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At least two prehistoric cultures had developed forms of surgery 12. The famous Egyptian architect and doctor, Imhotop, structured pyramids as well as had phenomenal feats in medicine in a land where wounds and other medical practices were common. The oldest, for which there is evidence to which a hole is drilled or scraped into the skull, thus exposing the dura mater in order to treat health problems related to intracranial pressure and other diseases. Evidence has been found in prehistoric human remains from Neolithic times, in cave paintings, and the procedure continued in use well into recorded history. Surprisingly, many prehistoric and pre-modern patients had signs of their skull structure healing. suggesting that many survived the operation. In ancient India, remains. from the early Harappan periods of the Indus Valley Civilization (c. 3300 BC) show evidence of teeth having been drilled dating back 9,000 years. A final candidate for prehistoric surgical techniques is ancient Egypt, where a mandible dated to approximately 2650 B.C. 61

shows two perforations just below the root of the first molar, indicating the draining of an abscessed tooth. The oldest known surgical texts date back to ancient India about 3500 years ago and many evidences found around the Indus valley civilization show that even dentistry is practiced then 13. Mehrgarh is now seen as a precursor to the Indus valley civilization. Discoveries at Mehrgarh changed the entire concept of the indus valley civilization. In April 2006, it was announced in the scientific journal 'Nature' that the oldest (and first early Neolithic) evidence for the drilling of human teeth in vivo (i.e. in a living person) was found in Mehragarh. According to the authors, their discoveries point to a tradition of proto dentistry in the early farming cultures of that region. Here we describe eleven drilled molar crowns from nine adults discovered in a Neolithic graveyard in Pakistan that dates from 7500 to 9000 years ago. Susruta is called as the father of surgery 14 and the first known surgeon in the world and even wrote a book on and his practices reached the Middle East and later to the west. In his book, he described over 120 surgical instruments, 300 surgical procedures and classifies human surgery into eight categories. Susruta is also 62

known as the father of plastic surgery and cosmetic surgery. He was a surgeon from the Dhanvantari school of Ayurveda In Ancient Egypt 15 surgeries were performed by priests specialized in medical treatments similar to that of today. ' The procedures were documented on papyrus and described patient case files; the Edwin Smith Papyrus (held in the New York Academy of Medicine) documents surgical procedures based on anatomy and physiology, while the Ebers Papyrus describes healing based on magic. Their medical expertise was later documented by Herodotus: 'The practice of medicine is very specialized among them. Each physician treats just one disease. The country is full of physicians, some treat the eye, some the teeth, some of what matters ,pertains to the abdomen, and others internal diseases Other ancient cultures to have surgical knowledge include Egypt, China and Greece. The Hippocratic Oath was an innovation of the Greek physician Hippocrates However ancient Greek culture traditionally considered the practice of opening the body to be repulsive and thus left known surgical practices such as lithotomy to such persons as practice In China, Hua Tuo was a famous Chinese physician 16 during the Eastern Han and Three Kingdoms era He was 63

the first person to perform surgery with the aid of anesthesia, albeit a rudimentary and un sophisticated form. It was unfortunate, however that after the era of Hua Tuo, surgery was largely neglected until modern times. In the Middle Ages, surgery was developed to a high degree in the Islamic world. Abulcasis (Abu al-Qasim Khalaf ibn al-Abbas AlZahrawi), an Andalusian Arab physician and scientist who practiced in the Zahra suburb of Cordoba, 17 wrote medical texts that shaped European surgical procedures up until the Renaissance. He is also often regarded as the Father of Surgery. In Europe, by the fifteenth century at the latest, surgery had split away from Physics as its own subject, of a lesser status than pure medicine, and initially took the form of a craft tradition until 18 Rogerius Salernitanus composed his Chirurgia, laying the foundation for modern Western surgical manuals up to the modern time. Late in the nineteenth century, Bachelor of Surgery degrees began to be awarded with the (MB), and the mastership became a higher degree, usually abbreviated ChM or MS in London, where the first degree was MB, BS. 64

Barber surgeons generally had a bad reputation that was not to 19 improve until the development of academic surgery as a speciality of medicine, rather than an accessory field. 20 Basic surgical principles for asepsis etc are known as Halsteads principles. Modern surgery developed rapidly with the scientific era. Ambroise Pare pioneered the treatment of gunshot wounds, and the first modern surgeons were battle field doctors in the Napoleonic Wars 21. Naval surgeons were often barber surgeons, who combined surgery with their main jobs as barbers. Three main developments permitted the transition to modern surgical approaches control of bleeding, control of infection and control of pain (anaesthesia).