History of Neurosurgery (eBook)

In Its Scientific and Professional Contexts

T. Forcht Dagi, Mel H. Epstein, Samuel H. Greenblatt (Herausgeber)

eBook Download: EPUB

1997 | 1. Auflage
640 Seiten
Thieme Publishers New York (Verlag)
978-1-63853-184-5 (ISBN)

Infos

A History of Neurosurgery is the first thorough book on the history of neurosurgery published since 1951. The book is organized around a specific historiographic framework that traces the advancement of the specialty. Included are chapters on ancient trepanation, Macewen's first use of the combined technologies of anesthesia, antisepsis and cortical localization in 1879 to plan and perform craniotomies, the emergence of Harvey Cushing's leadership, the evolution of modern neurosurgical techniques and technology and much more.

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The Evolution of Modern Surgery: A Brief Overview

Dale C. Smith, PhD

Modern surgeons, like their ancient, medieval, or early modern counterparts, are managers of trauma. However, one of the major differences between modern surgeons and their predecessors is the frequency with which the modern surgeon inflicts the trauma. In the surgical suites of today’s hospitals surgeons transplant organs, remove growths identifiable only by microscope, and reattach traumatically amputated limbs. These activities reflect both technical skill and an appreciation of the basic workings of the human body unimagined 150 years ago. Today’s surgeons are seen frequently as the elite of the medical profession. Yet, despite the great differences between modern surgery and that of the past, fundamental similarities remain. In the Hippocratic writings we find the following titles: “of hemorrhoids,” “of fistulae,” “on ulcers,” “of injuries of the head,” “of fractures,” “on articulations,” and “on reductions”—a collection which suggests that surgeons dealt then, as they deal now, with wounds. Surgeons make wounds to repair the anatomy and physiology gone awry and to remove structures that are pathological, and they repair wounds made by other agencies. The evolution of modern surgery is dependent upon both a social structure—the definition, training, certification, and monitoring of that profession we call surgery—and the acceptance of certain understandings and relationships in those subjects that we call the basic biological sciences. The interactions of these two areas are the determinants of the ability of the profession at any given time to assist in the treatment of patients.

Ancient and Medieval Surgery

In about the fifth century BC, the so-called Golden Age of Greece, a group of practitioners developed an understanding of disease as a natural process. That is, disease occurred and could be cured through natural means, not requiring the invocation of the supernatural. Pathology could be rationally understood. This revolution in thinking about the healing arts did not have a great deal of impact on the practice of surgery, because while some surgically removable pathology was related to understandings of disease and the workings of the body, the actual technical surgery was largely empirical and most ancient surgical pathology was practical in its orientation. The change did have an impact on the understanding of the healing of wounds and therefore the steps that could be taken to facilitate healing and the materials that might be added to wounds.47 The system for training practitioners to deal with wounds was informal but real. The pragmatic Hippocratic advice—“he who would become a surgeon therefore should enroll and follow troops”—was to gain experience where experience was to be gained most efficiently, where wounds occurred most frequently.24,38 Surgical training was then, as now, in part empirical and practical.

Surgery practiced by those who wrote about surgery for the next 2,000 years illustrated the import of the increasingly rational orientation of medicine. Some, like Galen (ca. AD 129-210), a Roman physician of the second century, realized that there was an orientation for some members of the profession which went beyond the immediate, practical need of the healer.

Anatomical study has one use for the man of science who loves knowledge for its own sake, another for him who values it only to demonstrate that Nature does nought in vain, a third for one who provides himself from anatomy with data for investigating a function, physical or mental, and yet another for the practitioner who has to remove splinters and missiles efficiently, to excise parts properly, or to treat ulcers, fistulae and abscesses.... The most useful part of the science of anatomy lies in just that exact study neglected by the professed experts. It would have been better to be ignorant of how many valves there are at each orifice of the heart, or how many vessels ministered to it, or how or whence they come, or how the paired cranial nerves reach the brain, than [not to know] what muscles extend and flex the upper and lower arm and wrist, or thigh, leg and foot, or what muscles turn each of these laterally, or how many tendons there are in each, from where they take their rise and how they are placed, or where a vein or a great artery and where a small underlie them.22

The empirical side of surgery, controlled by physical realities and technical limitations, persisted into and through the medieval period. There is every reason to believe that a tradition of preceptor to apprentice training by generation went forward, sometimes with geographical movement and sometimes in a constant area. The written surgery which re-emerged at Salerno in the 10th and 11th centuries was strikingly similar to the writings of the ancients. The scientific considerations of wound healing paralleled ancient traditions of debate, as surgeons continued to discuss the advantages of healing by first intention and healing with the formation of “laudable pus.” Various theoretical and empirical changes were made in dressing material as well as salves and ointments.63 With the introduction of gunpowder in the 15th century, a new type of wound, seemingly “poisoned” (in modern terms we would say “infected”), made its appearance and elicited an extensive debate on the appropriate treatment of “poisoned” or gunshot wounds.5 The contributions of Ambroise Paré (1510-1590) are probably the best known in this continuous empirical tradition. The traditional therapy for a poisoned wound was to pour boiling oil into it to destroy the action of the poison. At the siege of Turin, Paré ran out of oil and dressed the wounds with a digestive of turpentine and egg. The patients with less iatrogenic trauma did better and Paré changed his practice.34 Paré’s solution to the gunshot wound problem as well as his reintroduction of ligature in amputations and programmatic writing in the vernacular for non-university-educated surgeons seems to have encapsulated the best of the empirical, common technical tradition in early modern surgery.48

A contemporary of Paré’s might be said to provide the pinnacle of the development of the scientific tradition in surgery as it emerged in the Renaissance. The achievement of Andreas Vesalius (1514-1564), best known for his 1543 pioneering anatomical work, De humani corporis fabrica [On the structure of the human body], was the climax of a tradition of Renaissance humanism, renewing the study of Galenic anatomy, and the beginning of a new tradition of anatomical research. From his reading and research, Vesalius realized that Galenic anatomy, as taught through most of the medieval universities, was in fact a composite of animal structure. As a professor of surgery, teaching surgical anatomy, Vesalius realized the importance of human dissection in the training of all physicians, especially surgeons.55 It would take 200 years for the routine teaching of anatomy to spread through Europe as an appropriate part of the training of all surgeons. But slowly, with the passage of time and the installation of more rigorous professional education requirements, country after country made provision for the hands-on instruction of future surgical practitioners in anatomy.1

Early Modern Surgery and the Origin of the Profession

Southern and Northern Europe

The social history of surgery varies by principality and country. In southern Europe a large measure of the surgical tradition remained much more closely tied to the university-educated physicians; in northern Europe separate surgical professions evolved, sometimes with a small academic tier; at other times straightforwardly technical, apprentice-trained craft traditions dominated. Over the course of the 18th century, regardless of the particulars of the tradition, hands-on anatomical education became increasingly important and innovation in surgical therapy seemed to follow as practitioners became increasingly comfortable with their anatomical knowledge. The relationship between surgery and anatomy had always been real, but it was only in the 17th century that anatomical teaching for the benefit of surgical students became commonly recognized by society. When in 1672 Louis XIV established and endowed public demonstrations in surgical anatomy at the Jardin du Roi in Paris, a new standard was established in northern Europe. The Jardin would be entitled to cadavers from the public executioners even in preference to the Faculty of Medicine. Pierre Dionis (1643-1718) was named the first demonstrator; his lectures and demonstrations attracted large numbers of people. Louis XIV became more convinced of the utility of surgery when, in 1686, his surgeon, Charles-François Felix (d. 1703), successfully operated to close an anal fistula. This led in the 18th century to steady royal patronage for the profession of surgery and the teaching of anatomy, demonstrative and pathological, in its relation to surgical operations in the School of St. Côme. The school became the Royal Academy of Surgery in 1731 and under its auspices two generations of surgeons were trained. The practice of surgery was also systematically taught in Paris in the 18th century, largely at the public hospitals; the 1724 edict establishing teaching at St. Come authorized two experienced master surgeons to begin to teach at the Charité. There were courses of operations, usually lasting about...

Produkt-Details

• Erscheint lt. Verlag: 1.1.1997
• Verlagsort: Stuttgart
• Sprache: englisch
• Themenwelt: Medizinische Fachgebiete ► Chirurgie ► Neurochirurgie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Neurologie
• Themenwelt: Studium ► Querschnittsbereiche ► Geschichte / Ethik der Medizin
• ISBN-10: 1-63853-184-6 / 1638531846
• ISBN-13: 978-1-63853-184-5 / 9781638531845