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Procedures

 

At least two prehistoric cultures had developed forms of surgery. The oldest for which there is evidence is trepanation, in which a hole is drilled or scraped into the skull, thus exposing the dura mater in order to treat health problems related to intra cranial pressure and other diseases. Evidence has been found in prehistoric human remains from Neolithic times, in cave paintings, and the procedure continued in use well into recorded history. Surprisingly, many prehistoric and premodern patients had signs of their skull structure healing; suggesting that many survived the operation. Remains from the early Harappan periods of the Indus Valley Civilization (c. 3300 BCE) show evidence of teeth having been drilled dating back 9,000 years. A final candidate for prehistoric surgical techniques is Ancient Egypt, where a mandible dated to approximately 2650 BCE shows two perforations just below the root of the first molar, indicating the draining of an abscessed tooth.

The oldest known surgical texts date back to ancient Egypt about 3500 years ago. Surgical operations were performed by priests, specialized in medical treatments similar to today. The procedures were documented on papyrus and were the first to describe patient case files; the Edwin Smith Papyrus (held in the New York Academy of Medicine) documents surgical procedures based on anatomy and physiology, while the Ebers Papyrus describes healing based on magic. Their medical expertise was later documented by Herodotus: "The practice of medicine is very specialized among them. Each physician treats just one disease. The country is full of physicians, some treat the eye, some the teeth, some of what belongs to the abdomen, and others internal diseases."

Other ancient cultures to have surgical knowledge include India, China and Greece.

Sushruta (also spelled Susruta or Sushrutha), c. 6th century BCE,is known as the Father of Surgery. He was a renowned surgeon of Ancient India and the author of the book Sushruta Samhita. In his book written in Sanskrit, he described over 120 surgical instruments, 300 surgical procedures and classifies human surgery into 8 categories. He performed Plastic Surgeries, Cataract operations and Cesarean. He used to give a kind of herbal juice equivalent to anesthetics. He was a surgeon from the Dhanvantari school of Ayurveda.

Hippocrates stated in the oath (c. 400 BC) that general physicians must never practice surgery and that surgical procedures are to be conducted by specialists.

In ancient Greece, temples dedicated to the healer-god Asclepius, known as Asclepieia, functioned as centers of medical advice, prognosis, and healing. At these shrines, patients would enter a dream-like state of induced sleep known as "enkoimesis" not unlike anesthesia, in which they either received guidance from the deity in a dream or were cured by surgery. In the Asclepieion of Epidaurus, three large marble boards dated to 350 BCE preserve the names, case histories, complaints, and cures of about 70 patients who came to the temple with a problem and shed it there. Some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place, but with the patient in a state of enkoimesis induced with the help of soporific substances such as opium.

The Greek Galen was one of the greatest surgeons of the ancient world and performed many audacious operations, including brain and eye surgery that were not tried again for almost two millennia.

In China, Hua Tuo was a famous Chinese physician during the Eastern Han and Three Kingdoms era who performed surgery with the aid of anesthesia.

In the Middle Ages, surgery was developed to a high degree in the Islamic world. Abulcasis (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi), an Andalusian-Arab physician and scientist who practised in the Zahra suburb of Cè´¸rdoba, wrote medical texts that shaped European surgical procedures up until the Renaissance.

In Europe, the demand grew for surgeons to formally study for many years before practicing; universities such as Montpellier, Padua and Bologna were particularly renowned. According to Peter Elmer and Ole Peter Grell, "Guy de Chauliac (1298-1368) was one of the most eminent surgeons of the Middle Ages. His Chirurgia Magna or Great Surgery (1363) was a standard text for surgeons until well into the seventeenth century." By the fifteenth century at the latest, surgery had split away from physic as its own subject, of a lesser status than pure medicine, and initially took the form of a craft tradition until Rogerius Salernitanus composed his Chirurgia, laying the foundation for modern Western surgical manuals up to the modern time. Late in the nineteenth century, Bachelor of Surgery degrees (usually ChB) began to be awarded with the (MB), and the mastership became a higher degree, usually abbreviated ChM or MS in London, where the first degree was MB, BS.

Barber-surgeons generally had a bad reputation that was not to improve until the development of academic surgery as a specialty of medicine, rather than an accessory field. Basic surgical principles for asepsis etc., are known as Halsteads principles.

    

       

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