first choice for numerous health circumstances.
Surgical operations can restore and improve func-
tion, improve appearance, repair the damage of
traumatic injury, replace dysfunctional organs and
structures, remove tumors and infected tissue, and
correct potentially life-threatening congenital
anomalies. Surgeons in the United States perform
more than 25 million operations a year.
SURGERY NOMENCLATURE: TYPES OF OPERATIONSTerm Ends In Operation Is to
-ectomy remove a body part or segment of tissue
-ostomy establish a passage between two structures
-otomy open an area of the body
-plasty repair or reconstruct a body part
Anesthesia: Making Surgery Painless
Until the middle of the 19th century surgery was a
treatment of last resort, chosen only when the only
alternative was certain death. The most effective,
albeit unpredictable, anesthesia was a surprise
uppercut punch to the jaw that could render a per-
son unconscious long enough for a fast surgeon to
complete an operation such as extraction of a bullet
or AMPUTATIONof a limb. ALCOHOLand opium were
the drugs of choice for postoperative pain relief.
The first effective anesthetic agent was ether,
administered by having the person breathe fumes
as they evaporated from a saturated cloth. Though
chemists had compounded ether (sulfuric acid dis-
tilled in alcohol) since the 13th century and
explored it as a solvent and a sedative for cen-
turies, its properties as an anesthetic did not
become known until chemistry students in the
early 1800s began using it for entertainment at
parties. Their instructors observed that the more
ether a person inhaled, the more impervious he or
she was to pain. But not until the middle of the
century did surgeons begin to explore using ether
to intentionally intoxicate an individual to create a
state of unconsciousness. In 1842 American physi-
cian Crawford Long (1815–1878) used ether to
anesthetize a friend, then surgically removed sev-
eral cysts from the friend’s neck. The friend felt no
pain and had no memory of the surgery.
Discoveries of similar properties for chloroform
and nitrous oxide rapidly expanded anesthesia
options. These substances were more effective and
less noxious than ether and soon displaced it for
operations and dental procedures. Over the latter
decades of the 19th century surgeons refined the
mechanisms for delivery of anesthetic agents to
provide relatively predictable and safe anesthesia
during surgery. In the 1880s surgeons experiment-
ing with controlled delivery of anesthetic agents
had developed valve-controlled inhalers and the
precursor of the endotracheal tube, a tube inserted
into the trachea with an air-filled cuff on the end
to hold it in place and seal the trachea. By 1930
endotracheal intubation had become the standard
method for administering inhalation anesthesia, as
it remains today.
Modern anesthetic agents are faster acting,
more specific in the effects they achieve, and
much safer than their predecessors. Though
unpleasant side effects remain possible, anesthesia
for most people accomplishes precisely and only
the intended purpose. Anesthesiologists and certi-
fied nurse anesthetists (physicians and registered
nurses, respectively) who specialize in the delivery
of anesthesia, carefully administer anesthesia tai-
lored to each individual patient’s needs and health
circumstances.Antisepsis: Making Surgery Safe
Though surgeons knew all too well the high rate
of death after surgery, it was an obstetrician rather
than a surgeon who made the connection
between antisepsis and death rates among
patients. Hungarian physician Ignaz Philipp Sem-
melweis (1818–1865) noticed that the death rate
in the maternity ward was much higher among
women cared for by doctors than by midwives. His
investigation led him to recognize that doctors
often went directly from performing autopsies
(procedures in which midwives had no role) to
delivering babies. In 1846 Semmelweis imple-
mented procedures for doctors to wash their
hands with chlorinated lime before examining
obstetrical patients, and maternal death rates from
childbirth FEVER(puerperal fever) plummeted.
It was 20 years later that Louis Pasteur
(1822–1895) and Joseph Lister (1827–1912)
proved the connection between microscopic
“germs” and illnesses such as infection, and by the
1870s antisepsis was the standard of practice not
only for childbirth but also for surgery and other
treatment modalities. Today surgeons and other258 Surgery