surgery


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Surgical intervention in Dresden (1956)

The surgery (via Latin chirurgia of ancient Greek χειρουργία cheirurgía = needlework, crafts, hand action) is the branch of medicine that deals with the surgical treatment employed by illness and injury. A person performing surgery or parts of it is called a surgeon (from the Greek cheir-ourgos "craftsman").

history

Stone age

Depiction of surgical instruments on the back wall of the temple at Kom Ombo (331–304 BC)

Surgical interventions that were survived by the patients have been documented as early as the Stone Age . This art was not limited to Homo sapiens : a 50,000-year-old skeleton find of a male Neanderthal in a cave in Iraq proves an arm amputation . Survived trepanations have been documented for 12,000 years .

Ancient and Middle Ages

In ancient times , especially among the Egyptians , Greeks and Romans , operations were carried out with special (mostly metallic) tools. Little is known about the successes and healings. The tasks of surgery have always included hemostasis in the event of injuries and the treatment of broken bones as well as festering wounds and chronic ulcers . Conservative surgical therapy methods have also been known since ancient times. In about 1550 BC Chr. Incurred Papyrus Edwin Smith (an older copy of the text) describes the reduction and subsequent immobilization of mandibular fractures with rails and binding. The first specialist writer on surgical surgery known by name is considered to be in the 1st or 2nd century BC. (Klaudios) Philoxenus who worked in Egypt. He is referred to in the writings of Galenus as a chirurgos and Celsus saw in him one of the most important surgical specialist authors.

From the Middle Ages in early to modern times, the surgery was as " wound drug called" while for older today surgical works (especially sore medical drug manuals ) are named (since the 10th century - at Richerus - the chirurgicus or chirurgus distinguished from medicus ). An important representative of oriental surgery in the 9th / 10th centuries. Century was Abulcasis . The surgeon Guy de Chauliac formulated in the 14th century: "Surgery dissolves what is connected, connects what is separate and removes what is superfluous". For example, sponges soaked with opium were held in front of the patient's mouth and nose to relieve pain.

Field clerks and craft surgeons

Hieronymus Fabricius , Operationes chirurgicae , 1685

Until the advent of academic surgery, the bathing surgeon or surgeon with technical training (the craft surgeon ) performed operations. The surgeons working in the military were called field scissors . Modern surgery was promoted by military doctors, surgeons like Felix Würtz and Italian anatomists like Hieronymus Fabricius (1537-1619). From around the 16th century, autopsies expanded the knowledge of anatomy and the surgical horizons very significantly (autopsies had also been carried out by some ancient Greek doctors and occasionally in the Middle Ages ). Andreas Vesalius (1514–1564) is considered the founder of modern anatomy .

Daniel Schwabe (* 1592), Johann Dietz (1665–1738), Alexander Kölpin (1731–1801) and Heinrich Callisen (1740–1824) stand for the transition from Feldscher to surgeon . The most famous craft surgeon was Johann Andreas Eisenbarth (1663–1727), the most important surgeon of the Renaissance was Ambroise Paré .

Antisepsis

Due to a lack of knowledge about the risk of infection , the doctor's instruments and hands were often not cleaned. The smocks were dark back then, so that dirt and blood were harder to see on them and the smocks didn't have to be washed as often. The consequences of such unhygienic procedures were wound infections , sepsis and death.

Ignaz Semmelweis suspected the cause of puerperal fever in the middle of the 19th century , ordered strict hygiene measures for the first time from 1847 and made an important first contribution to the decrease in deaths. Joseph Lister experimented with carbolic acid , had his hands and instruments cleaned with it, sprayed it over the surgical field and, from around 1865, created a sterile atmosphere during the procedure. The breakthrough in surgery came with the discovery of pathogenic germs through the microscope , the findings of Louis Pasteur and Robert Koch and the subsequent development of asepsis . Their triumphant advance to today's standard was founded on the cleaning, disinfection and sterilization of medical tools and materials as well as the introduction of sterile surgical gloves made of rubber.

Pain numbness

The efficiency of today's surgery is inconceivable without the emancipation of anesthesiology . Before the introduction of sulfur ether anesthesia , the surgeon had to work extremely quickly because of the severe pain of the patient; deaths from pain ( shock ), along with those from infections and bleeding, were not uncommon. By Dominique Jean Larrey (1766-1842), the personal physician of Napoleon Bonaparte , is reported to have more than 200 amputations could make in a day. At that time, amputations were often mutilating measures, because wound closure was generally avoided. With careful stump formation and soft tissue covering, amputations today sometimes take more than an hour.

On October 16, 1846, the ethereal anesthesia was used by William Thomas Green Morton during an operation at the Massachusetts General Hospital in Boston . The "Ethereal Day of Boston" is now considered to be the birth of modern anesthesia and thus one of the prerequisites for modern surgery. On December 21, 1846, Robert Liston was the first doctor in Europe to use the new anesthetic method for a leg amputation in London. In 1847, James Young Simpson introduced chloroform for surgical and obstetric anesthesia. Out of habit, however, he operated very quickly and amputated the leg in 28 seconds. The surgeon August Bier and his assistant successfully used spinal anesthesia for the first time in 1898 (published in 1899).

Conservative surgery

Findings in anatomy, pathological anatomy and experimental physiology opened up new ways for surgeons to treat wounds in the 19th century. 1858 sparked cellular pathology of Rudolf Virchow the previously applied principles of humoral pathology from what is internal medicine, but also the surgical therapies impact not only on. Arterial bleeding was successfully stopped. More and more surgeons avoided interventions in the tissue structure and premature amputations. With his work on the healing of extremity injuries without amputation, the Swiss war surgeon and Prussian personal physician Johann Ulrich von Bilguer became known throughout Europe as a pioneer of conservative surgery from 1761. In wound care, the conservative = conservative approach began to dominate. The Scottish surgeon William Fergusson (1808–1877) introduced the term “conservative surgery” into technical language.

After the battle of Waterloo , the Göttingen surgeon and anatomist Konrad Johann Martin Langenbeck treated many gunshot wounded in the hospital in Antwerp. Since then, he has advised each surgical intervention to be carefully considered as an intervention in the complex organism. The German founders of conservative surgery include his students Friedrich von Esmarch , Louis Stromeyer , Nikolai Iwanowitsch Pirogow and Bernhard von Langenbeck (a nephew of Konrad Johann Martin Langenbeck). In France, Lucien Baudens (1804–1857) was her pioneer.

Before the Franco-Prussian War (1870–1871), all surgeons who went to hospitals had thoroughly familiarized themselves with the basic principles of conservative treatment of gunshot wounds. Signposts were:

  • Esmarch's Ueber Resection after Gunshot Wounds (1851),
  • Stromeyer's maxims of martial medicine (1855),
  • Loeffler's principles and rules for the treatment of gunshot wounds in war (1859),
  • Pirogov's Principles of General War Surgery (1864) and
  • Bernhard von Langenbecks on bullet fracture of the joints and their treatment (1868).

During the war, 18.8% of the wounded (17,000) were able to return to their unit as healed and fit for service. Thanks to the advancement of medicine and its implementation by the military doctors, the hospital began to become an important source of personnel replacement. Information about the activities of German surgeons during the Franco-Prussian War can be found in the surgical section of the five-volume report published by the Prussian War Ministry's medical department soon after the war. The editor was Richard von Volkmann , who himself had propagated and developed conservative wound treatment.

Operations on the heart

Advances in the fields of anesthesia and asepsis made it possible to make more and more organs of the human body accessible for surgical interventions by the turn of the 20th century. For a long time, however, the central organ of the blood circulation, the heart, was a major exception. Ludwig Rehn's first successful suturing of a heart wound in 1896 is considered a milestone in early cardiac surgery .

But for the time being more than such external interventions could not be dared. Cutting the wall of the heart in order to operate inside the heart seemed unthinkable in the early 20th century and was still impractical decades later. Although it could be done by hand, the main problem with intracardiac operations was simply a lack of operating time. In order to create a clear field of vision and avoid massive blood loss, the heart had to be clamped for the duration of an operation, i.e. H. be removed from the bloodstream, resulting in deadly oxygen starvation in the brain within minutes. In the first half of the 20th century, numerous, very different experiments were therefore devoted to extending this operating time. Sustainable success could only be achieved in the 1950s using induced hypothermia and, above all, the heart-lung machine . These methods, later also used in combination, made it possible for the first time to operate inside the bloodless heart with a calculable risk and thus put the field of cardiac surgery on a stable foundation.

Endoscopy

Introduced in gynecology by Kurt Semm in 1967 , minimally invasive surgery established itself in the 1990s . The patients are operated on with endoscopes that are inserted through stab incisions. The surgeon sees the field of work on the screen and operates the instruments indirectly. The epochal development of endoscopic surgery, described by the surgeon Ernst Kern in 1993 as the “second turning point in surgery”, was initiated by Johann von Mikulicz (1850–1905) in Vienna . It was only promoted by Olympus in Japan in the second half of the 20th century , where gastric cancer, which is difficult to detect, was more common than anywhere else in the world.

Surgical operations

Operation preparation (1978)

Specialist directions

According to the (model) further training regulations of 2008, surgery in Germany comprises the following specialties :

  1. General surgery
  2. Vascular surgery
  3. Cardiac surgery
  4. Pediatric surgery
  5. Orthopedics and trauma surgery
  6. Plastic and aesthetic surgery
  7. Thoracic surgery
  8. Visceral surgery

Other operational subjects are gynecology , ophthalmology , ear, nose and throat medicine , dermatology , oral and maxillofacial surgery , neurosurgery and urology . Since every country has its own training regulations, this classification is not generally applicable.

Famous surgeons from German-speaking countries

In the 19th century, German surgery gained worldwide recognition through Johann von Mikulicz . The first German surgeon association was founded by Friedrich Ernst Baumgarten (1810–1869). Helmut Wolff reports on the difficult situation of surgery in the German Democratic Republic . Some well-known surgeons from German-speaking countries are:

Mikulicz

We owe the most important surgeon biographies of the 20th century to Nissen and Wachsmuth. In 1952, Peter Bamm published his famous report on war surgery in the army of the Wehrmacht . That his veracity also included German war crimes is only being noticed today.

Trade journals

In Germany, Der Chirurg is the most important publication organ for surgery. Founded in 1860 and anglicised in 1998, Langenbeck's archive for surgery was recognized worldwide. The Zentralblatt für Chirurgie is the newsletter of eight surgeons' associations. The surgical general is widespread .

Textbooks (selection)

  • Rudolf Häring, Hans Zilch (Hrsg.): Textbook surgery with revision course. (Berlin 1986) 2nd, revised edition. Walter de Gruyter, Berlin / New York 1988, ISBN 3-11-011280-9 .

Important professional societies

See also

literature

  • Johann Gottlob Bernstein : History of surgery from the beginning to the present day. 2 volumes, Leipzig 1822/1823.
  • Lutz Braun: Surgery between illusion and reality. Reflections on Medicine and Society . Kaden Verlag, Heidelberg 2015, ISBN 978-3-942825-36-8 .
  • Walter von Brunn : Brief History of Surgery. Julius Springer, Berlin 1928.
  • the same: history of surgery. Bonn 1948.
  • Arnold van de Laar: Cut! The whole story of surgery is told in 28 operations. 2014.
  • Peter Bamm : The invisible flag . Munich 1952. New edition 1989, ISBN 978-3-8075-0007-2 .
  • Gert Carstensen , Hans Schadewaldt and Paul Vogt: Surgery in Art. Düsseldorf and Vienna 1983.
  • Georg Fischer : Surgery 100 years ago. FCW Vogel, Leipzig 1876.
  • Ernst Julius Gurlt : History of surgery and its practice. Popular Surgery - Ancient Times - Middle Ages - Renaissance. 3 volumes, Hirschwald, Berlin 1898; Reprint Hildesheim 1964; Digitized: Volume 1 ; Volume 2 ; Volume 3
  • Bernhard D. Haage, Wolfgang Wegner, Christoph Weißer: surgeon, surgery. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , pp. 251-257.
  • Knut Hæger: The Illustrated History of Surgery . Starke, London 1992, ISBN 1-872457-00-2 .
  • Heinrich Haeser : Overview of the history of surgery and the surgical status. Stuttgart 1879 (= German surgery , 1).
  • Friedrich Helreich : History of surgery , in: Handbook of the history of medicine , founded by Theodor Puschmann , ed. by Max Neuburger and Julius Pagel , Part III, Jena 1905, pp. 1–306 and pp. XI – XXXII.
  • Tony Hunt: The medieval surgery. Woodbridge (UK) 1992.
  • Siegfried Kiene , Richard Reding , Wolfgang Senst (eds.): Separate ways, undivided surgery; Contributions to surgery in the GDR. pro literatur Verlag, Augsburg 2009. ISBN 978-3-86611-398-5 .
  • Ernst Küster : History of the more recent German surgery. Edited by P. von Bruns , Enke, Stuttgart 1915 (= Neue Deutsche Chirurgie , 15)
  • Daniël de Moulin: A history of surgery with emphasis on the Netherlands. Dordrecht / Boston / Lancester 1988.
  • Rudolf Nissen : Light leaves, dark leaves. Memories of a surgeon . Stuttgart 1969; several reprints and reprints. ISBN 3-609-16029-2 .
  • Jörg Rehn : Experienced surgery. ecomed, Landsberg am Lech 1997, ISBN 3-609-51420-5 (autobiography and foray through 100 years of contemporary and surgical history).
  • Paul Ridder : Surgery and Anesthesia: From Crafts to Science . Hirzel, Stuttgart 1993, ISBN 3-8047-1256-8 .
  • Detlef Rüster: Old surgery: From the stone age to the 19th century , 4th edition. Verlag Gesundheit, Berlin 1999, ISBN 3-333-01029-1 (up to the 3rd edition, sub-title Legend and Reality ).
  • FX Sailer and FW Gierhake (eds.): Surgery seen historically: beginning - development - differentiation. Dustri-Verlag, Deisenhofen near Munich 1973, 262 pages, ISBN 3-87185-021-7 .
  • Ferdinand Sauerbruch : Lecture ("Description of the history of surgery, its position in the present and the importance of this branch of medicine"), given in the Prussian Academy of Sciences. In: Hans Rudolf Berndorff : A life for surgery. Obituary for Ferdinand Sauerbruch. In: Ferdinand Sauerbruch: That was my life. Kindler & Schiermeyer, Bad Wörishofen 1951 (with an appendix by Hans Rudolf Berndorff); several new editions, e.g. licensed edition for Bertelsmann Lesering, Gütersloh 1956, pp. 456–478, here: pp. 460–478.
  • Karl Sudhoff : Contributions to the history of surgery in the Middle Ages. Graphic and textual examinations in medieval manuscripts. I – II, Leipzig 1914/1918 (= studies on the history of medicine , 10 and 11/12).
  • Mario Tabanelli: La chirurgia italiana nell 'alto medioevo. 2 volumes. Florence 1965 (= Biblioteca della 'Rivista di storia delle scienze mediche e naturali'. Volume 15).
  • Jürgen Thorwald : The century of the surgeon . Droemer Knaur, Munich 1980, ISBN 3-426-03275-9 .
  • Karl Vossschulte : Achievements and results of modern surgery. Emil K. Frey on his 70th birthday . Stuttgart 1958.
  • Werner Wachsmuth : A life with the century . Springer, Berlin Heidelberg 1985, ISBN 978-3-540-15036-7 .
  • Christoph Weißer : Surgeon Lexicon: 2000 personalities from the history of surgery. Springer, Berlin 2019, ISBN 978-3-662-59238-0 .
  • Leo M. Zimmerman, Jlza Veith: Great ideas in the history of surgery. Baltimore 1961.

Web links

Commons : Surgery  - Collection of pictures, videos and audio files
Wiktionary: Surgery  - explanations of meanings, word origins, synonyms, translations
Wikibooks: Surgery  - Learning and Teaching Materials

Individual evidence

  1. Manfred Reitz: Stone Age Surgery . In: Pharmazeutische Industrie (Pharmind), 73, 2011, pp. 1755-1757
  2. Doris Schwarzmann-Schafhauser: Under the primacy of the cult of the dead? Surgery in Ancient Egypt . In: Würzburg medical history reports. , Volume 24, 2005, pp. 73-81
  3. Markwart Michler : Alexandrian surgery. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte . De Gruyter, Berlin 2005, ISBN 3-11-015714-4 , pp. 32-38.
  4. Walter von Brunn : On the history of hemostasis . In: The Medical World . Volume 9, 1935, p. 107 f.
  5. Volker Zimmermann: The medieval treatment of fractures in the work of Lanfrank and Guy de Chauliac. In: Würzburg medical history reports. Volume 6, 1988, pp. 21-34.
  6. Volker Zimmermann: Between empiricism and magic: The medieval fracture treatment by lay practitioners. In: Gesnerus. Volume 45, 1988, pp. 343-352.
  7. Philip Begardi: Index Sanitatis. Eyn schoens und vast useful Buechlin, called Zeyger the healthy theyt [...]. Worms 1539, sheet IV: “Chirurgici, these are doctors, so all you need to do your handicrafts are doctors, and heyssend Wundaertzet or Schneidaertzet, as if the old ones, so do heel wounds, old damage, lumps, cut off external waxes on the body, stuck and cut broken, broken and put crazy gliders into each other, connect, split, store and heal, with others like that. "
  8. Gerhard Schargus: The change in the therapy of facial skull fractures. In: Würzburg medical history reports. Volume 3, 1985, pp. 211-224, here: p. 211.
  9. ^ Ferdinand Peter Moog: Philoxenos. In: Werner E. Gerabek, Bernhard D. Haage, Gundolf Keil, Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. Walter de Gruyter, Berlin and New York 2005, ISBN 3-11-015714-4 , p. 1152 f.
  10. Markwart Michler (†): Alexandrian surgery. In: Werner E. Gerabek u. a. (Ed.): Encyclopedia of medical history. 2005, pp. 32-38; here: p. 36.
  11. ^ Gundolf Keil: Surgeon, surgery. In: Lexicon of the Middle Ages . Volume 2, 1983, Col. 1845-1860.
  12. ^ Gundolf Keil: Medieval surgery. In: Acta medicae historiae Patavina. Volume 30, 1983/1984 (1985), pp. 45-64.
  13. Gundolf Keil: "blutken - bloedekijn". Notes on the etiology of the hyposphagma genesis in the 'Pommersfeld Silesian Eye Booklet' (1st third of the 15th century). With an overview of the ophthalmological texts of the German Middle Ages. In: Specialized prose research - Crossing borders. Volume 8/9, 2012/2013, pp. 7–175, here: p. 12 f.
  14. Christine Boot: The 'Prager Wundarznei' of the 14th century, a traumatological field book from medieval Silesia. (Medical habilitation thesis, Würzburg 1989), Jan Thorbecke, Stuttgart 1993.
  15. Gundolf Keil: 'Kopenhagener Wundarznei'. In: Author's Lexicon . 2nd Edition. Volume 5, Col. 311 f. See also Hs. 3484 (northern Alsace 1468). Royal Library, Gamle kongelige samling. Copenhagen.
  16. ^ Gundolf Keil: 'Passauer Wundarznei'. In: Werner E. Gerabek et al. (Ed.): Enzyklopädie Medizingeschichte. 2005, p. 1110. See also Heinrich Schubert: Die Passauer Wundarznei. Medical dissertation Munich 1954.
  17. Knut Bentele, Gundolf Keil: The 'Würzburger Wundarznei'. Notes on a newly found medicine handbook of the late Middle Ages. In: Peter Jörg Becker, Eva Bliembach, Holger Nickel, Renate Schipke, Giuliano Staccioli (eds.): Scrinum Berolinense. (Festschrift Thilo Brandis ) 2 volumes, Berlin 2000 (= contributions from the State Library of Prussian Cultural Heritage in Berlin. Volume 10), Volume 1, pp. 358–387.
  18. ^ Bernhard Dietrich Haage: Medical Literature of the Teutonic Order in the Middle Ages. In: Würzburg medical history reports. Volume 9, 1991, pp. 217-231; here: p. 222.
  19. ^ Bernhard D. Haage: Surgery after Abū l-Qāsim in the 'Parzival' Wolframs von Eschenbach. In: Clio Medica. Volume 19, 1984, pp. 193-205.
  20. ^ Gundolf Keil: Heinrich von Pfalzpaint and plastic surgery of the skin. In: Oncological Dermatology. Edited by Günter Burg et al., Berlin et al., 1992, pp. 3-11; here: p. 3 f.
  21. ^ Theodor Husemann : The sleep sponges and other methods of general and local anesthesia in the Middle Ages. A contribution to the history of surgery. In: Deutsche Zeitschrift für Chirurgie 42, 1896, pp. 517-596; as well as: Further articles on surgical anesthesia in the Middle Ages. In: Deutsche Zeitschrift für Chirurgie 54, 1900, p. 503 ff.
  22. ^ Joseph Lister, Baron Lister (University of Glasgow)
  23. Ralf Vollmuth : Bilg (u) er, Johann Ulrich von. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 178 f.
  24. Peter Kolmsee : Under the sign of Aesculapia. An introduction to the history of the military medical service from the very beginning to the end of the First World War . Articles military medicine and military pharmacy, vol. 11. Beta Verlag, Bonn 1997, ISBN 3-927603-14-7 , pp. 124-125.
  25. ^ Benjamin Prinz: Operating on the Bloodless Heart: A History of Surgical Time Between Crafts, Machines and Organisms, 1900-1950 . In: NTM Journal for the History of Science, Technology and Medicine . tape 26 , no. 3 , 2018, p. 237-266 ( springer.com ).
  26. Ernst Kern: The second turning point in surgery. (Lecture on the occasion of Günther Hierholzer's 60th birthday in Duisburg on June 6, 1993) In: Würzburg medical history reports. Volume 12, 1994, pp. 363-373.
  27. Rabenstein et al. (2008)
  28. (Sample) training regulations and guidelines. ( Memento of the original from September 18, 2010 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. German Medical Association, accessed on January 28, 2013 @1@ 2Template: Webachiv / IABot / www.bundesaerztekammer.de
  29. ^ Axel Wellner: The Clausthal mountain surgeon Friedrich Ernst Baumgarten (1810–1869) - founder of the first German surgeon association. In: Medical historical messages. Journal for the history of science and specialist prose research. Volume 35, 2016 (2018), pp. 123-144.
  30. ^ H. Wolff: On the development of surgery and surgical research in the GDR . In: Deutsche Gesellschaft für Chirurgie - Mitteilungen , 1/2012, pp. 1–8
  31. Gottfried Walther: The upswing of German surgery to science under August Gottlieb Richter. Medical dissertation Jena 1960.
  32. Franz Xaver Ritter von Rudtorffer: Armamentarium chirurgicum selectum, or illustration and description of the most excellent older and newer surgical instruments. The copper plates engraved by Ponheimer. Strauss, Vienna 1817.