Despite outward appearances, it was actually not until the latter decades of the 19th century that the surgeon truly emerged as a specialist within the whole of medicine to become a recognized and respected clinical practitioner

What surgery now needed to sustain its continued growth was the ability to diagnose surgical diseases at earlier stages, to locate malignant growths while they remained small, and to have more effective postoperative treatment so that patients could survive ever more technically complex operations

• What surgery now needed to sustain its continued growth was the ability to diagnose surgical diseases at earlier stages, to locate malignant growths while they remained small, and to have more effective postoperative treatment so that patients could survive ever more technically complex operations

Such thinking was exemplified by the introduction in 1924 of cholecystography by Evarts Graham (1883-1957) and Warren Cole (1898-1990). In this case, an emerging scientific technology introduced new possibilities into surgical practice that were not necessarily related solely to improvements in technique.

• Such thinking was exemplified by the introduction in 1924 of cholecystography by Evarts Graham (1883-1957) and Warren Cole (1898-1990). In this case, an emerging scientific technology introduced new possibilities into surgical practice that were not necessarily related solely to improvements in technique.

To the surgeon, the discovery and application of cholecystography proved most important, not only because it brought about more accurate diagnoses of cholecystitis but also because it created an influx of surgical patients where few had previously existed. If surgery was to grow, large numbers of individuals with surgical diseases were needed.

• To the surgeon, the discovery and application of cholecystography proved most important, not only because it brought about more accurate diagnoses of cholecystitis but also because it created an influx of surgical patients where few had previously existed. If surgery was to grow, large numbers of individuals with surgical diseases were needed.

It was an exciting era for surgeons, with important clinical advances being made both in the operating room and in the basic science laboratory. Among the most notable highlights were the introduction in 1935 of pancreaticoduodenectomy for cancer of the pancreas by Allen Oldfather Whipple (1881-1963) and a report in 1943 on vagotomy for operative treatment of peptic ulcer disease by Lester Dragstedt (1893-1976).

• It was an exciting era for surgeons, with important clinical advances being made both in the operating room and in the basic science laboratory. Among the most notable highlights were the introduction in 1935 of pancreaticoduodenectomy for cancer of the pancreas by Allen Oldfather Whipple (1881-1963) and a report in 1943 on vagotomy for operative treatment of peptic ulcer disease by Lester Dragstedt (1893-1976).

Frank Lahey (1880-1953) stressed the importance of identifying the recurrent laryngeal nerve during the course of thyroid surgery; Owen Wangensteen (1898-1981) successfully decompressed mechanical bowel obstructions by using a newly devised suction apparatus in 1932; George Vaughan (1859-1948) successfully ligated the abdominal aorta for aneurysmal disease in 1921;

• Frank Lahey (1880-1953) stressed the importance of identifying the recurrent laryngeal nerve during the course of thyroid surgery; Owen Wangensteen (1898-1981) successfully decompressed mechanical bowel obstructions by using a newly devised suction apparatus in 1932; George Vaughan (1859-1948) successfully ligated the abdominal aorta for aneurysmal disease in 1921;

Max Peet (1885-1949) presented his splanchnic resection for hypertension in 1935; Walter Dandy (1886-1946) performed intracranial section of various cranial nerves in the 1920s; Walter Freeman (1895-1972) described prefrontal lobotomy as a means of treating various mental illnesses in 1936;

• Max Peet (1885-1949) presented his splanchnic resection for hypertension in 1935; Walter Dandy (1886-1946) performed intracranial section of various cranial nerves in the 1920s; Walter Freeman (1895-1972) described prefrontal lobotomy as a means of treating various mental illnesses in 1936;

Harvey Cushing (1869-1939) introduced electrocoagulation in neurosurgery in 1928; Marius Smith-Petersen (1886-1953) described a flanged nail for pinning a fracture of the neck of the femur in 1931 and introduced Vitallium cup arthroplasty in 1939;

• Harvey Cushing (1869-1939) introduced electrocoagulation in neurosurgery in 1928; Marius Smith-Petersen (1886-1953) described a flanged nail for pinning a fracture of the neck of the femur in 1931 and introduced Vitallium cup arthroplasty in 1939;

Vilray Blair (1871-1955) and James Brown (1899-1971) popularized the use of split-skin grafts to cover large areas of granulating wounds; Earl Padgett (1893-1946) devised an operative dermatome that allowed calibration of the thickness of skin grafts in 1939;

• Vilray Blair (1871-1955) and James Brown (1899-1971) popularized the use of split-skin grafts to cover large areas of granulating wounds; Earl Padgett (1893-1946) devised an operative dermatome that allowed calibration of the thickness of skin grafts in 1939;

Elliott Cutler (1888-1947) performed a successful section of the mitral valve for relief of mitral stenosis in 1923; Evarts Graham completed the first successful removal of an entire lung for cancer in 1933;

• Elliott Cutler (1888-1947) performed a successful section of the mitral valve for relief of mitral stenosis in 1923; Evarts Graham completed the first successful removal of an entire lung for cancer in 1933;

Claude Beck (1894-1971) implanted pectoral muscle into the pericardium and attached a pedicled omental graft to the surface of the heart, thus providing collateral circulation to that organ, in 1935;

• Claude Beck (1894-1971) implanted pectoral muscle into the pericardium and attached a pedicled omental graft to the surface of the heart, thus providing collateral circulation to that organ, in 1935;

Robert Gross (1905-1988) reported the first successful ligation of a patent arterial duct in 1939 and resection for coarctation of the aorta with direct anastomosis of the remaining ends in 1945; and John Alexander (1891-1954) resected a saccular aneurysm of the thoracic aorta in 1944.

• Robert Gross (1905-1988) reported the first successful ligation of a patent arterial duct in 1939 and resection for coarctation of the aorta with direct anastomosis of the remaining ends in 1945; and John Alexander (1891-1954) resected a saccular aneurysm of the thoracic aorta in 1944.

With such a wide variety of technically complex surgical operations now possible, it had clearly become impossible for any single surgeon to master all the manual skills as well as the pathophysiologic knowledge necessary to perform such cases.

• With such a wide variety of technically complex surgical operations now possible, it had clearly become impossible for any single surgeon to master all the manual skills as well as the pathophysiologic knowledge necessary to perform such cases.

Therefore, by the middle of the century, a consolidation of professional power inherent in the movement toward specialization, with numerous individuals restricting their surgical practice to one highly structured field, had become among the most significant and dominating events in 20th century surgery.

• Therefore, by the middle of the century, a consolidation of professional power inherent in the movement toward specialization, with numerous individuals restricting their surgical practice to one highly structured field, had become among the most significant and dominating events in 20th century surgery.

Ironically, the United States, which had been much slower than European countries to recognize surgeons as a distinct group of clinicians separate from physicians, would now spearhead this move toward surgical specialization with great alacrity.

• Ironically, the United States, which had been much slower than European countries to recognize surgeons as a distinct group of clinicians separate from physicians, would now spearhead this move toward surgical specialization with great alacrity.

Clearly, the course of surgical fragmentation into specialties and subspecialties was gathering tremendous speed as the dark clouds of World War II settled over the globe. The socioeconomic and political ramifications of this war would bring about a fundamental change in the way that surgeons viewed themselves and their interactions with the society in which they lived and worked

• Clearly, the course of surgical fragmentation into specialties and subspecialties was gathering tremendous speed as the dark clouds of World War II settled over the globe. The socioeconomic and political ramifications of this war would bring about a fundamental change in the way that surgeons viewed themselves and their interactions with the society in which they lived and worked

Two clinical developments truly epitomized the magnificence of post–World War II surgery and concurrently fascinated the public: the maturation of cardiac surgery as a new surgical specialty and the emergence of organ transplantation.

• Two clinical developments truly epitomized the magnificence of post–World War II surgery and concurrently fascinated the public: the maturation of cardiac surgery as a new surgical specialty and the emergence of organ transplantation.

Whereas the late 19th and 20th centuries witnessed a steady march of surgical triumphs in opening successive cavities of the body, the final achievement awaited the perfection of methods for surgical operations in the thoracic space.

• Whereas the late 19th and 20th centuries witnessed a steady march of surgical triumphs in opening successive cavities of the body, the final achievement awaited the perfection of methods for surgical operations in the thoracic space.

Throughout most of its evolution, the practice of surgery has been largely defined by its tools and the manual aspects of the craft. The last decades of the 20th century saw unprecedented progress in the development of new instrumentation and imaging techniques.

• Throughout most of its evolution, the practice of surgery has been largely defined by its tools and the manual aspects of the craft. The last decades of the 20th century saw unprecedented progress in the development of new instrumentation and imaging techniques.

These refinements have not come without noticeable social and economic cost. Advancement will assuredly continue, for if the study of surgical history offers any lesson, it is that progress can always be expected, at least relative to technology.

• These refinements have not come without noticeable social and economic cost. Advancement will assuredly continue, for if the study of surgical history offers any lesson, it is that progress can always be expected, at least relative to technology.

There will be more sophisticated surgical operations with better results. Eventually, automation may even robotize the surgeon's hand for certain procedures. Still, the surgical sciences will always retain their historical roots as fundamentally a manually based art and craft.

• There will be more sophisticated surgical operations with better results. Eventually, automation may even robotize the surgeon's hand for certain procedures. Still, the surgical sciences will always retain their historical roots as fundamentally a manually based art and craft.

In many respects, the surgeon's most difficult future challenges are not in the clinical realm but instead in better understanding the socioeconomic forces that affect the practice of surgery and in learning how to effectively manage them. Many splendid schools of surgery now exist in virtually every major industrialized city, but none can lay claim to dominance in all the disciplines that make up surgery.

• In many respects, the surgeon's most difficult future challenges are not in the clinical realm but instead in better understanding the socioeconomic forces that affect the practice of surgery and in learning how to effectively manage them. Many splendid schools of surgery now exist in virtually every major industrialized city, but none can lay claim to dominance in all the disciplines that make up surgery.

Likewise, the presence of authoritative individual personalities who help guide surgery is more unusual today than in previous times. National aims and socioeconomic status have become overwhelming factors in securing and shepherding the future growth of surgery worldwide. In light of an understanding of the intricacies of surgical history, it seems an unenviable and obviously impossible task to predict what will happen in the future.

• Likewise, the presence of authoritative individual personalities who help guide surgery is more unusual today than in previous times. National aims and socioeconomic status have become overwhelming factors in securing and shepherding the future growth of surgery worldwide. In light of an understanding of the intricacies of surgical history, it seems an unenviable and obviously impossible task to predict what will happen in the future.

In 1874, John Erichsen (1818-1896) of London wrote that “the abdomen, chest, and brain will forever be closed to operations by a wise and humane surgeon.” A few years later Theodor Billroth remarked, “A surgeon who tries to suture a heart wound deserves to lose the esteem of his colleagues.” Obviously, the surgical crystal ball is a cloudy one at best.

• In 1874, John Erichsen (1818-1896) of London wrote that “the abdomen, chest, and brain will forever be closed to operations by a wise and humane surgeon.” A few years later Theodor Billroth remarked, “A surgeon who tries to suture a heart wound deserves to lose the esteem of his colleagues.” Obviously, the surgical crystal ball is a cloudy one at best.

To study the fascinating history of our profession, with its many magnificent personalities and outstanding scientific and social achievements, may not necessarily help us predict the future of surgery. However, it does shed much light on the clinical practices of our own time.

• To study the fascinating history of our profession, with its many magnificent personalities and outstanding scientific and social achievements, may not necessarily help us predict the future of surgery. However, it does shed much light on the clinical practices of our own time.

To a certain extent, if surgeons in the future wish to be regarded as more than mere technicians, the profession needs to better appreciate the value of its past experiences. Surgery has a distinguished heritage that is in danger of being forgotten. Although the future of the art, craft, and science of surgery remains unknown, it assuredly rests on a glorious past.

• To a certain extent, if surgeons in the future wish to be regarded as more than mere technicians, the profession needs to better appreciate the value of its past experiences. Surgery has a distinguished heritage that is in danger of being forgotten. Although the future of the art, craft, and science of surgery remains unknown, it assuredly rests on a glorious past.

• General surgery

• Special surgery

• Prepare patient for surgery (operation)

• Patient disease

• Prepare surgeons for operation

• History of disease

• Manifestation of disease

• Examination

• Surgical therapy

• Bloody performance ( injure skin or mucosa)

• Non-bloody performance ( repair broken bone, luxation, reposition )

• Diagnostical

• Therapeutical

• Urgent - emergency

• Scheduled

• Easy

• Difficult

• For patient

• Strenuous
• Non strenuous

• Septic operation

• Aseptic operation

• Supraseptic operation

• Radical

• Palliative

• Absolute (bleeding)

• Relative (pain)

Probation punction (experimentally)

• Probation punction (experimentally)

• Probation excision

• Probation thoracotomy

• Probation laparotomy

• Probation arthrotomy

• Probation craniotomy

Incision

• Incision

• Discision

• Punction

• Excision

• Extirpation

• Amputation

• Exarticulation

Extraction

• Extraction

• Resection

• -stomy ( colostomy, gastrostomy)

• -tomy ( gastrotomy)

• -ectomy (gastrectomy)

• Reconstrucion - anastomosis

Surgery

• Surgery

• Neurosurgery

• Pediatric surgery

• Plastic surgery

• Orthopaedy

• Urology

• Traumatology

• Thank you for your attention!