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Chirurgia: The handicraft of medicine
OUR SURGICAL HERITAGE
Chirurgia: The Handicraft of Medicine Philatelically Illustrated Historic Survey of Surgery
Gerrit Verveen, Delft, The Netherlands
Ancient Times (Up to 500 A.D.)
1. The PAPYRUS SMITH proved to be a veritable surgical textbook between 2500 and 2000 B.C. The papyrus even gives a description of the human brain as it was observed with a fractured skull.
3. SUSRUTA-Samhita, the classic book from the ancient Indian civilization, is predominantly surgical: “Surgery is the first and highest section of medicine, the least susceptible for deceit, transparent in itself, full of mobility in its application, the worthy product of heaven, the secure source of respect on earth.. . .” In this Susruta compendium, most likely recorded between 800 B.C. and 400 A.D., plastic surgery of the nose, a cataract operation and lithotomy are described. The philatelicmaterial used In this survey
is part of a collection entitled “Medicine on Stamps.” Requests for reprints should be adbessed to Gerrit Verveen. Fransen v.d. Putt&mat 1, 2613 CG Delft, The Netherlands.
640
2. In MESOPOTAMIA, too, various surgical interventions (for example, for a cataract) were performed. Surgical instruments from these times (around 1800 B.C.), including scalpels, saws, lancets, trepans, and the statements on clay tablets which were unearthed in Nineveh, bear witness to this fact.
4. In the ancient MEXICAN CULTURE, surgery seems to have been developed more than in other primitive cultures. They used hair as suture material and performed embryotomies and many other operations. The PERUVIAN CULTURE was particularly known for trepanations, tumor excisions and even prostheses.
The American Journal of Surgery
5
5. In the ancient CHINESE CULTURE, surgery was performed rarely because of a deep-rooted aversion to bloodshed. The famous surgeon HUA TO (110-207 A.D.) had a remarkable knowledge of anesthetics. However, only when acupuncture and therapeutics failed did he proceed to surgery; together with wine he administered an anesthetic mixture which probably contained Cannabis indica.
Medieval Period (Up to 1500)
7. The writings of HIPPOCRATES (460-377 B.C.) taught that surgical measures are necessary when other means fail; even at that time, blood-letting and incisions were known. 8. RHAZES (865-925 A.D.), a Persian scientist, recorded much of the knowledge of his time in his compendium “El Hawi.” He used the intestines of animals for closing wounds. 9. One of the five famous books of AVICENNA (980-1037), whose knowledge is based on Aristotle and Galen, contains chapters on surgery; his work continued to be the standard work for physicians throughout the Middle Ages. 10
8
6. The oldest pictures of surgery almost all show the care of war-wounded. On this stamp, the picture on an ancient Greek vase (about 500 B.C.) is reproduced: it shows the treatment of the arm of PATROCLES by ACHILLES.
10. In Italy and France general medicine and surgery were never separated. As early as the 13th century, a surgical school was established in Bologna. In France, this occurred in the university town of Montpellier, where medicosurgical cooperation was usual.
Post Middle Ages (After 15001 11. PARACELSUS (1493-1541) was also intent upon surgery in addition to medicine in general. His book Die Grosze Chirurgie on the treatment of wound infections and ulcers appeared in 1536. 12. VESALIUS (1514-1564) was a professor of anatomy and surgery in Padua. His book De Humani Corporis Fabrica (1543) was not only revolutionary in the sphere of anatomy, but the pictures drawn by Calcar are artistic masterpieces as well. 13. For the great French surgeon PARE (1510-1590), there was no dividing line between internal medicine and surgery either. Pare founded the anatomic basis of surgery. In 1552, Par6 for the first time ligated arteries instead of stopping the bleeding with boiling oil or a glowing iron, as was customary then. 14. HARVEY (1587-1657), the discoverer of the blood circulation, was a professor of anatomy and surgery.
Volume 143, May 1982
641
Verveen
15. The Dutchman VAN DEVENTER (1651-1724) was one of the most prominent physicians of his time. Besides his study of rachitis, he aroused particular interest with his orthopedic apparatus and bandages, and he is rightly called the founder of orthopedics.
16. The Dutchman VAN SWIETEN (1700-1772), a pupil of Boerhaave and founder of the famous Viennese medical school, separated the chair of anatomy definitively from that of surgery. 15
16
17. A famous itinerant surgeon was EISENBARTH (1663-1727). Originally his profession was oculist, but he also treated cancers, stones, and hernias. No university training was needed at that time, for surgery was not yet a medical specialism. He anesthetized his patients before intervention with a heavy “Siidwein” (southern wine). In virtue of his results and after a supplementary examination, the Duke of Ahenburg granted him the privilege in 1686 to practice medicine for a stipulated fee. Finally he received the title “Koniglicher preussischer Rat und Hofoculist” (consultant to the Kingdom of Prussia and court oculist).
18. LARREY (1766-1842) was a court physician of Napoleon and accompanied him on his many campaigns. His descriptions of amputations are among the greatest works of medicine. Owing to his many novel measures (among others the “flying field-hospital”) he can rightly be considered the father of modern war surgery.
19. MCDOWELL (1771-1830) is rightly called the father of ovariotomy. He performed this operation successfully for the first time in 1809, without anesthesia and antisepsis. 20. Although there is much controversy in the literature about the matter, the “first painless surgical operation” was reputedly performed in 1842 by CRAWFORD LONG (1815-1878).
642
The American Journal ol Surgery
Philatelic Survey of the History of Surgery
21. The Dutchman MATHYSEN (1805-1878) invented the plaster bandage in 1851. Only now does it seem that this plaster bandage may be replaced by new materials. 22. Although not a physician, PASTEUR (1822-1895) contributed immensely to medicine as the father of bacteriology: he created the basis for antisepsis.
23
23
23
23. SEMMELWEIS (18181865), who was a professor of obstetrics in Budapest, must be considered the founder of asepsis. Owing to the measures he took around 1847, he conquered puerperal fever and is consequently called the “savior of mothers.” 25. PIROGOFF (1810-1881) was a Russian war surgeon in the Caucasus in 1847, where he introduced ether anesthesia In the Crimean war of 1854-1858 he served in the fortress of Sebastopol, where he developed novel methods for the care of amputation stumps (the socalled Pirogoff stump, or amputation under the knee).
24
26. BILLROTH (1829-1894) was a pioneer of visceral surgery. His name is inextricably connected with methods of stomach resection, the Billroth I and II procedures. He performed the first complete resection of the larynx in 1873 and, also successfully, the first resection of the pylorus for cancer in 1881. His motto: “All medicine should be surgical.”
24
27. Lung surgery actually started in 1882 with the proposal for introducing artificial pneumothorax by FDRLANINI (1847-1918). However, it was not until 10 years later that he performed this procedure for the first time.
24
Volume 143,May 1982
24. LISTER (1827-1912) was the man who made Pasteur’s ideas usablre in surgery by introducing the carbolic acid spray in about 1869. Antisepsis led to marked progress in surgery.
643
Verveen
28. KOCHER to Lister and pioneer work of the thyroid Nobel prize.
(1841-1917) was initially an assistant Billroth and became famous for his in physiology, pathology and surgery gland. In 1999 he was awarded the
29. EISELSBERG (1860-1939) was a pupil of Billroth and continued his work, he was the first to recognize in his studies on the thyroid gland the significance of the accessory thyroid gland. He was reputed as a neurosurgeon (for operations on intramedullary tumors as well as other procedures).
28
30. One of the most brilliant surgeons of France was TERRILLON (18441895), who was the first to describe the bursa subscapularis and related disorders. He was also the pioneer of surgical asepsis and sterilized his instruments by means of boiling as early as 1882.
32
31. In a survey of the history of surgery the invention of ROENTGEN (18451923) should not be omitted. The rays he discovered in 1895 often enable the surgeon to define his procedure of surgical intervention beforehand. Surgery without roentgenology is unthinkable today. 32. GROSSICH (1849-1926), a surgeon in Fiume, developed the sterilization of the operation area with tincture of iodine in 1998. 33. The brothers MAYO (1861-1939 and 18651939), the founders of the renowned American Mayo Clinic in Rochester in 1915, elaborated new techniques for visceral surgery and carcinoma.
34. Loss of blood was one of the most dangerous complications of surgery until LANDSTEINER’s (1868-1943) discovery of the blood groups in 1901 made blood transfusion possible. He was awarded the Nobel prize in 1930.
35. Brain surgery was performed as early as the 19th century by Horsley and Broca, but this specialism was really pushed by the studies of Cushing. An important share in this field was taken by the Portuguese surgeon MONIZ (18741955), who performed the first cerebral angiography as early as 1927 and frontal lobotomy in 1933 (Nobel prize in 1949).
The American Journal ol Surgery
Philatelic Survey of the History of Surgery
36. SAUERBRUCH (1875-1951) succeeded in improving intrathoracic surgery by his development of the cabinet for negative pressure. A method developed during World War I to make artificial limbs voluntarily mobile was also named after him tsauerbruch’s hands). 37. LERICHE (1879-1955) was the founder of physiologic surgery. His discoveries included the significance of the vegetative nervous system.
38. FRONT SURGERY
as a particular branch of surgery certainly deserves special attention. This postal card originates from a mobile surgical group during World War I.
volume 143, May 19s2
645
Verveen
40. Currently, surgeons have many DIAGNOSTIC METHODS at their disposal, including gastroscopy, cystoscopy, and bronchoscopy. The second 0 in the word proctologia in this stamp shows a mucous membrane seen through a proctoscope. 39. As is customary today in almost all disciplines, there are CONGRESSES for surgeons in many parts of the world to enable them to exchange new ideas and experiences.
41. Important weapons in the hands of the surgeon include antibiotics, which can be administered as preor postoperative prophylaxis or for postoperative infections. The history of antibiotics began with the discovery of penicillin by FLEMING in 1928. However, the drug only became medically applicable in 1941 through the work of FLOREY and CHAIN.
646
The American Journal of Surgery
Philatelic Survey of the History of Surgery
Transplantation
42. Even back in the olden days transplantation surgery was in the minds of physicians. This stamp depicts the transplantation of the leg of a negro as it was reputedly performed, according to legend, by the saints COSMAS and DAMIAN in the 3rd century.
42
43. A routine intervention today is the transplantation of the cornea. This was performed for the first time in 1918 and was developed into a routine operation by FILATOV (18751956), among others. As early as 1931 he instituted the first cornea bank. 44. CARREL (1873-1944) was a pioneer in transplantation surgery. As early as 1912, he was awarded the Nobel prize for his pioneering work in vascular surgery and homo-organ transplantation. 45. The Dutchman KOLFF also made an early contribution in this field by developing the artificial kidney in Kampen (Holland) in 1944. This apparatus made it possible to treat patients with terminal kidney insufficiency with kidney dialysis for a longer period. In 1950, the first successful kidney transplantation was performed in the United States. 46. In the 1960s the REPLACEMENT OF HEART VALVES by valves of synthetic material came into use, and today PACEMAKERS are being increasingly implanted. 47. The first heart transplantation in a human being was performed by BARNARD (born in 1922) in the Grooteschuur Hospital in Cape Town (South Africa) in December 1967. 48. So far, LUNG TRANSPLANTATION has given rather disappointing results, as is actually also the case in heart transplantation (in 1977, after I year, the survival rate was 68 percent).
647
Verveen
Operations 49. These stamps depict surgeons at work in old times (the Rembrandt paintings) and in modern hospitals. The devotion of the surgeon is from all times. v The first Rembrandt painting (top left) shows the famous “Anatomy Lesson of Dr. Nicolaes Tulp,” painted in 1632. Dr. Tulp was a reader in anatomy in the Guild of Surgeons of Amsterdam, In this painting Dr. Tulp is demonstrating the physiology of the arm on the body of a hanged criminal. The second Rembrandt painting (top right) is called “The Anatomy Lesson of Dr. Jan Deyman” and was painted in 1656. Dr. Deyman was the successor of Dr. Tulp in the Amsterdam Guild of Surgeons. In this lesson Dr. Deyman demonstrates the physiology of the skull on a thief’s body. Finally, the Columbian stamp (bottom right) shows a reproduction of a painting by Grau of the first cesarean operation performed in Columbia in 1844.
49
646
Tha American Journal cl Surgary
Chirurgia: The Handicraft of Medicine Philatelically Illustrated Historic Survey of Surgery
Gerrit Verveen, Delft, The Netherlands
Ancient Times (Up to 500 A.D.)
1. The PAPYRUS SMITH proved to be a veritable surgical textbook between 2500 and 2000 B.C. The papyrus even gives a description of the human brain as it was observed with a fractured skull.
3. SUSRUTA-Samhita, the classic book from the ancient Indian civilization, is predominantly surgical: “Surgery is the first and highest section of medicine, the least susceptible for deceit, transparent in itself, full of mobility in its application, the worthy product of heaven, the secure source of respect on earth.. . .” In this Susruta compendium, most likely recorded between 800 B.C. and 400 A.D., plastic surgery of the nose, a cataract operation and lithotomy are described. The philatelicmaterial used In this survey
is part of a collection entitled “Medicine on Stamps.” Requests for reprints should be adbessed to Gerrit Verveen. Fransen v.d. Putt&mat 1, 2613 CG Delft, The Netherlands.
640
2. In MESOPOTAMIA, too, various surgical interventions (for example, for a cataract) were performed. Surgical instruments from these times (around 1800 B.C.), including scalpels, saws, lancets, trepans, and the statements on clay tablets which were unearthed in Nineveh, bear witness to this fact.
4. In the ancient MEXICAN CULTURE, surgery seems to have been developed more than in other primitive cultures. They used hair as suture material and performed embryotomies and many other operations. The PERUVIAN CULTURE was particularly known for trepanations, tumor excisions and even prostheses.
The American Journal of Surgery
5
5. In the ancient CHINESE CULTURE, surgery was performed rarely because of a deep-rooted aversion to bloodshed. The famous surgeon HUA TO (110-207 A.D.) had a remarkable knowledge of anesthetics. However, only when acupuncture and therapeutics failed did he proceed to surgery; together with wine he administered an anesthetic mixture which probably contained Cannabis indica.
Medieval Period (Up to 1500)
7. The writings of HIPPOCRATES (460-377 B.C.) taught that surgical measures are necessary when other means fail; even at that time, blood-letting and incisions were known. 8. RHAZES (865-925 A.D.), a Persian scientist, recorded much of the knowledge of his time in his compendium “El Hawi.” He used the intestines of animals for closing wounds. 9. One of the five famous books of AVICENNA (980-1037), whose knowledge is based on Aristotle and Galen, contains chapters on surgery; his work continued to be the standard work for physicians throughout the Middle Ages. 10
8
6. The oldest pictures of surgery almost all show the care of war-wounded. On this stamp, the picture on an ancient Greek vase (about 500 B.C.) is reproduced: it shows the treatment of the arm of PATROCLES by ACHILLES.
10. In Italy and France general medicine and surgery were never separated. As early as the 13th century, a surgical school was established in Bologna. In France, this occurred in the university town of Montpellier, where medicosurgical cooperation was usual.
Post Middle Ages (After 15001 11. PARACELSUS (1493-1541) was also intent upon surgery in addition to medicine in general. His book Die Grosze Chirurgie on the treatment of wound infections and ulcers appeared in 1536. 12. VESALIUS (1514-1564) was a professor of anatomy and surgery in Padua. His book De Humani Corporis Fabrica (1543) was not only revolutionary in the sphere of anatomy, but the pictures drawn by Calcar are artistic masterpieces as well. 13. For the great French surgeon PARE (1510-1590), there was no dividing line between internal medicine and surgery either. Pare founded the anatomic basis of surgery. In 1552, Par6 for the first time ligated arteries instead of stopping the bleeding with boiling oil or a glowing iron, as was customary then. 14. HARVEY (1587-1657), the discoverer of the blood circulation, was a professor of anatomy and surgery.
Volume 143, May 1982
641
Verveen
15. The Dutchman VAN DEVENTER (1651-1724) was one of the most prominent physicians of his time. Besides his study of rachitis, he aroused particular interest with his orthopedic apparatus and bandages, and he is rightly called the founder of orthopedics.
16. The Dutchman VAN SWIETEN (1700-1772), a pupil of Boerhaave and founder of the famous Viennese medical school, separated the chair of anatomy definitively from that of surgery. 15
16
17. A famous itinerant surgeon was EISENBARTH (1663-1727). Originally his profession was oculist, but he also treated cancers, stones, and hernias. No university training was needed at that time, for surgery was not yet a medical specialism. He anesthetized his patients before intervention with a heavy “Siidwein” (southern wine). In virtue of his results and after a supplementary examination, the Duke of Ahenburg granted him the privilege in 1686 to practice medicine for a stipulated fee. Finally he received the title “Koniglicher preussischer Rat und Hofoculist” (consultant to the Kingdom of Prussia and court oculist).
18. LARREY (1766-1842) was a court physician of Napoleon and accompanied him on his many campaigns. His descriptions of amputations are among the greatest works of medicine. Owing to his many novel measures (among others the “flying field-hospital”) he can rightly be considered the father of modern war surgery.
19. MCDOWELL (1771-1830) is rightly called the father of ovariotomy. He performed this operation successfully for the first time in 1809, without anesthesia and antisepsis. 20. Although there is much controversy in the literature about the matter, the “first painless surgical operation” was reputedly performed in 1842 by CRAWFORD LONG (1815-1878).
642
The American Journal ol Surgery
Philatelic Survey of the History of Surgery
21. The Dutchman MATHYSEN (1805-1878) invented the plaster bandage in 1851. Only now does it seem that this plaster bandage may be replaced by new materials. 22. Although not a physician, PASTEUR (1822-1895) contributed immensely to medicine as the father of bacteriology: he created the basis for antisepsis.
23
23
23
23. SEMMELWEIS (18181865), who was a professor of obstetrics in Budapest, must be considered the founder of asepsis. Owing to the measures he took around 1847, he conquered puerperal fever and is consequently called the “savior of mothers.” 25. PIROGOFF (1810-1881) was a Russian war surgeon in the Caucasus in 1847, where he introduced ether anesthesia In the Crimean war of 1854-1858 he served in the fortress of Sebastopol, where he developed novel methods for the care of amputation stumps (the socalled Pirogoff stump, or amputation under the knee).
24
26. BILLROTH (1829-1894) was a pioneer of visceral surgery. His name is inextricably connected with methods of stomach resection, the Billroth I and II procedures. He performed the first complete resection of the larynx in 1873 and, also successfully, the first resection of the pylorus for cancer in 1881. His motto: “All medicine should be surgical.”
24
27. Lung surgery actually started in 1882 with the proposal for introducing artificial pneumothorax by FDRLANINI (1847-1918). However, it was not until 10 years later that he performed this procedure for the first time.
24
Volume 143,May 1982
24. LISTER (1827-1912) was the man who made Pasteur’s ideas usablre in surgery by introducing the carbolic acid spray in about 1869. Antisepsis led to marked progress in surgery.
643
Verveen
28. KOCHER to Lister and pioneer work of the thyroid Nobel prize.
(1841-1917) was initially an assistant Billroth and became famous for his in physiology, pathology and surgery gland. In 1999 he was awarded the
29. EISELSBERG (1860-1939) was a pupil of Billroth and continued his work, he was the first to recognize in his studies on the thyroid gland the significance of the accessory thyroid gland. He was reputed as a neurosurgeon (for operations on intramedullary tumors as well as other procedures).
28
30. One of the most brilliant surgeons of France was TERRILLON (18441895), who was the first to describe the bursa subscapularis and related disorders. He was also the pioneer of surgical asepsis and sterilized his instruments by means of boiling as early as 1882.
32
31. In a survey of the history of surgery the invention of ROENTGEN (18451923) should not be omitted. The rays he discovered in 1895 often enable the surgeon to define his procedure of surgical intervention beforehand. Surgery without roentgenology is unthinkable today. 32. GROSSICH (1849-1926), a surgeon in Fiume, developed the sterilization of the operation area with tincture of iodine in 1998. 33. The brothers MAYO (1861-1939 and 18651939), the founders of the renowned American Mayo Clinic in Rochester in 1915, elaborated new techniques for visceral surgery and carcinoma.
34. Loss of blood was one of the most dangerous complications of surgery until LANDSTEINER’s (1868-1943) discovery of the blood groups in 1901 made blood transfusion possible. He was awarded the Nobel prize in 1930.
35. Brain surgery was performed as early as the 19th century by Horsley and Broca, but this specialism was really pushed by the studies of Cushing. An important share in this field was taken by the Portuguese surgeon MONIZ (18741955), who performed the first cerebral angiography as early as 1927 and frontal lobotomy in 1933 (Nobel prize in 1949).
The American Journal ol Surgery
Philatelic Survey of the History of Surgery
36. SAUERBRUCH (1875-1951) succeeded in improving intrathoracic surgery by his development of the cabinet for negative pressure. A method developed during World War I to make artificial limbs voluntarily mobile was also named after him tsauerbruch’s hands). 37. LERICHE (1879-1955) was the founder of physiologic surgery. His discoveries included the significance of the vegetative nervous system.
38. FRONT SURGERY
as a particular branch of surgery certainly deserves special attention. This postal card originates from a mobile surgical group during World War I.
volume 143, May 19s2
645
Verveen
40. Currently, surgeons have many DIAGNOSTIC METHODS at their disposal, including gastroscopy, cystoscopy, and bronchoscopy. The second 0 in the word proctologia in this stamp shows a mucous membrane seen through a proctoscope. 39. As is customary today in almost all disciplines, there are CONGRESSES for surgeons in many parts of the world to enable them to exchange new ideas and experiences.
41. Important weapons in the hands of the surgeon include antibiotics, which can be administered as preor postoperative prophylaxis or for postoperative infections. The history of antibiotics began with the discovery of penicillin by FLEMING in 1928. However, the drug only became medically applicable in 1941 through the work of FLOREY and CHAIN.
646
The American Journal of Surgery
Philatelic Survey of the History of Surgery
Transplantation
42. Even back in the olden days transplantation surgery was in the minds of physicians. This stamp depicts the transplantation of the leg of a negro as it was reputedly performed, according to legend, by the saints COSMAS and DAMIAN in the 3rd century.
42
43. A routine intervention today is the transplantation of the cornea. This was performed for the first time in 1918 and was developed into a routine operation by FILATOV (18751956), among others. As early as 1931 he instituted the first cornea bank. 44. CARREL (1873-1944) was a pioneer in transplantation surgery. As early as 1912, he was awarded the Nobel prize for his pioneering work in vascular surgery and homo-organ transplantation. 45. The Dutchman KOLFF also made an early contribution in this field by developing the artificial kidney in Kampen (Holland) in 1944. This apparatus made it possible to treat patients with terminal kidney insufficiency with kidney dialysis for a longer period. In 1950, the first successful kidney transplantation was performed in the United States. 46. In the 1960s the REPLACEMENT OF HEART VALVES by valves of synthetic material came into use, and today PACEMAKERS are being increasingly implanted. 47. The first heart transplantation in a human being was performed by BARNARD (born in 1922) in the Grooteschuur Hospital in Cape Town (South Africa) in December 1967. 48. So far, LUNG TRANSPLANTATION has given rather disappointing results, as is actually also the case in heart transplantation (in 1977, after I year, the survival rate was 68 percent).
647
Verveen
Operations 49. These stamps depict surgeons at work in old times (the Rembrandt paintings) and in modern hospitals. The devotion of the surgeon is from all times. v The first Rembrandt painting (top left) shows the famous “Anatomy Lesson of Dr. Nicolaes Tulp,” painted in 1632. Dr. Tulp was a reader in anatomy in the Guild of Surgeons of Amsterdam, In this painting Dr. Tulp is demonstrating the physiology of the arm on the body of a hanged criminal. The second Rembrandt painting (top right) is called “The Anatomy Lesson of Dr. Jan Deyman” and was painted in 1656. Dr. Deyman was the successor of Dr. Tulp in the Amsterdam Guild of Surgeons. In this lesson Dr. Deyman demonstrates the physiology of the skull on a thief’s body. Finally, the Columbian stamp (bottom right) shows a reproduction of a painting by Grau of the first cesarean operation performed in Columbia in 1844.
49
646
Tha American Journal cl Surgary