3rd Year Medical Students, English

Section
University of Medicine and
Pharmacy Tirgu Mures
Radu Neagoe MD, PhD
Associate Professor of Surgery
Second Department of Surgery

Surgical Semiology = definition

of terms
Semiology = the study of signs (Greek
semeion = sign)
- the branch of medicine dealing with
symptoms / the combined symptoms of the
disease
Surgical semiology = dealing with
symptoms / signs of surgical diseases
+ general principles which govern the
surgical activities

Historical moments in
surgery

Those who cannot remember the

past are condamned to repeat it
George Santayana

SURGERY - Where does the word come

from?
- Latin = chirurgia
- Old French (surgerie)
Orig in Greek (Keiron - hand ergos work)
- anglicized = surgery
Definition
Surgery is the branch of medicine in which healing is
consequence of a surgical action
the surgeons hand is led by his brain (G Crille)

Was it always like this?

Evolution of surgery = evolution of

mankind
Prehistoric medicine
Paleolithic era (when humans became really
humans)
believed that their lives where determined by spirits
they knew something about bone structure
evidence of cannibalism .
were afflicted with specific ailments and diseases..

A broken clavicle, incorectly

healed after surgical
repositioning..

Neolithic era

Geophagy = to eat soil-like or earthy substances, such as

chalk and clay
Trepanation (trepanning, trephining) = the oldest type of
surgery proven archeologically
the oldest trepanned skulls date back to the mesolithic era
(Kiev-Ukraine ~ 7300-6200 BC)
attempt to cure diseases/free the victim of demons ??

Trepanned skulls for mythical purposes, with special

surgical tools, during life

Old civilizations:

healers (priests) those who

performed minor surgeries

Medicine in Mesopotamia (the land between the

rivers)

Sumerians (and after.Babylonians )

the civilization have begun
with the development of
cuneiform writing (3000 BC) cuneiform tablets!
library of Asshubanipal - 660 medical tablets!!
had surgical instruments/described minor operations
Law Code of Hammurabi (1700 BC) well preserved law
code, included./ the principle = eye for eye

Ancient Egyptian medicine

The Egyptian civilization was the first great civilization on this
planet/ the dawn of what we call medical care
The Channel Theory..spirits blocked the channels!!
parchments (papiyruses, Papyri) with medical text
bass-reliefs (Luxor, Theba)
amputations of limbs
wound dressing with onions
dressing burns with honey/ vascular ligature

The Ebers Papyrus (Papyrus Ebers)

Georg Moritz Ebers (1837-1898), a German novelist and
Egyptologist, discovered this medical papyrus at Thebes (Luxor)
in 1873-74.
the oldest papyry preserved
20-meter long scroll, covering 100 pages
>700 remedies, magical formulae, incantations aimed to
banish demons responsible for disease
The Ebers Papyrus explaining
the besttreatment for
asthma

Ancient Greek medicine

the Ancient Greeks 700 BC- 600AD
lent more towards rational thinking in medicine
Pythagorean School - Sicily and Calabria
brought the theory of numbers into the natural
sciences
Alcmaeon (around 500 BC)
student of Pythagoras
one of the most eminent medical theorist and
philosopher
the first who wondered about the internal
causes of illness

Bust of Pythagora in
Rome

Hippocrates (Kos , 460-370 BC)

Father of Medicine

The

School of Kos - Corpus Hippocraticum (>60

procedures)
surgical manouvers orthopedic procedures
compressive dressing for hemostasis
reduction of scapula dislocation
pleural punction, flebotomy
cauterization, suturing
surgical infection smelly emanations
The Hippocratic Oath a vow taken by medical students

Hippocrates (The Constitution of Man) interpreted

medicine according to the theory of humors (inspired by the
natural matters basic components = E/W/A/F)
The human body consisted of 4 humors, the balance of which is
essential for a good health
1. Blood
2. Phlegm
3. Yellow bile
4. Black bile
The theory survived more than 2000 years!!

Did the Greeks perform surgery?

dissected dead bodies
war surgery, especially first aid
setting broken/dislocated bones

Ancient Roman medicine

the

Roman civilization started around 800 BC

interested in prevention than cure
the Greek influence on Roman medicine was huge
the Romans had painkillers (opium, scopolamine),
tools, hospitals
surgeons with experience gained in battlefields

Surgical tools found at Pompei

Celsus (60 BC 20 AD)

De medicine libri acto
mainly describing surgical acts
Well-known inflammation signs
tumor, calor, dolor
Galen (Galenus) (131-201AD)
famous Greek doctor
studies in anatomy
the father of experimental
medicine

rubor,

The Middle Ages few general

data
spanned 1000 yrs (5th 15th century)
Early (Dark Ages), High and Late Middle Ages
characterized as a period of stagnation
the only places that managed to continue learning
and studying science were the monasteries /
knowledge was the preserve of priests
politics, lifestyles, beliefs and thoughts were
dominated by the Roman Catholic Church
the authoritarian Church made people believe
blindly in what Galen had written
humorism prevailed right up until the 19th
century
study of anatomy was forbidden

What was Medieval surgery like?

There were some advances in Surgery

Surgeons were a distinct group, apart from doctors
Barbers-come -surgeons (guild) the real
ones!!
dressings
bleedings
suction cups
Impromptu surgeons performed surgeries
hernia
cistostomy
cataract
Educated surgeons
Theoretical training
Poor practical skills

Islamic medicine
The Islamic Golden Age- 8th to 15th
Centuries
establishment of hospitals, paid for by the
charitable donations (Zakat tax)
The father of islamic medicine

Al

Rhazi (Rhases) 850-923 AD

-200 books about medicine
-refining the scientific method and
promoting experimentation and
observation
- wrote about the crucial relationship
between doctors and patients
- tried to understand the causes of
symptoms
- wrote about brain and nervous system

Islamic medicine
Avicenna (Abu-Ali-Ibn-Sina, 9801037), the great polymath
The canon = a core text for physicians
across the islamic world and Europe
(translated in many languages)/ a
detailed guide for diagnosing and
treating ailments
Al Kindi (800-870), the documenter of
Islamic medicine
-influenced by Galen
Medical Formulary = many preparations
drawn from plant, animal and mineral
sources

The Renaissance period

From 1450s onwardsadvances in medical practice
accelerated dramatically.
Andreas Vesalius(1514 -1564), a Flemish anatomist,
physician, was the author of one of the most influential
books on human anatomy"De Humani Corporis Fabrica (On
the Structure of the Human Body)/ The Father of
Anatomy

De humanis
corpori fabrica
(Basel 1543)

William Harvey(1578 - 1657), an English

doctor was the first person to properly describe
the systemic circulation and properties of blood,
which is pumped around the body by the heart.
Paracelsus(Philippus Aureolus
Theophrastus Bombastus von Hohenheim,
1493 - 1541), a German-Swiss doctor,
astrologer, alchemist, botanist.
- the use of minerals and chemicals in the body /
he proposed that certain chemical and mineral
balances in the body were required for health

Ambroise Pare (1510-1590)

considered the father of modern forensic

pathology and surgery
developed new techniques for treating wounds
described spreading modalities of infections
introduced hemostasis by ligature
imagined arm and hand prosthesis, surgical and
orthopedic instruments

Leonardo Da Vinci (1452 - 1519)

painter, sculptor, scientist, engineer,
mathematician, musician, anatomist, inventor,
cartographer, botanist, geologist and writer
Da Vinci rapidly became an expert in
topographic anatomy, and drew several studies
of tendons, muscles, bones, and other features of
the human body. The Hospital of Santa Maria Nuova,
Florence, allowed him to dissect human corpses
he also studied the mechanical functions of bones
and how the muscles made them move - he is said
to have been one of the first researchers of
biomechanics.

The Rennaissance Era- 14th-16th

Leonardo da Vinci (1452-1519) -

Leonardos anatomy
drawings.

The birth of modern surgery

Louis Pasteur microbes are responsible for infections
Ignaz Semmelweis reduced puerperal sepsis
(postpartum infections) by urging doctors to wash their
hands between patients
Lister carbolic acid as cleansing and disinfectant agent
Ernst von Bergmann introduced steam sterilization
under pressure (instruments, equipment)
William Halsted introduced sterile rubber gloves /
modern operating theatre / residency scheme of training
surgeons
The development of anesthesia ether anesthesia
(1840)

As regards Surgery..
Theodor Billroth (1881, Wien)
gastrectomy
Langenbuch (1882) cholecystectomy
Synmonds (1883) - appendectomy

Modern surgery conclusions:

4 major advances in related disciplines
that helped the advancement of surgery:
1.
2.
3.
4.

Knowledge of anatomy
Discovery of anesthesia
Intraoperative hemostasis
Concept of asepsis

20th century surgery landmarks

improved

understanding of shock
knowledge of blood group & blood transfusion
understanding of blood clotting
development of antibiotics & analgesics
development of imagistic techniques
electrically powered surgical instruments,
surgical stapling
medical lasers
hypothermia, transplantation of organs
minimally invasive surgery

Romanian history of medicine

Neolithic era
trepanned skull discovered in Alba Iulia, Decea
surgical instruments for trepanation (Galaiu
Bistriei)

Dacia
a full case of surgical instruments (Graditea
Mucelului)
Scyntia Minor Greek doctors

Modern era:

The first sanitary legislation = Organic

regulation, under the Russian domination (19th
century) - the last Russian Governor of Bucharest

Pavel Kisselef Bucharest Governor

1829-1834

Colea Hospital founded by

Mihail Cantacuzino
Bucharest first Hospital,
constructed in1704
Initially designated for poor people
The model - Ospedale di S.
Lazzaro e Mendicanti from Venice

Carol Davila (18281884)

1857 - he founded the
National School of Medicine
and Pharmacy in Bucharest,
with 8 year training
there were 90 medical
students and 20 pharmacy
ones / the school was
recognized by the French
Government

Thoma Ionescu (1860-1926):

Paris Medicine and Law graduate
PhD thesis- Lvolution intrauterine du
colon pelvien
1890 - laureat of French Academy for
the paper Les hernies
intraperitoneales (intraperitoneal
hernias)
1894 - wrote a chapter in Poirier and
Charpy Treaty Lanatomie du tube
digstif

 Developed the method of high

rachianesthesy

Anniversary Medalintroduction of high

rachianesthesy, 1908

Tirgu Mures Surgery

our Teachers..
Professors Mathyas, Papay, V.Emilian Bancu
(General Surgery), Maros (Anatomy), Ciugudeanu
(Orthopedics), Nicolescu (Urology),....

71 years
history
...we are who we are thanks to the School that shaped us Th.
Burghele