Surgery Before the 19th Century

Before 1800, there was not much record of surgical procedures being performed. Those who were considered medical professionals were just grasping the basic concepts of human anatomy. However, archeologists have found skulls with signs of trepanation (ie, burr holes) during digs.

In 600 BC, Sushruta was known to be the father of surgery. His followers were required to study for 6 years before they did hands-on surgical training. They made an oath to do no harm, similar to the Code of Hammurabi that was composed around 1750 BC. Sushruta’s students first performed surgery on vegetation and, once they proved themselves, they were allowed to operate on humans.

Abulcasis, who was born in 936 AD, would rise to be a prominent physician-pharmacist-surgeon in Spain. In the year 1000 AD, he wrote a book titled The Clearance of Medical Science for Those Who Can Not Compile It. It was a 30-volume medical encyclopedia covering all aspects of medicine and surgery in addition to pharmacology, midwifery, and chemistry. He had several chapters dedicated to surgery in which he discussed the use of instruments and how to perform numerous surgeries. He devised several dental devices and artificial teeth made of animal bones. He is credited to be the first to describe ectopic pregnancy and perform thyroidectomy. The following are also some of the topics he wrote about:

• Surgery of the eye, ear, and throat. He fully described tonsillectomy and tracheostomy.
• Development of instruments for internal examination of the ear, removal of objects from the throat, removal of polyps, and urethral inspection. He would develop more than 200 types of surgical instruments.
• The exposure and division of the temporal artery to relieve certain types of headaches.
• Use of cauterization, usually to treat skin tumors or open abscesses.
• Application of ligature for bleeding vessels and use of catgut for internal stitching.
• Treatment for anal fistulas.
• Setting dislocated bones and fractures.
• Removal of urinary bladder calculi. He advised that the treating physician has to insert a finger into the rectum of the patient, move the stone down to the neck of the bladder, and then make an incision in the rectal wall or the perineum and remove the stone.
  

In 1540, a concept known as barber-surgeons came to light. Barbers and surgeons formed the United Barber Surgeons Company. Barbers performed procedures, such as tooth extractions and bloodletting. In 1630, Wilhelm Fabry, the “Father of German Surgery,” performed the first amputation for gangrene.

References:

1. Clunie A. Surgery…a violent profession. Hartford Stage. Accessed August 9, 2023. https://www.hartfordstage.org/stagenotes/ether-dome/history-of-surgery
   
2. Rutkow I. Empire of The Scalpel. New York, NY: Scribner; 2022.
   
3. Schneider D. The Invention of Surgery. Holland, OH: Dreamscape Media, LLC; 2020.
   
4. Gawande A. Two hundred years of surgery. New Engl J Med. 2012;366(18):1716-1723. https://doi.org/10.1056/nejmra1202392

AORN Resources

AORN members can access:

• Watchful Care: A History of America's Nurse Anesthetists - AORN Journal
• Doctoral Education in Nursing: History, Process, and Outcome - AORN Journal
• Images of Nurses: Perspectives from History, Art, and Literature - AORN Journal
• History Corner: Discovery and Detective Work - AORN Journal
• Lessons from history can serve us today - AORN Journal
• Perioperative Nurse Week: Its History and Its Future - AORN Journal
• History Corner: Perioperative Nursing in the Early 1900s - AORN Journal
• History Corner: Wash the Sand Out of the Sponges - AORN Journal