Timeline of Medieval and Early Modern Surgery.


The Timeline of Medieval and Early Modern surgery lists new surgical operations and significant scientific advances. It covers the period from the end of the Western Roman Empire, with the sack of Rome in in 410 and the eclipse of Greek surgery, the advent of the Arab empire with its golden age and moves finally to the birth of the Renaissance in Europe, ending just before the discovery of anaesthesia in 1846. A brief framework is included of how the learning of the ancients, which was written mainly in Greek, was embraced and advanced following the Arab conquests and its subsequent transmission to Europe when translation into Latin. As in the Timeline of Surgery in Antiquity the data here has been drawn from many sources and these are acknowledged in the references at the end of each section.


c. = Circa = Approximate date. BCE = Before the Common Era or Before the Christian Era. CE = Common Era or Christian Era. cent. = century. f. = floret = He flourished/flowered = time of most productive work.



410 AD. Rome and the beginning of the Dark Age in the west.

Alaric the Goth sacked Rome in 410 and as a result no progress in the art and science of surgery was made in the West for hundreds of years. What had been learned by the Greeks and Romans was forgotten. For example, the practice of tying arteries that were bleeding was not known and instead boiling oil or cautery with its attendant additional pain was used. There were no medical schools and dissection was forbidden on religious grounds, as disease was once again thought to be the result of divine displeasure (1). Scientific medicine was first reawakened six centuries later in Salerno in southern Italy and a classic age of scholarship commenced with the arrival of the Carthaginian physician Constantine Africanus in 1077. Salerno was not part of the Arab Empire but fused Arab and Byzantine-Greek culture was present and many texts were then translated there from the Arabic into Latin. Learning and medical advances also flourished in Alexandria in Egypt, first under the Ptolemies and then under the Arabs (2).

References. (1). A History of Surgery by Harold Ellis, 2001. Greenwich Medical Media Ltd. ISBN 1-84110-023-4. (2). Wikipedia.

6th century. Byzantium. Brachial artery aneurysm ligation.

Brachial artery aneurysm ligation is well described by Aetius of Amida (502-575), who became physician to Justinian 1 (482-565), Emperor of Byzantium. He wrote: ‘An aneurysm located at the end of the elbow is thus treated. First, we trace the artery leading to it from the armpit to the elbow along the inside of the arm. Then we make an incision on the inside of the arm three or four fingers breadths below the armpit, where the artery is easily felt. We expose the blood vessel, and when it can be lifted free with the hook, we tie it with two ligatures and divide it between them. We fill the wound with incense and a lint dressing and then apply a bandage. Next, we open the aneurysm itself and no longer fear bleeding. We move the blood clot present and seek the artery that brought the blood. Once found it is lifted free with the hook and tied as before. By again filling the wound with incense we stimulate good suppuration’ (1). The instructions are clear and could be followed by another surgeon of that time provided he had some anatomical knowledge. Sepsis was accepted as inevitable at that time, Aetius calls what we know as infection as ‘good suppuration’ and in the Western Europe it was called ‘laudable pus’ until the 20th century (2).

References: (1). The Cambridge Illustrated History of Medicine edited by Roy Porter. Cambridge University Press, 1996. (2). A History of Surgery by Harold Ellis, 2001. Greenwich Medical Media Ltd. ISBN 1-84110-023-4.

7th century. Islamic Conquest and the development of scholarship.

Between 623 and 751 the Muslim armies conquered Arabia and then in the west conquered; Syria, Palestine, Egypt, north Africa and Spain, finally being stopped following the Battle of Poiters in France; to the east they conquered Persia and lands as far as the Talas River in China where a Chinese army was defeated (1). The Arabs conquerors were a curious people their victories brought to them the intellectual treasure houses of Persia and the learned academies of the Greeks in Alexandria (Egypt). Shortly after their conquest of Egypt the Greek works of Hippocrates, Aristotle and Galen were translated into Arabic. This spread of knowledge eventually coalesced in Baghdad and produced notable learned and famous physicians including: Abu Bakr Muhammad ibn Zakariyya al-Razi (854-925 CE), known as Rhazes in the West, his observations of infectious diseases superseded those of Galen. Rhazes came to influence Avicenna and Albucasis to give their western names. A map will show how the Greek and Arabic medical writings eventually became available in the west through Salerno in Italy in the 8th century and Spain in the 12th century. Meanwhile the practitioners of Arabian medicine were the most important preservers of Greek medicine and also made significant advances (2).

Reference. (1). The Times History of the World. Editor Richard Ovary. Pub. in 1999 by Times Books. ISBN 0-00-761900-6. (2). A History of Surgery by Harold Ellis, 2001. Greenwich Medical Media Ltd. ISBN 1-84110-023-4.

7th century. Byzantium. Tracheostomy by Paul of Aegina.

Paul of Aegina (c. 625-c. 690) a Greek from Byzantium wrote ‘The Medical Compendium in Seven Books’ in Greek, possibly while he was in Alexandria during the first decades following the Muslim conquest. He was given an Arabic name, Al-kawabeli (the Accoucheur). His text in Greek was translated into Arabic by Hunayn Ibn Ishaq al-Ibadi (809-873). Paul of Aegina gave the reason for carrying out a tracheostomy as due to inflamed and indurated tonsils obstructing the airway. For reasons we are not given he did not carry out a tonsillectomy as previously described. He continued his account as follows. ‘When we engage in the operation we slit open part of the trachea below the top of the windpipe, about the third or fourth ring, for this is a convenient situation, being free of flesh and because the vessels are at a distance from the part that is divided. Therefore, bending the patient’s head backwards so as to bring the windpipe into better view, we make a transverse incision between two of the rings so that it may not be the cartilage that is divided but the membrane connecting the cartilage, we judge that the windpipe has been opened from the air rushing through it with a hissing noise and with the voice being lost. After the urgency of the suffocation has passed, we pare the lips of the incision so as to make them raw surfaces and then have recourse to sutures, but sew the skin only but not the cartilage’ (1).
There is an account of tracheostomy by Ibn Zuhr (d. 1162) in Muslim Spain (2). It was apparently practised. He carried out a tracheostomy on a goat in case he ever had to perform it as he had never seen it performed in a human (1). There have been suggestions that tracheostomy was performed in pre-dynastic ancient Egypt (31st century BCE) the depictions of the suggested operation cannot be anatomically reconciled with tracheostomy operation and may have represented human sacrifice (3).

References: (1) Harold Ellis in his book ‘A History of Surgery’, says that this description would well serve a modern textbook. History of Surgery by Harold Ellis, 2001. Greenwich Medical Media Ltd. ISBN 1-84110-023-4. (2). Medieval Islamic Medicine. Peter E. Pormann & Emily Savage Smith. Edinburgh University Press. 2010. ISBN 978 0 7486 2066 1. (3). Bloomstedt P. Tracheostomy in ancient Egypt. J. Laryngol. Otol. Aug; 128(8): 665-8. 2014.

9th century. Islamic Califate. The Sheikh of Translators.

Hunayn Ibn Ishaq al-Ibadi (809-873) was a Nestorian Arab from Mesopotamia who worked during the Islamic Golden Age of the Abbasid Califate in Baghdad. he mastered four languages, Arabic, Syriac, Greek and Persian and was known as the ‘Sheikh of Translators’. He and his students transmitted their Syriac and Arabic translations throughout the Arab world. In his lifetime he translated 116 works into Arabic and also produced 36 books of his own. Twenty-one of which covered the field of medicine and including ‘Ten Treatises on Ophthalmology’. He was placed in charge of the famous House of Wisdom, the Bayt al Hikmah in Baghdad by the Caliph al-Mamun and translated Greek texts making them available to scholars. His Kitab ila Aglooqan fi Shifa al Amraz is a masterpiece of translation of Galen’s Commentaries and many other books (1).

Reference: (1). Wikipedia: Hunyan ibn Ishaq.

c. 900. Islamic Califate. Largest medical Textbook before 1500.

The largest medical Textbook before 1500 was by Rhazes (1), Abu Bakr Muhammad ibn Zakairyya Al-Razi (854-925) who demonstrated advances in clinical diagnosis, being the first to differentiate smallpox from measles. He produced a treatise on ‘Examining the Physician’ with quotations from Hippocrates and Galen so further defining the questions to ask, so as to assess the suitability of a student to be a physician. This was further refined over the next 250 years and his book translated into Latin, ‘Liber de Medicina ad Almansorum’ formed part of the medical curriculum of almost every university through to the 16th century (2).

References: (1). Medieval Islamic Medicine by P.E. Pormann and Emilie Savage-Smith. Edinburgh University Press, 2007, ISBN 978 0 7486 2066 1. (2). A History of Surgery by Harold Ellis, 2001. Greenwich Medical Media Ltd. ISBN 1-84110-023-4.

9th century. Islamic Califate. Hospitals.

The Roman military were the first to have purpose built hospitals along the northern frontier of their Empire in the first century CE. These were for the wounded or sick soldiers. Please see the Timeline in Antiquity. However, a hospital was built in the 9th century in Iraq by the Arab Nestorian Patriarch Timothy 1 (d. 823) in the south-east of Baghdad for a large sum of money. Later the Caliph al-Muqtadir (r. 908-932) with his mother and vizier established hospitals in Baghdad in the 910s and 920s. The Adudi hospital which was the most important was established in 982 and was staffed by 25 doctors and was later described as having many chambers and rooms and all the appurtenances of a royal residence. Important hospitals were also built in Damascus and Cairo over the next three centuries, the earliest built in Muslim Spain was in Granada in 1397. The medical needs of the wealthy were still provided in their private houses.

Reference: Medieval Islamic Medicine by P.E. Pormann and Emilie Savage-Smith. Edinburgh University Press, 2007, ISBN 978 0 7486 2066 1.

c. 1000. Islamic Califate. Surgical closure of an Abdominal knife wound

Surgery for an Abdominal knife wound with protrusion of the intestines is described by Abu al-Qasim al-Zahrawi (fl.c. 1000). The abdominal wall was sutured. Pormann and Savage-Smith concluded that physicians did attempt on occasion to treat abdominal wounds surgically.

Reference: Medieval Islamic Medicine. Peter E. Pormann & Emily Savage Smith. Edinburgh University Press. 2010. ISBN 978 0 7486 2066 1.

c. 1000. Islamic Califate. Arrow wounds to the head and neck.

Arrow wounds to the head and neck were treated by Abu al-Qasim al-Zahrawi (fl.c. 1000), also called Albucasis. The arrowhead was extracted in four cases, one arrow to the eye, two to the nose and one to the throat. He made no attempt to extract arrows in the abdomen or back on four occasions, probably he considered that the wounded man would not survive anyway due to the arrows being lodged in vital organs

Reference: Medieval Islamic Medicine. Peter E. Pormann & Emily Savage Smith. Edinburgh University Press. 2010. ISBN 978 0 7486 2066 1.

11th century. Islamic Califate. The Canon of Medicine

The Canon of Medicine was written by Hakim Ibn-Sina known as Avicenna (c. 980-1037). He was a Persian polymath who was regarded as one of the most significant thinkers of the Islamic Golden Age. The Canon was a five-volume medical encyclopaedia in which he wrote; ‘Medicine is a science from which one learns the states of the human body with respect to what is healthy and what is not, in order to preserve the good health when it exists and restore it when it is lacking’. Ibn Sina described the division between diseases that only affected one part of the body, and those not specific to any part of the body. For those in the first category, the cause, symptoms and treatments were logically presented from head to toe. The conditions not specific to part of the body were divided into fevers, pustules, ulcer, swellings, leprosy, smallpox, wounds, obesity, fractures and dislocations, poisons and animal and insect bites. Ibn Sina listed twenty-three types of fever. He also systematised and synthesised the Greek medical literature. His Canon came to dominate the medieval Islamic world and Europe and was used as a medical textbook for several centuries (1).

Reference: (1). Medieval Islamic Medicine. Peter E. Pormann & Emily Savage Smith. Edinburgh University Press. 2010. ISBN 978 0 7486 2066 1.

11th Century. Europe, Italy. Translation of Ancient Greek and Arabic medical texts into Latin.

Constantinus Africanus (b. c. 1020-1087) was a Christian monk originally from Carthage in North Africa who travelled widely in Syria, India, Ethiopia, Persia and Egypt. He studied at the famous medical school in Salerno, Southern Italy and then entered the Monastery at Monte Cassino (founded in 529). There he translated into Latin the works of Hippocrates and Galen from the Greek. He also translated thirty-seven books from Arabic into Latin, including two treatises by Isaac Israel the western Caliphate’s (Al-Andalus/Muslim Spain) greatest physician and the works of the Arab physicians Razes and Avicenna and was thus responsible for the transmission of these texts to Western Europe.

Reference: https://www.britanica.com.biography.

13th century. Western Europe. The Birth of Learning with the foundation of universities.

The oldest university was Bologna in Italy founded in 1088, then Oxford grew informally from 1096 and was recognised as a university by 1167. Cambridge University was founded in 1231 and the Sorbonne in Paris in 1257 and many more followed. Medieval Europe was receiving and learning from the translations, initially into Latin and then finally into the vernacular of individual European States, of Greek documents that had been translated into Arabic and original Arabic literature and practice, then at its cultural peak. These translations included those on astronomy, mathematics, science and medicine. Also, technological innovations came to Europe via the Silk Road from China, such as gunpowder and paper. Many Arabic words, such as alchemy (chemistry), algebra, sugar, camphor and cotton were absorbed into the European languages.

1252. Western Europe, France. Establishment of Surgical Guilds.

The beginning of surgeons gathering together in institutions in Western Europe was the foundation of the Guild of Barber Surgeons in Montpellier in 1252, Paris followed in 1260 and in London there was a guild of surgeons from about 1300 (2). In 1540, King Henry VIII granted a charter to the ‘Company of Barbers-Surgeons’. In 1745 the barbers and surgeons parted and the surgeons became the Company of Surgeons and eventually became the ‘Royal College of Surgeons of England’ (RCS) in 1843 (3). The establishment of the early institutions took place at an opportune time as the works of Hippocrates and Galen became available in Western Europe. Their original writings in Greek having been translated into Arabic were now available in Latin (the common language of the educated classes in Europe in the Middle Ages), they were soon translated into French and English. The revival of direct study of anatomy was on the point of being hastened and advanced by the publication of ‘Certaine Works of Chirurgerie’ by Galen (130 – 200 CE) translated by Thomas Gale (c. 1507- 1587) into English and published in 1563-1564 (2). Galen was read by Versalius who made significant new advances in the study of anatomy by his personal dissection of cadavers. Versalius published ‘De Humani Corporis Fabrica’ in 1543 that became the standard anatomical text for three hundred years (4).

References: (1). The History of the Royal College of Surgeons of England by Zachary Cope. Printed by Anthony Blond ltd, London, 1959. Also, the website of the Royal College of Surgeons of England. (2). A History of Surgery with emphasis on the Netherlands by Daniel de Moulin, Published by Martinus Nijhoff in 1988. (3). Galen of Pergamon by George Sarton. University of Kansas Press, 1954. (4). Andreas Versalius, The Reformer of Anatomy by James Moores Ball. Trieste Publishing Pty Ltd, 2017.

1257.Western Europe, Italy. Pus is not laudable.

Theodoric of Lucca (1205-1296), an Italian Dominican friar published his ‘Chirurgia’ in which he disputed the teaching of Galen (c. 131-201) and of subsequent Arab authors, that suppuration and the formation of pus were necessary for wound healing. Despite Theodoric’s independent thinking, the idea of ‘laudable pus’ generally continued until the teachings of Lister in the nineteenth century, nearly seven hundred years later. Theodoric wrote: ‘As all modern surgeons profess, pus should be generated in wounds. No error can be greater than this. Such a practice is to hinder nature, to prolong the disease and prevent the consolidation of the wound’ (1). Theodoric was before his time. He not the first to be ignored in this matter, being himself unaware that Galen had been physician to the Gladiators in Pergamon from 158 -161 CE and had observed and wrote that some wounds healed without suppuration (2).

References: (1). A History of Surgery by Harold Ellis. Published by Greenwich Medical Media Ltd. 2001. (2). Galen of Pergamon by George Sarton. Pub. University of Kansas Press 1954.

c.1246. Islamic Califate Cairo. Discovery of the pulmonary circulation.

The discovery of the pulmonary circulation was by Ibn al-Nafis (d. 1288), who was a Syrian physician who spent most of his life in Cairo. He asserted correctly that the blood in the right ventricle of the heart must reach the left ventricle by way of the lungs alone and denied that there was any connection between the ventricles. This was a significant advance on Galen’s anatomy, that believed that blood was produced by the liver and passed to all the organs and peripheral parts where it was consumed. Ibn al-Nafis’ work was extraordinary as Islamic writings on anatomy were conservative and otherwise deviated little from their Hellenistic models.

Reference: Medieval Islamic Medicine. Peter E. Pormann & Emily Savage Smith. Edinburgh University Press. 2010. ISBN 978 0 7486 2066 1.

1440. Europe, Germany. Printed Journals in Europe and the dissemination of knowledge.

The Renaissance in Europe spread rapidly from the south to the north and during this century the interest in the arts, science and medicine flourished. The speed that information was transmitted was a new phenomenon driven by the printing press. In 1440 Johannes Gutenburg (c.1398 - 1468) a German in the Holy Roman Empire, facilitated this rapid spread of knowledge through the printed word. Within sixty years printing presses were in operation throughout Europe and had produced more than twenty million volumes. The original inventors of printing were the Chinese during the Han Dynasty of 2016 BCE – 220 CE. Their technique was to print on paper or cloth using texts carved on stone and later the templates were carved in wood, but it did not develop further.

1543. Europe, Italy. Anatomy becomes a modern science under Versalius.

New anatomical studies by Versalius (1514-1564), finally overthrew the dogma laid down by Galen (c. 131-201 CE) one thousand-four-hundred years earlier. Galen personally dissected many different species of animals, but the Barbary macaque was his proxy for humans. Galen’s anatomical findings were a revolution of its time, but were not subsequently added to or revised for over one-thousand-four-hundred years (1). During these centuries anatomy was not directly studied, instead reference was made to the ancient texts. Andreas Versalius was a Flemish anatomist with a doctorate of medicine from Padua University. He had read Galen’s work and was fired with enthusiasm and when he was appointed Professor of surgery at the age of 23, he personally carried out his own meticulous dissections on the bodies of executed criminals which was now permitted. These were public dissections that attracted wide audiences of surgeons and students from all over Europe to observe and learn. Versalius recruited an artist, whose obstinacy tormented him so that he felt. ‘more unfortunate than the criminal whose body he had dissected’. It is significant that the artist’s name was omitted from his book. He was initially thought to have been Titan, but it seems that Jan Stephan van Kalker who died in 1546 was the artist. ‘De Humani Corporis Fabrica’ (The Structure of the Human Body) was published in 1543. Versalius pointed out errors in classical writing, even those of Galen, showing for example that the human kidney was not lobulated as in the pig and that there were no pores between the ventricles of the heart. He contributed to a new atmosphere of enquiry based on foundations of fact as the ancient wisdom had now lost its long held unquestioned validity (2). During the three hundred years from 1543-1846, the surgical renaissance starting with Versalius’ anatomy and finally ushered in the age of modern surgery with the advent of general anaesthesia in 1846. (3). This enabled surgeons to eventually plan and carry out elective detailed surgery on patients with diseases within the three great cavities of the body, the abdomen thorax and cranium.

References: (1) Galen on Anatomical Procedures, Translated by Charles Singer. Oxford University Press, 1956. Reprinted in 1999. (2). Andreas Versalius, the Reformer of Anatomy by James Moores Ball Trieste 2017. ISBN 9780649026388. (3). The Cambridge Illustrated History of medicine. Editor Roy Porter. Cambridge University Press, 1996.

1585. Europe, France. European battlefield surgery catches up with Galen.

Ambrose Paré (1510-1590) a French barber-surgeon in Paris published his ‘Oeuvres’ (Works) in French, rather than Latin, in 1585. He had considerable experience of battlefield wounds and ligated bleeding arteries and veins rather than using cautery. He concocted an ointment of egg yolk, rose oil and turpentine to use with a dressing. His treatments were less painful than before and wounds became infected less frequently.

Reference: A History of Surgery by Harold Ellis. Greenwich Medical Media Ltd, 2001.

1597. Europe, Italy. Advent of Plastic Surgery.

Gaspar Tagliacozzi (1545-1599) an Italian surgeon in Bologna is regarded as the father of modern plastic surgery. He published: ‘On the Surgery of Mutilations by Grafting’. This describes years of trial and error documented with drawings. He reconstructed ears, lips and noses. The latter caused either by trauma or syphilis were replaced by means of an arm flap, predating the pedicle flap of Harold Gilles in the First World War, three hundred years later (1). In c. 450 BCE, nearly two-thousand years before Tagliacozzi, Sushruta a Hindu surgeon, described the first known plastic surgery with a pedicle flap used for earlobe and nose reconstruction (2). (See Timeline of Surgery in Antiquity),

Reference: A History of Surgery by Harold Ellis. Greenwich Medical Media Ltd. 2001. (2). The healing Hand by Guido Majno. Harvard University Press. 1975, paperback edition 1991.

1609. Europe, Italy. The compound microscope was developed by Galileo Galilei.

Galileo Galilei (1564-1642) was an Italian polymath and invented many things including a telescope and a thermometer. Galileo’s microscope was novel in that it had both convex and concave lenses. Galileo’s microscope was an improvement on that of Zaharias Jansen who in 1590 mounted two lenses in a tube to make the first microscope. The microscope became a tool of inestimable value in furthering the understanding of nature, the advancement of medicine and a bridge between anatomy and physiology.

References: Cambridge Illustrated History of Medicine edited by Roy Porter. Cambridge University Press, 1996. ISBN 0 521 44211 7.

1628. Europe, England. The circulation of the blood demonstrated by William Harvey.

Dr William Harvey (1578-1657) an English physician published his account of the circulation of the blood in ‘Exercitation De Motu Cordis et Sanguinis in Animalibus’ published in 1628. Before Harvey the accepted view in the seventeenth century and stretching back to Hippocrates (c. 460 – c. 370 BCE) and Galen (c. 130 – c. 210 CE) was confusing with no coherent understanding of the function of the heart or circulation and a belief that the liver was the originator of the blood (1). Harvey was the first to describe exactly and in detail the systemic circulation of the blood. He postulated that in the tissues, blood passed from the arteries via capillaries to the veins, so returning to the heart. He could not see the capillaries, even with a lens, but showed that they must exist from his experiments. He believed that the heart must be studied while functioning. Harvey first worked out the quantity of blood expelled on each heartbeat, in an animal or bird, and the number of heartbeats in half an hour. The capacity of the heart studied (converted into metric numbers) was 43ml and of this 4.7ml was ejected with each heartbeat. He estimated the heart beat approximately one-thousand beats every half hour. The total volume pumped every half hour was 4.7 litres and in 24 hours would total 225 litres pumped. These findings disproving the claims from antiquity of the liver producing blood, as the daily volume pumped was so large that the only explanation was that it must be circulating. The next set of experiments were on reptiles and were wide ranging, but the essence was if he tied the vena cava the heart emptied and if he tied the great arteries the heart swelled up confirming ejection and return of the blood to the heart. His famous demonstration on the arms of a person showed, that in the veins the blood all flows towards the heart and backflow is prevented by valves (2)(3). This was proof enough that the blood circulated and the postulated capillaries were identified not long afterward by Marcello Malpighi (1628-1694) in his microscopic study of the lung of a frog. It is interesting to note that Harvey was physician to both King James 1 and then King Charles 1. In spite of his eminent position his publication of ‘De Motu Cordis’ was criticised by contemporary physicians, who continued to believe in Galen’s description of the circulation, despite the evidence to the contrary. Harvey’s medical practice was badly damaged by these criticisms, but ultimately his findings were accepted.

References: (1). The Heart and Vascular System in Ancient Greek Medicine. From Alcmaeon to Galen by C.R.S. Harris. Oxford University Press, 1973, special edition 2001, ISBN 0-19-858135-1, (The Chapter on Galen gives a masterly summary of the heart and blood in antiquity). (2) Wikipedia. (3). Power D’Arcy 1897. William Harvey, Masters of Medicine. T. Fisher Unwin. ISBN 978-1-4179-6578-6.

1665. Europe. England. Journals rapidly circulate advances in medicine & surgery

‘The Philosophical Transactions’ of the Royal Society of London founded in 1660 were first published in 1665 and carried articles by celebrated names in science and medicine. The ‘Acta Medica et Philosophica Hafniensia’ was published between 1673 and 1680 in Denmark by Thomas Batholin (1616 – 1680). This journal also included articles on zoology and botany. In the USA the ‘Medical Repository’ was published in 1797 (1). The Edinburgh Medical Journal was first published in 1802. It was followed by Lancet in England in 1803. These and many other journals enabled standard practice and new procedures to be rapidly disseminated (2).

References: (1). Wikipedia. (2). A History of Surgery by Harold Ellis. Greenwich Medical Media Ltd. 2001, ISBN 1 84110 023 4.

1673. Europe, Netherlands. First Identification of Bacteria.

Anthoni van Leeuwenhoek (1632-1723), a Dutchman who manufactured his own microscope was the first microbiologist. He drew pictures of his discoveries, one being bacteria collected from his own mouth. After initial scepticism, his work was fully accepted by the Royal Society of London, he was made a fellow and had lengthy correspondence with the Royal Society until his death.

Reference: Wikipedia.

1761. Europe, Italy. The First description of anatomical pathology by Giovanni Batista Morgagni.

Giovanni Batista Morgagni (1682-1771), an Italian anatomist who studied at Bologna and became professor of anatomy in Padua in Italy, published his final and most significant work in five volumes ‘De Sedibus et Causis Morborum’ in 1761. This work was translated into French in 1765, English in 1769 under the title of the’ Seats and Causes of Disease’ and into German in 1771. Morgagni described the anatomical changes in organs and tissues at post-mortem of patients who had died of disease rather than hanging and so established the fundamental principle that a large proportion of diseases are not vaguely dispersed throughout the body, but originate locally, in specific organs and tissues.

Reference: A History of Surgery by Harold Ellis. Greenwich Medical Media Ltd. 2001, ISBN 1 84110 023 4.

1799. Europe. England. The Hunterian Museum at the Royal College of Surgeons of England.

The Hunterian Museum (1) is named after John Hunter (1728-1793) a Scottish surgeon who practised in London and also had his own anatomy school (2). His collections included many artefacts and dissections of man and animals from all over the world. His interests included comparative anatomy. Among his many dissections of animals were exotic specimens brought back by Joseph Banks (1743-1820), who travelled round the world with Captain James Cook (1728-1779), in HMS Endeavour from 1768 - 1771 (3). His specimens demonstrate the importance of structure to function and among his exhibits is a comparison between the neurology of the earthworm and other animals to that of man. With modern genetic studies the relationship to all these creatures can be made but Hunter did not make an evolutionary connection. That was left to Charles Darwin and Alfred Wallace Russell whose papers on evolution were presented to the Linnean Society of London in 1858. Darwin’s great work ‘On the Origin of Species’ was published a year later. Not all the artefacts of Hunter’s detailed and brilliant anatomical and surgical experiments have survived the depredations of time and war, but the many that remain are the centre piece of this splendid museum.

References: (1). The Royal College of Surgeons of England, Lincolns Inn Fields, London. (2). The Knife Man: Blood, Body-snatching and the birth of modern Surgery. by Wendy Moore: Bantam Books 2005. (3). Voyages of Discovery. Three Centuries of Natural History Exploration by Dr Tony Rice. 1999 The Natural History Museum, London. ISBN 1-902686-02-0.

1809. USA. First successful laparotomy for a huge ovarian cyst diagnosed preoperatively.

The first ovarian excision through a laparotomy was by Ephraim McDowell (1771-1830) an American surgeon, who was trained in Edinburgh and was in practice in the small town of Danville in Kentucky, USA. He was called to see a Mrs Crawford who was 44 years old, who thought she was in labour. McDowell travelled the 60 miles to her home on horseback. His physical examination revealed a large abdominal swelling situated more to the left side of the abdomen. Vaginal examination revealed a normal cervix and an empty uterus. He diagnosed a huge ovarian cyst and said that if the patient could come to his house he would perform an experiment. The patient appeared a week later and the operation was successful in removing a huge left ovarian cyst through a left paramedian incision. She returned home 25 days later. The operation was without any strong analgesia and of course no anaesthetic at that date. A heroic operation on a brave woman. He waited to publish this operation until 1817 when he had carried out two more such operations successfully. His primacy was eventually accepted by his colleagues and he was then acknowledged as the ‘father of abdominal surgery’. Mrs Crawford and her husband moved to Indiana, where she was a state representative in the legislature and died aged 78.

Reference: A History of Surgery by Harold Ellis. Greenwich Medical Media Ltd. 2001, ISBN 1 84110 023 4.

1824. Europe, France. Bladder calculi removed by trans-urethral ‘lithotrity’.

Jean Civiale (1792-1867) of Paris devised an instrument that he called a trilabe for grasping, breaking and removing bladder stones (1). This was an advance on the operation described by the Hindu surgeon Sushruta Samhita in c. 450 BCE whose operation to remove bladder stones was carried out through a perineal incision, see the Surgical Timeline in Antiquity (2). This is the same operation that Samuel Pepys (1633 – 1703), the London Diarist underwent in 1658 (3).

References: (1). A History of Surgery by Harold Ellis. Greenwich Medical Media Ltd. 2001, ISBN 1 84110 023 4. (2). The healing Hand by Guido Majno. Harvard University Press. 1975, paperback edition 1991. (3). The Diary of Samuel Pepys by Robert Latham. Published by Bell and Hyman, 1985.

1827. Europe, France. Partial Prostatectomy.

During a supra-pubic cystotomy to remove a bladder calculus, Jean Amussat (1796-1856) of Paris, noted a prostatic mass (middle lobe) which he excised, the operation was successful. (see 1886). (As the incision was made with a full bladder, displacing the peritoneum was not opened. This was an extraperitoneal operation).

1831. Europe, England. Pioneering treatment of cholera by intra-venous fluids.

Sir William Brooke O’Shaughnessy FRS. (1808-1889) was Scottish Physician and Chemical pathologist, who examined the fluids and measured the specific gravity of the excreta of cholera victims. discovered a saline deficiency in the bloodstream and indicated the possibility of replacing it. This would require absorption or injection into a vein (1). In 1832 Thomas Aitchison Latta (1796-1833) was the first to treat a patient who was moribund and near the point of death from cholera, she was pale, her eyes were sunken, extremities cold and her jaw was dropped. Latta inserted a tube into a vein and then using a syringe he repeatedly injected saline. After six pints of fluid she revived and began to talk. The results were published in the Lancet in 1832. This technique was tried on other cholera sufferers with enthusiasm, but was abandoned as the strength of the electrolyte content of the fluid to be injected could not at that time be measured and few of Thomas Aitchison Latta ’s patients survived (2). (See 1902).

References: (1). Moon J.B. (1967). Sir William Brooke O’Shaughnessy: The foundations of fluid therapy and the Indian telegraph Service. New England Journal of Medicine. 276 (5): 283-284. (2). Wikipedia.

1840s. Europe, Poland. The rise of therapeutic nihilism.

The rise of therapeutic nihilism began in the 1840s in the big European medical centres leading to the recognition that the decoctions and infusions then available for treatment were either useless or harmful. One such physician was Joseph Dietl (1804-1878) of Krakow, Poland, who taught his students that they could not develop panaceas or banish death bur must discover why people became ill, through scientific study of disease. This was a significant change in philosophy born from the scientific advances then driving the industrial revolution. With this new philosophy, Europe was on the cusp of the great surgical revolution. See ‘Timeline of Modern Surgery’.

Reference: The Cambridge Illustrated History of Medicine Edited by Roy Porter. Cambridge University Press 1996. If you wish to continue, please click on Timeline of Modern Surgery.