Surgery - Geka

Japanese: 外科 - げか

A branch of medicine. Surgery is a translation of the Greek word "surgery," which is derived from the Greek word meaning "to work with one's hands." It means the medical art or medicine (surgery) of curing illnesses through surgery. Therefore, the history of surgery overlaps with the history of surgery in many ways. Therefore, we will leave the history of surgery to the surgery section, and here we will mainly outline the evolution of surgery and the various departments of surgery that are currently subdivided.

[Tatsuyuki Kudo]

Changes in surgery

Modern surgery and contemporary surgery began in the mid-19th century, but up until then surgery was limited to empirical medicine, and only palliative treatments were performed for external injuries and war wounds. The surgeons were monks or shady people who called themselves doctors, and by today's standards, extremely haphazard treatments were rampant. After the Renaissance, a somewhat guild-like system was created, and barbers worked as surgeons. Around this time, schools began to open all over Europe. Thus, the publication of Vesalius' book on human anatomy, Fabrica, in 1543 became a catalyst for the widespread study of anatomy, which came to mean the study of surgery. Thus, the barber surgeons, who wore short coats, were called the short-coat school, while the university school, who wore long coats, were called the long-coat school, and the two groups continued to be at odds with each other until the 19th century.

The modern era of surgery began with the invention of ether inhalation anesthesia by American physician Morton (1844). At the same time, in Vienna, Semmelweis succeeded in preventing puerperal fever by disinfecting midwives' hands with chlorcalcium. The British physician Lister then introduced the concept of antiseptic and disinfection (1867), and the foundation of modern surgery was established. This gave courage to physicians who were ready to take on more difficult and complicated surgeries. As surgical techniques became more complicated, hemostasis became necessary. The method of stopping bleeding by tying bleeding arteries with thread began as early as the 16th century, thanks to the ingenuity of French physician Paré. During this period, the invention and innovation of various excellent hemostatic forceps made it possible to quickly treat many bleeding arteries and veins, and the three pillars of modern surgery - anesthesia, asepsis, and hemostasis - were perfected. Against this background, surgery began to be undertaken in previously unexplored areas, such as kidney removal, stomach cancer removal, and goiter removal.

However, even at this new stage in the 19th century, doctors simply removed their coats, rolled up their shirts, and washed their hands. It was not until the beginning of the 20th century that we saw surgeons in their completely disinfected white coats, white caps, and masks as we see them today. Nurses also appeared around this time, and their roles as specialist assistants and managers in the operating room were established at the same time. During this period, X-rays and blood types, which were important for the development of surgery, were discovered in 1895 and 1901, respectively. The importance of X-ray examination goes without saying, but the discovery of blood types was also significant in that it made blood transfusions safe and made it possible to perform surgery under heavy bleeding.

The progress of medicine in general has been remarkable since the Second World War. The development of sulfa drugs led to the launch of chemotherapy, and the subsequent appearance of antibiotics, which led to a dramatic decline in infectious diseases, which had been the greatest enemy of surgery. Furthermore, new types of antibiotics are continually being discovered, as well as interferon, which is effective against viruses, allowing surgery to pioneer new paths forward.

[Tatsuyuki Kudo]

Surgery departments

The specialization of medicine and the training organizations for specialists have played a major role in the development of surgery. In Europe, obstetrics was independent from early on, and ophthalmology, otolaryngology, urology, and gynecology were also divided into separate departments. Later, orthopedics was divided as a department of bone and musculoskeletal surgery, and lung surgery, neurosurgery, and cardiac surgery were divided according to specialized organs. In Japan, the independence of specialties was delayed due to the influence of World War II, but after 1960, surgery developed rapidly, and doctors specializing in each field were born. In addition, the independence of anesthesiology as an auxiliary department should be noted. This trend of specializing into specialties is global, and although there are some differences, countries that are considered to be developed have adopted a specialist system. This is intended to improve the level of medical care by granting qualifications through examinations after a certain period of training, protecting the status of doctors, and improving the level of medical care. In Japan, at present, only anesthesiology and neurosurgery have established a similar certification system in the surgical field. Below are the current surgical departments and their areas of responsibility.

[Tatsuyuki Kudo]

General Surgery

In addition to abdominal surgery and trauma, it covers infectious diseases such as suppurative diseases of the extremities such as wheal, myositis, inflammation and abscesses around the anus, neck diseases such as cervical lymphadenitis and goiter, and diseases of the breasts and anus. Of these, abdominal surgery includes inguinal hernia, appendicitis, peritonitis, cholelithiasis, cholangitis, gastric ulcers, duodenal ulcers, as well as cancer of the esophagus, stomach, large intestine and rectum, and diseases of the spleen and pancreas, and is sometimes called digestive surgery. As mentioned above, traumatology is the field that gave birth to surgery, and even now, after the great wars have ceased, its importance has increased due to the increase and severity of disasters, and the role of emergency surgeons who are in charge of the early stages is large. In addition, vascular diseases such as peripheral blood vessels, aorta, and arteries and veins of the limbs are also included in general surgery, but there is also a tendency for vascular surgery, which specializes in these diseases, to be separated out. There are also departments that call themselves endocrine surgery and transplant surgery, and a special one is pediatric surgery.

[Tatsuyuki Kudo]

Thoracic Surgery

It began as lung surgery in the past, and in Japan as pulmonary tuberculosis surgery in particular. Currently, it mainly treats lung tumors, lung abscesses, and severe bronchiectasis, and also includes a few chest diseases, and is also called respiratory surgery.

[Tatsuyuki Kudo]

Cardiac Surgery

The main focus is on congenital diseases of the heart and the great blood vessels connected to it, and some departments call themselves cardiovascular surgery or circulatory surgery in addition to vascular surgery.

[Tatsuyuki Kudo]

Neurosurgery

The department deals with diseases of the brain and spinal cord, including tumors, hemangiomas, aneurysms, cerebral hemorrhage, abscesses, and trauma. The advancement of this department has been greatly contributed to by advances in neurology, the widespread use of ventriculography and cerebral angiography, and the invention and introduction of diagnostic methods that apply electroencephalography and radioisotopes, ultrasound diagnostics, CT scanners, and nuclear magnetic resonance scanners.

[Tatsuyuki Kudo]

Orthopedics

This is a bone and limb surgery department that deals with fractures, joint diseases, and congenital diseases of the hands and feet.

[Tatsuyuki Kudo]

Plastic Surgery

It targets morphological abnormalities, deformities, defects, and scars on the exterior of the body, and endeavors to repair the form and function through procedures such as skin grafting.

[Tatsuyuki Kudo]

Urology

In Japan, it seems to have developed independently from surgery, but it is a part of abdominal surgery. Its main targets are tumor inflammation and stones in the kidneys, ureters, prostate and bladder. Recently, for those who have lost kidney function, an artificial kidney has been used to remove waste products from the blood through dialysis, and kidney transplants have also become possible.

[Tatsuyuki Kudo]

Gynecology

It is a surgical department that deals with the female genitals, and some departments advertise themselves as obstetrics and gynecology as well as obstetrics.

[Tatsuyuki Kudo]

Otolaryngology

Each department is named after the organ it targets, and they are sometimes collectively referred to as otolaryngology.

[Tatsuyuki Kudo]

Ophthalmology

It is a surgical specialty that deals with diseases of the eye and its adnexa (such as the eyelids and eye muscles), and some also specialize in pediatric ophthalmology.

Naturally, surgery continues to progress with the help of progress and development in other fields. Among diagnostic methods and equipment, there is, first of all, the development of new X-ray diagnostic methods, namely the practical application of diagnostic equipment based on completely new principles, such as the so-called CT scanner and nuclear magnetic resonance. Furthermore, improvements in equipment have made it possible to observe the bile duct far beyond the conventional range, helping to expand the range of surgical applications and establish safety. Meanwhile, there have been developments such as cutting and cauterization using lasers and scalpels, which are also opening up new areas of surgical treatment. The future of surgery should be one in which the range of treatment targets is expanded while at the same time ensuring safety under strict consideration of suitability.

[Tatsuyuki Kudo]

"The Dawn of Surgery" by J. Thorwald, translated by Masao Shiotsuki (Kodansha Bunko)

Source: Shogakukan Encyclopedia Nipponica About Encyclopedia Nipponica Information | Legend

Japanese:

医学の一分科。外科とは、手と働きという意味の2語からなるギリシア語、つまり「手で仕事をする」という意味のギリシア語を語源とするsurgeryの訳語で、手術によって病気を治す医術あるいは医学（外科学）の意である。したがって、外科の歴史といえば手術の歴史に重複するところが多い。そこで外科の沿革は手術の項目に譲り、ここでは主として外科学の変遷の概説と、現在細分化されている外科の各科について述べる。

［工藤達之］

外科学の変遷

近代外科、現代の外科学の発足は19世紀中葉以後になるが、それまでの外科はいわゆる経験医学の域を脱することができず、外傷や戦傷に対する姑息(こそく)的な治療しか行われなかった。担当者は僧侶(そうりょ)か医師と自称するいかがわしい連中であり、今日の目でみると、でたらめ極まる治療が横行していた。ルネサンス以後にはややギルド的な制度が生まれ、外科医は理髪師が兼業していた。このころ、ヨーロッパの所々に学校が開かれ始めた。かくして1543年ベサリウスによる人体解剖書『ファブリカ』の発行が契機となって解剖を学ぶことが広く行われるようになり、このことが外科を学んだことを意味するようになった。そこで、短い上衣を着ていた床屋外科医を短衣派、大学派は長衣を着ていたので長衣派とよんで区別し、この両者が対立したまま19世紀に入った。

　近代外科の幕はアメリカの医師モートンのエーテル吸入麻酔法の発明（1844）によって開かれ、同じころウィーンではゼンメルワイスが、助産婦の手指をクロールカルキで消毒することにより産褥(さんじょく)熱の予防に成功した。続いてイギリスの医師リスターにより制腐・消毒の概念が導入されるに及び（1867）、今日の外科の基礎ができあがった。これによって勇気を得た医師たちは、より困難で複雑な手術に立ち向かうこととなる。手術手技の複雑化に伴い、止血が必要となる。出血する動脈を糸で結んで止血する方法は、フランスの医師パレの創意によって早く16世紀に始まった。この時期には、種々の優れた止血鉗子(かんし)の創案工夫によって多数の出血動静脈を手早く処理することが可能となり、近代外科の三本柱である麻酔・無菌法・止血法が完成した。こうした背景の下に腎臓(じんぞう)摘出、胃癌(がん)の摘除、甲状腺腫(せんしゅ)の摘出など、従来は未踏とされていた領域に次々とメスが加えられるようになる。

　しかし、19世紀の新段階でも、医師は上衣を脱いでワイシャツをたくし上げ、手を洗うだけであった。今日みられるような完全に消毒された白衣・白帽・マスクに身を包んだ外科医の姿をみるには20世紀の初頭まで待たねばならない。看護婦の誕生もだいたいこのころで、手術場の専門助手として、またそのマネージャーとしての職務が確立するのも期を同じくしている。この時期に、外科の発展にとって重要なX線と血液型が、それぞれ1895年と1901年に発見された。X線検査の重要性についてはいうまでもないが、血液型の発見は輸血を安全なものとし、大量出血下の外科手術を可能とした意義は大きい。

　医学全般の進歩は第二次世界大戦を境にして目覚ましい。すなわち、サルファ剤の開発を契機とする化学療法の発足と、これに引き続いて現れた抗生剤により、外科の大敵であった感染性疾患の激減がみられ、さらに今日まで次々と発見される新種の抗生剤のほか、ウイルスに対して有効なインターフェロンなどを駆使しつつ、外科は新しい進路を開拓して進んでいく。

［工藤達之］

外科各科

外科の発達に医学の専門分化と専門医の訓練組織の果たした役割は大きい。ヨーロッパでは、産科は早くから独立しており、早く眼科と耳鼻科、さらに泌尿器科と婦人科が分科した。その後、骨と運動器の外科として整形外科が分科し、専門臓器別に肺外科、脳神経外科、心臓外科の分科をみている。日本では、第二次世界大戦の影響もあって分科独立が遅れていたが、1960年（昭和35）以後に外科の急速な発達がみられ、それぞれを専門とする医師が生まれている。このほか、補助的分科としての麻酔科の独立も特記すべきであろう。このような専門科の分科傾向は世界的なものであり、先進国といわれる諸国では多少の差はあっても専門医制度を採用している。これは、一定の修練期間を経たのち、試験によって資格を与え、身分を保護して医療レベルの向上を企図するものである。日本では現在のところ、外科領域では麻酔科と脳神経外科のみがそれに近い認定医制度を設けているだけである。以下、現在分科している外科各科とその担当領域を述べる。

［工藤達之］

一般外科

腹部外科や外傷をはじめ、ひょうそなど四肢の化膿(かのう)性疾患、筋炎、肛門(こうもん)周囲の炎症や膿瘍(のうよう)などのいわゆる感染症のほか、頸部(けいぶ)リンパ腺炎や甲状腺腫などの頸部疾患、乳房や肛門の疾患などを対象としている。このうち、腹部外科には鼠径(そけい)ヘルニア、虫垂炎、腹膜炎、胆石症、胆道炎、胃潰瘍(かいよう)、十二指腸潰瘍などのほか、食道・胃・大腸および直腸の癌、脾臓(ひぞう)や膵臓(すいぞう)の疾患なども含まれ、消化器外科とよばれることもある。また外傷学は前述のように外科学の発端となった分野であるが、大きい戦争のとだえた現在でも、災害の増大と激甚化によって重要性が増し、その初期を担当する救急外科の医師の役割は大きい。なお、末梢(まっしょう)血管、大動脈、四肢の動脈や静脈など血管疾患も一般外科に含まれるが、これを専門とする血管外科も分科する傾向にある。そのほか内分泌外科や移植外科を標榜(ひょうぼう)するものもあり、特殊なものに小児外科がある。

［工藤達之］

胸部外科

古くは肺外科、ことに日本では肺結核外科に始まった。現在は肺腫瘍、肺膿瘍、重症気管支拡張症などが主で、少数の胸部疾患が含まれ、呼吸器外科ともよばれる。

［工藤達之］

心臓外科

心臓とそれにつながる大血管の先天性疾患がおもな対象で、血管外科とともに心臓血管外科あるいは循環器外科を標榜するものもある。

［工藤達之］

脳神経外科

脳と脊髄(せきずい)の疾患を対象とし、腫瘍、血管腫、動脈瘤(りゅう)、脳出血、膿瘍、外傷などを取り扱う。この科の進歩には、神経学の進歩と、脳室撮影法や脳血管撮影法の普及、脳波や放射性同位元素を応用する診断法、超音波診断法、CT装置、核磁気共鳴法装置などの発明導入などが大きく貢献している。

［工藤達之］

整形外科

骨と四肢の外科で、骨折をはじめ関節疾患や手足などの先天性疾患などを取り扱う。

［工藤達之］

形成外科

身体外表の形態異常、醜形、欠損や瘢痕(はんこん)などを対象とし、植皮術などによって形態的、機能的な修復努力をする。

［工藤達之］

泌尿器科

日本では外科から離れて独自の発達をしたようにみえるが、腹部外科の一部である。腎・輸尿管・前立腺・膀胱(ぼうこう)の腫瘍炎症、結石などをおもな対象とする。近来、腎機能を失ったものについて、人工腎臓を用いて血液中の老廃物を透析して除去する方法が行われ、腎移植なども行われるようになった。

［工藤達之］

婦人科

女性性器を対象とする外科で、産科とともに産婦人科を標榜するものもある。

［工藤達之］

耳鼻科・咽喉科

それぞれ対象とする器官を名称としており、まとめて耳鼻咽喉科とすることもある。

［工藤達之］

眼科

目とその付属器（眼瞼(がんけん)や眼筋など）の疾患を対象とする外科で、小児眼科を標榜するものもある。

　当然のことながら外科は、他領域の進歩発展に助けられて進歩を続ける。診断法と装置について特筆すべきものをあげると、まず新しいX線診断法の開発、すなわち、いわゆるCT装置とか核磁気共鳴法など、まったく新しい原理に基づく診断装置の実用化などがある。また装置の改良により、ファイバースコープなどは従来の範囲をはるかに超えて胆道の観察までを可能とし、手術の適応範囲の拡大と安全性の確立に役だっている。一方、レーザー・メスによる切断・焼灼(しょうしゃく)の開発などがあり、やはり外科治療の新しい領域を開きつつある。外科の将来はこのように治療対象の拡大と同時に厳しい適応の検討下に、安全性を確保しながら進められるべきものであろう。

［工藤達之］

『J・トールワルド著、塩月正雄訳『外科の夜明け』（講談社文庫）』