Do you like the idea of using your hands, lifting a scalpel, and curing ailments with

你是否喜歡用你的手，舉起手術刀，並治療疾病的想法與。

immediacy?

即時性？

Surgery is romanticized and idealized for good reason.

手術被浪漫化、理想化是有原因的。

This is the history of surgery.

這就是外科的歷史。

Dr. Jubbal, MedSchoolInsiders.com.

朱波醫生，醫派內參網。

Over the last century, the human lifespan has been extended by almost 30 years.

在上個世紀，人類的壽命已經延長了近30年。

Given that humans have been walking the planet for 200,000 years, this is the product of

鑑於人類已經在地球上行走了20萬年，這是由人類在地球上行走的產物。

something recent and immensely profound.

最近發生的、無比深刻的事情。

During the Renaissance, a collective scientific conscience was born that bred revolutions

在文藝復興時期，誕生了一種集體的科學良知，孕育了革命。

in math, physics, chemistry, biology, anatomy, human physiology, philosophy, and religion.

在數學、物理、化學、生物、解剖學、人體生理學、哲學和宗教方面。

We started to understand the way the world works at an unprecedented pace, and with a

我們開始以前所未有的速度瞭解這個世界的運作方式，並以一種

framework in place for understanding nature, we rebuilt the discipline focused on the inner

在理解自然的框架下，我們重建了專注於內在的學科。

composition of the human body - anatomy - the basis of medicine.

人體的構成--解剖學--醫學的基礎；

Soon after, surgery was reborn and equipped to do so much more than the bloodletting and

不久之後，外科重生，並具備了比放血和放血更多的條件。

trephination procedures, or drilling holes in skulls, that were used to "free illness,

顱骨鑽孔手術，或在頭骨上鑽孔，用來 "祛病"。

spirits, and demons" during the Ancient Times.

魑魅魍魎 "在古代。

Before this period, one couldn't even dream of antiseptics and anesthesia.

在這個時期之前，人們連做夢都不敢想防腐劑和麻醉劑。

We didn't understand that microorganisms could invade the body and cause illness and

我們不瞭解微生物會侵入人體，導致疾病和。

infection, and as a result, doctors would wear black, unwashed overcoats layered with

感染，是以，醫生們會穿上黑色的、沒有洗過的大衣，在大衣上層層疊疊地鋪上一層薄薄的塑料薄膜。

blood, pus, and other bodily matter.

血液、膿液和其他體液；

The same set of instruments would be used on different patients and wiped down by the

同樣的一套器械會用在不同的病人身上，並由

same unwashed cloth before each operation.

每次操作前都要用同一塊未清洗的布。

Patients would be strapped down to the table as it was believed they should remain alert

病人會被綁在桌子上，因為人們認為他們應該保持警惕。

and awake to increase the odds they come out of the procedure alive.

並清醒地增加他們活著走出手術室的機率。

With the horrific nature of this work preceding anesthesia, surgeons were praised for operating

由於這項工作在麻醉前的可怕性，外科醫生在手術中受到了讚揚。

quickly to minimize suffering.

迅速減少痛苦。

Of course, this came at the cost of accuracy and precision, leading to an additional layer

當然，這是以準確度和精確度為代價的，導致了額外的一層。

of issues.

的問題。

The timeline of surgical history is dated all the way back to 6500 BC.

外科史的時間線可以一直追溯到公元前6500年。

However, we're going to highlight the past two thousand years, focusing on events prior

然而，我們要強調的是過去兩千年的事情，重點是之前的事情。

to the Renaissance, during the Renaissance, and during the modern times when this field

到文藝復興時期，在文藝復興時期，以及在這個領域的現代時期

took shape into what we recognize surgery to be.

形成了我們所認識的手術。

You can't delve into the history of surgery without discussing Galen, a surgeon of the

深入研究外科歷史，就不能不討論蓋倫這個外科醫生。

Roman Empire and a pioneer anatomist whose ideas - many of which were massive misinterpretations

羅馬帝國和一個先驅的解剖學家，他的想法 - 其中許多是巨大的曲解。

- influenced (and misled) western medicine for 1,300 years.

- 影響（和誤導）西醫1300年。

Having studied in Alexandria, the grandest medical center of the ancient world, Galen's

在古代世界最宏偉的醫學中心--亞歷山大學習過，蓋倫的。

contributions to medicine rank him second only to Hippocrates.

對醫學的貢獻僅次於希波克拉底。

A cut-throat gunner, Galen regularly tested his medical contemporaries with his intellect

蓋倫是個刀槍不入的人，他經常用他的智慧考驗同時代的醫學家們

and daring attitude.

和大膽的態度。

On one occasion, Galen disemboweled a live ape and challenged his dumbfounded medical

有一次，蓋倫將一隻活猿剖腹，向他那目瞪口呆的醫學界發起挑戰。

rivals to fix the wound, none of whom could.

競爭對手來修復傷口，沒有一個人能做到。

He then beamed in, secured the intestines, repaired the wound in a glamorous surgery,

然後，他束手就擒，固定好腸子，修復傷口，做了一個魅力十足的手術。

and won himself the opportunity to serve as the chief physician to a reputed troop of

併為自己贏得了為一支著名的部隊擔任主治醫生的機會。

Gladiators.

角鬥士。

Today, when an NFL player takes a hard hit, the NFL team physicians kick into action to

如今，當一名NFL球員受到重創時，NFL的隊醫們就會啟動行動，以。

treat injury and restore functionality.

治療損傷，恢復功能。

Galen's role wasn't so simple.

蓋倫的作用並不那麼簡單。

Throughout the Roman empire, gladiators would entertain audiences through violent, bloody

在整個羅馬帝國，角鬥士通過暴力、血腥的方式取悅觀眾。

combat with other gladiators, wild animals, and condemned criminals.

與其他角鬥士、野生動物和被判刑的罪犯的戰鬥。

At his core, Galen was focused on understanding man's anatomy, but human dissections had

蓋倫的核心是專注於瞭解人類的解剖學，但人體解剖有

been strictly forbidden.

一直嚴禁。

So when he treated dying gladiators, he would carefully peer into fatal wounds, trying to

所以當他治療垂死的角鬥士時，他會小心翼翼地窺視致命的傷口，試圖... ...

understand what the human body looked like from the inside.

瞭解人體從內部看是什麼樣子。

He made many original observations about wound healing and wound management, some of which

他對傷口癒合和傷口處理提出了許多獨到的看法，其中有些是

were glaringly wrong.

是明顯的錯誤。

He thought, for example, that bone was composed of sperm.

例如，他認為骨頭是由精子組成的。

Galen resorted to performing experiments and dissections on living and dead monkeys, pigs,

蓋倫採用對活的和死的猴子、豬進行實驗和解剖。

sheep, goats, and other animals.

綿羊、山羊和其他動物；

He felt that the anatomical structures of these animals mirrored those of humans, and

他認為，這些動物的解剖結構與人類的解剖結構相吻合。

used their composition to make inferences about the human body.

用它們的組成來推斷人體的情況。

Though he ultimately contributed greatly to the understanding of many different organ

雖然他最終對許多不同器官的理解做出了巨大貢獻。

systems, Galen was also responsible for many misconceptions.

系統，蓋倫也要為許多錯誤的觀念負責。

The problem was that he was incredibly prolific - having published over 2,000,000 words in

問題是，他的產量非常高--他在《世界日報》發表了超過200萬字的文章。

his lifetime - and his ideas, though not corroborated, were taken as dogma, dominating medical science

他的觀點雖然沒有得到證實，但卻被視為教條，主導了醫學科學。

for over a thousand years.

一千多年來，。

Somehow the fact that Galen's work was centered around animal dissections and not humans was

不知何故，蓋倫的工作是圍繞著動物解剖，而不是人類，這是個事實

lost in translation.

丟失的翻譯。

For 1,300 years, Galenic physiology misguided the scientific world, and it's an interesting

在1300年的時間裡，蓋倫生理學誤導了科學界，這是個有趣的問題

exercise to imagine what medicine would be like today if those 1,300 years of science

想象一下，如果有1300年的科學，今天的醫學會是什麼樣子？

had been used more productively.

已被更有效地利用。

During the early renaissance, physicians who had been trained in universities considered

在文藝復興早期，在大學裡接受過培訓的醫生們認為。

surgery beneath them.

手術在他們下面。

Again, they were primarily learning from Galen's animal research.

同樣，他們主要是學習蓋倫的動物研究。

These physicians diminished the field of surgery, which consisted mainly of amputations and

這些醫生縮小了外科領域，主要包括截肢和手術。

bloodletting.

放血；

Bloodletting was rooted in the Ancient Times when Hippocrates, The Father of Medicine,

放血是植根於古代，醫學之父希波克拉底。

said that existence was represented by four elements - earth, air, fire, and water - which

說，存在由四種元素--地、氣、火、水--代表。

were related to humans through four basic humors, or fluids: blood, phlegm, black bile,

通過四種基本的體液或液體：血液、痰液、黑膽汁與人類發生關係。

and yellow bile.

和黃膽。

This was the basis of the famous humoral theory: each humor was related to a particular personality

這就是著名的幽默理論的基礎：每一種幽默都與特定的人格有關。

type, and illness was seen as an imbalance of the four humors.

型，而疾病則被視為四種體質的不平衡。

When Galen declared blood as the most dominant humor, propagating his ideas through the power

當蓋倫宣稱血液是最主要的幽默，通過力量來宣傳他的思想的時候

of his pen, bloodletting - the process by which blood was drained to relieve illness

- became accepted as the standard treatment for many conditions.

- 成為許多疾病的標準治療方法。

Over time, the practice was subject to increasing controversy and Renaissance physicians started

隨著時間的推移，這種做法受到越來越多的爭議，文藝復興時期的醫生們開始

relegating this procedure to Renaissance surgeons.

把這種手術歸結為文藝復興時期的外科醫生。

However, the surgeons of the early Renaissance were not even physicians - they were barbers.

然而，文藝復興早期的外科醫生甚至不是醫生，他們是理髮師。

Yes, the same barbers that hook you up with crisp fades and beard lineups were wielding

是的，同樣的理髮師給你掛上清脆的淡妝和鬍鬚的陣容，他們揮舞著

the scalpel as well.

手術刀以及。

Though they didn't have a medical education, these barber-surgeons were apprenticeship-trained

雖然他們沒有接受過醫學教育，但這些理髮師和外科醫生都是學徒制的。

to cut hair, conduct amputations, drain blood, and complete small surgical procedures.

剪髮、進行截肢、放血、完成小手術。

You could theoretically have a clean shave and an amputation in one sitting by the same

理論上說，你可以用同一個人一次就把鬍子刮乾淨，然後再做截肢手術。

practitioner.

醫師。

Just as blacksmiths would become masters of their craft, barbers would also become excellent

就像鐵匠會成為手藝大師一樣，理髮師也會成為優秀的鐵匠。

at performing tooth extractions and treating war wounds.

擅長拔牙和治療戰爭創傷；

The red-and-white-striped barber poles at your local barber shop actually represent

當地理髮店的紅白條理髮杆其實代表著

the blood and bandages of barber-surgeons.

理髮外科醫生的血和繃帶。

Because these individuals were not doctors, they were also addressed as Mister instead

由於這些人不是醫生，所以也稱他們為先生而不是先生。

of Doctor.

博士的。

Today, some British surgeons continue to address themselves as Mister for historical significance.

今天，一些英國外科醫生為了歷史意義，仍以先生自稱。

During the 16th century, surgeons would use red-hot pokers and boiling oil to seal off

在16世紀，外科醫生會用紅熱的鍋和沸油來封堵。

the raw, bleeding flesh of amputation wounds.

截肢傷口的生血肉。

And just as agonizing as this treatment was, it was just as ineffective at stopping blood

而就在這種治療的痛苦中，它的止血效果也同樣不理想。

loss or preventing infection.

損失或防止感染。

Then one day, a barber surgeon named Ambroise Paré found himself short of hot oil.

有一天，一位名叫安布羅斯-帕雷的理髮師發現自己缺少熱油。

In what happened to be a sweeping turn for medical history, he decided to use threads

恰好是醫學史上的一次大轉折，他決定用線材

from his coattail to tie off the ends of bleeding vessels before dressing a wound with gauze.

在用紗布包紮傷口之前，從他的大衣尾巴上扎掉出血的血管末端。

To great surprise, prompt healing ensued, and Paré established himself as the father

出乎意料的是，隨後迅速痊癒，帕雷也確立了自己的父親地位。

of modern surgery, catalyzing a series of surgical breakthroughs that soldiers on the

的現代外科手術，催化了一系列外科手術的突破，兵臨城下。

battlefield have been forever thankful for.

戰場上已經永遠感恩。

Since 210 AD, Galen's ideas prevailed and massive misconceptions had been forged in

自公元210年以來，蓋倫的思想佔了上風，大量的錯誤觀念已經在

the minds of generations of scientists and physicians.

幾代科學家和醫生的思想。

Finally, during the Renaissance, Andreas Vesalius forced the world to rethink it all.

最後，在文藝復興時期，安德烈亞斯-維薩留斯迫使世界重新思考這一切。

For centuries, the medical establishment had been teaching students in a two step process:

幾百年來，醫學機構一直以兩步走的方式教授學生。

first, professors would read anatomical text, most of which was built off of Galen's inaccurate

首先，教授們會讀解剖學的文章，其中大部分是建立在蓋倫的不準確的基礎上的。

ideas; then a surgeon (or his servant) would perform a dissection for students to observe.

念；然後由外科醫生（或其僕人）進行解剖，讓學生觀察。

The medical students of the time rarely had opportunities to engage with cadavers themselves,

當時的醫學生很少有機會親自接觸屍體。

they didn't have textbooks to take home, and they definitely didn't have Anki or

他們沒有課本帶回家，他們也肯定沒有安琪或

Memm flashcards to shuffle through from the comfort of their couch.

Memm flashcards可以在舒適的沙發上進行洗牌。

Their learning opportunities were limited, and a true familiarity of the human body could

他們的學習機會是有限的，真正熟悉人體可

only be acquired after a long surgical career.

只有在長期的外科生涯中才能獲得。

The irony lies in the fact that Galen's greatest virtue - his emphasis on observing

諷刺的是，蓋倫最偉大的美德--他強調遵守

for oneself - was lost over time.

為自己--隨著時間的推移，失去了。

However, Andreas Vesalius broke with this tradition and began openly doing dissections

然而，安德烈亞斯-維薩利烏斯打破了這一傳統，開始公開做解剖工作

himself because for the first time since the ancient times, human dissections had been

因為自古以來，人類的解剖第一次被發現。

permitted.

允許。

He started relearning human anatomy from cadavers and scrutinizing ancient text, which helped

他開始從屍體上重新學習人體解剖學，仔細研究古文字，這有助於

him ultimately recognize that most of Galen's research was founded on animal vivisections.

他最終認識到，蓋倫的大部分研究都是建立在動物活體解剖的基礎上。

Vesalius began to rewrite anatomical text from his own research, pointing out Galen's

維薩留斯開始根據自己的研究改寫解剖學文本，指出蓋倫的

errors and facing resentment from the scholars of the time.

錯誤，並面臨當時學者的不滿。

Then, in 1543, he published De Humani Corporis Fabrica - which means On the Fabric of the

然後，在1543年，他出版了De Humani Corporis Fabrica--意思是On the Fabric of the Humani Corporis Fabric。

Human Body - a landmark, revolutionary textbook.

人體--一本具有里程碑意義的革命性教材。

Besides the fact that this was the first resource accurately compiling information on the anatomy

除了這是第一份準確編纂解剖學資料的資料外，這也是第一份準確編纂解剖學資料的資料。

of the human body for medical students, it was also one of the first publications where

為醫學生提供的人體知識，它也是最早的出版品之一，其中包括

illustrations - the earliest anatomical models - had been incorporated alongside ancient

插圖--最早的解剖模型--已經與古代的圖畫結合在一起。

text.

文本：

Now this might seem small, but I assure you that it is not.

現在，這可能看起來很小，但我向你保證，它不是。

The incorporation of anatomical illustrations catalyzed a paradigm shift in medical education,

解剖插圖的加入催化了醫學教育模式的轉變。

science, and surgery because it provided students with a much-improved method to study human

科學和外科，因為它為學生們提供了一個大大改進的研究人類的方法。

anatomy.

解剖學。

Up until this time, students had been learning primarily by watching operations and hearing

在此之前，學生主要是通過看操作和聽講解來學習的

professors readout anatomic text.

教授們讀出解剖學的文字。

If a cadaver was available by mere chance for medical students to use, they were expected

如果僅僅是偶然有一具屍體可供醫學生使用，他們就應該......。

to work quickly, dissecting and studying each organ system as efficiently as they could.

迅速開展工作，儘可能高效地解剖和研究每個器官系統。

However, they were entirely reliant on their memory and retention of this newly acquired

然而，他們完全依靠自己的記憶和保持這種新獲得的。

knowledge since graphic visuals of the human body were absent from their coursework.

知識，因為他們的課程作業中沒有人體的圖形視覺。

These illustrations - intricately shaded with fine, visceral detail - served as 2D models

這些插圖--以精細、內臟的細節複雜地著色--作為二維模型。

to truly gather a deep understanding of the human body, liberating students from their

以真正聚集對人體的深刻理解，把學生從他們的

learning constraints, and more importantly, it forced interdisciplinary collaborations

學習的限制，更重要的是，它迫使跨學科合作。

to take place between anatomists, like Vesalius, and artists, like Leonardo da Vinci.

發生在解剖學家，如維薩留斯，和藝術家，如達文西之間。

This collaboration evolved as artists and sculptors started producing three-dimensional

這種合作隨著藝術家和雕塑家開始製作三維立體作品而不斷髮展。

wax anatomical models by the 17th and 18th centuries, many of which are still available

17和18世紀的蠟質解剖模型，其中許多仍可使用。

today in cities like Florence.

今天在佛羅倫薩等城市。

These wax models captured an unprecedented volume of information and allowed students

這些蠟模捕捉了前所未有的信息量，讓學生們

to understand the human anatomy from a three-dimensional, spatial orientation that increased the rate

從三維空間方位瞭解人體解剖結構，提高了速度。

at which surgeons in training and medical students could understand the inner layout

在這一點上，受訓的外科醫生和醫科學生可以瞭解內部佈局

of the human body.

的人體。

These models were eerily accurate - capturing the intricacies of death and decay, blood

這些模型準確得令人毛骨悚然--捕捉到了死亡和腐爛的複雜性，血液

vessels, the brain, and even facial expressions - and are truly significant to the advancement

of medical education.

醫學教育。

Wax anatomical modeling during the Renaissance was all the rage.

文藝復興時期，蠟質解剖模型風靡一時。

For the first time in the course of human history, medical students were fed a deep

在人類歷史進程中，醫學生第一次被灌輸了深刻的

understanding of the human body as they could sit with surprisingly accurate three dimensional

對人體的理解，因為他們可以以驚人的精確的三維坐姿坐在那裡。

wax anatomical models and fully take in the composition of the human body.

蠟制解剖模型，充分攝取人體的構成。

These didactic tools allowed scientists and physicians to understand anatomy and physiology

這些教學工具使科學家和醫生能夠了解解剖學和生理學。

to a greater degree than ever before, but there was still much to learn.

到了比以往任何時候都更大的程度，但仍有很多東西需要學習。

In the 1700s, body snatchers would flock to cemeteries, stealing cadavers for dissection.

在17世紀，搶屍者會湧向墓地，偷取屍體進行解剖。

In the 1800s, ether and chloroform started to become popular as anesthetics, and for

19世紀，乙醚和氯仿作為麻醉劑開始流行，對

the first time, patients didn't have to face an excruciating amount of pain in their

第一次，患者不必再面對他們的痛苦。

surgical procedures.

手術程序；

With the newfound capacity to sedate patients, we could spend much more time studying the

隨著新發現的鎮靜病人的能力，我們可以花更多的時間來研究。

human body and making sense of disease, advancing the rate at which we acquired medical knowledge.

人體和對疾病的認識，進步了我們獲得醫學知識的速度。

One of my personal favorites from this era is Dr. William Halsted, a cocaine-addicted,

這個時代我個人最喜歡的一個人是威廉-哈斯泰德醫生，一個可卡因上癮的人。

incredibly badass surgeon whose influence is difficult to overstate.

令人難以置信的壞蛋外科醫生，其影響力是難以誇大的。

Spending his early life as a jock with subpar grades, he eventually found an interest in

他早年以成績不佳的運動員身份度過，最終發現對

medicine and emerged at the top of his class at the Columbia University College of Physicians

醫學，並在哥倫比亞大學醫學院的班級中名列前茅。

and Surgeons.

和外科醫生。

After studying under the tutelage of many prominent surgeons and scientists in New York

在紐約許多著名的外科醫生和科學家的指導下學習後。

and Europe, he started to teach surgery, creating a hands-on experience for his students.

和歐洲，他開始教授外科手術，為學生創造實踐經驗。

Known for being a charismatic, inspiring teacher and a bold surgeon, ***he also performed one

他以富有魅力、鼓舞人心的教師和大膽的外科醫生著稱，***還進行了一次。

of the first gallbladder operations in the US on his own mother at 2 AM*** - with no

凌晨2點在美國為自己的母親做了第一臺膽囊手術***--沒有任何副作用。

experience, he meticulously removed seven gallstones, and his mother made a full recovery.

經驗，他一絲不苟地切除了7顆膽結石，母親也完全康復。

In 1884, Halsted started self-experimenting with cocaine for its anesthetic power.

1884年，哈爾斯特德開始自我試驗可卡因的麻醉能力。

In an effort to understand whether it could be used on his patients, he would inject it

為了瞭解是否能用在病人身上，他就會給病人注射。

in himself, ultimately enslaving himself to the drug.

在自己身上，最終把自己奴役在毒品上。

After years of recovery, his friend, William Welch, invited him to serve as one of four

經過多年的康復，他的朋友威廉-韋爾奇邀請他擔任四位 "中國人 "之一。

founding Professors of the Johns Hopkins School of Medicine.

約翰-霍普金斯醫學院的創始教授。

At Johns Hopkins, he pioneered medical education by establishing the first formal surgical

在約翰-霍普金斯大學，他開創了醫學教育的先河，建立了第一所正規的外科醫院。

residency training program in the United States.

美國的住院醫師培訓項目。

He designed this system off of ideas that he had come across in Europe and laid the

他根據在歐洲遇到的想法設計了這個系統，並奠定了這個系統的基礎。

foundation for how residency training programs across the country would be organized: they'd

為如何組織全國的住院醫師培訓項目奠定基礎：他們會

start with an internship, followed by six years as an assistant resident and two years

從實習開始，然後是6年的助理住院醫師和2年的住院醫師

as a house surgeon.

作為一個家庭醫生。

This structure created role models and teachers that future generations of surgeons could

這種結構創造了榜樣和老師，讓未來的外科醫生能夠

look up to, and under this system, Halsted trained Harvey Williams Cushing and Walter

仰望，在這個體系下，哈爾斯特德訓練出了哈維-威廉姆斯-庫欣和沃爾特-。

Dandy, the founders of neurosurgery.