|
 


 
 2
  


! The first surgical techniques were

developed to ?
??
 

? 
that man encountered in the course of his
everyday life.
! iome Asian tribes used a mix of saltpeter and
sulfur was poured placed on wounds and lit on
fire in order to cauterize wounds.

! The Dakota Indians used the quill of a feather

attached to an animal bladder to suck out
purulent material

! The discovery of needles from the stone age

seem to suggest they were used to in suturing.
! Tribes in India and iouth America developed an
ingenious method of sealing minor injuries by
applying termites or scarabs.
2
  
! The oldest surgery in which a hole is drilled or scraped
into the skull, thus exposing the dura mater in order to
treat health problems related to intracranial pressure
and other diseases.
 

 
|ammurabi's Code itself contains specific legislation
regulating surgeons and medical compensation as
well as malpractice and victim's compensation:

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 ten shekels in money.
216. If the patient be a freed man, he receives five
shekels.
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.
219. If a physician make a large incision in the
slave of a freed man, and kill him, he shall
replace the slave with another slave.
220. If he had opened a tumor with the
operating knife, and put out his eye, he
shall pay half his value.
! [0,000 or so cuneiform tablets that have been
discovered, about 800 of them deal with
medical themes.

r

! ‰irst surgeon from 4000 BC.
 x 

 

! Îrote the first treaty of surgery in 2700 BC.
! Egyptian God of medicine.
    

! Is the only surviving copy of part of an Ancient
Egyptian textbook on trauma surgery.

! The text begins by addressing injuries to the

head, and continues with treatments for
injuries to neck, arms and torso, where the
text breaks off.
! Among the treatments are closing wounds
with sutures (for wounds of the lip, throat,
and shoulder), preventing and curing infection
with honey and moldy bread, and stopping
bleeding with raw meat.

! Immobilization was often advised for head

and spinal cord injuries, which is still in
practice today in the short-term treatment of
some injuries.
! The papyrus also describes anatomical
observations in exquisite detail.

! It contains the first known descriptions of

the cranial sutures, the meninges, the
external surface of the brain,
the cerebrospinal fluid, and
the intracranial pulsations
! The papyrus shows that the heart,
vessels, liver, spleen, kidneys, ureters and
bladder were recognized, and that the blood
vessels were known to be connected to the
heart.




! The most important discovery relating to
ancient Egyptian knowledge of medicine.
! Is considered one of the oldest treaties on
medicine and the most important medical
papyri.
! The text is dated to about 1550 BC 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.
! án 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 in Kom ámbo,
Egypt depict surgical tools.
 G 
|
 
! Îas a famous Chinese physician during the
Eastern |an and Three Kingdoms era.
! |e was the first person to perform surgery
with the aid of anesthesia, some 1600 years
before the practice was adopted by
Europeans.
! also devised techniques to enhance health. |e
developed the Î  (§
‰rolics of the
‰ive Animals), a series of exercises based on
movements of the tiger, deer, bear, ape, and
crane.

! |e was well known for being able to diagnose

miscarriages by examining a woman's pulse
and to tell whether the dead fetus was male
or female depending on the position of the
fetus.
a
  
! Conducted a two way exchanged of hearts
between people.
x rx
xx
x|x

! |e became one of the most renowned

surgeons of the Muslim era and was physician
to King Al-|akam-II of ipain.
! |e is best known for his early and original
breakthroughs in surgery as well as for his
famous Medical Ecyclopaedia called x
 ,
which is composed of thirty volumes covering
different aspects of medical science.
! The more important part of this series comprises
three books on surgery, which describe in detail
various aspects of surgical treatment as based on
the operations performed by him, including
cauterization, removal of stone from the bladder,
dissection of animals, midwifery, and surgery of
eye, ear and throat.
! |e perfected several delicate operations,
including removal of the dead foetus and
amputation.
! was the inventor of several surgical
instruments, of which three are notable:
A. An instrument for internal examination of the
ear,
B. An instrument for internal inspection of the
urethra.
C. Instrument for applying or removing foreign
bodies from the throat.
! |e specialized in curing disease by
cauterization and applied the technique to as
many as 50 different operations.
   x




x 
! Is possible one of the oldest forms of anesthesia,
and it has been for thousands of years before our
time.

 
! Known to have been used for millenia, both for
recreation and as an anesthetic.
 ‰   

 

 

 
! The next real breakthrough to come was the
invention of ligatures, widely believed to have
originated with Abulcasis in the 10th century
and improved by Ambroise Paré in the 16th
century.
 x



! Introduced the ?
  ?

instead

of cauterization during amputation. To this he
designed the 


  (crow's beak),
a predecessor to modern hemostats.
! Although ligatures often spread infection, it
still was an important breakthrough in surgical
practice.
   




  ?

! woticed that medical students fresh from the
dissecting room were causing excess maternal
death compared to midwives.
! Postulated the theory of washing with
chlorinated lime solutions͞.
! iemmelweis, despite ridicule and opposition,
introduced compulsory hand washing for
everyone entering the maternal wards and was
rewarded with a plunge in maternal and fetal
deaths.
 



! |e is best known for his remarkable
breakthroughs in the causes and preventions
of disease.
! |is discoveries reduced mortality
from puerperal fever, and he created the
first vaccine for rabies.
 A

 



?


 x?
  
! |e successfully introduced „
 „
„


to sterilize surgical instruments and to

clean wounds, which led to reduced post-
operative infections and made surgery safer for
patients.
! Carbolic acid (phenol) had been in use as a means
of deodorizing sewage, so Lister tested the results
of spraying instruments, the surgical incisions,
and dressings with a solution of it.
! |e also made surgeons wear clean gloves and
wash their hands before and after operations
with 5% carbolic acid solutions.

! Instruments were also washed in the same

solution and assistants sprayed the solution in
the operating theatre.

! áne of his conclusions was to stop

using porous natural materials in manufacturing
the handles of medical instruments.
! |e also developed a method of
repairing kneecaps with metal wire and
improved the technique of mastectomy.
 |



! An American dentist who pioneered the use of
anaesthesia in dentistry, specifically ?  
 

(or laughing gas).

! ‰irst bore witness to the effects of laughing

gas in 1844 when he volunteered to have it
demonstrated on him by Gardner Quincy
Colton, a member of a traveling circus.
! |e then began utilizing it on his own patients.
|e did not attempt to patent the discovery
because he stated that pain relief should be
'as free as the air'.
   2 





? 



x
?

! An American dentist who first publicly
demonstrated the use of inhaled
?
as a
surgical anesthetic in 1846.

! án ieptember [0, 1846, Morton performed a

painless tooth extraction after administering
ether to a patient.
! Boston surgeon |
 
 arranged for a
now-famous demonstration of ether on
áctober 16, 1846 at the Massachusetts
General |ospital. At this demonstration
 !  Î
 painlessly removed
a tumor from the neck of a  "

# 
?
x??
 A  
! A British physician and a leader in the
adoption of anesthesia and medical hygiene.
! inow was one of the first physicians to study
and calculate dosages for the use of ether and
also chloroform as surgical anesthesia.
! |e personally administered chloroform
to Queen Victoria when she gave birth to the
last two of her nine children, Leopold in 185[
and Beatrice in 1857.
! This led to wider public acceptance
of obstetric anesthesia.
 |

 x 

! The surgeon wore his street clothes, with
perhaps a butcher's apron to protect his
clothing from blood stains, and he operated
bare-handed with non-sterile instruments and
supplies.
Œ Œ

! iome surgeons began wearing cotton gauze
masks in surgery.
! áperating theatre staff began wearing heavy
rubber gloves to protect their hands from the
solutions used to clean the room and
equipment
Π
! Advances in surgical antisepsis (now called
aseptic technique) and the science of wound
infection led to the adoption of antiseptic
drapes and gowns for operating room (á )
use.
! Instruments, supplies and dressings were
routinely sterilized by exposure to either high-
pressure steam or ethylene oxide gas.
! áriginally, operating room attire was white to
emphasize cleanliness.

Π
 Π

! Most hospitals had abandoned white
operating room apparel in favor of various
shades of green.
Π
! iurgical attire had largely reached its modern
state: a short-sleeve V-necked shirt and
drawstring pants or a short-sleeve calf-length
dress, made of green cotton or
cotton/polyester blend.
! Tie-back or bouffant-style cloth cap, a gauze or
synthetic textile mask, a cloth or synthetic
surgical gown, latex gloves and supportive
closed-toe shoes.