A procedure called trepanation (also called trephinning or trepanning) is the earliest known surgical procedure in the history of surgery. It involves drilling a hole into the skull, without tampering with the membrane around the brain. The oldest known trepanned cranium, dating back to 7300-6220 BC was found in Kiev, Ukraine. This procedure addresses disorders related to abnormal intracranial pressure, and many cultures worldwide have been found to use it. However, modern surgery is discarding this practice.
An ancient Egyptian mandible, dating back to about 2750 BC has also been discovered. It has perforations in the mouth, indicative of draining of an abscessed tooth. Interestingly, recent explorations in the pyramids of Egypt led to the discovery of proof of brain surgery on a laborer, who lived for two years after the procedure!
The earliest known text on the subject of surgery is the Edwin Smith papyrus. It dates back to the 1600s BC, but contains information dating back to 3000 BC. This ancient Egyptian book on surgery describes procedures related to examination, diagnosis and treatment of many diseases in intricate detail.
An eminent figure in the history of surgery is Sushrutha (400 BC). It was on the banks of the river Ganges in India, in what is known as Benares today, that he studied, practiced and taught the art of surgery. He has made some very important and innovative contributions to this field because of which he is hailed as the ‘Father of Surgery’. Much of the information available on him is known from the Sushrutha Samhita, a treatise written by him.
Although the boundaries between the roles of a surgeon and that of a physician are blurred, their historical roots are distinct from each other. A physician was more respected and revered than a surgeon. In terms of hierarchy, the status of surgery was lower than that of pure medicine.
The first modern surgeons emerged during the Napoleonic wars as doctors who treated injured, wounded soldiers. They mostly dealt with amputations. Naval surgeons were often barbers, who along with their regular jobs, as also did surgery.
In the 1840’s with the discovery of anesthetic chemicals such as chloroform, the pain and trauma associated with surgery was lifted. Apart from relieving the patient’s pain, doctors could now operate on the internal organs with anesthesia.
However, longer operations meant prolonged exposure of surgical wounds to open air. This heightened the risk of post surgical complications and infections that were often fatal. However, in the late 19th century, the proponents of microbiology such as Louis Pasteur and Joseph Lister strongly encouraged the idea of utmost cleanliness and sterile surroundings during and after surgery.
By the early 19th century, the status of surgeons was high. In 1800, surgeons began to be offered a formal status by the Royal College of Surgeons via membership. Member surgeons were known by the title ‘Mister’, and it was considered a sign of honor. Today, only surgeons who are members of this elite fraternity can call themselves Mister, Miss, Mrs. or Ms. However, Americans surgeons and physicians are always addresses as ‘Doctor’.
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