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5 MILESTONES THAT CHANGED THE HISTORY OF SURGERY

To delve into the history of surgery is to venture into the history of man, science, and culture. To such an extent that in ancient times there were those who believed that due to the perfection and expertise that these practices demanded, their practice was more akin to art than to science. In fact, surgery, etymologically speaking, means "manual labor".





The progress of science and medicine made it possible to lay the scientific foundations of modern surgery in the 19th century. What were the main milestones that allowed the advancement and professionalization of surgery?


1. The emergence of pathological anatomy


Pathological anatomy, a branch of medicine devoted to the study of diseases in order to achieve correct diagnoses from biopsies, cytologies, and autopsies, has its beginnings in the naturalistic philosophy of Empedocles. Hippocrates, based on Empedocles' developments, was the first to relate pathology to the alteration of humors (blood, lymph, black bile, and yellow bile). On his side and in the Middle Ages, Galen turned these theories into dogmas. 


It was only during the Renaissance, with the gradual fall of theocentrism and the flourishing of culture and science, that the first anatomists appeared, with Leonardo Da Vinci standing out among the most important figures, archetype of the conjunction of science and art related to the beginnings of surgery.  


2. Anesthesia, the battle against pain


It is impossible for us today to imagine surgery without anesthesia. However, the discovery of anesthesia is relatively new. Its appearance as such dates back to the middle of the 19th century and its discovery modified surgical practices not only in relation to pain but also to the speed that defined "a good surgeon" at that time. Anesthesia also allowed the development of more sophisticated techniques with optimal results in the field. 


Although some names precede the history of anesthesia, the dentist William Morton decided to try first hydrochloric and then sulfuric ether as anesthesia. In 1846 Morton tested the effects of this on his body and obtained 8 minutes of total insensibility. 


The first surgery was performed that same year at Massachusetts General Hospital, where surgeon John Warren, founder of Harvard Medical School, amputated a leg using sulfuric ether. Soon after, its use was incorporated into obstetrical procedures and soon spread throughout Europe. 


3. Asepsis and antisepsis, the battle against infection


With the development of anesthesia, the duration of operations increased and this gave way to wound infections. The development of asepsis and antisepsis was essential for the advancement of surgery. 


Antisepsis had its precedent in the observations of Ignaz Semmelweis, a renowned Hungarian obstetrician who, in 1847, asked physicians and students to wash their hands with a chlorinated substance when leaving the dissection room, resulting in a decrease in puerperal fever from 12.34% to 3.04%. 


Louis Pasteur's findings on pathological germs inspired the British surgeon Joseph Lister, a precursor in the development of antisepsis. It was Lister who proposed spraying the surgical space first with carbolic acid and then with phenolic acid to keep germs away. This measure revolutionized the operating rooms.


For his part, Robert Koch, upon discovering the destructive effect of steam jets on bacteria and spores, promoted sterilization with steam jets, both for instruments and for sutures and bandaging materials. 


Another transcendental advance in the fight against infections was the discovery of penicillin in 1928 by the Scottish microbiologist Alexander Fleming.


4. From the operating amphitheater to the modern operating room


Hand in hand with the new knowledge and new technologies of each era, operating theaters were and are, without a doubt, the hospital space that has evolved the most over time.


In the 18th century, the space for surgical practices acquired its own name: Operation Theaters. In these specialized units, surgeons offered their knowledge and skills to large audiences. In the mid-19th century, with advances in anesthesia, asepsis and antisepsis, surgery acquired scientific status and the design of the operating rooms we know today began.


In the 20th century, Paul Nelson proposed the separation of clean-dirty flows and from then on the concept of the "germ-proof" operating room took on a decidedly technical character. The entire surgical space is thought out and designed, paying attention to every detail. Lighting, air conditioning systems, constant air renewal flow, pressure controllers, sterilizers for the environment and surgical instruments and the use of disposable materials make up the atmosphere of this technical-technological universe which is the modern operating room and which is specified, renewed and diversified in the light of new advances and innovations.


5. Image-assisted surgery


Technological advances in recent decades, including the development of robotics, augmented reality and the internet of things, have made it possible to adjust the level of precision of surgeries, multiplying their possibilities and proposing safer, less intrusive procedures with shorter recovery times.


These developments not only make it possible to obtain valuable preoperative and intraoperative information, but are also the basis for assisted surgery, which, among other things, allows professionals to determine complex maneuvers and procedures remotely.


In relation to the constant technological advances and the adaptation of surgical spaces, the development of modular operating rooms allows for the reconfiguration of surgical units. This, in turn, allows for more flexible and specific circuit segregation models, which allow for the incorporation or replacement of technology and equipment (panels, monitors, screens, etc.) more easily than in traditional operating rooms. 


Conclusion


From the development of anesthesia to the fight against infections, the history of surgery is more than exciting. Each era confronts this adrenaline-filled discipline with the challenge of thinking, often against the prejudices of the time, the best cooperation between humans, knowledge, and technologies.


Knowing the latest news and technological developments that can be used to improve surgical procedures and provide innovative solutions will always be the basis for thinking about the present and the future of surgery.


As time goes by, not only new medical-surgical products, techniques, and materials are incorporated. In addition, the number of cutting-edge teams of professionals is multiplying.



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