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History of Surgery had been started from the prehistoric time with its appropriate technique and tools applicable during the age. There was no sophisticated care of hygiene and anatomic knowledge in the early days; the basic research was started using trial and error on every case and it had set a very strong basic which still makes sense and counts into modern practice.
The following summary of history of surgery is compiled from various sources based on the timeline set in dr. Schell's lecture: The History of Surgery.
The Ancient Medicine (Prehistoric Time)
People had strong magic beliefs and connection to multiple gods during the prehistoric time, so that any cases of illness were also believed as the punishments from angry gods for community's or one's moral failure. Some common cases recorded were respiratory and digestive problems, infections, and gynecologic disorders. Life expectancy low, then 28-35 years was a successful range of survival. Cancer and degenerative diseases were not relevant at that time.
The early surgery practice in Europe was trepanation, drilling a hole in the head. Evidences found skulls with holes from the Neolithic European ages, about 7000 years ago. Since supernatural beliefs was very strong, the cranial drilling was also intended to get rid of evil spirits; the only possible causes for psychosis, mental illness, epilepsy and headaches or migraines.
This is how it works; a part of frontal, parietal, or occipital bones of the skull is removed, to expose the dura mater, the tough fibrous membrane forming the outer envelope of the brain. ("Trephination, An Ancient Surgery").
Still with the magical practices, they also applied other medical actions such as blood letting out of the body and finger amputations to get rid of the wicked spirits.
However, during its development, trephining was found effective during the war. Lawson (2001) discussed that Neolithic wars used a lot of blunt weapons like sling stones and clubs. Such weapons were aimed at the head, resulting severe bleeding and blood clots in the cranial arteries. Another case of cranium fractures required victims (soldiers) to have an operation.
This is how, as archaeologists said, the surgeons needed to do the trepanation "to remove splinters of skull bone," creating a way for the blood to let out and "relieve pressure from blood clots that formed when blood vessels were broken."
Neither sophisticated surgery method nor well-trained surgeons presented during the war. All the processes had to run through trial and error, since little was known about human anatomy. Lawson further explained, variety of techniques was applied. In South America, first people used obsidian, a kind of volcanic rock, which later upgraded into bronze instruments after the discovery of metal.
Charlotte Roberts of University of Durham, England, as told by Lawson explained that surgeons would scrap the skull and remove the layers of bone until breaking through to the brain; or until exposing the dura mater.
In "Trephination," it is explained; the drill to bore into the skull is hard and smooth wooden shaft, to create tidy small circular (created by drill) or rectangular (created by knife) grooves. The holes were ranging from about half an inch to 6 inches. The wound would then covered with a shell, a gourd, or piece of silver.
One that was very common was the bow drill technique. The instrument was a piece of hard but elastic stick with leather thong. Surgeons put the tip on the particular point on the head and make the hole through the bone. To perform the procedure, the operator positioned the drill tip on the head and thereby made the bore through the bone.
The skull piece must be taken very carefully to prevent fractures to avoid excessive trauma and infection during the pre-anaesthesia and pre-antisepsis era. However this practice indeed was a successful advancement of skills as it was widespread in many continents, from Europe, Peru, Bolivia, South America, and even Asia ("Trephination, An Ancient Surgery").
History of Surgery" also informs that before metal instruments were found, surgeons used "stone scalpel, wooden stick from hard material, stone knife, knives, awls, drills, scissors, saws, forceps, clamps, syringes, mirrors, needles, cast, splints, & bandages." They also developed wooden and metal limbs.
B. Mesopotamian and Babylonian Surgery
Records of Mesopotamian health and medicine services were put in historical tablets and diorite. Hammurabi (2250 BC), the renowned judge in the Mesopotamian era introduced the emergence of physician profession and also the first regulation in medical practices to the community, in the Law Code of Hammurabi. The first regulation concerning malpractice was included here.
The law clearly mentioned that physician who handled surgery case was in full responsibility of the safety of the patient. Schell further informs that when a surgeon found a failure in surgery ("opening an abscess"), which claimed a life, or "result in the loss of the eye," then he must have his hand cut off. If the patient was a slave, then the doctor must replace with a slave as well. However when operation succeeded, the patient had to pay ten shekels of silver, or two if it was a slave.
The common surgeries were the surgery of the eye, bladder, and pus drainage when infection occurred. As cited in "Medicine in Ancient Mesopotamia," explained in three historical tablets, the doctor made a cut "to drain pus from the pleura" using a knife. Sesame oil was used as anti-bacterial agent, to apply in a dressing to cover the wound. This is an early method of asepsis. In the mean time, knife was also used to scrap the skull of the patient when injuries came over the head.
C. Egyptian Surgery
Egyptians was the first advanced civilization with all organized systems and knowledge in all aspects of live. They wrote and recorded any discoveries and practices including medical skills, which enabled historians to study about it.
The Egyptians' life was a mixture of religious and intellectual customs, in which affected the development of medicine. Therefore, they also used magic spells, sometimes mixed with natural materials to cure disease.
In "The History of Medicine," Egyptians had learned about major organ functions and able to locate them. They knew life pulse come from the heart, bladder produce urine, and blood vessels were in charge of the blood circulation. They even reset broken bones, carried out eye operation and external healing of wounds from the battlefield; but all of them were less sophisticated. The knowledge was gained through the practice of embalming and mummification, but the religion still prohibited examination of the organs, especially through sections.
Papyrus (2000 B.C.) wrote about gynecologic surgery and veterinary medicine. Another expert, Edwin Smith Papyrus (1600 B.C.) described about diagnosis and examination procedures in details. According to Bune and Gregor, they used tools like knives, drills, saws, hooks, forceps and pinchers, scales, spoons, copper tools and a vase with burning incense. When they started to use metal blades, the managed to heat up the blade until it glowed red and used it to cut wound and seal up the skin, also in dental surgery to treat abscesses. No anesthetics recorded whatsoever.
Honey, grease (from vegetable or animal oil) and lint (from vegetable fiber) were used as healing application on wounds, after stitching. It was also necessary to put some meat to cover the wound, to prevent severe bleeding. Another method of using tapes to seal up wounds was also introduced, to cover up possible infection from stitches. A kind of primitive antiseptic such as willow leaves was also used.
D. Ancient Indian Medicine
Around 800 BC surgery was already known in India as Shastrakarma. Indian medicine had Shushruta. Schell archived the methods used in Indian surgery that includes incision, excision, scraping, puncturing, probing, extraction, provoking secretion, and suturing." Shusutra's book of medicine, "Shushrutasamahita," also described around 100 surgical instruments. Wine and hypnotism were used as the first anesthetics.
In "Ancient India's Contribution to Medical Science," Shushruta was a well-known surgeon in India who based his work on Hidu practice. He learned human anatomy and performed eye surgery to remove cataracts and rhinoplasty (the early generation in plastic surgery). He used a kind of lancet to extract the cataract, without any aid of anesthetics, and merely milk for comforting the eye.
At that time, cutting ear and nose was a common punishment, then he needed to perform rhinoplasty to restore it; which attract attention from people throughout the country.
Shushruta also was a pioneer in anatomy study. He was reported to use human cadaver ("required to be perfectly preserved using simple extraction from certain tree bark or grass; the dead person must not be too old and not died of disease or poison").
E. Aztec and Mexican Medicine
According to Schell, this kind of practice was well developed although it happened in 16 century. The procedure included suture and embryotomy. The society did not manage well to put everything in record, so little evidence found about medicine history. However, there were over 1200 kinds of traditional drugs recorded by…[continue]
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