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