A BRIEF HISTORY OF GENERAL SURGERY by Tien Chen
G eneral surgery is a specialty that encompasses management of conditions pertaining to‘ the head and neck, breast, skin, and soft tissues, abdominal wall, extremities, and the gastrointestinal, vascular, and endocrine systems’. 1
However, this is a distinction that has only arisen over the last 100 years or so. If we take a chronological approach to the history general surgery, it is perhaps useful to confine the discussion to one based on anatomy. Indeed, there seems to have been only a few sparse accounts of successful surgeries throughout history relating to surgery conducted on the anatomical areas now considered under the domain of general sugery. For example, English surgeon Claudius Amyand performed the first successful recorded appendectomy in 1735‘ for the cure of a discharging sinus in the right thigh, which evidently communicated with an irreducible scrotal hernia’. 2
In Blumgart’ s Surgery of the Liver, Pancreas and Biliary Tract, it is pointed out that surgery performed on the liver was mostly restricted to avulsion of a portion that was exposed through the abdominal wall due to trauma, such as that by Berta in 1716. 3
Furthermore, they make the comment that‘ true hepatobiliary operations’ did not occur until the issues of pain and infection could be effectively dealt with. 3
Hence it seems that the major advances in surgery, let along general surgery, have occurred following the famous experiments of Boston dentist William Morton with advent of anaesthesia, as well as the pioneering work of British surgeon Joseph Lister amongst other medical luminaries on antisepsis.
In his article published in the New England Journal of Medicine, general and endocrine surgeon Atul
Gawande notes that early on in the 19th century, surgery was largely confined to the management of‘ external conditions’, of which‘ surgical accounts often spoke of failure more than derring-do’. 4
Gawande also notes that‘ entering the abdomen, for instance, was regarded with reproach— attempts had proved almost uniformly fatal … the chest and joints were also out of reach’. 4
General surgeon and medical historian Ira Rutkow argues that the sophistication of surgery and its specialties grew, starting from the 1880s, based on four fundamental areas of knowledge, namely that of anatomy, the control of haemorrhage, the pathophysiological understanding of diseases, anaesthesia as well as infection control. 5
Rutkow illustrates a situation whereby from the early 20th century onwards, the stage was set for surgery to become increasingly specialised as surgery and medicine became increasingly intertwined and scientific. 5
The Royal Australiasian College of Surgeons was established in the late 1920s6, a time during which surgery was beginning to progressively resemble modern surgery as we know it today. It has been recognised that the major specialty group at the time in the Fellowship was that of general surgery, with other surgical specialties such as‘ gynaecology, orthopaedics, ophthalmology and otolaryngology’ also being established. 6
Notably, the RACS now recognises nine surgical specialties encompassing cardiothoracic surgery, general surgery, neurosurgery, orthopaedic surgery, otolaryngology, paediatric surgery, plastic and reconstructive surgery, urology and vascular surgery. 6
References [ 1 ] What are the surgical specialties?. 2015. [ ONLINE ] Available at: https: // www. facs. org / education / resources / medical-students / faq / specialties. [ Accessed 17 August 2015 ]. [ 2 ] Deaver, JB, 1905. Appendicitis: Its Hist ory, Anatomy, Clinical Aetiology, Pathology. 3rd ed. Philadelphia: P. Blakiston’ s son & c o. [ 3 ] Jarnagin, WR, 2012. Blumgar t’ s Surgery of the Liv er, Pancreas and Biliary Tract. 5th ed. Philadelphia: Else vier Inc. [ 4 ] Gawande, A, 2012. Two Hundred Years of Surgery. The New England Journal o f Medicine, vol 366, pp. 1716-1723. [ 5 ] Townsend, CM, Beauchamp, RD, Evers, BM, Mattox, KL, 2012. Sabiston Textbook of Surgery. 19th ed. Philadelphia: Else vier Inc. [ 6 ] A Brief Hist ory of the Royal Australasian College of Surgeons. 2015. [ ONLINE ] Available at: http: // www. surgeons. org / media / 310429 / Brief _ History( JM). pdf. [ Accessed 17 August 2015 ].
11 | SURGIA Newsletter The General Surgery Edition