Surgery

HideShow resource information
View mindmap
  • Surgery
    • Problem 1: Pain
      • Early anaesthetics
        • Ether
          • Michael Faraday
            • 1815
            • Published its' properties
          • Irritates the lungs
          • Very flammable; made cauterisation even more dangerous
          • Used publicly by Liston in 1846
            • Amputation
          • Very popular
          • William Morton was the first to use it
            • Removed a tumor from a patients' neck
          • Longer lasting
            • Sometimes lasted too long
        • Laughing gas - nitrous oxide
          • Humphrey Davy
            • Discovered it but was not interested in its' pain relieving qualities
            • 1799
            • Accidental discovery
          • Horace Wells
            • Dentist
            • Decided to use it in dentistry operations
            • The patient involved in his first public use of it still felt some pain
              • He was boo'd off stage and denounced as a dentist
                • Committed suicide 3 years later
          • Didn't work on everyone
        • Alcohol
          • Dilated blood vessels causing the patient to lose more blood
        • Herbal anaesthetics
          • Opioids
          • No way to measure dose
      • Opposition to anaesthetics
        • Pain is God's will
        • Pain during childbirth was God's punishment to Eve
        • Effects not fully understood or realised
        • Doctors worried that it would be easier for a patient to die is they were unconscious during an operation
        • Number of patients dying after operations increased after anaesthetics used
      • Chloroform
        • Joseph Simpson
          • Grew obsessed with finding a new anaesthetic
          • Invited friends round to experiment with different drugs
            • Accidentally discovered chloroform
        • Made popular as it was used by both Kate Dickens and Queen Victoria in 1853
        • Dosage was difficult to measure
          • Hannah Greener died whilst having a toenail removed
        • Affected the heart
        • John Snow
          • 1848
          • Developed inhaler to regulate dosage
      • How anaesthetics hindered surgery
        • Created the 'Black Period of surgery'
          • More people gained infections relating to surgery
            • Still no knowledge about the causes of infection
      • How anaesthetics helped surgery
        • Surgery became longer
        • Surgery became deeper
        • Surgery became more complex
      • Local anaesthetics
        • Main one was cocaine
          • Surgeons realised how addictive it was
            • Developed a non-addictive substitute called novocaine
    • Problem 2: Infection
      • Opposition to antsceptics
        • Carbolic spay irritates the skin and lungs
        • The Germ Theory may not be true
        • It slows down operations and causes blood loss
        • Other surgeons didn't have the same amount of success as Lister - they were less able
        • Antisceptics may stop body's own defences
        • Lister's methods were always changing
      • Ignaz Semmelweiss
        • Hungarian Doctor Working in Vienna
        • Published his work in a book called 'Etiology, Concept and Prophlaxis of Childbed Fever' in 1861
          • Badly recieved
            • He had no proof for his findings
        • Women were frequently dying of childbed fever
          • Now known as septacaemia (bloodpoison-ing)
          • More often at the hands of doctors than midwives
            • Semmelweiss linked the childbed fever to doctors who performed dissections and didn't wash their hands
        • Forced doctors to wash their hands using water and chloride lime
          • Many refused
          • He lost his job
        • Went insane so his wife commited him to a phychiatric ward
          • Died a few weeks later of childbed fever
      • Asceptic Surgery
        • Surgery without germs
        • Operating theatres abd hospitals were thouroughly cleaned
        • 1887 - all instruments steam sterilised - process discovered by Koch in 1878
        • 1894 - sterilised gloves used
        • Sterilised clothing worn
        • Sterilised cloth on all surfaces
        • Surgeons and nurses wear masks
      • Joseph Lister
        • Actively searching for a way to kill germs
        • Realised that carbolic acid was used to stop sewers smelling and hypothesised that it killed germs in sewers
          • Applied it to wounds and sprayed it during operations
            • Percentage of his post-op deaths fell from 46% to 15%
        • Stages of development
          • 1. He soaked instruments and bandages in carbolic acid
            • 2. Carbolic acid spray developed. First it was pumped by hand, then it was steam powered. Sprayed during surgery
    • Problem 3: Bloodloss
      • Joseph Lister
        • Developed catgut ligatures (made from sheep gut)
          • Soaked these in carbolic acid to sterilise
        • Found that silk ligatures could not be sterilised
        • Developed catgut ligatures which dissolved
      • Early ways of dealing with bloodloss
        • Ambroise Pare
          • 1500s
          • Developed ligatures
            • Tying blood vessels with a silk thread
              • Very prone to infection
              • Required a lot of skill
          • Developed metal clips to put on arteries during an operation
        • Cautery irons
          • Sealing the wound with heat
          • Very painful
        • 1600s
          • Blood transfusions attempted using both animal and human blood
            • Patient usually died
            • Procedure banned
      • Blood transfusions
        • Richard Wiel
          • Found that blood could now be stored in refrigerated conditions
        • Richard Lewisohn 1915
          • Found that adding sodium citrate to blood stopped clotting
            • Meant that a donor did not have to be present during the transfusion
        • Francis Rous and James Turner 1916
          • Adding citrate glucose solution to blood means that it can be stored for even longer
            • Requested transfusions now possible
        • Karl Landsteiner
          • Discovered blood types in 1901
            • Transfusion now possible
              • Donor had to be there as no wayof storing blood
        • Blood Depots
          • First one in 1917
            • For battle of Cambrai
          • Blood group  'O' used as it can be given to anyone
      • Why is bloodloss a problem?
        • It makes it difficult for the surgeon to see what he is doing
        • Leads to a drop in blood pressure which can be fatal
    • WW1
      • Borken bones
        • Methods to pin shattered bones discovered
        • Developments in artificial limbs
      • Fighting infection
        • Asceptic surgery impossible
        • Ways to treat gangrene discovered
          • Cut away infected tissue and soak the wound in saline solution
      • Skin grafts
        • Harold Gillies
          • Set up his own plastic surgery hospital
            • The first of its' kind
          • Developed the Indian Pedicle and the Russian tube Pedicle
            • Called it the Waltzing tube pedicle
              • Wove a tube of skin around the body
      • Blood transfusions
        • Ways of transporting blood found
        • See bloodloss section
      • Facial Surgery
        • Eye
        • Ear
        • Nose
        • Throat
      • X-Rays
        • More machines quickly manufactured and installed
          • Paid for by government
        • Development of mobile x-ray units
        • Helped reduce need for exploratory surgery as shrapnel could be located
      • Successful attempts at brain surgery
      • Heneage Ogilvey
        • Identified ways in which war improves surgery
          • Industry and Government devote resourses to surgeons and equipment
          • Brings surgeons together to share ideas
          • Surgeons have more practise and work harder
    • Factors
      • War
        • Mobile X-Rays
        • X-Rays
        • Saline solution for gangrene
        • Florence Nightingale
        • Blood tranfusions
        • Lots of practise for surgeons
        • Plastic surgery
        • New techniques and new instruments for new wounds
        • Prosthetic limbs
      • Science and Technology
        • The Germ Theory by Louis Pasteur
        • Alexander Wood invents hypodermic needle 1853, used in blood transfusions
        • The Carbolic acid spray by Joseph Lister
        • Invention of the chloroform inhaler by John Snow
        • Invention of steam steriliser
        • Marie Curies portable x-ray device
        • Mass production of instruments and rubber gloves
        • Landsteiner and blood groups
        • 1895 - Rontgen's discovery of x-rays
        • Use of chemicals for antisceptics, anaesthetics and blood storage
      • Communicati-ons
        • The Lancet publishes about Hannah Greener's death
        • Rontgen doesn't patent x-rays
        • Newspapers report Queen Victoria's use of chloroform
        • Shared ideas e.g. the Germ Theory
        • Pasteur, Lister and Koch all attemd a scientific conference in London

Comments

No comments have yet been made

Similar History resources:

See all History resources »See all Medicine through time (OCR History A) resources »