Ebook A history of surgery (3E): Part 2
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Ebook A history of surgery (3E): Part 2
The surgery of warfareMankind has always been subject to injury; the earliest surgeons were no doubt those men and women who were particularly skilled Ebook A history of surgery (3E): Part 2d in binding up the contusions, lacerations, fractures, perforations and evisceration* of their fellows (Figure 9.1). Since man is undoubtedly the most vicious and aggressive of all animals, much of this trauma was inflicted in battle, and warfare has therefore played an important part in the develo Ebook A history of surgery (3E): Part 2pment of wound management. Indeed, it has been said that the only thing to benefit from war is surgery.Figure 9.1 Achilles bandages the arm of PatroclEbook A history of surgery (3E): Part 2
us during the Trojan Wars 1200 BC. (From a painting on an ancient Greek vase.)Until the introduction of gunpowder into warfare in the 14th century, waThe surgery of warfareMankind has always been subject to injury; the earliest surgeons were no doubt those men and women who were particularly skilled Ebook A history of surgery (3E): Part 2e penetrating and lacerating injuries, and the blunt instruments would produce severe contusions. The early surgeons well recognised that some injuries were going to prove almost invariably fatal. These comprised penetration of a vital structure, such as a perforating wound of the skull, chest or ab Ebook A history of surgery (3E): Part 2domen, or haemorrhage from a major blood vessel. However, if the victim survived the initial injury, he was very likely to live. This was because thesEbook A history of surgery (3E): Part 2
e lacerated and contused wounds produced little tissue destruction and thus allowed the natural powers of the body's healing to cure the victim. So thThe surgery of warfareMankind has always been subject to injury; the earliest surgeons were no doubt those men and women who were particularly skilled Ebook A history of surgery (3E): Part 2ve, at least did little harm. Haemorrhage would be treated by pressure on the wound or the use of the cautery. The technique of tying the bleeding artery, a device introduced by the Alexandrian surgeons around 250 BC and described by the Roman writer Celsus in the 1st century An, appeared to have be Ebook A history of surgery (3E): Part 2en forgotten.The medieval surgical textbooks often carried an illustration of a ‘wound man' that showed the various injuries the surgeons of the MiddlEbook A history of surgery (3E): Part 2
e Ages might be called upon to treat; we can guess quite accurately which would prove successful and which would be almost certainly lethal (Figure 9.The surgery of warfareMankind has always been subject to injury; the earliest surgeons were no doubt those men and women who were particularly skilled Ebook A history of surgery (3E): Part 2ow of the Royal College of Surgeons (FRCSJ.)THE INVENTION OF GUNPOWDERGunpowder appears to have been invented in China and was used in the manufacture of fireworks and, probably.also in cannons. It first appeared in Europe in the 14th century, and it is well documented that cannons were employed in Ebook A history of surgery (3E): Part 2the Battle of Crécy in 1346 when Philip VI of France was defeated by Edward III and his longbowmen. The introduction of firearms completely changed thEbook A history of surgery (3E): Part 2
e pathology of war wounds. The gross tissue destruction produced by the musket ball and cannon provided a wonderful medium for the growth of bacteria,The surgery of warfareMankind has always been subject to injury; the earliest surgeons were no doubt those men and women who were particularly skilled Ebook A history of surgery (3E): Part 2and gas gangrene. Thus, dreadful wound infection andgangrene of a type not previously seen were encountered by surgeons treating these war wounds. Now this, of course, was centuries before our knowledge of the bacterial causation of wound infection. It was not unreasonable, therefore, for military s Ebook A history of surgery (3E): Part 2urgeons to conclude that these awful complications were due to the poisonous nature of the gunpowder itself. The solution was obviously to destroy theEbook A history of surgery (3E): Part 2
poison, and this was done by means of a red-hot cautery or by the use of boiling oil poured into the wound. The great popularity of the latter methodThe surgery of warfareMankind has always been subject to injury; the earliest surgeons were no doubt those men and women who were particularly skilled Ebook A history of surgery (3E): Part 2 Art of Surgery was first published in Rome in 1514 and went through more than 40 editions in many languages; it greatly influenced the surgical thinking of his time, of course, we now know that this practice had the opposite effect to the one desired. The red-hot cautery (Figure 9.3) and the boilin Ebook A history of surgery (3E): Part 2g oil in fact destroyed more tissue than the missile itself and aggravated an already serious situation, as wellFigure 9.3 Cauterisation of a wound ofEbook A history of surgery (3E): Part 2
the thigh.The inas inflicting untold torture upon the poor soldier victim.We now come to one of those great landmarks that punctuate surgical historyThe surgery of warfareMankind has always been subject to injury; the earliest surgeons were no doubt those men and women who were particularly skilled Ebook A history of surgery (3E): Part 2little town of Laval in the Province of Maine (Figure 9.4). His father was probably a valet de chambre and barber to the local squire, and he may thus have obtained some interest in the work of barbersurgeons. Pare's sister married a barber-surgeon who practised in Paris, and his elder brother was a Ebook A history of surgery (3E): Part 2 master barber-surgeon in Vitré. Paré may have begun the study of surgery with his brother, and it is certain that he did work with a barber-surgeon iEbook A history of surgery (3E): Part 2
n the provinces before coming to Paris at the age of 22 as an apprentice barber-surgeon. He was soon appointed compagnon-chirurgeon, roughly equivalenThe surgery of warfareMankind has always been subject to injury; the earliest surgeons were no doubt those men and women who were particularly skilled Ebook A history of surgery (3E): Part 2•A. P-AN- AT. + Í ■>-•Figure 9.4 Ambroise Pare, aged 45. (From Geoffrey Keynes: Apologie and Treatise of Ambroise Pare. London, Falcon, 1951.)3 or 4years and must have gained a great experience in that repository of pathology.Perhaps because he could not afford to pay the fees for admission to the r Ebook A history of surgery (3E): Part 2anks of the barbersurgeons. Pare started his career at the age of 26 as a military surgeon. In those days, there was no organised medical care for theEbook A history of surgery (3E): Part 2
humble private soldiers of armies in the field. Surgeons were attached to individual generals and to other important personages. and might, if they wThe surgery of warfareMankind has always been subject to injury; the earliest surgeons were no doubt those men and women who were particularly skilled Ebook A history of surgery (3E): Part 2panions or of a motley crowd of horse doctors, farriers, quacks, mountebanks and camp followers.Pare was appointed surgeon to the Mareschal de Montejan, who was colonel-general of the French infantry. Illis, his first of many campaigns, took him to Turin, and it was here in 1537 that he made his fun Ebook A history of surgery (3E): Part 2damental observations on the treatment of gunshot wounds. He soon realised that the accepted method of treating these injuries with boiling oil did moEbook A history of surgery (3E): Part 2
re harm than good and substituted a more humane and less destructive dressing. Here is his description of what today might well be called one of the eThe surgery of warfareMankind has always been subject to injury; the earliest surgeons were no doubt those men and women who were particularly skilled Ebook A history of surgery (3E): Part 2to sleep and have come into the ward to see how a patient is before anyone else is around, with pulse racing, to see whether the treatment we have carried out has been a brilliant success or a disastrous failure?I was at that time a fresh-water surgeon, since I had not yet seen and treated wounds ma Ebook A history of surgery (3E): Part 2de by firearms. It is true I had read in Jean de Vigo in his first book of Wounds in General Chapter 8, that wounds made by firearms are poisoned becaEbook A history of surgery (3E): Part 2
use of the powder. For their cure he advised their cauterisation with oil of elders mixed with a little theriac. To not fail, this oil must be appliedThe surgery of warfareMankind has always been subject to injury; the earliest surgeons were no doubt those men and women who were particularly skilled Ebook A history of surgery (3E): Part 2gs, which was to apply the oil as boiling as possible. So I took128 The surgery of warfareheart to do as they did. Finally, my oil was exhausted and I was forced instead to apply a digestive made of egg yolk, rose oil and turpentine. That night I could not sleep easily, thinking that by failure of c Ebook A history of surgery (3E): Part 2auterising, I would find the wounded in whom I had failed to put the oil dead of poisoning. This made me get up early in the morning to visit them. ThEbook A history of surgery (3E): Part 2
ere, beyond my hopes, I found those on whom I had used the digestive medication feeling little pain in their wounds, without inflammation and swellingThe surgery of warfareMankind has always been subject to injury; the earliest surgeons were no doubt those men and women who were particularly skilled Ebook A history of surgery (3E): Part 2r wounds. Then I resolved never again to so cruelly burn the poor wounded by gunshot.Paré also went on to show that bleeding after amputation of a limb should be arrested not by the terrible method of the red-hot cautery but by simply tying the divided blood vessels. Ligation of blood vessels was kn Ebook A history of surgery (3E): Part 2own to the ancients, and Pares only claim, as he makes quite clear in his own writings, was that he was the first to apply this technique in performinEbook A history of surgery (3E): Part 2
g amputations. He first employed the ligature in amputation of the leg in 1552 at the siege of Danvillier but did not publish his technique until 1564Gọi ngay
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