How has Surgery developed over time?
In the modern world people needing surgery can usually go into an operating theatre reasonably confidently. The main threats to a patient, pain, infection and blood loss, have all but been eradicated and for many operations there is little to fear. This however is a relatively recent development. This page provides a brief overview of some of the things that have enabled surgeons to perform at this level.
Surgery in the Prehistoric and Ancient World:
Prehistoric man is known to have performed successful surgery. Evidence exists of operations that even nowadays would make you think twice about under under the knife! Trephining, for example, is known to have happened thousands of years ago. This operation involves cutting a hole into the skull. In prehistoric and ancient times this may have been designed to release evil spirits, and would have been conducted without anaesthetics, blood transfusions or sterile equipment. However, bone growth on remains suggests that it WAS successfully carried out.
What does this tell us about early surgery?
It shows than man has been aware of the need to operate for a long long time. It also shows that efforts have been made to develop surgical equipment throughout time. Evidence from early medical writings shows us that ancient man was aware of the threats to patients and that they attempted to tackle the problems of pain and blood loss. (Use of herbs with antiseptic and pain numbing qualities are recorded by the Egyptians).
However, the types of surgery performed were quite limited. They appear to have been restricted to fixing broken bones, removing cysts and growths on the skin and making incisions into hard bone areas, such as the skull.
How did surgery develop?
Surgical knowledge was greatly enhanced by a number of things. Firstly, warfare. The Roman Army, for example, had large medical corps that worked with their armies. At each battle the surgeons would develop their methods of removing arrowheads, amputating limbs and would observe the effects of both the operation and the aftercare. Surgeons who worked with Gladiators, including Galen, developed their knowledge of the anatomy and developed surgical techniques based on this knowledge. This limited knowledge developed slowly. As new weapons were introduced, new treatments followed.
Secondly, they learnt through experience and experimentation. For example, surgeons in the Ancient World performed operations during childbirth that are little different to the Caesarian sections that are often carried out today. This shows us that people in the Ancient world were able to use surgery to save lives – though the operation at that time was likely to save only the child, the operation was usually only conducted when the mother was thought to be dying.
Surgery of this kind continued throughout the Middle Ages, Renaissance period and into the Industrialising world. Surgery was often quick, crude and extremely dangerous.
Some features of pre-modern surgery:
– use of things to numb pain, for example use of alcohol, or knocking the patient unconscious.
– use of items to prevent blood loss, for example by padding the wound with linen / cloth.
– speed. Surgeons knew that the patient was unlikely to survive a long operation, so speed was highly important.
Into the Modern Age:
The main barriers to developments in Surgery were:
- An inability to prevent blood loss.
- Lack of understanding about the cause of infections during surgery.
- Limited effectiveness of painkillers.
These were overcome in a very short space of time. Technological and scientific breakthroughs in the 19th century led to a revolution in surgical techniques.
The following are some of the main breakthroughs:
Dealing with Blood loss
- Blood groups were identified.
- Blood Transfusions were tried, tested and introduced.
- Development of Blood banks.
Dealing with infection
- Germ Theory identifies the ca sue of infection.
- Development of antiseptics and later aseptic surgery.
- Technological improvements enable sterile ‘use once’ pieces of equipment.
Dealing with pain
- Introduction of controllable anaesthetics.
- Acceptance of anaesthetics following endorsement by Queen Victoria.
- Development of drugs to control pain (during, after and away from surgery).
- Surgeons don’t need to operate to find out what is happening inside the body anymore. They can use X-Rays, CT Scans, MRI Scans etc to establish causes of conditions without needing to perform exploratory operations (for many but not all conditions).
- Emerging technologies have allowed surgeons to perform keyhole surgery.
- Modern Warfare has resulted in the development of surgical techniques to deal with burns, radiation and exposure to chemicals.
See a detailed timeline of the development of surgery through time.