A short history of the A short history of the evolution of surgeryevolution of surgery

László DamjanovichLászló Damjanovich

Professor of SurgeryProfessor of Surgery

Evolution of surgeryEvolution of surgery

Introduction to modern surgeryIntroduction to modern surgery

Short history of the Medical School of Short history of the Medical School of Debrecen and the Surgical InstituteDebrecen and the Surgical Institute

„„The abdomen, the chest and The abdomen, the chest and the brain will forever be shut the brain will forever be shut from the intrusion of the wise from the intrusion of the wise

and humane surgeon.”and humane surgeon.”

Sir John Ericksen, Surgeon Sir John Ericksen, Surgeon Extraordinaire to Queen Victoria, Extraordinaire to Queen Victoria,

18371837

„„Today our colleagues perform an Today our colleagues perform an average of 80.000 operations average of 80.000 operations each day (in the USA), many in each day (in the USA), many in the abdomen, chest or brain” the abdomen, chest or brain”

Daniel J. Riskin, UCLA, Daniel J. Riskin, UCLA, 20062006

Epochs of SurgeryEpochs of Surgery

Characteristics of the pre-modern phase:Characteristics of the pre-modern phase: Lack of significant anatomical knowledgeLack of significant anatomical knowledge Progress was made by the isolated Progress was made by the isolated

achievement of outstanding personalities achievement of outstanding personalities Methods were tested during major wars under Methods were tested during major wars under

the pressure of necessitythe pressure of necessity Clerical dogmas prevailed over scientific Clerical dogmas prevailed over scientific

contributionscontributions

Medical heritage of early Medical heritage of early civilizationscivilizations

The earliest written piece of medical The earliest written piece of medical history, 1600-1500 B.C. history, 1600-1500 B.C. Edwin Smith Edwin Smith Egyptian papyrusEgyptian papyrus::

surgery was well defined, having important surgery was well defined, having important role in medicine role in medicine contains case reports in a logically contains case reports in a logically

arranged seriesarranged seriespersonal cleanliness, hygiene and personal cleanliness, hygiene and correct correct diagnosis before treatment was important diagnosis before treatment was important

Scope of surgical activitiesScope of surgical activities

Bandages, dressingsBandages, dressings

CircumcisionCircumcision

Opening abscessesOpening abscesses

Fractures, dislocationsFractures, dislocations

Lithotomies (urolith)Lithotomies (urolith)

Hemorrhoides, fistulasHemorrhoides, fistulas

AmputationsAmputations

Tooth extractionsTooth extractions

HerniotomiesHerniotomies

Hippocrates Hippocrates (460-375 b.c.)(460-375 b.c.)

„„The father of medicine”The father of medicine”

MedicineMedicine and and surgerysurgery was was one disciplineone discipline

Great attention to Great attention to observation, detail, record observation, detail, record keeping, gathering keeping, gathering knowledge about knowledge about diseases, cleanliness, diseases, cleanliness, order, practiceorder, practice

„„Humoralpathology”Humoralpathology”

Corpus Hippocraticum, Corpus Hippocraticum, devotion to the patient, devotion to the patient,

Ancient textbooksAncient textbooks

Ayur Veda Ayur Veda (The book of life) (The book of life) India, ChinaIndia, ChinaCode of Code of HammurabiHammurabi 2000 B.C. 2000 B.C. Mesopotamia)Mesopotamia) (Surg., Medical, Legal text)(Surg., Medical, Legal text)

AlexandriaAlexandria: : Aristotle, Herophilos, ErasistratosAristotle, Herophilos, Erasistratos

Roman empireRoman empire: : Celsus 8 books, Galenus Celsus 8 books, Galenus (treated gladiators, dissected pigs, many errors, great (treated gladiators, dissected pigs, many errors, great impact until XV. century, disagreement was heresy)impact until XV. century, disagreement was heresy)

Arabic periodArabic period, , Avicenna Avicenna (Persian) (Persian) Xth century: Xth century: The Canon (surgery as a necessary evil, Baghdad, The Canon (surgery as a necessary evil, Baghdad, Damascus, Cairo: hospital-med. schools)Damascus, Cairo: hospital-med. schools)

Medieval medicine (476-1453)Medieval medicine (476-1453)

Religious medicine, dogmasReligious medicine, dogmas

Low social status of surgeonsLow social status of surgeons

Surgery practiced by barber surgeonsSurgery practiced by barber surgeons

Clerical ban on autopsies, absense of Clerical ban on autopsies, absense of anatomical knowledge (dissection on pigs)anatomical knowledge (dissection on pigs)

Miracles made by saintsMiracles made by saints

Illnes is a retribution from heavenIllnes is a retribution from heaven

Hospitals maintained by the churchHospitals maintained by the church

The sick taken care of by nunsThe sick taken care of by nuns

The Salerno SchoolThe Salerno School

First school of formal training,commenced in the First school of formal training,commenced in the 12th century, southern Italy12th century, southern ItalyThe first secular medical schoolThe first secular medical schoolRevival of ancient knowledgeRevival of ancient knowledgeDissection on pigsDissection on pigsMore emphasis on surgeryMore emphasis on surgeryRecording own experience of surgeonsRecording own experience of surgeonsRoger of Salerno: Cyrurgia Rigerii 1170- the first Roger of Salerno: Cyrurgia Rigerii 1170- the first independent surgical work in the Westindependent surgical work in the WestThe school moves to Bologna after his deathThe school moves to Bologna after his death

Development of medicine in the Development of medicine in the middle agesmiddle ages

LanfrancLanfranc 1315. France, 1315. France, against „pus bonum et against „pus bonum et laudabile” keep it cleanlaudabile” keep it clean

Pope Sixtus Pope Sixtus IV. (1414-IV. (1414-1484) appr. autopsies, 1484) appr. autopsies, stimulation of studiesstimulation of studies

Leonardo da VinciLeonardo da Vinci, , Michelangelo, Dürer, Michelangelo, Dürer, Titian…Titian…

Jacob SylviusJacob Sylvius, Paris: , Paris: Galen’s anatomyGalen’s anatomy

Andreas VesaliusAndreas Vesalius, , Brussels: at age 23, Brussels: at age 23, professor of surgeryprofessor of surgery

De Humani Corporis De Humani Corporis fabrica (at age 28)fabrica (at age 28)

ParacelsusParacelsus, Basel:, Basel:

„„internal medicine and internal medicine and surgery must not be surgery must not be separated”separated”

Ambroise Paré 1510-1590Ambroise Paré 1510-1590

Apprentice of VesaliusApprentice of Vesalius

Field surgeon in the French armyField surgeon in the French army

Performed autopsiesPerformed autopsies

Used turpentine, instead of burning oil to Used turpentine, instead of burning oil to treat gunshot wounds, amputated limbstreat gunshot wounds, amputated limbs

Routine ligature of vesselsRoutine ligature of vessels

Invented new instruments, limb prosthesesInvented new instruments, limb prostheses

XVIII. EnlightenmentXVIII. Enlightenment

Revival of ancient medical knowledgeRevival of ancient medical knowledge

William and John Hunter William and John Hunter

Anatomy of the gravid uterus (William)Anatomy of the gravid uterus (William)

Ligature of the aneurysm of the superficial Ligature of the aneurysm of the superficial fem. art. (instead of amputation) in four fem. art. (instead of amputation) in four cases succesfullycases succesfully

Angina pectoris in his own case (John)Angina pectoris in his own case (John)

Beginning of modern surgeryBeginning of modern surgery

Phase I: Phase I: introduction of anaesthesia (Morton)introduction of anaesthesia (Morton)anesthetic – the agentanesthetic – the agent

1842. January: William E. Clarke tooth 1842. January: William E. Clarke tooth extraction under ether narcosis Rochester, NYextraction under ether narcosis Rochester, NY

1846. October: Dr.John C. Warren 1846. October: Dr.John C. Warren (NEJM, AMA, (NEJM, AMA,

1st dean of Harvard)1st dean of Harvard) jaw tumor removal under ether jaw tumor removal under ether narcosis performed by William T.G. Morton narcosis performed by William T.G. Morton

Warren

and

Morton

Early development of biomedical Early development of biomedical sciencessciences

Edward Edward Jenner Jenner (surgeon): 1749-1823 (surgeon): 1749-1823 Vaccination, pox Vaccination, pox

Theodor Theodor SchwannSchwann::

1810-1882, cells1810-1882, cells

Rudolf Rudolf VirchowVirchow

1821-1902, cellular 1821-1902, cellular pathologypathology

Francois Francois MagendieMagendie

1783-1855, nervous 1783-1855, nervous system anatomysystem anatomy

Claude Claude BernardBernard

1813-1878, 1813-1878, experimental physiology experimental physiology homeostasishomeostasis

Antisepsis-asepsis, II. phaseAntisepsis-asepsis, II. phase

Louis Louis PasteurPasteur: correlation between rotting and : correlation between rotting and oxygen content of the air, discovery of bacteriaoxygen content of the air, discovery of bacteriaJoseph Joseph ListerLister: carbolic acid used for sanitation in : carbolic acid used for sanitation in Carlisle, wound toilette, and operating instruments, Carlisle, wound toilette, and operating instruments, death rate dropped to 1/3, lead and zinc plates to death rate dropped to 1/3, lead and zinc plates to cover woundscover woundsSemmelweisSemmelweis Ignácz: hypochloric acid for Ignácz: hypochloric acid for decontamination of the hand after autopsiesdecontamination of the hand after autopsiesR.KochR.Koch: TB, anthrax, steem for sterilization: TB, anthrax, steem for sterilizationTrendelenburg, SchimmelbuschTrendelenburg, Schimmelbusch: steam sterilization: steam sterilizationSteril rubber gloves: Steril rubber gloves: HalstedHalsted 1891. 1891.Face mask: Face mask: HunterHunter 1900. 1900.

The first The first (surgical) (surgical)

Nobel Prize in medicineNobel Prize in medicine

Theodor Kocher Theodor Kocher 1841-1917. Bern1841-1917. Bern

1909:1909:

„…„…for his work in physiology, pathology for his work in physiology, pathology and surgery on the thyroid gland…”and surgery on the thyroid gland…”

Features of modern surgeryFeatures of modern surgery

High degree of specialization (heart, High degree of specialization (heart, vascular, chest, pediatric, colorectal…)vascular, chest, pediatric, colorectal…)

Maximum use of related sciences (rtg, US, Maximum use of related sciences (rtg, US, CT, MRI, laboratory tests, endoscopy…)CT, MRI, laboratory tests, endoscopy…)

Fast and wide share of informationFast and wide share of information

Research oriented development of surgery Research oriented development of surgery guided by the rules of science and law guided by the rules of science and law

and grants! and grants!

Independent disciplines sprouting Independent disciplines sprouting from general surgeryfrom general surgery

UrologyUrology

OrthopedicsOrthopedics

RadiologyRadiology

TraumatologyTraumatology

Chest surgeryChest surgery

Heart surgeryHeart surgery

Pediatric surgeryPediatric surgery

Hand surgeryHand surgery

Vascular s.Vascular s.

Transplantation s.Transplantation s.

NeurosurgeryNeurosurgery

Head and neck s.Head and neck s.

Ophtalmic s.Ophtalmic s.

Plastic s.Plastic s.

Cooperation between disciplinesCooperation between disciplines

„„Clinical Sciences”Clinical Sciences”

Anesthesiology, ICUAnesthesiology, ICU

Imaging: US, CT, MR, PET, Imaging: US, CT, MR, PET, nuclear medicinenuclear medicine

Laboratory diagnostics, Laboratory diagnostics, microbiology labmicrobiology lab

Internal medicine (gastroent., Internal medicine (gastroent., endocrin., cardiol., nephrol…)endocrin., cardiol., nephrol…)

SurgerySurgery

Theoretical Sciences”Theoretical Sciences”Anatomy, physiol., chemistry, Anatomy, physiol., chemistry, physicsphysics

PharmacologyPharmacology

Engineering (sterilization, Engineering (sterilization, lighting, laparoscopy, lighting, laparoscopy, endoscopy, US cutting endoscopy, US cutting devices, staplers, implantsdevices, staplers, implants

Immunology (transfusion, Immunology (transfusion, transplantation…)transplantation…)

Genetics (FAP, HNPCC…)Genetics (FAP, HNPCC…)

ScienceScience ArtArt,,

Personal challengePersonal challenge

HandicraftHandicraft

Surgery

Historical moments of the Historical moments of the University of DebrecenUniversity of Debrecen

Calvinist Coll. 1541Calvinist Coll. 1541

University XVII th centuryUniversity XVII th century

1750- István Hatvani: natural 1750- István Hatvani: natural sciences in the curriculasciences in the curricula

1906. Gyula Kenézy, theol., law, 1906. Gyula Kenézy, theol., law, science and medical facultiesscience and medical faculties

1914-1918. University of Arts and 1914-1918. University of Arts and Sciences, Floris KorbSciences, Floris Korb

1921: Inauguration of the Medical 1921: Inauguration of the Medical FacultyFaculty

Four out of 15 professors stay in Four out of 15 professors stay in Debrecen during WW IIDebrecen during WW II

1951: Med. Fac. becomes and 1951: Med. Fac. becomes and independent university: DOTEindependent university: DOTE

1977: Dentistry Fac. founded1977: Dentistry Fac. founded

1987: English Program initiated1987: English Program initiated

1998: University Assoc. of 1998: University Assoc. of Debrecen DATE, DOTE, KLTE, Debrecen DATE, DOTE, KLTE, KFRTF, LFZFDK, ATOMKI, DRHEKFRTF, LFZFDK, ATOMKI, DRHE

2000: UD MHSC2000: UD MHSC

Prof. Tivadar Hüttl