Posted in History & Literature

Surgeon

In many cultures (especially in Asian countries), the public conception of doctors has changed where surgeons are considered the “real doctors”. This is particularly evident in Asian dramas where main characters tend to be surgeons, saving the patient’s life with dramatic operations and charisma. The idea that surgeons are superior to physicians may go as far as some adults advising medical students to become surgeons for a higher status (again, more evident in Asia). However, as the root of surgery is completely different from that of medicine, technically it is a misnomer to call a surgeon a “doctor”.

This is reflected in the relatively unknown fact that a fully-trained surgeon is referred to as “mister”, not “doctor”. To understand why surgeons call themselves Mr., we must look into the origin of the surgical discipline.

In ancient times, surgery was limited to treating flesh wounds and setting bones (with some exceptions such as trepanation), such as those sustained during battles. Other than the odd few cases of specialised surgeons such as Galen of ancient Greece and Hua Tuo of ancient China, it is hard to find records of doctors employing surgery as a form of treatment. This was mainly due to two reasons: that surgery was considered a “dirty, unrefined” form of treatment, and that surgery was too risky.

For a long time, especially in the Western world, surgery was considered to be of a lower status compared to medicine. It was considered more of a craft tradition – something which physicians believed was beneath them. Because of this, surgeries were mainly performed by barbers in medieval Europe. One can still find evidence of a barber’s alternative historical role on the barber’s pole, which has white, red and blue stripes. The white stripe symbolises bandages, the red symbolises arterial blood and the blue symbolises venous blood. This originates from the practice of bloodletting, where white bandages wrapped around a pole would get dyed red from the blood, giving the appearance of the barber’s pole. The profession of “surgeon” did not formally appear until around the 18th century when a Guild of Surgeons was formed in England. However, physicians refused to accept surgeons as equals for a further century. When they did come to accept that surgery was a legitimate form of medical treatment, the surgeons decided that they did not want to be assimilated as doctors, so they chose to keep their title of “mister” to distinguish themselves from physicians.

The reason why surgery was considered an unrefined art in the past mainly focuses on three issues: bleeding, pain and infections. Before modern surgical developments, uncontrolled bleeding was a real issue in surgery. This not only made surgeries extremely messy, but it was also dangerous for the patient as patients would often die from shock (dangerously low blood pressure). On top of this, anaesthetics was only introduced in the late 19th century, meaning before that, patients had to suffer the pain of their flesh being cut and stitched with no relief. Of course, this meant that surgeries were almost always a brutal scene, with the agonising screams of the patients filling the room, while they sprayed blood everywhere. Lastly, even if the patient somehow survived the surgery without bleeding out or dying from the stress and pain, there still remained a high risk of post-operative infection. Thus, surgeries were most often unsuccessful and were considered a barbaric form of treatment with no promise.

Thanks to medical advancements, surgery has become an important aspect of medicine, where one cannot live without the other. However, the tension still remains between physicians and surgeons, with each profession jokingly mocking the other whenever a chance arises.

Posted in Science & Nature

Caesarean Section

(To read about how babies are made and born, read the From Cell to Birth miniseries! https://jineralknowledge.com/tag/arkrepro/?order=asc)

Most animals give birth through a female’s vagina. Of course humans are the same when it comes to natural birth, but nowadays, it is not uncommon to find women wanting a caesarean instead of the traditional method. A caesarean (also called C-section) is a surgical procedure where the fetus is taken out by cutting through the lower abdomen into the uterus. The history of caesareans is quite dark. Back in the old days when medicine was not advanced, caesareans were mostly used to rescue fetuses from mothers who had died during childbirth. The first record of a successful caesarean where the mother survived dates back to the 1500s. Many people believe the word “caesarean” came from the Roman emperor Julius Caesar, who was allegedly born via a caesarean. However, it was rare for caesareans to be performed in Roman times and even if they were, the mothers almost certainly died in the process. Given that his mother was alive and healthy well into his adulthood, it is highly unlikely that Caesar was born by caesarean (there are no concrete records of it either).

There is much debate to whether a caesarean is better or worse than natural birth (except in emergency situations where a caesarean is required). According to research (in cases without known risks to the fetus), the mortality rate is definitely higher in babies born by caesarean compared to those born naturally. This is most likely due to a caesarean bypassing some of the physiological changes that occur during vaginal birth.

Another debate is about the use of general versus regional anaesthesia (spinal block) when doing a caesarean. A fascinating fact about childbirth is that when a baby is born, it cries to expand its lungs but then quietens down for about an hour (unless it is in pain or there is some stimuli). This is possibly a mechanism to allow bonding between the mother and baby. New mothers often remember the moments following the birth of the child as extremely emotional and blissful. Contrastingly, mothers who are under general anaesthesia and not awake when their child is born bond less with the baby initially (some mothers do not even recognise the baby as their own). Thus, unless it is an emergency caesarean, a spinal block (which allows the mother to be awake and painless) is preferable over general anaesthesia.

Lastly, it is common tradition to cut the umbilical cord straight after the child is born. But is this okay? When the fetus is in the uterus, it shares its cardiovascular system with the placenta. The umbilical cord connects the two and carries blood to and fro. At any given point, the placenta contains 30~50% of the fetal blood. If the umbilical cord is suddenly cut, the fetus essentially loses this blood, being born in a state of low blood volume. If you look at the umbilical cord, you can see that it is about 1m in length, which is enough for the baby to be put next to the mother’s breasts for breastfeeding and bonding. Perhaps we are cutting the cord too soon, not letting the blood flow back from the placenta to the fetus.

If you think about it, humanity has been giving birth without too many problems to survive generation after generation for 200,000 years (otherwise we would not exist). Although the mortality rate was high, Mother Nature has optimised childbirth over time through evolution. Ergo, it is possible that modern medicine is intervening too much in a natural process. We must always consider whether medical advances are helpful or harmful to us.

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Posted in Psychology & Medicine

Trepanation

When and what was the first surgery performed by mankind? Many would believe it to be a simple procedure such as suturing a wound. But would you believe that the earliest surgical procedure was brain surgery in 6500BC? Surprisingly, this is true.

Archaeologists have found a large amount of skulls with a large, round hole in them. Some of the oldest skulls with holes were found in France, where 40 skulls from the Neolithic era were excavated. Archaeologists believed these holes to be from a battle leading to a dent in the skull. However, these holes were actually the results of a surgery (signs of bone recovery can be seen around the edges of the hole, suggesting the patients were alive for some time even after the operation). These skulls all belonged to trepanation patients.

Trepanation is the surgical opening of the skull by drilling a hole in it. This is an ancient surgery that can be found throughout history. Hippocrates and Galen from ancient Greece both recorded detailed instructions on trepanation, ancient Incans performed the surgery and it was also common during the Middle Ages and the Renaissance in Europe. These surgeries were most likely indicated for skull fractures where fragments were embedded in the brain. During the Middle Ages when it was better known that the brain was the seat of the soul, trepanation was used for psychiatric treatments too. For example, in 15th century Netherlands, trepanation was used to excise a so-called stone of madness that was supposedly the cause of insanity. Like this, it was believed that trepanation could release the demons and insanity trapped in the skull.

Although this operation sounds hilariously misled, it is still used in modern medicine. Of course, it is not known to treat insanity, but rather to treat brain bleeds. Extradural and subdural haemorrhages occur when a rupture of an artery in the brain causes a collection of blood in the skull, compressing the brain. This is a dangerous situation which can lead to a stroke or even death. One treatment of this condition is trepanation, or a burr hole, where a small hole is drilled in the skull to relieve the pressure, lowering intracranial pressure and stabilising the patient. Trepanation is an excellent example of how we can learn from the past and how medical knowledge from ancient times is sometimes still valid.

Posted in Psychology & Medicine

Scrubs

Scrubs is the uniform that surgeons, anaesthetists, emergency department doctors and nurses wear for the freedom and mobility required in activities such as surgery and CPR. Also, since it is owned and washed by the hospital instead of being privately owned, it is more hygienic and helps prevents infections. A noticeable trait of scrubs (and also surgical gowns) is that almost every hospital uses a shade of blue or green instead of white. Why is this?

The reason being, looking at a surgical scene for a long period of time can cause eye fatigue and afterimages due to the redness of blood and organs. Afterimage is a phenomenon that occurs when the retina becomes insensitive to a strong colour and instead making the complementary colour stand out more. Ergo, a surgeon looking at blood and organs for too long will see afterimages of a blue shade, which may cause accidents to happen as it overlaps on white surfaces or the surgical field. Clothing of blue or green colour neutralises the afterimage and is much easier on the eyes, reducing the fatigue. Lastly, blue-green colours have a calming psychological effect, which helps in a high-tension, stressful environment such as in an operating theatre.

Posted in Psychology & Medicine

ICU Syndrome

ICU stands for intensive care unit and is the place where patients are sent after an operation to stabilise and recover under supervision. ICU patients commonly have a very unique and strange post-operative experience.

ICU syndrome is a type of delirium where the patient experiences severe anxiety, fear, hallucinations or delusions. Although the cause has not been determined, it is likely related to post-op stress, the segregation and loneliness in the ICU room and confusion from coming out of anaesthesia. This is especially the case if an emergency situation led to the surgery being longer than expected or resulted in additional surgery, causing extreme confusion in the patient.

A patient suffering from ICU syndrome tends to be extremely excited and unstable. They may develop intense paranoia or distrust (especially against medical professionals), which can lead to fits or dangerous acts such as pulling out cannulas and lines. A friend or loved one talking calmly to the patient has a great effect in helping the patient overcome the delirium. Therefore, allowing the family to visit to keep the patient company and calm is an effective way to prevent ICU syndrome. However, if the situation spirals out of control, a sedative or anti-psychotic may need to be administered.

A study states that about 25% of patients admitted to the ICU suffer from ICU syndrome. It is one of the most common causes of delirium and any patient can get it (elderly patients are more likely to). Interestingly, there is a theory that medical professionals are more likely to suffer ICU syndrome after an operation.
Nowadays, the term ICU syndrome or ICU psychosis is discouraged and is instead grouped under delirium (which is an actual psychiatric disorder, not just a general term).