Art and Science of Surgery

12 May

Modern  surgery has evolved from one of the most despised branches of medicine into  one of the most  respected,  powerful,  and  best compen- sated areas of medical specialization.  The transformation seems to have occurred  with remarkable speed once surgeons  were given the tools to overcome  pain  and  infection,  two  of the  greatest  obstacles  to  major operative  procedures.  General  anesthesia  was introduced  in the 1840s and antisepsis in the 1870s.

A  closer  examination   of  the   evolution   of  surgery,   however, suggests a more complex explanation for the remarkable changes that occurred  in the nineteenth  century. First of all, surgeons could point to a long history of successes, if not in major operative procedures,  then, at least in the treatment of wounds,  ulcers, skin diseases, fractures,  dislo- cations, and so forth. In comparison  to the treatment of internal diseases by physicians, the surgeons who treated  traumatic injuries, urinary  dis- orders,  and  broken  bones had  good  reason  to boast  of the efficacy of their methods.  Indeed,  it could  be argued  that,  as surgeons  used their claims of expertise  and  knowledge  to close the gap between medicine and  surgery,  they established  the basis for the professionalization and modernization of a powerful, unified, and inclusive medical profession.

Taking  a  broader   view of  surgery,  the  developments  that  took

place from  the time of Ambroise  Pare´  (1510–1590) to  the early nine- teenth  century  can be largely attributed to the work  of inventive  sur- geons,  better  education   and  practical  training,   and  anatomical and physiological  researches.  Even when allegiance to  humoral  pathology was all pervasive, the surgical point of view had to focus more narrowly and  pragmatically   on  localized  lesions.  As  the  study  of  correlations between the course of disease in the living and  pathological  lesions in the dead  gained  support,  physicians  increasingly  accepted  the validity of  a  localized  pathology.   Surgery  not  only  gained  much  from  the researches  of physicians,  but  also  contributed an  empirical,  anatomi- cally based  point  of view that  was to have important ramification  for medicine as a whole.

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