The earliest finding of surgery was discovered in Keiv, Ukraine. A scull dating back to 7300 6220 B. C. was found to have holes drilled into the skull bone. This procedure called trephining was common in the early days to relieve health problems related to increases pressure on the brain. Another skull discover in Egypt revealed two holes drilled in to the mandible just below the molar. This is an indication of drainage of an abscess from an infected tooth. The earliest documentation of surgery appeared in 1600 B. C. The Edwin Smith papyrus is believed to be the first surgical textbook. This Egyptian text contained information on surgical procedures that date back to 3000 B. C.
Until the 16th century surgical procedures was mainly limited to trephining and amputations performed by trained surgeons who were also many times the town barber as well. Surgeons of that time were not trained in medical schools and were not considered doctors of medicine. The art of surgery was learned through mentoring and apprenticeship of another surgeon. Many of these surgeons began as surgical assistants while learning from their mentor. Famed surgeon Denton Cooley assisted Dr. Alfred Blalock in the first “blue baby operation” to correct a heart defect. Surgeons today are still trained in this manner through resident and fellowship programs beginning as an assistant to the attending or advanced residents or fellows.
Surgery as a science began at the time of Andreas Versalius in 1537 when he changed the way surgeons were educated in the human anatomy. At the age of 23, Versalius filled the new position of lecturer in surgery and human anatomy. There he became the first to study anatomy by dissecting human bodies instead of animals such as apes. Historically all human dissection during this period was performed by a surgical assistant while the surgeon stood up on a pedestal and observed. The surgical assistant would dissect a particular anatomical structure or organ and present it to the surgeon for study and lecture about it. Andreas Versalius changed the way to study anatomy and practice surgical techniques by performing human dissections himself. He was also noted for his anatomy illustrations based on human dissection that he used for visual aids when lecturing and teaching.
During the Civil War surgical were in great demand. They provided all types of services ranging from manning a bandage station just outside musket ball range on the battlefield to operating rooms at major city hospitals. When war broke out between the states both side were relatively short handed in their respective medical corps. The United States Army started with only one surgeon general, thirty surgeons, and eighty three assistant surgeons. The Confederate Army recruited state militias into the army. A surgeon and an assistant surgeon was a member of each regiment that soon became clustered with others to provide the needed medical care of the wounded. At the end of the war there were more than eleven thousand surgeons, doctors, and assistant surgeons who had served or were serving in the military. Most were providing contract work as noncommissioned military personal on a part time basis.
Modern day surgical revolution began in the mid 1800s when Joseph Lister developed the practice of antisepsis and asepsis for use during surgical procedures. Lister, in 1854 became the first surgical assistant to James Syme, a well known British surgeon. Lister began using pure carbolic acid as an antiseptic applying it to surgical wounds and surgical dressings with moderately good results. He would actually spray the antiseptic into the air in proximity to the operating table before an operation began. Lister’s new techniques were slow to become popular among the great surgeons of the time. The theory of germs causing infections in surgical patients was just a hypothesis which the practical minded surgeon found difficult to embrace. The importance of germ theory and bacteriology was first expanded by a group of German surgeons who developed the technique of steam and boiling to sterilize surgical instruments and linens. It wasn’t till the 1890s that aseptic technique became common practice in most American and European operating rooms. After listening to Lister speak, a man named Robert Wood Johnson created the idea that a sterile ready to use dressing would be a practical application of Lister’s germ theory. In 1886 Robert Wood Johnson teamed up with his two brothers, James Wood and Edward Mead Johnson and created a company called Johnson & Johnson to manufacture surgical dressings. Lister’s development asepsis and antiseptics is thought by many to be the greatest surgical revolution ever, even greater than the establishment of anesthesia.
At the turn of the 20th century the art of surgery was becoming widely accepted as a respected domain of medicine by the medical community. Famed surgeons such as Theodor Billroth and Theodor Kocher developed surgical techniques and shared them with the surgical community and the public by utilizing theater type operating rooms with grandstands for people to watch the procedure. Many of these procedures are still in use today. Denton Cooley and Michael DeBakey would later revolutionize the surgical techniques to treat cardiovascular conditions. Many of their techniques are used in many different surgical specialties today. Perhaps the surgeon who set the most significant scientific tone for modern day surgery was William Halsted (1852 – 1922). A professor of surgery at the newly opened Johns Hopkins Hospital and School of Medicine, Halsted moved the surgical procedures from the public display to a closed clean sterile environment of the operating we use today. He developed his new surgical procedures based on anatomic, pathologic, and physiologic principles which were first developed using lab animal experimentation before employing it on humans. His clinical results were outstanding and quickly accepted by the surgical community. As a professor of surgery his goal was not only to teach surgeons the technical aspects of surgery but to teach them to be educators as well. With the development of Halsted’s surgical principles the art of surgery became the science of surgery moving it from the quasi-profession where it had been prior. Some say that without Halsted’s contributions surgery might never have fully developed. Halsted and his surgical assistant are also well known for the development of the surgical glove. His assistant, nurse Caroline Hamptom, developed a rash on her hands when exposed to the mercuric chloride used for antiseptics. Not wanting to risk losing his assistant as well as his mistress, Halsted recruited Goodyear Rubber Company to make a pair of rubber gloves to protect nurse Hamptom’s hands during surgery. Other surgical personnel as well as surgery students were quick to follow by wearing gloves to protect their hands not as a sterile barrier.
Most recent history of surgery has provide the surgeon with modern day technologies including robotics, laparoscopy, and a highly sophisticated regime of medicines to better care for the surgical patient. The progression of surgical history in the past 20 years has equaled and surpassed the past 2000 years. Surgical history is being written every day, imagine what the next generation’s history will tell.
