Scientific surgery The discipline of surgery was put on a sound, scientific footing during the
Age of Enlightenment in Europe (1715–90). An important figure in this regard was the Scottish surgical scientist (in London)
John Hunter (1728–1793), generally regarded as the father of modern scientific surgery. He brought an
empirical and
experimental approach to the science and was renowned around Europe for the quality of his research and his written works. Hunter reconstructed surgical knowledge from scratch; refusing to rely on the testimonies of others he conducted his own surgical experiments to determine the truth of the matter. To aid comparative analysis, he built up a collection of over 13,000 specimens of separate organ systems, from the simplest plants and animals to humans. Hunter greatly advanced knowledge of
venereal disease and introduced many new techniques of surgery, including new methods for repairing damage to the
Achilles tendon and a more effective method for applying ligature of the
arteries in case of an
aneurysm. He was also one of the first to understand the importance of
pathology, the danger of the spread of
infection and how the problem of
inflammation of the wound, bone
lesions and even
tuberculosis often undid any benefit that was gained from the intervention. He consequently adopted the position that all surgical procedures should be used only as a last resort. Hunter's student
Benjamin Bell (1749–1806) became the first scientific surgeon in Scotland, advocating the routine use of opium in post-operative recovery, and counseling surgeons to "save skin" to speed healing; his great-grandson
Joseph Bell (1837–1911) became the inspiration for
Arthur Conan Doyle's literary hero Sherlock Holmes. Other important 18th- and early 19th-century surgeons included
Percival Pott (1714–1788), who first described
tuberculosis of the spine and first demonstrated that a cancer may be caused by an environmental
carcinogen after he noticed a connection between
chimney sweep's exposure to soot and their high incidence of
scrotal cancer.
Astley Paston Cooper (1768–1841) first performed a successful ligation of the abdominal aorta.
James Syme (1799–1870) pioneered the Symes Amputation for the
ankle joint and successfully carried out the first
hip disarticulation. Dutch surgeon
Antonius Mathijsen invented the
Plaster of Paris cast in 1851.
Anesthesia Beginning in the 1840s, European surgery began to change dramatically in character with the discovery of effective and practical anesthetic chemicals such as
ether, first used by the American surgeon
Crawford Long (1815–1878), and
chloroform, discovered by
James Young Simpson (1811–1870) and later pioneered in England by
John Snow (1813–1858), physician to
Queen Victoria, who in 1853 administered chloroform to her during childbirth, and in 1854 disproved the
miasma theory of contagion by tracing a cholera outbreak in London to an infected water pump. 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. American surgeon
J. Marion Sims (1813–83) received credit for helping found
gynecology, but later was criticized for failing to use anesthesia on enslaved Black test subjects.
Antiseptic surgery The introduction of anesthetics encouraged more surgery, which inadvertently caused more dangerous patient post-operative infections. The first progress in combating infection in Europe 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 dismissed his advice. Until the pioneering work of British surgeon
Joseph Lister in the 1860s, most medical men in Europe believed that chemical damage from exposures to bad air (see "
miasma") was responsible for
infections in wounds, and facilities for washing hands or a patient's
wounds were not available. Lister became aware of the work of French
chemist and
microbiology pioneer,
Louis Pasteur, who showed that rotting and
fermentation could occur under
anaerobic conditions if
micro-organisms were present. Pasteur suggested three methods to eliminate the
micro-organisms responsible for
gangrene: filtration, exposure to heat, or exposure to
chemical solutions. Lister confirmed Pasteur's conclusions with his own experiments and decided to use his findings to develop
antiseptic techniques for wounds. As the first two methods suggested by Pasteur were inappropriate for the treatment of human tissue, Lister experimented with the third, spraying
carbolic acid on his instruments. He found that this remarkably reduced the incidence of gangrene and he published his results in
The Lancet. Later, on 9 August 1867, he read a paper before the British Medical Association in Dublin, on the
Antiseptic Principle of the Practice of Surgery, which was reprinted in the
British Medical Journal. His work was groundbreaking and laid the foundations for a rapid advance in infection control that saw modern antiseptic operating theatres widely used within 50 years. Lister continued to develop improved methods of
antisepsis and
asepsis when he realised that infection could be better avoided by preventing bacteria from getting into wounds in the first place. This led to the rise of sterile surgery. Lister instructed surgeons under his responsibility to wear clean gloves and wash their hands in 5% carbolic solution before and after operations, and had surgical instruments washed in the same solution. He also introduced the steam steriliser to
sterilize equipment. His discoveries paved the way for a dramatic expansion to the capabilities of the surgeon; for his contributions he is often regarded as the father of modern surgery. These three crucial advances - the adoption of a scientific methodology toward surgical operations, the use of anaesthetic and the introduction of sterilised equipment - laid the groundwork for the modern invasive surgical techniques of today. In the late 19th century
William Stewart Halstead (1852–1922) laid out basic surgical principles for asepsis known as
Halsteads principles. Halsted also introduced the latex
medical glove. After one of his nurses suffered skin damage due to having to sterilize her hands with carbolic acid, Halsted had designed a rubber glove that could be dipped in carbolic acid.
X-rays The use of
X-rays as an important medical diagnostic tool began with their discovery in 1895 by German
physicist Wilhelm Röntgen. He noticed that these rays could penetrate the skin, allowing the skeletal structure to be captured on a specially treated
photographic plate.
Modern technologies In the past century, a number of technologies have had a significant impact on surgical practice. These include
electrosurgery in the early 20th century, practical
endoscopy beginning in the 1960s, and
laser surgery,
computer-assisted surgery and
robotic surgery, developed in the 1980s. ==Timeline of surgery and surgical procedures==