The History of Surgery

Podcast Transcript

Over the years, human life expectancy has increased dramatically.

While there have been many developments that have led to longer human lifespans, most of that has come from just a few major advancements.

One of the biggest of which has been the development of surgery.

The types of surgical procedures that exist today are just the latest in a long line of physical medical procedures.

Learn more about surgery and the techniques and technologies that allow for modern operations on this episode of Everything Everywhere Daily.

There have been three things that have been responsible for the majority of advancements in human health: vaccinations, antibiotics, and surgery.

Vaccinations and antibiotics are chemical and biological treatments.

Surgery, however, is physical. It involves the use of instruments to fix, repair, or remove things physically from a body. More often than not, it’s an invasive procedure that involves making an incision in the skin.

There are different types of surgery today, from routine outpatient surgery to extremely serious surgery that might include full organ transplants.

All of these surgery types have the same general history, and that history goes back far deeper than most people realize.

The earliest evidence of surgery dates back approximately 10,000 years to the Neolithic period. Archaeological discoveries reveal that prehistoric humans practiced trepanation, a procedure involving the drilling or scraping of holes in the skull.

What’s fascinating is that many of these ancient skulls show signs of healing, indicating patients survived these procedures.

We don’t know exactly what the purpose of these procedures was. They may have been performed to treat head injuries or perhaps in response to spiritual beliefs about releasing evil spirits.

However, given the lack of knowledge of medicine or even metalworking, most of those early surgical recipients needed it like they needed another hole in their head.

Ancient civilizations built upon these early foundations in remarkable ways. The Edwin Smith Papyrus from ancient Egypt, which dates back to around 1600 BC, reads like an early surgical textbook, describing 48 cases of trauma and their treatments.

Egyptian physicians understood wound care, used sutures made from animal sinew, and even performed basic cataract surgery. They approached medicine with surprising methodical thinking, categorizing injuries and outcomes much like modern medical case studies.

In ancient India, Sushruta, often called the “father of surgery,” compiled the Sushruta Samhita around 600 BC. This text describes over 300 surgical procedures and 120 surgical instruments.

Sushruta’s work included cataract extraction, kidney stone removal, and remarkably detailed plastic surgery techniques for reconstructing noses and ears. The precision of these descriptions suggests a sophisticated understanding of anatomy that wouldn’t be matched in the Western world for over a thousand years.

The key advancement that allowed these early surgeries was the development of basic anesthesia through alcohol, opium, and various plant extracts. Ancient surgeons also recognized the importance of cleanliness, though they didn’t understand the scientific reasons behind infection, as the germ theory of infection was still thousands of years away.

The Greeks, notably Hippocrates and Galen, as well as the Romans built upon this knowledge. Galen, a Greek physician in Rome in the 2nd century CE, performed animal dissections and wrote extensively about anatomy, influencing surgical theory in Europe for over a millennium. However, Roman surgery was largely limited to battlefield medicine.

In the Roman military, field medics were attached to legions and often worked in designated medical tents or field hospitals established near camps.

These surgeons were trained in wound care, amputation, and treatment of fractures, often using tools like forceps, scalpels, and bone saws that closely resemble modern surgical instruments. Cauterization and herbal antiseptics were employed, but as with the ancient Indians, they had no clue why it worked.

Medieval Europe saw a complex relationship with surgery. The Christian church’s influence created a paradox – while caring for the sick was considered holy work, cutting into the human body was sometimes considered problematic. This led to a division between physicians, who diagnosed illnesses and prescribed treatments, and barber-surgeons.

Barber-surgeons were medical practitioners in medieval and early modern Europe who performed a wide range of services, from cutting hair and shaving beards to carrying out surgical procedures such as bloodletting, tooth extraction, lancing boils, and amputations.

Over time, barber-surgeons became increasingly important, especially in military and urban settings, though they were often viewed as craftsmen rather than members of the scholarly medical elite.

Their trade was formally recognized in several countries—for example, with the establishment of the Company of Barber-Surgeons in England in 1540—though eventually, surgery and barbering split into distinct professions as medical science advanced.

The reason why barber poles have red stripes is that they used to perform bloodletting.

The Islamic world during this period emerged as a leader in surgical advancements. Physicians like Al-Zahrawi in the 10th century in Córdoba wrote comprehensive surgical texts that included detailed illustrations of surgical instruments.

His work “Al-Tasrif” described procedures for removing kidney stones, performing cesarean sections, and treating fractures. Islamic surgeons also made significant advances in ophthalmology, developing sophisticated techniques for cataract surgery.

As sophisticated as these medieval surgeries were, they lacked effective anesthesia and antiseptic practices. Surgeons had to work quickly, and patient survival rates were low due to infection and shock.

The Renaissance brought a fundamental shift in thinking that revolutionized surgery. The period’s emphasis on direct observation and anatomical study, pioneered by figures like Leonardo da Vinci and Andreas Vesalius, provided surgeons with accurate knowledge of human anatomy for the first time.

Ambroise Paré, a French military surgeon, made several crucial innovations in the 16th century. He abandoned the brutal practice of cauterizing wounds with boiling oil, instead using gentle treatments and ligatures to tie off blood vessels. The development of the printing press allowed surgical knowledge to spread more rapidly. Detailed anatomical texts with accurate illustrations became available, standardizing surgical education across Europe.

The 18th and early 19th centuries saw surgery become more systematic and scientific. John Hunter in England established surgery as a scientific discipline based on careful observation and experimentation. He emphasized understanding the underlying pathology before attempting treatment.

Despite this, Hunter still suffered from the same basic problems as ancient and medieval surgeons.

The 19th century saw the solution to many of these ancient problems.

The first was the use of ether as an anesthetic.

The public demonstration of ether anesthesia by William Morton at Massachusetts General Hospital in 1846 marked surgery’s true beginning as we know it today.

For the first time, surgeons could work methodically without causing unbearable pain. This single advancement opened up the possibility of complex internal procedures.

You’ve probably seen movies where a patient was asked to bite on a stick after taking a swig of whisky before getting a limb amputated. With anesthesia, this sort of thing was no longer necessary….although it did still happen throughout the 19th century.

The other big 19th-century advancement was Louis Pasteur’s germ theory of disease, which I’ve covered in a previous episode.

Using Pasteur’s theory, British surgeon Joseph Lister began using carbolic acid to sterilize surgical instruments, clean wounds, and spray the air in operating rooms, which led to a significant decline in infection-related deaths.

His methods initially faced resistance but eventually gained widespread acceptance, laying the foundation for modern aseptic surgery.

In 1879, Joseph Lawrence, an American chemist, developed his own surgical antiseptic that he named after Lister. The name was Listerine.

Sterilization of instruments via autoclaves, hand washing, surgical gloves, and sterile gowns soon followed. This made the operating room much safer and expanded surgical possibilities.

Another major advancement was a better understanding of Hemostasis or blood clotting and the development of improved techniques for controlling bleeding allowed surgeons to work on more complex procedures without patients bleeding to death.

The early 20th century saw surgery evolve into the sophisticated discipline we recognize today. There were several key developments that enabled this transformation.

The invention of the X-ray in 1895 by German physicist Wilhelm Roentgen marked a groundbreaking advancement in both medicine and surgery.

This non-invasive method of visualizing the internal structure of the body quickly transformed diagnostic medicine, allowing surgeons to locate fractures, foreign objects, and later, tumors without making an incision.

Within months of its discovery, X-rays were being used in hospitals across Europe and the United States, revolutionizing preoperative planning and significantly improving the accuracy and safety of surgical interventions.

Karl Landsteiner’s discovery of blood types in 1901 made safe blood transfusions possible, dramatically reducing surgical mortality.

The discovery of anticoagulants and the use of refrigeration enabled blood transfusions to be conducted without a donor being physically present near the recipient.

The first non-direct blood transfusion took place in 1914 by Belgian doctor Albert Hustin.

This led to the creation of blood banks and the widespread practice of blood donation.

The development of safer anesthetic agents and a better understanding of physiology made longer, more complex procedures feasible. Even with ether, surgeries still had to be relatively quick. Now it was possible to have operations that lasted hours.

With many of these basics covered, the door opened to a host of new surgical techniques.

The 20th century marked the transformation of surgery into a high-precision, often life-saving branch of medicine.

World War I and World War II pushed innovation in trauma surgery, skin grafting, reconstructive surgery, and blood transfusion techniques.

Open-heart surgery emerged with the use of heart-lung bypass machines in the 1950s.

Heart-lung bypass machines are medical devices that temporarily take over the function of the heart and lungs during surgery, allowing surgeons to operate on a still and bloodless heart by circulating and oxygenating the patient’s blood outside the body.

Organ Transplantation became viable mid-century.

Early attempts in the early 20th century failed largely due to tissue rejection, but progress accelerated after World War II with a better understanding of the immune system. The first successful human organ transplant occurred in 1954, when Dr. Joseph Murray transplanted a kidney from one identical twin to another, thereby avoiding immune rejection.

Neurosurgery truly emerged as a modern discipline in the late 19th and early 20th centuries. Key figures such as Victor Horsley pioneered brain tumor removal and spinal surgery, while Harvey Cushing, often regarded as the father of modern neurosurgery, introduced meticulous surgical techniques, the use of electrocautery to control bleeding, and careful documentation of brain tumors.

Laparoscopic surgery, also known as minimally invasive surgery, is a surgical technique that allows operations to be performed through small incisions using specialized instruments and a camera called a laparoscope. Developed in the 20th century, with the first laparoscopic appendectomy performed in 1983, this method represented a major shift from traditional open surgery.

The laparoscope provides a live video feed from inside the body, allowing surgeons to view and manipulate organs with precision while minimizing trauma to surrounding tissue. Laparoscopic procedures reduce recovery time, pain, scarring, and the risk of infection, and have become standard for many operations.

The art and science of surgery are still advancing, and there are many innovations on the horizon.

Robotic systems, like the da Vinci Surgical System, allow for extremely precise movements with smaller incisions and fewer complications.

Image-guided surgery, using real-time MRI or CT scans, can improve outcomes in neurosurgery and cancer treatment.

Tele-surgery and remote-controlled robotic systems have also been tested, expanding surgical expertise globally.

This means that robotic surgery systems could be set up in the most remote communities, and experienced surgeons could operate from anywhere in the world.

This isn’t pie-in-the-sky science fiction either. There have been prototype robotic surgery systems that have already been tested.

From crude stone tools scraping skulls to machines guided by algorithms performing microsurgery, the history of surgery is a journey of incremental improvement.

Each advancement, whether the adoption of anesthesia, antiseptics, or robotics, has been enabled by broader scientific and technological revolutions.

Surgery today is not totally without risk, but it is safer and more effective than ever before, and it is also continuously evolving at the frontiers of biology and technology.