Surgery
- Created by: libbygrace
- Created on: 20-05-16 16:02
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- 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
- Michael Faraday
- 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
- He was boo'd off stage and denounced as a dentist
- Didn't work on everyone
- Humphrey Davy
- Alcohol
- Dilated blood vessels causing the patient to lose more blood
- Herbal anaesthetics
- Opioids
- No way to measure dose
- Ether
- 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
- Joseph Simpson
- 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
- More people gained infections relating to surgery
- Created the 'Black Period of surgery'
- 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
- Surgeons realised how addictive it was
- Main one was cocaine
- Early anaesthetics
- 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
- Badly recieved
- 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%
- Applied it to wounds and sprayed it during operations
- 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
- 1. He soaked instruments and bandages in carbolic acid
- Opposition to antsceptics
- 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
- Developed catgut ligatures (made from sheep gut)
- 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
- Tying blood vessels with a silk thread
- 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 attempted using both animal and human blood
- Ambroise Pare
- 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
- Found that adding sodium citrate to blood stopped clotting
- 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
- Adding citrate glucose solution to blood means that it can be stored for even longer
- Karl Landsteiner
- Discovered blood types in 1901
- Transfusion now possible
- Donor had to be there as no wayof storing blood
- Transfusion now possible
- Discovered blood types in 1901
- Blood Depots
- First one in 1917
- For battle of Cambrai
- Blood group 'O' used as it can be given to anyone
- First one in 1917
- Richard Wiel
- 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
- Joseph Lister
- 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
- Called it the Waltzing tube pedicle
- Set up his own plastic surgery hospital
- Harold Gillies
- 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
- More machines quickly manufactured and installed
- 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
- Identified ways in which war improves surgery
- Borken bones
- 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
- War
- Problem 1: Pain
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