his

own, among which the introduction of views in
which we see female surgeons illustrated for the
first time.
10
 Cerrahiyetü'l-Haniyye consisted of three
chapters
 cauterisation treatments
 surgical procedures
 fractures and dislocations
 Cerrahiyetü'l-Haniyye was also a valuable
source for acupuncturists. He described
acupuncture techniques and point locations
11
 Toothache, haemorrhoids, eczema and
dermatophytosis are described

DEVELOPMENT OF MODERN SURGERY
 Steps enabling bigger surgeries
 Anesthesia
 Asepsis
and antisepsis
 Hemostasis and hemostatic devices
12
 Dr.Crawford Long 1842 excized a cystic mass
of neck under ether anesthesia.
 Dr.John C.Warren -1846 – Massachusetts

General – Excized a vascular tumor from the
chin and published this in (Henry Bigelow
Boston Medical And Surgical Journal)
13
OTHER DEVELOPMENTS
 Anesthesia developed afterwards and
became a different branch after WW2.
 Hand washing
 Surgical gloves and mask usage
14
IGNAZ SEMMELWEİS 1818-1865
 A phycician of Hungarian origin.
 Known as Asepsy –antisepsy
 Vien - Puerperal sepsis
15
JOSEPH LİSTER 1827 – 1912
 British Surgeon– One of the pioneers of antiseptic
surgery
 Used carbolic acid (phenol) under the influence of
Pasteur’s “germ theory”
 Tried to get rid of airborne infectious factors
 Had lowered infections and gangrene rates after
surgeries done under carbolic ascid pulverizations
of the patient and gauze peds
16
 Severe reductions of mortality after open fracture
surgeries and published this in The Lancet
 Bergman/Schimmelbusch – 1885 Steam
Sterilisator
 Mikulicz – Antiseptics should not be used in open
wounds
17
SURGİCAL GLOVES
 1890 – Halsted
 1894 – Hunter Rob – Gynecologist
Mask
 1897 – Breslau Uni, Germany– C.Fluegge
 Droplets contain microorganisms?
 “Stummes Operien” – Cushing
(modern neurosurgery, x rays, elektrocautery)
18
SURGİCAL HEMOSTASİS
 3000 BC – Sumerian Town UR – First pickup

 Clamping of a vessel – El Zehravi
 Ambroise Pare (1510-1590) – Arterial clamping
 New York Roosevelt Hospital – Single clamp –
Halsted
 Mikulicz – Multiple clamps 12
19
SURGİCAL SUTURES
 Cotton silk, tail hair, ant heads
 Al Zehravi - Catgut
 J. Lister - Cromic Catgut
 Halsted - Silk
 Development of Synthetic absorbable and non-

absorbable suture materials
20
THE SURGEON
 Every patient is unique

 Every anatomic problem is different
 Are you sure you are the right person for the
job ?
 Surgery is an athletic branch. You should be fit
physicially and mentally

 “I never pan anything after a scheduled big
21
operation!”
 Avoid surpises
 Do NOT order a test you would NOT see the
result
 “All that is wrong can not be righted. Be sure
the wrongs are rightly sighted”
 Never operate in a patient who is getting
rapidly well OR worse
22
 “If you want a disaster of severe gravity, just try
the wrong side or the wrong body cavity”
 Never be a lone wolf. Seek for consultation in hard
situations
 For the body – homeostasis
 For the mind - equanimity
23
 1735. Claudius Amyand performed the first
successful appendectomy.
 1773. Bernard Peyrilhe treated breast cancer
by radical mastectomy which included both

the pectoral muscle and axillary lymph nodes
.
 1882. William Stewart Halsted of Johns
Hopkins Hospital performed the first

complete radical mastectomy in the U.S.,
which became the standard treatment.
 1881 Theodore Billroth – gastrectomy
 1882 Langenbuch - cholecystectomy

4 major advancements in related
disciplines helped the advancement of surgery:
1. Knowledge of Anatomy
2. Discovery of Anaesthesia
3. Intraoperative haemostasis
4. Concepts of asepsis
20 TH CENTURY LAND MARKS
 Improved understanding shock

 Knowledge of blood groups & blood
transfusion technics
 Development of antibiotics & analgesics
 Electrically powered surgical devices
 Surgical stapling instruments
 Surgical glues
 Radiologic imagination
 Minimal invasive surgery
 Transplantation

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Prof.Dr.

PRİNCİPLES AND HİSTORY

needs surgical/invasive intervention

or scraped into the human skull, exposing the

 The Edwin Smith papyrus is an instructional text for treatment of

combat Eurypylus asks Patroclus “to cut out this arrow

 The Hippocratic Oath, written in the 5th

eye diseases, wound cauterisation,

therapies like pharmacy, bloodletting

 It was the first illustrated surgical atlas and the

last major medical encyclopedia from the Islamic

Sabuncuoglu introduced many innovations of his

dermatophytosis are described

 Dr.John C.Warren -1846 – Massachusetts

 Surgical gloves and mask usage

 Vien - Puerperal sepsis

 3000 BC – Sumerian Town UR – First pickup

 Ambroise Pare (1510-1590) – Arterial clamping

 New York Roosevelt Hospital – Single clamp –

 Development of Synthetic absorbable and non-

 Every patient is unique

physicially and mentally

by radical mastectomy which included both

Hopkins Hospital performed the first

 1882 Langenbuch - cholecystectomy

 Improved understanding shock

 Electrically powered surgical devices

 Surgical stapling instruments

 Minimal invasive surgery

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