Surgery and anaesthetics in the 19th century

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  • Surgery and anesthetics in the 19th century
    • before anaesthetics
      • amputations
        • extremely painful
        • many people died from blood loss or infection
        • sawdust on floor to soak up blood
          • tourniquet around the thigh to soak up the blood
    • anaesthetics
      • Ether
        • irritated the eyes and lungs causing coughing and sickness
        • flammable and came in a bottle difficult to carry
      • laughing gas
        • used in surgery by dentists
          • but did not make patients unconscious, so wasn't solution to pain
      • impact of anaesthetics
        • surgery was pain free
          • complex operation
        • research into safer and more effective anaesthetics
      • Opposition
        • pain relief interfering with God's plan
        • new and not fully understood
    • Antiseptics
      • Infection
        • sepsis = condition where harmful bacteria harms flesh, leading to decay and infection
          • lots of people died from this because doctors didn't understand infection
            • 'Black period' of surgery
        • operating conditions weren't hygienic
          • surgeons wore normal clothes
          • dirty instruments and operating table
          • blood loss was a big problem
        • early attempts to control infection
          • Ignaz Stemmelweiss
            • saw correlation between death rate in childbirth and people working in wards
            • made people wash hands in chlorinated solution
              • reduced death rate
          • Florence Nightingale
            • had high standard of hygiene in hospitals
            • but didn't understand infection
              • believed in miasma
              • tightly bound wounds in hot temperature, which encouraged bacteria growth
      • Joseph Lister
        • Pasteur proved infection caused by microbes
        • carbolic acid
          • interested in Pasteur's work and found carbolic acid killed microbes causing infection
          • first, soaked bandages in carbolic acid
            • then used solution of carbolic acid to clean wounds, equipment and bandages
              • worked in antiseptic conditions
            • instead of using silk to tie bandages, causing infection- Lister used catgut which could be sterilised in carbolic acid
              • developed a form of catgut that dissolved, so a thread didn't need to be left hanging out of a wound
          • Lister made a carbolic acid spray
        • Reactions to Lister's antiseptics
          • Opposition
            • couldn't see microbes, so didn't believe they caused disease
            • doctor's who copied Lister didn't always copy correctly
              • said Lister was wrong
            • Lister kept changing methods to improve work but other doctors didn't trust this
            • equipment was expensive and heavy
              • a lot of extra work
            • Untitled
          • Pasteur's ideas spread slowly
          • Lister's carbolic spray seemed very extreme
            • slowed down operations
      • From antiseptic to aseptic
        • Robert Koch's discovery
          • 1978, steam was more effective than carbolic acid at killing harmful microbes
        • aseptic surgery= preventing there being ANY germs in the operating theater to infect wounds
        • operating theaters and hospitals vigorously cleaned
        • 1887, all instruments steam sterilised
        • surgeons wore surgical gowns and face masks
        • 1894, sterilised rubber gloves used
    • problem with blood loss
      • shock
        • when a patient looses too much blood and their body can't function properly
      • transfusions
        • 17th century = transfusions from animals but many patients died, so it was banned
        • usual way to control blood loss was cautery
          • cautery = sealing the blood vessel by placing a hot iron on the wound
          • 16th century, Ambroise Pare developed metal clips to place on arteries
            • not very effective
              • before Pasteur's germ theory, so infection carried in to wound by surgeon's hands
            • also used ligaments
              • silk thread tied around a blood vessel to stop bleeding
                • didn't always work
        • problems with transfusions
          • James Blundell brought transfusions back to Britain
          • clotting
          • availability
            • storing blood
              • Richard Lewisohn
                • Adding sodium-citrate stopped blood clotting
                  • donor didn't have to be present, more transfusions
                • blood could be refrigerated
              • Francis Rous and James Turner
                • adding citrate glucose, meant blood could be stored longer
                  • could ask for donations
              • Geoffrey Keynes
                • developed portable machine to store blood
                  • transfusions could happen near to battlefield
          • Immune response
            • Blood types
              • Karl Landsteiner suggested there were three different blood groups: A, B, O
                • AB later added in 1902
                • showed some blood types were incompatible
                • but effect of work wasn't immediate because there was the problem of storing blood
                  • needed a live donor
        • After First World War
          • British surgeons not convinced storing blood was as effective as having a live patient
            • blood groups often got mixed up
            • bottles blood stored in, weren't always bacteria free
            • Type O worked for everyone, so doctors targeted type O but led to shortage of donors
            • Doctors and surgeons reluctant to change, didn't trust new methods
    • Role of war in development of surgery
      • New developments in surgery
        • surgeons under immense pressure and gained lots of experience
        • soldiers suffered deep wounds from explosives
          • Surgeons cut away infected tissue and soaked wound in saline
        • more brain injuries meant surgeons had to try new methods
        • plastic surgery
          • Gillies's method
            • layer of skin lifted and attached to a tube, other end was attached to body so healthy skin could grow.
            • kept very detailed notes
        • advances in prosthetic limbs
      • science and technology
        • technology
          • X rays discovered by Wilhelm Roentgen in 1895
            • didn't take out  a patent, so people could copy ideas
              • use of x-rays spread quickly
            • simplified surgery
              • surgeons able to extract bullets and shrapnel effectively
                • reduced problems of bleeding and infection
        • science
          • chemistry important in developing antiseptics and anaesthetics
            • surgeons more willing to do complex operations
              • began dealing with internal problems
                • infection was controlled
      • spread of ideas
        • medical journals to inform other surgeons
          • most surgeons read the same journals
          • journals only published ideas based on good science
          • problems
            • also published methods that didn't work
              • stopped surgeons trying new techniques
              • spread of ideas was slow because of rejection
        • communication wasn't always effective
        • newspapers and public opinion
          • important as public opinion influenced development of surgery
      • impact
        • how did WW1 change surgery?
          • effective blood transfusions
          • development of x-rays
          • fighting infection
          • the development of plastic surgery
          • the development of brain surgery

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