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A presentation on various instruments used in surgery..The presentation is about type of instruments their uses and any modifications. It's helpful for a surgery pg student.
We know that the past is our foundation for future developments. We must build upon it so that we too can act as a stable foundation for future generations. One must be aware of the way surgeons in the past have contributed to Orthopaedics.
This presentation is a brief historical review Mankind's cumulative experience in fracture management which was Started by the Ancient very primitive trials and ended by the presence of Robotic and Telesurgery the so called Remote surgery.
A presentation on various instruments used in surgery..The presentation is about type of instruments their uses and any modifications. It's helpful for a surgery pg student.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
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Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
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mortality, and public health costs than all illicit drugs combined. The
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(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
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1. THE RISE OF
MODERN SURGERY
Dr. Sunil K S Gaur
MS (Surgery),
HIMS,Varanasi, India
2. Why study history?
■ To help us understand the field
today.
■ To make better decisions so that we
don’t repeat the mistakes of the
past.
■ To inspire us
■ To develop critical thinking skills
3. The Beginnings
■ From earliest recorded history through late 19th century – Pre-scientific, Pre-
anaesthetic and Pre-antiseptic times.
■ Operations were always frightening, frequently infected and often fatal.
■ Inevitably for ailments that could be visualized – on skin, just below skin, extremities
or in mouth
■ Till 14th century by Barber-surgeons.
– Vocation passed from father to son
– Ostracized by elite, university educated physicians
– Lanced abscesses, fixed simple fractures, dressed wounds, extracted teeth and
rarely amputated a digit or limb
4. Barber-surgeons
■ According toWikipedia:
“The barber surgeon, one of the
most common European medical
practitioners of the Middle Ages, was generally
charged with caring for soldiers during and
after battle. In this era, surgery was seldom
conducted by physicians, but instead
by barbers, who, possessing razors and
coordination indispensable to their trade, were
called upon for numerous tasks ranging from
cutting hair to amputating limbs.
In this period surgical mortality was
very high, due to blood loss and infection. Yet
since doctors thought that blood letting treated
illness, barbers also applied leeches.
Meanwhile, physicians considered themselves
to be above surgery.[1] Physicians mostly
observed surgical patients and offered
consulting, but otherwise often chose
academia, working in universities, or chose
residence in castles where they treated the
wealthy.”
5. The Beginnings (contd.)
■ Around 15th century, highborn physicians began to show interest in surgery.
■ As surgical techniques evolved wider range of surgeries were performed.
■ Ligated arteries, excised large visible tumours, performed trephinations, reduction of
hernias, performed rudimentary stomas, anal fistulas, cataracts, etc.
■ However, opening the cavities of the body was unknown and dangerous.
■ Despite the imperfection of their knowledge, prescientific surgeons with their
unwavering approach to treatment many a times achieved cure with technical
confidence.
6. The Beginnings (contd.)
■ Though surgeons never needed a diagnostic and pathophysiologic revolution in the style of
physician, they did need elaboration of 4 key elements:
– Knowledge of anatomy These 2 elements started to be
– Control of bleeding addressed by 16th century
– Control of pain 1840s
– Control of infection 1870s
■ Other soon to come
– discoveries like x-ray, blood transfusion, frozen section, etc.
– administrative and organizational events (education & training programs, experimental
surgical laboratories, textbooks, journals and professional societies and licensing boards)
– allowed surgery to emerge as a speciality.
7. Knowledge of Anatomy
■ Around late-1400s: Pope Sixtus IV and Pope ClementVII lifted the long-standing ban of
human dissection.
■ In 1543: AndreasVesalius presented his treatise, De Humani Corporis Fabrica Libri
Septem (On the Fabric of Human Body in Seven Books)
– Corrected errors of past Greek and Roman authorities.
– Had pictures that were scientifically accurate and creatively beautiful: believed to be
works of artists from school ofTitian,Venice.
■ In 1628: William Harvey showed that heart acts as a pump forcing blood in arteries
and back via veins.
■ During 18th and first half of 19th century surgeon-anatomist made some of their most
remarkable observations.
8.
9. Control of Bleeding
■ Ancient medical saying: “Those diseases that medicine does not cure, iron cures; those
that iron cannot cure, fire cures; and those that fire cannot cure are incurable”
■ Application of hot iron or boiling oil for haemostasis.
■ Around 1530s and 40s: Ambroise Pare sought other approaches to staunch
haemorrhage.
– Was a barber-surgeon
– But due to great reputation, served as surgeon-in-chief for 4 French kings
– Made a member of Paris-basedCollege of St. Come
10. Control of Bleeding (contd.)
■ During a battle his supply of boiling oil ran out, so used a paste of egg-yolk, crushed
rose petals and olive oil – later he observed that wounds were neither as inflamed nor
as tender.
■ Thus, started experimenting with alternate methods.
■ Decisive answer came in the form of reintroduction of “ligature” – proved to be a
turning point.
■ Also developed a pinching instrument called bec de corbin (crow’s beak).
■ Did not became very popular immediately due to lack of exposure.
■ Early 18th century: Jean-Louis Petit invented screw compressor tourniquet.
12. Control of Bleeding (contd.)
■ 1880s: Began experimenting with electric devices
■ 1926:William Bovie developed electro-scalpel which was used by Harvey Cushing.
■ Now many energy devices are used for haemostasis like monopolar and bipolar
electrocautery, harmonic scalpel, vessel sealers etc.
13. Control of Pain
■ In prescientific era, patients refused surgery because of pain.
■ Also, scalpel wielder was more concerned about speed than dissection.
■ Mid 1830s: Nitrous oxide had been discovered
– Initially used as recreational agent.
– After few puffs person lost equilibrium and knocked into nearby object but had little
discomfort.
– This pain relieving potential was recognized by physicians.
■ 1844: Horace Wells, pioneered the use of laughing gas in dentistry.
■ According toWikipedia:
– “He gave a demonstration to medical students at the MassachusettsGeneral Hospital in Boston onJanuary 20, 1845.
However, the gas was improperly administered and the patient cried out in pain.The patient later admitted that
although he cried out in pain, he remembered no pain and did not know when the tooth was extracted.[1]The audience of
students in the surgical theatre jeered "humbug".”
15. Control of Pain (contd.)
■ 1846: WilliamT. G. Morton demonstrated the use of sulfuric ether
– in a public demonstration at Massachusetts General Hospital anaesthetized a man
with inhalation of sulfuric ether and a small vascular tumour was excised from the
neck without any pain
– The surgeon John CollinsWarren uttered the five famous words in history of surgery,
“Gentlemen, this is no humbug.”
■ 1885: Nerve blocks,William Halstead
■ At the same time: Spinal anaesthesia by James Corning andAugust Bier
■ 1934: Intravenous anaesthetic agent – SodiumThiopental
17. Control of Infection
■ Pain would make surgery difficult, but infection would result in death.
■ 1857: Louis Pasteur showed that fermentation was carried out by invisible “germs”
■ 1860: Refuted the theory of spontaneous generation and demonstrated that germs
contaminated the liquids from outside
■ 1865: Joseph Lister gave concept of antisepsis
– These “germs” were cause of wound healing difficulties
– Proposed use of antiseptic solution (carbolic acid) for hand dipping, wound dressing
and cleaning of surfaces & instruments.
– Also developed sterile absorbable sutures eliminating the need to bring out the ends
from incision
19. Control of Infection (contd.)
■ However, acceptance was slow and uneven.
■ Overtime, antisepsis gave way to asepsis.
■ 1878: Rubber gloves developed by India-RubberWorks in Surrey, England
■ 1897: Jan Mikulicz-Radecki developed single-layer gauge mask.
21. Other Advances
■ X-rays
– Dec 1895, Wilhelm Roentgen
– By March 1896, first
contributions regarding use of
roentgenography in medicine
were reported
22. Other Advances (contd.)
■ Blood transfusion:
– Earlier scattered reports of
transfusion throughout 19th
century.
– Halstead gave blood to his sister
for post-partum haemorrhage.
– 1901: Karl Landsteiner, ABO
groups
– 1914:WW1, anticoagulants and
refrigeration
– 1937: First blood bank
– 1939: Rh grouping, Landsteiner
– 1939: Separation of plasma and
cells – widely used inWW2 https://www.youtube.com/watch?v=u2tWqs8a0hY
&list=TLGG7I-uBhDmW1gwODAxMjAyMA&index=7
24. Other Advances (contd.)
■ Frozen section – Freezing microtome, 1895
■ Standardized postgraduate surgical education and training programs – Halstead
followed German approach and developed in 1889
■ Experimental surgical research laboratories – 1895, Halstead animal dissection lab.
■ Specialty journals and textbooks – 1880s, Annals of Surgery and Principles and
Practice of Surgery by David H. Agnew.