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Evolution of Surgeons : Barbers to Nobel Laureates

August 13, 2018

In England , where I trained, as soon as I obtained the Fellowship of the Royal College of Surgeons I was addressed as Mr. Prasad instead of Dr. Prasad. This was a very important milestone in my life and this prefix will stay with me whenever I work in the U.K.
 

Till the early part of the last century, till the discovery of antibiotics and modern anesthesia surgeons were barbers who could stitch wounds, lance boils, remove skin tumors and even treat fractures. They were not physicians, hence were called Mr. There were no female surgeons I presume hence there was no need to call a female surgeon "Mrs" !
 

 A historical depiction of a surgeon/barber lancing a boil


Surgeons over the centuries have been great thinkers and innovators and were responsible for the great advances in modern medicine. Surgeries like heart  and lung transplantation, complex neurosurgery for deep seated brain tumors and aneurysms, fine retinal surgery or even simple cataract surgery restoring vision to millions of people must have been first performed by geniuses who pushed boundaries, took risks and were supported in their effort by the patients themselves and their families.

I was, in my own humble way, faced with such a situation when I performed the first Robotic Spine Surgery using the Da Vinci robot, when I told the patient and his family that I have never done this surgery before, in fact it was not done anywhere outside of USA at that time, hence not formally trained to do this procedure. However I felt this was the best minimally invasive option for the patient and assured them that there would be no more risk than for a regular spine surgery. I am glad they consented to the procedure for which neither  I nor the hospital billed him.

 

Theodor Kocher was the first surgeon in 1909 to be conferred the prestigious Nobel Prize for his work on the physiology, pathology and surgery of the thyroid gland  In July 1883 he even tried to reverse the unexpected consequence of total thyroidectomy by reinserting thyroid tissue into the patient’s body. He thus performed the first organ transplant and Thyroid transplantation became the prototype of all other organ transplants.

French-American Alexis Carrel, who in, 1912 won the second Nobel Prize for Surgery in recognition of his work on blood vessels surgery and organ transplantations. He noted that the success of allotransplant was blocked by a problem that could not be solved by surgical means. In an experiment, Carrel grafted a dog’s kidney from its original site to the neck making sure that that kidney survived till the time it remained within the same animal. However, if the surgeon did exactly the same thing between different individuals the transplanted kidney invariably died. Scientists of that time analyzed this phenomenon and held immune system responsibly. Since the problem seemed to be insurmountable, organ transplantation was temporarily abandoned. It took till 1945 before surgeons restarted transplant surgery.  In 1954, surgeons at the Peter Bant Brigham Hospital in Boston transplanted a kidney from the healthy identical twin brother to a man with a severe renal disease. The transplant worked. It was considered breakthrough and earned Joseph E. Hurray the Nobel Prize in 1990. In 1960’s immunosuppressant’s initiated a new phase in the history of transplant surgery.

The Nobel Prize for Medicine was controversially awarded in 1949  to the Portuguese Antonio Eges Moniz for “the discovery of prefrontal Leucotomy” a surgical intervention to relieve many psychiatric conditions. At that time, the psychosurgery became a strategy for solving mental disorders through surgical intervention.  In the years following World War II, the use of psychosurgery reached its heyday, peaking all over 5000 such operations performed in 1949 alone. My father, Prof Rishishwar Prasad, was one of the first to perform this procedure in India on patients of the Ranchi Mental hospital for Indian patients and the European Mental Hospital in the fifties. That is, until he adapted to using newly-introduced drugs to treat patients. 

 Having said all that I often say to my patients who ask too many questions when I am busy, " I am just a surgeon, go ask a physician."

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