Surgery means “the treatment of disease, injury or deformity by manual or instrumental operations, as the removal of diseased parts of tissue by cutting.” Like any other profession, surgery has shaped its environment through its experiences, referencing to own requirements and regulations throughout history. From early primitive operations to contemporary hospitals, places of surgery have started to evolve and enhance.

Around 3000 B.C., the Egyptian's played significant role about medicine and there had found carvings for a surgical operation. Unless the information about the place where these operations occurred are inadequate. In ancient Greek, time of the Hippocrates, temples served as healing and rehabilitative spaces. The system could monitor separate rooms for patients to rest and recover. In the Middle Ages, barbers’ service was not only cutting men’s hair or beard. They were performing minor surgical operations such as tooth extraction, bloodletting, and even amputations.  These operations, just like in barbershops and, also performed in patients’ houses. Although there were surgeons educated (considered as practitioners in modern surgery) in university, due to financial difficulties, more people sought advice from barber-surgeons. One could think of these barbershops as prior to operating theaters. (2)

 

OPERATING THEATER

Beginning of the 19th century, the operation was executed within a dedicated room, emphasizing the activity as heroic and grandiose. These areas were referred to as operating amplifiers because they had seating areas where students and participants could see the operation in progress.  urgery was a frustrating phenomenon in those days since there was no electricity, anesthesia, or medical gas lines.

In early  19th century, interior design of the room was organized by; •    A circular layout with the operating table in the middle. The area was the building's hearth, which is easily accessible. • A skylight and numerous windows to let in sunshine and to control shadows because the operations took place during the daylight hours.

In late 19th century, the location of the operating theater was commonly edges of the hospital and it was having own enterance, which easily noticable from outside. Before artificial lights,the location of a hospital's surgical environment can be inferred from windows to invite natural light.

According to Connor, three scientific advancements made huge impact on architecture of the surgery; anesthesia, antisepsis and X-ray. He suggests that alterations have been implemented to operating rooms and their furniture to offer smooth, impermeable surfaces that were easy to clean and did not harbor germs.

 

INVENTION OF ANESTHESIA

William Morton carried out the first-ever anesthesia-assisted operation by using inhaled ether in 1846. The procedure involved the removal of a neck tumor, which could be interpreted as the emergence of the first contemporary surgical anesthetic. This invention was a big game changer of the procedure and design of the currently recognized surgery. One of the biggest surgical phobias was vanished. Surgeons were not limited by time and patients were not traumatized during and after surgery. With the advent of devices like oxygen masks, anesthetic machines, anesthetic vaporizers, suction units, etc., anesthesia became more efficient and widespread as technology advanced and anesthesia became inextricable part of the surgery. In order to fulfill the requirements of this subject, the operating room's architecture was modified. In the present day, hospitals even have anesthesia chambers that are designed next to operating rooms.

 

ASEPSIS and ANTISEPSIS

During surgery or any other invasive medical operation, asepsis is a collection of treatments aimed to minimize infection. All methods of treating infection by getting rid of and stopping the growth of harmful bacteria are together referred to as antisepsis. It was impossible to discuss operating room sterilization awareness before to the 19th century. Surgeons carried out operations while wearing ordinary clothing. Infection was therefore unavoidable. Over fifty percent of the procedures were failing. "It is safer and better that all should put on a complete change of costume rather than simply wear a sterilized coat and pair of trousers over the ordinary clothing," stated Dr. Hunter Robber in 1894, the year that surgical scrubs were first used. He also suggested that this clothes be made white so that it would be easier to wash. Surgeons could do more intricate procedures thanks to anesthesia, however because there was no limited time constraint, the wounds and flesh tissues were remained open to infection for a lengthy amount of time. Joseph Lister first proposed a antiseptic system in 1867, by practicing carbolic acid to wounds, aiming antiseptic surgery. Additionally, he advised surgeons to use carbolic spray to clean their hands, glows, and instruments prior to surgery. In the belief that the vapor was going to eliminate all germs, he sprayed the operation room with acid lotion. Infection rates were decreased from45% to 15% by Lister's carbolic spray and pre-operative care.

 

THE SURGICAL SUIT

By removing the limitations of daylight, the development of artificial light allowed surgeons to concentrate with greater precision. In order to prevent unwanted pass-offs, the surgery rooms were transferred from the hospital's periphery to the inner part of the structure. Preparation rooms were designed around the operation room. More than a theater, it turned into a suit. The operating room was fully separated, artificially lit, and set up in a sequence of smaller, identical spaces within a specific hospital zone by the time of World War II. The surgical team restricts access to this particular region. To maintain the sterile area, public connections were prohibited.

 

CONCLUSION

From the earliest historical periods to the present, architecture has always been shaped by process requirements and technological advancements. Thanks to scientific improvements made by its surgeons, operating rooms became the model that we use today. As technology advances, the architecture of the operating room will also transform. And architects will be an passionate companians  of this process.

 

REFERENCES:

Britannica, T. Editors of Encyclopaedia (2022, September 29). surgery. Encyclopedia Britannica. 2022, September 29. https://www.britannica.com/science/surgerymedicine

Rutkow, I.M. Origins of Modern Surgery. In: Norton, J.A., et al. Surgery. Springer, New York, NY. 2008. https://doi.org/10.1007/9780-387-68113-9_1

Adams, A. (2017). Surgery and Architecture: spaces for operating. 

Gawande, A. (2012). Two hundred years of surgery. New England Journal of Medicine, 366(18), 1716–1723.

Michaleas S N, Laios K, Charalabopoulos A, et al. (December 21, 2022) Joseph Lister (1827-1912): A Pioneer of Antiseptic Surgery.

J.T.H. Connor, ‘The Victorian Revolution in Surgery’, Science, 304 (2004): 54–55

Belkin, N. Use of scrubs and related apparel in health care facilities. AJIC.

Buicho, J.L. (2016). From formalwear and frocks to scrubs and gowns: A brief history of the evolution of operating room attire. American Colloge of Surgeons.

El-Ayman, Y., Naguib, S., & Wasefy, T. (2023). Historical Journey of surgery and surgeons. Deleted Journal, 0(0), 0. https://doi.org/10.21608/ijhegy.2023.244175.1038

Adams, A., & Schlich, T. (2006). Design for Control: Surgery, Science, and Space at the Royal Victoria Hospital, Montreal, 1893–1956. Medical History, 50(3), 303–324. https://doi.org/10.1017/s0025727300010000