Modern surgery developed rapidly with the scientific era. Ambroise Paré pioneered the treatment of gunshot wounds, and the first modern surgeons were battlefield doctors in the Napoleonic Wars. Naval surgeons were often barber surgeons, who combined surgery with their main jobs as barbers. Three main developments permitted the transition to modern surgical approaches - control of bleeding, control of infection and control of pain (anaesthesia).
Bleeding
Before modern surgical developments, there was a very real threat that a patient would bleed to death before treatment, or during the operation. cauterization (fusing a wound closed with extreme heat) was successful but limited - it was destructive, painful and in the long term had very poor outcomes. Ligatures, or material used to tie off severed blood vessels, are believed to have originated with Ambroise Pare (sometimes spelled "Ambrose"[5]) during the 16th century, but were highly dangerous until infection risk was brought under control - at the time of its discovery, the concept of infection did not exist. Finally, early 20th century research into blood groups allowed the first effective blood transfusions.
Infection
The concept of infection was unknown until relatively modern times. The first progress in combating infection was made in 1847 by the Hungarian doctor Ignaz Semmelweis who noticed that medical students fresh from the dissecting room were causing excess maternal death compared to midwives. Semmelweis, despite ridicule and opposition, introduced compulsory handwashing for everyone entering the maternal wards and was rewarded with a plunge in maternal and fetal deaths, however the Royal Society in the UK still dismissed his advice. Significant progress came following the work of Pasteur, when the British surgeon Joseph Lister began experimenting with using phenol during surgery to prevent infections. Lister was able to quickly reduce infection rates, a reduction that was further helped by his subsequent introduction of techniques to sterilize equipment, have rigorous hand washing and a later implementation of rubber gloves. Lister published his work as a series of articles in The Lancet (March 1867) under the title Antiseptic Principle of the Practice of Surgery. The work was groundbreaking and laid the foundations for a rapid advance in infection control that saw modern aseptic operating theatres widely used within 50 years (Lister himself went on to make further strides in antisepsis and asepsis throughout his lifetime).
Pain
Modern pain control (anesthesia) was discovered by two American dentists, Horace Wells (1815-1848) and William Morton. Before the advent of anesthesia, surgery was a traumatically painful procedure and surgeons were encouraged to be as swift as possible to minimize patient suffering. This also meant that operations were largely restricted to amputations and external growth removals. Beginning in the 1840s, surgery began to change dramatically in character with the discovery of effective and practical anaesthetic chemicals such as ether and chloroform, later pioneered in Britain by John Snow. In addition to relieving patient suffering, anaesthesia allowed more intricate operations in the internal regions of the human body. In addition, the discovery of muscle relaxants such as curare allowed for safer applications.
[edit] Conditions treated by surgery
Surgery is used to both as a treatment, and as an aspect of treatment, for many conditions, including:
* Physical trauma, e.g. wounds
* Anatomical Abnormalities
* Disorders of function
* Inflammation
* Ischaemia and infarction
* Metabolic disorders
* Neoplasia
* Other abnormalities of tissue growth, e.g. cysts, hyperplasia or Organ hypertrophy, as well as some cancers, if caught early enough
* Deformity and heavy scarring.
* Brain damage and nerve damage
[edit] Common procedures
Four of the most common surgical procedures in the United States are obstetric: episiotomy, repair of obstetric laceration, cesarean section, and artificial rupture of the amniotic membrane
The most common non-obstetric surgical procedures include amputation, appendectomy, cataract surgery, circumcision, dental extraction and herniorraphy.
According to 1996 data from the US National Center for Health Statistics, 40.3 million inpatient surgical procedures were performed in the United States in 1996, followed closely by 31.5 million outpatient operations.
[edit] See also
* Anesthesia
* ASA score or pre-operative physical fittness
* Biomaterial
* Cardiac surgery
* Drain
* Endoscopy
* FACS
* Hypnosurgery
* Knot
* List of surgical procedures
* Minimally invasive procedure
* Perioperative mortality
* Surgeon
* Traumatology
source : http://en.wikipedia.org/wiki/Surgery
No comments:
Post a Comment