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

After all, it is a difficult task to treat the symptoms of illnesses such as arthritis, asthma, heart failure, and diabetes, to name but a few, if there is no scientific understanding or internal knowledge of what constitutes their basic pathologic and physiologic underpinnings.

With the breathtaking advances made in pathologic anatomy and experimental physiology during the 18th and the first part of the 19th centuries, physicians would soon adopt a therapeutic viewpoint that had long been prevalent among surgeons. It was no longer a question of just treating symptoms; the actual pathologic problem could ultimately be understood.

• With the breathtaking advances made in pathologic anatomy and experimental physiology during the 18th and the first part of the 19th centuries, physicians would soon adopt a therapeutic viewpoint that had long been prevalent among surgeons. It was no longer a question of just treating symptoms; the actual pathologic problem could ultimately be understood.

Internal disease processes that manifested themselves through difficult-to-treat external signs and symptoms were finally described via physiology-based experimentation or viewed pathologically through the lens of a microscope.

• Internal disease processes that manifested themselves through difficult-to-treat external signs and symptoms were finally described via physiology-based experimentation or viewed pathologically through the lens of a microscope.

Because this reorientation of internal medicine occurred within a relatively short time and brought about such dramatic results in the classification, diagnosis, and treatment of disease, the rapid ascent of mid-19th century internal medicine might seem more impressive than the agonizingly slow, but steady advance of surgery.

• Because this reorientation of internal medicine occurred within a relatively short time and brought about such dramatic results in the classification, diagnosis, and treatment of disease, the rapid ascent of mid-19th century internal medicine might seem more impressive than the agonizingly slow, but steady advance of surgery.

In a seeming contradiction of mid-19th century scientific and social reality, medicine appeared as the more progressive branch, with surgery lagging behind. The art and craft of surgery, for all its practical possibilities, would be severely restricted until the discovery of anesthesia in 1846 and an understanding and acceptance of the need for surgical antisepsis and asepsis during the 1870s and 1880s.

• In a seeming contradiction of mid-19th century scientific and social reality, medicine appeared as the more progressive branch, with surgery lagging behind. The art and craft of surgery, for all its practical possibilities, would be severely restricted until the discovery of anesthesia in 1846 and an understanding and acceptance of the need for surgical antisepsis and asepsis during the 1870s and 1880s.

Still, surgeons never needed a diagnostic and pathologic revolution in the manner of the physician. Despite the imperfection of their scientific knowledge, the pre–modern era surgeon did cure with some technical confidence.

• Still, surgeons never needed a diagnostic and pathologic revolution in the manner of the physician. Despite the imperfection of their scientific knowledge, the pre–modern era surgeon did cure with some technical confidence.

That the gradual evolution of surgery was superseded in the 1880s and 1890s by the rapid introduction of startling new technical advances was based on a simple culminating axiom—the four fundamental clinical prerequisites that were required before a surgical operation could ever be considered a truly viable therapeutic procedure had finally been identified and understood:   

• That the gradual evolution of surgery was superseded in the 1880s and 1890s by the rapid introduction of startling new technical advances was based on a simple culminating axiom—the four fundamental clinical prerequisites that were required before a surgical operation could ever be considered a truly viable therapeutic procedure had finally been identified and understood:   

1.    Knowledge of human anatomy   

• 1.    Knowledge of human anatomy   

• 2.    Method of controlling hemorrhage and maintaining intraoperative hemostasis   

• 3.    Anesthesia to permit the performance of pain-free procedures   

• 4.    Explanation of the nature of infection along with the elaboration of methods necessary to achieve an antiseptic and aseptic operating room environment

The first two prerequisites were essentially solved in the 16th century, but the latter two would not be fully resolved until the ending decades of the 19th century. In turn, the ascent of 20th century scientific surgery would unify the profession and allow what had always been an art and craft to become a learned vocation.

• The first two prerequisites were essentially solved in the 16th century, but the latter two would not be fully resolved until the ending decades of the 19th century. In turn, the ascent of 20th century scientific surgery would unify the profession and allow what had always been an art and craft to become a learned vocation.