Surgery is the branch of medicine in which injuries or disorders of the body are treated by manipulation or removal of the relevant body part – typically using surgical instruments and via an incision made into the body.
The archaeological record suggests primitive methods of surgery – including the amputation of limbs and the stitching-up and cauterizing of wounds (including an ingenious ancient South American method that involved using insects to eat around the rotten edges of a wound before ‘stapling’ it with the insects’ twisted-off heads) – have been practised for thousands of years. Trepanning, in which a hole is drilled into the skull, usually with a view to relieving pressure on the brain, is another particularly gruesome procedure with a long history. By the 18th century BCE, the Babylonians had even produced a system of precise payments for successful surgeries – along with punishments for less effective surgeons, including the removal of their hands.
For millennia, practical restrictions meant that surgery had amounted to little more than amputations and the removal of external growths, but later in the 18th century a much wider range of treatments became available. In 1884, for instance, an English surgeon, Rickman Godlee, became the first to remove a brain tumour, while the following year witnessed the first successful heart surgery (conducted by a Norwegian, Axel Cappelen). The horrors of the First World War demanded new innovations and developments, and it was in this period that viable blood transfusions were pioneered, along with restorative plastic surgery. The 20th century would be filled with other landmarks – for example, the first gender reassignment operation and the first hip replacement. The processes of transplanting healthy organs to replace diseased ones also developed at a pace from the 19th century. After the first modern skin graft in 1823, the first cornea transplant followed in 1905, with the first kidney transplant in 1950, the first heart and liver transplants both occurring in 1967, the first hand transplant in 1998 and the first face transplants in the 2000s.
Furthermore, in recent years, with the development of microsurgery (using microscopes and miniaturized instruments) and keyhole surgery (which is minimally invasive thanks to the use of technologies including fibre optics), surgery has become a field in which ever more is possible as the risks involved decline.
The lowly surgeon
The 6th-century-BCE Indian physician Sushruta and the Greek Galen (129–c. 210 BCE) are among the first named surgical pioneers, each displaying a volume of knowledge and expertise unrivalled in their respective eras. Nonetheless, as of the medieval period, surgeons enjoyed a distinctly lower status than physicians. While doctors required a university education, so-called barber-surgeons were largely unregulated and might or might not be highly skilled. They used crude tools for everything from the setting of broken bones to the removal of limbs. All the while, three great impediments remained to the development of surgery: basic inabilities to control bleeding, infection and pain.
Despite the notable efforts of figures including Al-Zahrawi (936–1013) in the Arab world, the Italian Rogerius (author of Practica Chirurgiae – The Practice of Surgery – published around 1180), and the 16th-century Andreas Vesalius working out of Padua (see entry on Human Dissection here), it was not until the 18th century that surgery started to get on to a firmer setting. It became more professional thanks to figures like the Scottish surgeon and anatomist John Hunter (1728–93), who not only demanded rigour in practice but personally collected some 14,000 anatomical specimens for study. Surgery also became a discipline studied in university, bringing an end to the era of the semi-skilled surgeon-barber.