Surgery is the branch ofmedicine that deals with the physical manipulation of a bodily structure to diagnose, prevent, or cure an ailment.Ambroise Paré, a 16th-century French surgeon, stated that to perform surgery is, "To eliminate that which is superfluous, restore that which has been dislocated, separate that which has been united, join that which has been divided and repair the defects of nature."
Since humans first learned how to make and handle tools, they have employed these skills to develop increasingly sophisticated surgical techniques. However, until theIndustrial Revolution, surgeons were incapable of overcoming the three principal obstacles which had plagued the medical profession from its infancy—bleeding,pain andinfection. Advances in these fields have transformed surgery from a risky art into a scientific discipline capable of treating many diseases and conditions.
The first surgical techniques were developed to treat injuries and traumas. A combination of archaeological and anthropological studies offer insight into much earlier 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 seems to suggest they were used in the suturing of cuts (theMaasai used needles ofacacia 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 bit the edges of the wound and then twisted the insects' neck, leaving their heads rigidly attached like staples.[1]
The oldest operation for which evidence exists istrepanation[2] (also known as trepanning, trephination, trephining or burr hole fromGreekτρύπανον andτρυπανισμός), in which a hole is drilled or scraped into the skull for exposing thedura 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] andNeolithic times, incave paintings, and the procedure continued in use well into recorded history (being described by ancient Greek writers such asHippocrates). 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 theDnieper River in the 1970s show the existence of trepanation inMesolithic times dated to approximately 12000 BCE.[7] The remains suggest a belief that trepanning could cureepileptic seizures,migraines, and certainmental 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]
The oldest known surgical amputation was carried out inBorneo about 31,000 years ago.[10] The operation involved the removal of the distal third of the left lower leg. The person survived the operation and lived for another 6 to 9 years. This is the only known surgical amputation carried out before theNeolithic Revolution and its farming transition. The next oldest known amputation was carried out about 7000 years ago on a farmer in France whose left forearm had been surgically removed.[11]
Examples of healed fractures in prehistoric human bones, suggesting setting and splinting have been found in the archeological record.[12]Among some treatments used by theAztecs, 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 offir was inserted into the cavity of themedulla..."[13] Modern medicine developed a technique similar to this in the 20th century known as medullary fixation.
Bloodletting is one of the oldest medical practices, having been practiced among diverse ancient peoples, including theMesopotamians, theEgyptians, the Greeks, theMayans, Indians 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 theWest, and during theRenaissance one could find bloodletting calendars that recommended appropriate times to bloodlet during the year and books that claimed bloodletting would cureinflammation,infections,strokes,manic psychosis and more.[14]
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.[15]
Nevertheless, the Sumerians developed several important medical techniques: inNinevah archaeologists have discovered bronze instruments with sharpened obsidian resembling modern day scalpels, knives, trephines, etc. TheCode 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:[16]
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 tenshekels 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.
Around 3100 BCE Egyptian civilization began to flourish whenNarmer, the first Pharaoh of Egypt, established the capital ofMemphis. Just as cuneiform tablets preserved the knowledge of the ancient Sumerians,hieroglyphics preserved the Egyptians'.
In the first monarchic age (2700 BCE) the first treatise on surgery was written by Imhotep, the vizier of PharaohDjoser, priest, astronomer, physician and first notable architect. So much was he famed for his medical skill that he became the Egyptian god of medicine.[17] Other famous physicians from the Ancient Empire (from 2500 to 2100 BCE) wereSachmet, the physician of PharaohSahure andNesmenau, 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 inKom 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 theEbers Papyrus, named after its discovererGeorg Ebers.The Ebers Papyrus, conserved at theUniversity of Leipzig, is considered one of the oldest treaties on medicine and the most importantmedical 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.
Plates vi and vii of theEdwin 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.[12][18] The Smith Papyrus describes a treatment for repairing a broken nose,[19] and the use of sutures to close wounds.[20] Infections were treated with honey.[21] 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.
Teeth discovered from a Neolithic graveyard inMehrgarh had shown signs of drilling.[22]Analysis of the teeth shows prehistoric people might have attempted curing toothache with drills made fromflintheads.[23][24]
Sushruta (c. 600 BCE)[25] is considered as the "founding father of surgery". His period is usually placed between the period of 1200 BC – 600 BC.[26] One of the earliest known mention of the name is from theBower Manuscript where Sushruta is listed as one of the ten sages residing in the Himalayas.[27] Texts also suggest that he learned surgery atKasi from LordDhanvantari, the god of medicine in Hindu mythology.[28] He was an early innovator of plastic surgery who taught and practiced surgery on the banks of theGanges in the area that corresponds to the present day city ofVaranasi inNorthern India. Much of what is known about Sushruta is inSanskrit contained in a series of volumes he authored, which are collectively known as theSushruta 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 andrhinoplasty.[29]
Surgeons are now considered to be specializedphysicians, whereas in the early ancient Greek world a trained general physician had to use his hands (χείρ inGreek) 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:χειρουργείν).
InThe IliadHomer names two doctors, “the two sons ofAsklepios, the admirable physiciansPodaleirius andMachaon and one acting doctor,Patroclus. Because Machaon is wounded and Podaleirius is in combatEurypylus asks Patroclus “to cut out this arrow from my thigh, wash off the blood with warm water and spread soothing ointment on the wound."[30]
TheHippocratic Oath,[31] 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 theHippocratic corpus[32] and theHippocratic 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 aslithotomy. Works from the Hippocratic 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, andOn Hemorrhoids.[18]
Herophilus of Chalcedon andErasistratus of Ceos were two greatAlexandrians who laid the foundations for the scientific study of anatomy and physiology.[33] 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 fromCelsus andGalen of Pergamum (Greek:Γαληνός)[18][34]
Galen'sOn the Natural Faculties, Books I, II, and III, is an excellent paradigm of a very accomplished Greek surgeon and physician of the 2nd centuryRoman era, who carried out very complex surgical operations and added significantly to the corpus of animal and human physiology and the art of surgery.[18][34] He was one of the first to useligatures in his experiments on animals.[35] Galen is also known as "The king of the catgut suture"[36]
In China, instruments resembling surgical tools have also been found in the archaeological sites ofBronze Age dating from theShang dynasty, along with seeds likely used for herbalism.[37]
Hua Tuo (140–208) was a famous Chinese physician during theEastern Han andThree Kingdoms era. He was the first person to perform surgery with the aid ofanesthesia, some 1600 years before the practice was adopted by Europeans.[38]Bian Que (Pien Ch'iao) was a "miracle doctor" described by the Chinese historianSima Qian in hisShiji who was credited with many skills. Another book,Liezi (Lieh Tzu) describes that Bian Que conducted a two way exchange of hearts between people.[39] 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.[40] Nonetheless, it establishes the concept of heart transplantation back to around 300 BCE.
Hunayn ibn Ishaq (809–873) was an ArabNestorian Christian physician who translated many Greek medical and scientific texts, including those ofGalen, writing the first systematic treatment ofophthalmology. Egypt-born Jewish physicianIsaac Israeli ben Solomon (832–892) also left many medical works written in Arabic that were translated and adopted by European universities in the early 13th century.
The Persian physicianMuhammad ibn Zakariya al-Razi (c. 865–925) advanced experimental medicine, pioneering ophthalmology and foundingpediatrics. The Persian physicianAli ibn Abbas al-Majusi (d. 994) worked at theAl-Adudi Hospital in Baghdad, leavingThe Complete Book of the Medical Art, which stressed the need for medical ethics and discussed the anatomy and physiology of the human brain. Persian physicianAvicenna (980–1037) wroteThe Canon of Medicine, a synthesis of Greek and Arab medicine that dominated European medicine until the mid-17th century.
In the 9th century theMedical School of Salerno in southwest Italy was founded, making use of Arabic texts and flourishing through the 13th century.
Abulcasis (936–1013) (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi) was anAndalusian-Arab physician and scientist who practised in theZahra suburb ofCordoba. He is considered to be the greatest medieval surgeon, though he added little to Greek surgical practices.[18] His works on surgery were highly influential.[41][42]
African-born Italian Benedictine monk (Muslim convert)Constantine the African (died 1099) ofMonte Cassino translated many Arabic medical works into Latin.
Spanish Muslim physicianAvenzoar (1094–1162) performed the first tracheotomy on a goat, writingBook of Simplification on Therapeutics and Diet, which became popular in Europe. Spanish Muslim physicianAverroes (1126–1198) was the first to explain the function of the retina and to recognize acquired immunity with smallpox.
In the late 12th centuryRogerius Salernitanus composed hisChirurgia, laying the foundation for modern Western surgical manuals.Roland of Parma andSurgery of the Four Masters were responsible for spreading Roger's work to Italy, France, and England.[18] Roger seems to have been influenced more by the 6th-centuryAëtius andAlexander of Tralles, and the 7th-centuryPaul of Aegina, than by the Arabs.[43]Hugh of Lucca (1150−1257) founded the Bologna School and rejected the theory of "laudable pus".[18]
In the 13th century in Europe skilled town craftsmen calledbarber-surgeons performed amputations and set broken bones while suffering lower status than university educated doctors. By 1308 theWorshipful 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 18th-centuryAge of Enlightenment.[44]
Guy de Chauliac (1298–1368) was one of the most eminent surgeons of the Middle Ages. HisChirurgia Magna orGreat Surgery (1363) was a standard text for surgeons until well into the seventeenth century."[45]
There were some important advances to the art of surgery during this period.Andreas Vesalius (1514–1564), professor of anatomy at theUniversity of Padua was a pivotal figure in theRenaissance transition from classical medicine and anatomy based on the works ofGalen, to an empirical approach of 'hands-on' dissection. His anatomic treatiseDe 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 wasAmbroise Paré (sometimes spelled "Ambrose" (c. 1510 – 1590)[46]), 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. Paré began to employ a less irritating emollient, made ofegg yolk,rose oil andturpentine. He also described more efficient techniques for the effectiveligation of theblood vessels during anamputation. In the same century,Eleno de Céspedes became perhaps the first female, transgender, or intersex surgeon in Spain, and perhaps in Europe.[47][48][49]
Another important early figure was German surgeonWilhelm Fabry (1540–1634), "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 assistantMarie Colinet (1560–1640) improved the techniques forCaesarean 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.
Surgical pioneers in Early modern Europe
Andreas Vesalius (1514–1564)
Ambroise Paré (c. 1510–1590), father of modern military surgery
Wilhelm Fabry (1540–1634), father of German surgery
The discipline of surgery was put on a sound, scientific footing during theAge of Enlightenment in Europe (1715–90). An important figure in this regard was the Scottish surgical scientist (in London)John Hunter (1728–1793), generally regarded as the father of modern scientific surgery.[50] He brought anempirical andexperimental 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 ofvenereal disease and introduced many new techniques of surgery, including new methods for repairing damage to theAchilles tendon and a more effective method for applying ligature of thearteries in case of ananeurysm.[51] He was also one of the first to understand the importance ofpathology, the danger of the spread ofinfection and how the problem ofinflammation of the wound, bonelesions and eventuberculosis 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.[52]
Hunter's studentBenjamin Bell (1749–1806) 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 great-grandsonJoseph Bell (1837–1911) became the inspiration forArthur Conan Doyle's literary hero Sherlock Holmes.
Beginning in the 1840s, European surgery began to change dramatically in character with the discovery of effective and practical anesthetic chemicals such asether, first used by the American surgeonCrawford Long (1815–1878), andchloroform, discovered byJames Young Simpson (1811–1870) and later pioneered in England byJohn Snow (1813–1858), physician toQueen Victoria, who in 1853 administered chloroform to her during childbirth, and in 1854 disproved themiasma theory of contagion by tracing a cholera outbreak in London to an infected water pump.[53] In addition to relieving patient suffering, anaesthesia allowed more intricate operations in the internal regions of the human body. In addition, the discovery ofmuscle relaxants such ascurare allowed for safer applications. American surgeonJ. Marion Sims (1813–83) received credit for helping foundgynecology, but later was criticized for failing to use anesthesia on enslaved Black test subjects.
Pioneers of Anesthesia
Crawford Long (1815–1878)
James Young Simpson (1811–1870) by Henry Laing Gordon
The introduction of anesthetics encouraged more surgery, which inadvertently caused more dangerous patient post-operative infections. The first progress in combating infection in Europe was made in 1847 by theHungarian doctorIgnaz 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 theRoyal Society dismissed his advice.Until the pioneering work of British surgeonJoseph Lister in the 1860s, most medical men in Europe believed that chemical damage from exposures to bad air (see "miasma") was responsible forinfections in wounds, and facilities for washing hands or a patient'swounds were not available.[54] Lister became aware of the work of Frenchchemist andmicrobiology pioneer,Louis Pasteur, who showed that rotting andfermentation could occur underanaerobic conditions ifmicro-organisms were present. Pasteur suggested three methods to eliminate themicro-organisms responsible forgangrene: filtration, exposure to heat, or exposure tochemical solutions. Lister confirmed Pasteur's conclusions with his own experiments and decided to use his findings to developantiseptic techniques for wounds. As the first two methods suggested by Pasteur were inappropriate for the treatment of human tissue, Lister experimented with the third, sprayingcarbolic acid on his instruments. He found that this remarkably reduced the incidence of gangrene and he published his results inThe Lancet.[55] Later, on 9 August 1867, he read a paper before the British Medical Association in Dublin, on theAntiseptic Principle of the Practice of Surgery, which was reprinted in theBritish Medical Journal.[56][57][58] 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 ofantisepsis andasepsis 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.[59] He also introduced the steam steriliser tosterilize 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.[60] 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 centuryWilliam Stewart Halstead (1852–1922) laid out basic surgical principles for asepsis known asHalsteads principles. Halsted also introduced the latexmedical glove. After one of his nurses suffered skin damage due to having to sterilize her hands with carbolic acid, Halsted had designed a rubber glove that could be dipped in carbolic acid.
Pioneers of Antiseptic surgery
Ignaz Semmelweis (1818-1865), 1894 copperplate engraving byJenő Doby
Louis Pasteur (1822-1895) before 1895 byPaul Nadar
Joseph Lister (1827-1912) in 1902, The father of modern surgery
William Stewart Halsted (1852–1922) by John H. Stocksdale
The use ofX-rays as an important medical diagnostic tool began with their discovery in 1895 by GermanphysicistWilhelm Röntgen. He noticed that these rays could penetrate the skin, allowing the skeletal structure to be captured on a specially treatedphotographic plate.
c. 2613–2494 BCE. A jaw found in anEgyptian Fourth Dynasty tomb shows the marks of an operation to drain a pus-filled abscess under the first molar.[30]
1600 BCE. TheEdwin 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. TheEbers Papyrus from Egypt listed over 800 drugs and prescriptions.
1250 BCE.Asklepios and his sonsPodaleirius andMachaon were reported byHomer as battlefield surgeons.[30] He also reported arrowheads cut out; styptics; administration of sedatives and bandaging of wounds with wool.[30]
400 BCE. About this yearHippocrates 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 theFour temperaments theory of disease, and leaving theHippocratic 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."[30] 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."
50 CE. About this time Roman physician-surgeonAulus Cornelius Celsus died, leavingDe Medicina, which described the "dilated tortuous veins" surrounding a breast cancer, causing Galen to later give cancer (Latin for crab) its name. He advised againstradical mastectomy involving the pectoral muscles, and warned that surgery should only be attempted in the benign stage (first of four).
200 CE. About this yearGalen 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 CE. About this yearLeonidas 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 CE.Hua Tuo began using wine and cannabis as an anesthetic during surgery.
476 CE. TheFall 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.
1879. After becoming the first to diagnose the location based on neurological findings alone, Scottish surgeonWilliam Macewen (1848–1924) performed the first successful non-primary (trephined) brain tumor removal, pioneeringbrain surgery.
1882.William Stewart Halsted of Johns Hopkins Hospital performed the first complete radical mastectomy in the U.S., which became the standard treatment.
1884. After English physicianAlexander Hughes Bennett (1848–1901) diagnosed the location based on neurological findings alone, English surgeonRickman Godlee (1849–1925) completed the first primary (exposed) brain tumor removal.
1884. Austrian ophthalmologistKarl Koller first usedcocaine as a local anesthetic for eye surgery.
1895. The first successful cardiac surgery was performed by Norwegian surgeonAxel 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 surgeonLudwig Rehn.
1900. About this time theCargile membrane was introduced into surgery.
1995. Use of adult stem cells in neoregeneration of abdominal wall apponeurosis, used in surgical treatment of incisional hernia. Indian surgeon B.G. Matapurkar.
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 firstvirtual surgery usingGoogle 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.[64]
2016. The first uterus transplant in the U.S. at Cleveland Clinic.
^Agelarakis, Anagnostis P. (2006)."Artful Surgery".Archaeology Magazine.59 (2).
^Ralph Solecki, Rose Solecki andAnagnostis Agelarakis, “The Proto-Neolithic Cemetery in Shanidar Cave”, Texas: A&M University Press, College Station, 2004
^Restak R (2000) Mysteries of the mind. National Geographic Society, Washington D.C.
^Salmoral, Manuel Lucena (1990).América 1492: retrato de un continente hace quinientos años [America 1492: portrait of a continent five hundred years ago] (in Spanish). Anaya.ISBN978-84-207-3766-9.[page needed]
^Longrigg, James (2002).Greek Rational Medicine: Philosophy and Medicine from Alcmaeon to the Alexandrians. Taylor & Francis.ISBN978-0-203-03344-9.[page needed]
^abGalen, On the Natural Faculties, Books I, II, and III, Loeb Classical Library, Harvard, 2000[page needed]
^Lois N. Magner (1992).A History of Medicine. CRC Press. p. 91.
^Sherer, Adina; Epstein, Fred; Constantini, Shlomi (1 May 2004). "Hua Tuo, patron of surgeons, or how the surgeon lost his head!".Surgical Neurology.61 (5):497–498.doi:10.1016/j.surneu.2003.11.037.PMID15120241.
^Kahan, BD (April 1988). "Pien Ch'iao, the legendary exchange of hearts, traditional Chinese medicine, and the modern era of cyclosporine".Transplantation Proceedings.20 (2 Suppl 2):2–12.PMID3284067.
^Graham, A.C. "The Date and Composition of Liehtzyy," Asia Major 8, pp. 139−198. 1961.
^Emilio Maganto Pavón,El proceso inquisitorial contra Elena/o de Céspedes. Biografía de una cirujana transexual del siglo XVI, Madrid, 2007.
^Francisco Vazquez Garcia,Sex, Identity and Hermaphrodites in Iberia, 1500–1800 (2015,ISBN1317321197), page 46.
^Moore, Wendy (2005).The Knife Man: The Extraordinary Life and Times of John Hunter, Father of Modern Surgery. Broadway Books.ISBN978-0-7679-1652-3.[page needed]
^Robinson, Victor (June 2005).The Story Of Medicine. Kessinger Publishing. p. 420.ISBN9781419154317.
^Lister, Joseph (March 1867). "On a new method of treating compound fracture, abscess, etc.: with observations on the conditions of suppuration".The Lancet.89 (2272):326–329.doi:10.1016/S0140-6736(02)51192-2.
^O'Connor, Stephen (2009). "Chapter 11: Surgery". In Corner, Jessica; Bailey, Christopher (eds.).Cancer Nursing Care in Context (2nd ed.). Chichester: John Wiley & Sons. p. 218.ISBN9781444309256.
^Dran, Henri-François Le (1768).The operations in surgery. printed for Hawes Clarke and Collins, J. Dodsley, W. Johnston, B. Law and T. Becket. Retrieved7 December 2012.
^London, Hunterian Museum; curator.), Elizabeth Allen (George Qvist; England, Royal College of Surgeons of (1993).A guide to the Hunterian Museum: John Hunter, 1728–1793. Royal College of Surgeons of England. Retrieved7 December 2012.
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