Early Surgery and Its Pioneers

Early Steps in Surgery

• Ancient surgery was limited to basic procedures such as wound healing, abscess opening, and foreign body removal.
• Interventions were rudimentary and often based on religious and mystical beliefs.
• Trepanation, drilling holes in the skull, was practiced in ancient cultures.
• Hygiene and science did not play a significant role in medicine during this period.

Hippocrates and Early Antisepsis

• Hippocrates, considered the father of medicine, lived from 460 to 370 BCE.
• He believed that pus formation was not a natural part of healing, a revolutionary idea for his time.
• He advocated for handwashing before treating patients, a fundamental practice for infection prevention.
• He emphasized the importance of good lighting during procedures, a detail essential in the absence of modern technology.

Aulus Cornelius Celsus and Wound Cleaning

• Celsus, a Roman writer, wrote about wound cleaning and the need to prevent contamination during surgery.
• He lived around 25 BCE to 50 CE.
• His understanding of asepsis was rudimentary, but he recognized the importance of hygiene.

Dioscorides and Natural Antibacterials

• Dioscorides, a Greek physician, lived in the 1st century CE.
• He documented the use of natural substances with antibacterial properties, such as olive oil and vinegar.
• His work, "De Materia Medica," highlighted the use of these substances for treating wounds and preventing infections.

Galen and the Theory of Laudable Pus

• Galen, a Greek physician, lived from 130 to 200 CE.
• He promoted the theory of laudable pus, believing that pus was a sign the body was fighting infection.
• This belief delayed progress in surgery and antisepsis for over two millennia.

The Rise of Modern Surgery and Antisepsis

• In the 15th century, Ambrosio Paré, a French surgeon, challenged traditional beliefs related to wound treatment.
• He advocated for less painful methods, replacing boiling oil cauterization with turpentine, which he believed was less traumatic.
• He also opposed the theory of laudable pus.

Giovanni Maria Lancisi and Infection Control

• Lancisi, an Italian physician, lived from 1654 to 1662.
• He proposed measures to prevent the spread of infectious diseases, even though bacteria were unknown at the time.
• He stressed the importance of cleanliness and disinfection in medical environments, laying the groundwork for hospital hygiene.

Antony van Leeuwenhoek and the Discovery of Bacteria

• In the 17th century, Antony van Leeuwenhoek, a Dutch scientist, observed bacteria using his microscope.
• He published his findings in 1683 though their full significance was not realized until later.

The Professionalization of Surgery

• In 1661, Frederick the Great of Prussia allowed individuals without medical titles, such as barbers, to treat wounds due to a shortage of skilled surgeons.
• In 1684, the French confraternity of Saint Cosmas, which grouped surgeons, was reorganized as the Royal Academy of Surgery, furthering the professionalization of surgery.

The 19th Century: Transforming Surgery

• The 19th century witnessed advancements in surgery, driven by the industrial revolution and scientific breakthroughs.
• Surgeons faced three major challenges: pain, hemorrhage, and infection.
• Anesthesia was introduced in the 1840s, addressing the problem of pain.
• Hemorrhage control improved with new hemostasis techniques.
• Infection remained a significant challenge.

Bernard Gaspar and Early Studies on Infection

• Bernard Gaspar, in 1808, demonstrated that infected blood could spread disease, suggesting the role of body fluids in transmission.

Oliver Wendell Holmes and Ignas Semmelweis on Puerperal Fever

• In 1843, Oliver Wendell Holmes proposed that puerperal fever, a childbirth complication, was contagious and preventable through handwashing.
• In 1847, Ignaz Semmelweis, in Hungary, observed lower mortality rates from puerperal fever in women treated by midwives who washed their hands.
• He introduced chlorinated handwashing, but his ideas were largely rejected, and he died in a mental asylum.

Louis Pasteur and the Germ Theory of Disease

• In the 1850s, Louis Pasteur, a French scientist, studied fermentation and discovered the role of microorganisms.
• He conducted his famous swan-necked flask experiment, challenging the theory of spontaneous generation and proving that germs came from the air.

Joseph Lister and the Introduction of Antisepsis

• Joseph Lister, a Scottish surgeon, in 1865, introduced antisepsis in surgery using carbolic acid (phenol) to disinfect wounds and the operating environment.
• His methods significantly reduced postoperative infections, marking a shift toward modern antisepsis.

John Tyndall and Heat Sterilization

• John Tyndall, an Irish physicist, in 1877, showed that air particles contained microorganisms that could be killed by heat.

Charles Chamberland and the Autoclave

• In 1879, Charles Chamberland, an assistant to Pasteur, developed the autoclave for sterilizing instruments and bandages.

Ernst von Bergmann and Sterilization Techniques

• Ernst von Bergmann, a German surgeon, in 1891, refined Lister's practices and promoted the sterilization of surgical instruments with heat instead of chemical disinfection.

Further Advancements in Surgical Asepsis

• Gustav Neuber, in 1893, introduced sterile gowns and caps for surgeons.
• Johan Mikulicz, in 1897, proposed the use of masks during surgery.
• William Stewart Halsted, in 1890, commissioned Goodyear to design rubber gloves for surgical staff.

The Evolution of Asepsis

• By the 1948, Adolfo Reu, a Swedish physician, promoted worldwide aseptic techniques, leading to a gradual shift from antisepsis.