surgery

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Branch of medicine concerned with the treatment of disease, abnormality, or injury by operation. Traditionally it has been performed by means of cutting instruments, but today a number of technologies are used to treat or remove lesions, including ultrasonic waves and laser surgery.

Surgery is carried out under sterile conditions using an anaesthetic. There are many specialized fields, including cardiac (heart), orthopaedic (bones and joints), ophthalmic (eye), neuro (brain and nerves), thoracic (chest), and renal (kidney) surgery; other specialities include plastic and reconstructive surgery, and transplant surgery.

Historically, surgery for abscesses, amputation, dental problems, trepanning, and childbirth was practised by the ancient civilizations of both the Old World and the New World (see prehistoric medicine, ancient Egyptian medicine, Greek medicine, and Roman medicine).

During the Middle Ages, Arabic surgeons passed the techniques of Islamic medicine on to Europe, where, during the Renaissance, anatomy and physiology were pursued (see Renaissance medicine).

Great advances in the practice of surgery were made in 19th-century medicine, although, conservatism hindered the adoption of new techniques and ideas; the Hungarian obstetrics assistant Ignaz Semmelweis, who promoted hand-washing in chlorinated lime to prevent cross-infection, was forced to resign for trying to enforce this method of asepsis (clinical hygiene), although mortality on his wards had fallen dramatically.

Anaesthetics were pioneered in the mid-19th century: the use of ether was used for amputations by the Scottish surgeon Robert Liston, and chloroform was introduced in 1847 by Scottish obstetrician James Simpson. Eminent surgeons such as John Snow and James Syme championed the adoption of anaesthetics, and Snow became the first specialist anaesthetist, administering chloroform to Queen Victoria during the birth of Prince Leopold in 1853.

In the second half of the 19th century Joseph Lister's discovery of antiseptics, championed by such surgeons as William Cheyne, became the basis for successful surgical practice. Other notable 19th-century surgeons include Johann Dieffenbach, who pioneered plastic surgery in Berlin, Germany. The discovery of antibiotics and effective methods of blood transfusion in the first half of the 20th century made surgery safer and more effective.

Some early operations, such as thoracoplasty (causing partial collapse of a lung) for tuberculosis, have been replaced by other treatments. Also, the need for exploratory surgery has been reduced by the introduction of noninvasive imaging techniques, such as ultrasound and CAT scans (computed axial tomography scans). The practice of endoscopy (examination of the interior of the body by direct viewing) has enabled the development of minimally invasive keyhole surgery.

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