The Art and Science of Surgery

Modern surgery has evolved from one of the most despised branches of medicine into one of the most respected, powerful, and best compensated 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, dislocations, and so forth. In comparison to the treatment of internal diseases by physicians, the surgeons who treated traumatic injuries, urinary disorders, 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 nineteenth century can be largely attributed to the work of inventive surgeons, 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, anatomically based point of view that was to have important ramification for medicine as a whole.

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