Do you like the idea of using your hands, lifting a scalpel, and curing ailments with

immediacy?

Surgery is romanticized and idealized for good reason.

This is the history of surgery.

Dr. Jubbal, MedSchoolInsiders.com.

Over the last century, the human lifespan has been extended by almost 30 years.

Given that humans have been walking the planet for 200,000 years, this is the product of

something recent and immensely profound.

During the Renaissance, a collective scientific conscience was born that bred revolutions

in math, physics, chemistry, biology, anatomy, human physiology, philosophy, and religion.

We started to understand the way the world works at an unprecedented pace, and with a

framework in place for understanding nature, we rebuilt the discipline focused on the inner

composition of the human body - anatomy - the basis of medicine.

Soon after, surgery was reborn and equipped to do so much more than the bloodletting and

trephination procedures, or drilling holes in skulls, that were used to "free illness,

spirits, and demons" during the Ancient Times.

Before this period, one couldn't even dream of antiseptics and anesthesia.

We didn't understand that microorganisms could invade the body and cause illness and

infection, and as a result, doctors would wear black, unwashed overcoats layered with

blood, pus, and other bodily matter.

The same set of instruments would be used on different patients and wiped down by the

same unwashed cloth before each operation.

Patients would be strapped down to the table as it was believed they should remain alert

and awake to increase the odds they come out of the procedure alive.

With the horrific nature of this work preceding anesthesia, surgeons were praised for operating

quickly to minimize suffering.

Of course, this came at the cost of accuracy and precision, leading to an additional layer

of issues.

The timeline of surgical history is dated all the way back to 6500 BC.

However, we're going to highlight the past two thousand years, focusing on events prior

to the Renaissance, during the Renaissance, and during the modern times when this field

took shape into what we recognize surgery to be.

You can't delve into the history of surgery without discussing Galen, a surgeon of the

Roman Empire and a pioneer anatomist whose ideas - many of which were massive misinterpretations

- influenced (and misled) western medicine for 1,300 years.

Having studied in Alexandria, the grandest medical center of the ancient world, Galen's

contributions to medicine rank him second only to Hippocrates.

A cut-throat gunner, Galen regularly tested his medical contemporaries with his intellect

and daring attitude.

On one occasion, Galen disemboweled a live ape and challenged his dumbfounded medical

rivals to fix the wound, none of whom could.

He then beamed in, secured the intestines, repaired the wound in a glamorous surgery,

and won himself the opportunity to serve as the chief physician to a reputed troop of

Gladiators.

Today, when an NFL player takes a hard hit, the NFL team physicians kick into action to

treat injury and restore functionality.

Galen's role wasn't so simple.

Throughout the Roman empire, gladiators would entertain audiences through violent, bloody

combat with other gladiators, wild animals, and condemned criminals.

At his core, Galen was focused on understanding man's anatomy, but human dissections had

been strictly forbidden.

So when he treated dying gladiators, he would carefully peer into fatal wounds, trying to

understand what the human body looked like from the inside.

He made many original observations about wound healing and wound management, some of which

were glaringly wrong.

He thought, for example, that bone was composed of sperm.

Galen resorted to performing experiments and dissections on living and dead monkeys, pigs,

sheep, goats, and other animals.

He felt that the anatomical structures of these animals mirrored those of humans, and

used their composition to make inferences about the human body.

Though he ultimately contributed greatly to the understanding of many different organ

systems, Galen was also responsible for many misconceptions.

The problem was that he was incredibly prolific - having published over 2,000,000 words in

his lifetime - and his ideas, though not corroborated, were taken as dogma, dominating medical science

for over a thousand years.

Somehow the fact that Galen's work was centered around animal dissections and not humans was

lost in translation.

For 1,300 years, Galenic physiology misguided the scientific world, and it's an interesting

exercise to imagine what medicine would be like today if those 1,300 years of science

had been used more productively.

During the early renaissance, physicians who had been trained in universities considered

surgery beneath them.

Again, they were primarily learning from Galen's animal research.

These physicians diminished the field of surgery, which consisted mainly of amputations and

bloodletting.

Bloodletting was rooted in the Ancient Times when Hippocrates, The Father of Medicine,

said that existence was represented by four elements - earth, air, fire, and water - which

were related to humans through four basic humors, or fluids: blood, phlegm, black bile,

and yellow bile.

This was the basis of the famous humoral theory: each humor was related to a particular personality

type, and illness was seen as an imbalance of the four humors.

When Galen declared blood as the most dominant humor, propagating his ideas through the power

of his pen, bloodletting - the process by which blood was drained to relieve illness

- became accepted as the standard treatment for many conditions.

Over time, the practice was subject to increasing controversy and Renaissance physicians started

relegating this procedure to Renaissance surgeons.

However, the surgeons of the early Renaissance were not even physicians - they were barbers.

Yes, the same barbers that hook you up with crisp fades and beard lineups were wielding

the scalpel as well.

Though they didn't have a medical education, these barber-surgeons were apprenticeship-trained

to cut hair, conduct amputations, drain blood, and complete small surgical procedures.

You could theoretically have a clean shave and an amputation in one sitting by the same

practitioner.

Just as blacksmiths would become masters of their craft, barbers would also become excellent

at performing tooth extractions and treating war wounds.

The red-and-white-striped barber poles at your local barber shop actually represent

the blood and bandages of barber-surgeons.

Because these individuals were not doctors, they were also addressed as Mister instead

of Doctor.

Today, some British surgeons continue to address themselves as Mister for historical significance.

During the 16th century, surgeons would use red-hot pokers and boiling oil to seal off

the raw, bleeding flesh of amputation wounds.

And just as agonizing as this treatment was, it was just as ineffective at stopping blood

loss or preventing infection.

Then one day, a barber surgeon named Ambroise Paré found himself short of hot oil.

In what happened to be a sweeping turn for medical history, he decided to use threads

from his coattail to tie off the ends of bleeding vessels before dressing a wound with gauze.

To great surprise, prompt healing ensued, and Paré established himself as the father

of modern surgery, catalyzing a series of surgical breakthroughs that soldiers on the

battlefield have been forever thankful for.

Since 210 AD, Galen's ideas prevailed and massive misconceptions had been forged in

the minds of generations of scientists and physicians.

Finally, during the Renaissance, Andreas Vesalius forced the world to rethink it all.

For centuries, the medical establishment had been teaching students in a two step process:

first, professors would read anatomical text, most of which was built off of Galen's inaccurate

ideas; then a surgeon (or his servant) would perform a dissection for students to observe.

The medical students of the time rarely had opportunities to engage with cadavers themselves,

they didn't have textbooks to take home, and they definitely didn't have Anki or

Memm flashcards to shuffle through from the comfort of their couch.

Their learning opportunities were limited, and a true familiarity of the human body could

only be acquired after a long surgical career.

The irony lies in the fact that Galen's greatest virtue - his emphasis on observing

for oneself - was lost over time.

However, Andreas Vesalius broke with this tradition and began openly doing dissections

himself because for the first time since the ancient times, human dissections had been

permitted.

He started relearning human anatomy from cadavers and scrutinizing ancient text, which helped

him ultimately recognize that most of Galen's research was founded on animal vivisections.

Vesalius began to rewrite anatomical text from his own research, pointing out Galen's

errors and facing resentment from the scholars of the time.

Then, in 1543, he published De Humani Corporis Fabrica - which means On the Fabric of the

Human Body - a landmark, revolutionary textbook.

Besides the fact that this was the first resource accurately compiling information on the anatomy

of the human body for medical students, it was also one of the first publications where

illustrations - the earliest anatomical models - had been incorporated alongside ancient

text.

Now this might seem small, but I assure you that it is not.

The incorporation of anatomical illustrations catalyzed a paradigm shift in medical education,

science, and surgery because it provided students with a much-improved method to study human

anatomy.

Up until this time, students had been learning primarily by watching operations and hearing

professors readout anatomic text.

If a cadaver was available by mere chance for medical students to use, they were expected

to work quickly, dissecting and studying each organ system as efficiently as they could.

However, they were entirely reliant on their memory and retention of this newly acquired

knowledge since graphic visuals of the human body were absent from their coursework.

These illustrations - intricately shaded with fine, visceral detail - served as 2D models

to truly gather a deep understanding of the human body, liberating students from their

learning constraints, and more importantly, it forced interdisciplinary collaborations

to take place between anatomists, like Vesalius, and artists, like Leonardo da Vinci.

This collaboration evolved as artists and sculptors started producing three-dimensional

wax anatomical models by the 17th and 18th centuries, many of which are still available

today in cities like Florence.

These wax models captured an unprecedented volume of information and allowed students

to understand the human anatomy from a three-dimensional, spatial orientation that increased the rate

at which surgeons in training and medical students could understand the inner layout

of the human body.

These models were eerily accurate - capturing the intricacies of death and decay, blood

vessels, the brain, and even facial expressions - and are truly significant to the advancement

of medical education.

Wax anatomical modeling during the Renaissance was all the rage.

For the first time in the course of human history, medical students were fed a deep

understanding of the human body as they could sit with surprisingly accurate three dimensional

wax anatomical models and fully take in the composition of the human body.

These didactic tools allowed scientists and physicians to understand anatomy and physiology

to a greater degree than ever before, but there was still much to learn.

In the 1700s, body snatchers would flock to cemeteries, stealing cadavers for dissection.

In the 1800s, ether and chloroform started to become popular as anesthetics, and for

the first time, patients didn't have to face an excruciating amount of pain in their

surgical procedures.

With the newfound capacity to sedate patients, we could spend much more time studying the

human body and making sense of disease, advancing the rate at which we acquired medical knowledge.

One of my personal favorites from this era is Dr. William Halsted, a cocaine-addicted,

incredibly badass surgeon whose influence is difficult to overstate.

Spending his early life as a jock with subpar grades, he eventually found an interest in

medicine and emerged at the top of his class at the Columbia University College of Physicians

and Surgeons.

After studying under the tutelage of many prominent surgeons and scientists in New York

and Europe, he started to teach surgery, creating a hands-on experience for his students.

Known for being a charismatic, inspiring teacher and a bold surgeon, ***he also performed one

of the first gallbladder operations in the US on his own mother at 2 AM*** - with no

experience, he meticulously removed seven gallstones, and his mother made a full recovery.

In 1884, Halsted started self-experimenting with cocaine for its anesthetic power.

In an effort to understand whether it could be used on his patients, he would inject it

in himself, ultimately enslaving himself to the drug.

After years of recovery, his friend, William Welch, invited him to serve as one of four

founding Professors of the Johns Hopkins School of Medicine.

At Johns Hopkins, he pioneered medical education by establishing the first formal surgical

residency training program in the United States.

He designed this system off of ideas that he had come across in Europe and laid the

foundation for how residency training programs across the country would be organized: they'd

start with an internship, followed by six years as an assistant resident and two years

as a house surgeon.

This structure created role models and teachers that future generations of surgeons could

look up to, and under this system, Halsted trained Harvey Williams Cushing and Walter

Dandy, the founders of neurosurgery.

In an era where surgeons were praised for operating with speed, Halsted became increasingly

slow and meticulous.

He believed that cancers spread through the bloodstream and led the first radical mastectomy

for breast cancer in New York in 1882.

He even pioneered many aspects of modern surgery, having introduced rubber gloves into the operating