surgery
Surgery is treatment of disease and
correction of deformity or defect by manual and operative procedures, with or
without the use of drugs. This branch of medicine is subdivided according to
the nature of the procedure employed, including: general surgery, which deals
with all manner of cases; orthopedic surgery, which pertains to the correction
of deformity; and plastic surgery, which involves the building up of tissues
and the restoration of lost parts, principally by the transfer of tissue. Surgery
is also 
subdivided according to the region
involved, as: intracranial (brain) surgery; aural (ear) surgery; cardiovascular
(heart and blood-vessel) surgery; and abdominal surgery. Many elements have
contributed to the development of surgery, such as the gradual accumulation of
knowledge concerning anatomy and physiology, the discovery of the circulation
of the blood, the perfection of the microscope, the discovery of X-rays, and
the invention of better instruments and apparatus, including laser and ultrasonic
devices. The discovery of anesthesia and antisepsis has broadened the scope of
surgery so that patients formerly treated with plasters and medicines are now
subjected to surgical intervention. For further information, see separate
articles on most of the doctors and organs and diseases mentioned in this
article.
Early History
Elementary general surgical
procedures were known in many diverse societies since ancient times, but more
scientific surgical techniques were not practiced until the 3rd century
BC.
Ancient
The ancient Egyptians are said to
have performed operations such as castration, lithotomy (removal of stones from
the bladder), amputations, and various eye operations. In
Medieval
Medieval surgery was practiced from
the decline of the Alexandrian school to the beginning of the 16th century.
The Roman physician Aulus Cornelius Celsus, the Greek physician and philosopher
Galen, and Paul of Aegna, a Greek surgeon of the late-7th century,
virtually shaped the course of surgery throughout the Middle
Ages. Byzantine and Arabian medicine helped to foster surgery, and, during the
latter part of this period, European countries, especially
Sixteenth to Nineteenth Century
During the 16th, 17th,
and 18th centuries, many discoveries in surgical practice were made.
Much credit belongs to the French surgeon Ambroise Paré, who was a member of
the Corporation of Barber Surgeons. Paré successfully employed the method of
ligating arteries in order to control hemorrhage, 
thus eliminating the old method of
cauterizing (searing) the bleeding part with a red-hot iron.
During this period the English
physician and anatomist William Harvey discovered the circulation of the blood.
Anton van Leeuwenhoek, the Dutch lensmaker and naturalist, contributed to the
evolution of the microscope. This made possible the discovery by the English
physicist Sir Robert Hooke of the cellular structure of plants and the
discovery by the Italian anatomist Marcello Malpighi of the cellular
composition of the blood and of other details, thus paving the way for
discoveries in such fields as bacteriology and pathology.
Many able surgeons contributed to
the development of surgery during the latter part of this period. In
Modern Surgery
The era of modern surgery probably
began with the notable event of the performance (1809) of ovariotomy (removal
of the ovaries) in the treatment of ovarian disease by the American surgeon
Ephraim McDowell of 
knowing of McDowell's work. The
American surgeon Valentine Mott ligated important blood vessels in the
treatment of aneurysm (abnormal expansion of a blood vessel); James Sims, of
With the discovery (1842-1847) of
anesthesia, that barrier to progress in actual operations was removed. Hospital
gangrene, septicemia, tetanus, and pyemia remained as problems, however. Not
until the French chemist Louis Pasteur evolved his germ theory and discovered
that fermentation is caused by micro-organisms did surgery reach its full
development. When the British surgeon Sir Joseph Lister applied the discoveries
of Pasteur to surgery and formulated his theory concerning sepsis and
antisepsis, another major obstacle was removed.
Surgery today is practiced for the
following purposes: diagnosis, such as surgical opening of the body for
exploratory purposes, and excision of tissue for examination (although modern
diagnostic tools eliminate the need for some of this); the correction of
deformity or abnormality; the cure of disease; the amelioration of suffering;
and the prolongation of life.
Corrective Surgery
At present, corrective surgery is
employed for clubfoot, harelip, cleft palate, bowlegs, deformed spine,
congenitally dislocated hip joints, and many heart and blood-vessel diseases.
In correcting conditions caused by accident or disease, plastic surgery is used.
Some surgeons have entered the field of cosmetic surgery, changing
“unattractive” features, as well as treating crumpled ears, malformed noses,
and other conditions caused by accident or disease.
Curative Surgery
Surgery is employed in the treatment
of sarcoma, tuberculosis, and osteomyelitis. In the field of bone diseases, the
British surgeon Sir William Arbuthnot Lane originated the procedure known as
bone plating; John Murphy of Chicago contributed to the technique of
arthroplasty, or plastic surgery of joints; and Fred Albee and other American
surgeons have contributed to surgery of the spine by their work on bone
transplantation and osteoplasty (plastic surgery on bone).
The brain is subjected to inspection
and many kinds of operation, including removal of tumors, evacuation of
abscesses, and clearing of blood clots and other obstructions to blood vessels.
The spinal cord too is subjected to surgical treatment and is also the site of
injection for induction of spinal analgesia. The peripheral nervous system,
like the brain and spinal cord, is amenable to surgical treatment in the relief
of affections of the nerves themselves, or in the course of the surgical care
of other diseases.
The vascular system, including the
heart, has been brought within the domain of experimental and practical
surgery. Whereas a large proportion of the practical surgical work on the heart
formerly dealt with injuries such as stab or gunshot wounds, many current heart
operations are performed to correct congenital heart abnormalities and tight or
leaky heart valves resulting from diseases such as rheumatic fever. The
ligation of arteries for the control of hemorrhage has played an important part
in surgical practice since Paré introduced it in the 16th century.
Many blood-vessel diseases that were
formerly fatal or crippling are cured surgically today. The surgeon can restore
normal blood circulation to vital organs by eliminating obstructions and
stopping leaks in arteries. Damaged sections of arteries can be removed and the
channel restored by grafting in a segment from a donor or, if the defect is not
too extensive, by sewing together the cut ends. Arterial defects can be
repaired by: opening the vessel and scraping out the clot; bypassing or
replacing the obstructed segment with a natural or synthetic graft; or widening
the bore of an artery by inserting material in its wall. Sometimes vessels are
cauterized by laser if surgery is too risky.
The history of respiration-system
surgery was entirely changed as a result of the invention of means of operating
upon the lungs and other thoracic viscera without collapse of the lungs. This
is accomplished by various kinds of apparatus designed to maintain the
necessary differential air pressure during operation, by the hypoatmospheric
and the hyperatmospheric methods. In present-day surgery, one lung or portions
of a lung can be removed safely in patients with cancerous conditions or
inflammatory infections such as tuberculosis.
In surgery of the gastrointestinal
tract, ulcers and tumors are excised, injuries are repaired, adhesions
resulting from inflammatory processes are broken up, and portions of the tract
that are distorted as a result of adhesions are restored to normal function.
Again, lasers may be used to cauterize lesions. Portions of the stomach and
intestine are sometimes removed because of an ulcer or cancer. The liver and
gallbladder and their appendages also can be operated on successfully. For
example, when gallstones are present the gall bladder can be removed.
The genitourinary system, that is,
the kidney, bladder, and organs of reproduction, is the site of many operative
procedures. Surgery of the female generative organs, such as ovaries, uterus,
and Fallopian tubes, is a field in which impressive achievements have been
recorded. The present trend in the surgical treatment of these organs is
towards conservatism.
A comparatively new phase of surgery
is the treatment of conditions resulting from disordered function of the
ductless glands and other organs having internal secretion (endocrine glands).
The pineal and pituitary glands in the brain, the thyroid, parathyroid, and
thymus glands in the neck, the pancreas, the suprarenal capsules, the liver,
the spleen, the sexual glands (ovaries and testes), and other structures are
currently classed among the organs of internal secretion.
Ameliorative Surgery
Surgery is often employed to
ameliorate suffering when a cure is unlikely, especially in the relief of
cancer. Suffering may be relieved: by cutting nerves that are pressed on by the
tumors; by removing portions of the malignant growth that impinge on other
organs, causing pain or impaired function; and by clearing up ulcerating areas
and skin grafting. Sometimes very large areas of degeneration may be cleared up,
especially with the aid of certain forms of electricity, and the surface
covered with other portions of the patient's body.
Recent Developments
Preoperative care and preparation of
patients has made significant advances, and diagnosis of deep-lying conditions
has been simplified by a multitude of devices, including CAT (Computerized
Axial Tomography) scanners. The methods of surgical anesthesia have been
greatly improved, including spinal anesthesia, which has, however, proved
inadvisable for patients in a condition of shock. Introduction of antibiotics
has eliminated postoperative pneumonia and significantly reduced other
infections. Hemorrhage and rupture of wounds following surgery are less common
because of improved surgical techniques and better suture materials. Embolism,
the breaking away of a blood clot that may travel and lodge in a vital organ,
is curtailed by the use of anticoagulants and by early ambulation of patients
after surgery. Postoperative shock is now controlled by intravenous administration
of fluids and by blood transfusion. During the war in
Prefrontal lobotomy,
that is, severing of nerves of the four quadrants of the frontal lobes of the
brain to relieve the pain and anxiety of involutional depression, obsessive
tension states, and schizophrenia, largely has been replaced by the use
of such drugs as tranquillizers and psychic energizers. The
electroencephalograph, a device that records brain waves, has been of great
value in diagnosing cerebral conditions, as the electrocaudery has been in
brain surgery.
Cryosurgery is one of the so-called
bloodless techniques available to modern surgeons. It has been used to treat
Parkinson's disease and certain eye ailments, brain tumors, and glandular
disorders. Another method involves focusing a beam of radioactive particles on
the site of a tumor. Irradiation has been effectively employed in treating
tumors of lymphoid tissue and tumors of the urinary tract. Early diagnosis and
surgical removal or, when inoperable, exposure to radium or X-rays, has
significantly reduced mortality and prolonged the life of cancer victims.
Surgeons have also used helium ion beams to treat eye cancers and heal lesions
in the brain, and have used laser beams to weld back detached retinas.
Surgical ligation has proved
valuable in treating some heart defects, including the installation of
pacemakers. When hypertension is caused by a diseased kidney, removal of the
affected kidney has relieved the condition. High blood pressure as a result of
the narrowing of the renal artery can be reduced to normal by several surgical
procedures, the most common being bypass grafting and patch grafting. The
anticoagulant drug heparin has proved valuable in vascular surgery and cerebral
thrombosis.
Removal of the spleen has been
successful in treating congestive splenomegaly (enlargement of the spleen) and
spherocytic jaundice. A new technique for observing the condition of the
stomach wall (gastroscopy) has advanced diagnosis and treatment of gastric
disorders, including cancer. Marked advances have been made in surgery of the
descending colon and in rectal surgery. Great advances have also been made in
surgery of the prostate gland. The oestrogen diethylstilbestrol has been most
effective in the treatment of tumors of the prostate, as has castration.
Modern surgical techniques permit
operations that only a few years ago might have been considered impossible. An
example is the stapes operation, or stapedectomy, in which the tiny bones of
the inner ear are exposed in order to correct a hearing disorder known as
conduction deafness. The surgery is performed within such a small area that
surgeons must view their work through a special microscope. The stapes, one of
the small bones that transmit sound vibrations in the inner ear, is replaced by
a tiny plastic tube or piece of stainless steel wire.
Microsurgery techniques were also
used successfully for the first time in rejoining a severed limb in 1962, at 
at the shoulder was restored to
nearly normal use. Today, about two-thirds of the attempts to rejoin severed
limbs succeed. An operation in which the legs of extremely tall persons are
shortened by sawing out sections of bone and rejoining the severed parts was
first achieved in 1965. Sterilized calf bone was developed in the 1960’s as a
replacement for human bone. Artificial skin and cloned human skin were both
developed in the 1980’s.
Plastics, particularly silicone and
Teflon, are now commonly used in permanently implanted artificial organ parts,
including corneas, heart valves, and Fallopian tubes. Plastics are used in
plastic surgery for parts of noses, ears, and chins. Artificial blood vessels
and tubes to drain fluids from the brain and chest are made from plastics that
do not trigger an immune reaction when implanted and joined with natural
tissue. A single-ventricle heart pump can temporarily support the circulation
of patients whose hearts are damaged to such an extent that they cannot provide
their bodies with adequate circulation. An artificial heart to replace the
human heart permanently or for prolonged periods was first used in 1982 and has
been used several times since then, but several technical and physiological
problems remain to be solved.
One of the most remarkable
achievements of modern surgery is the transplanting of vital organs from one
human body to another. Since the first kidney transplant was accomplished at
