OCR, History, Medicine, Through, Time, Unit 8 Surgery

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HISTORY OF MEDICINE ­ DEVELOPMENTS IN SURGERY
Background
Up until the 19th Century there were no really successful attempts to
overcome the three surgical barriers that prevented longer and more
complex operations.
Pain had been conquered with alcohol or opium in the Middle East however
it had side-effects. Blood Transfusions were attempted but nearly always
unsuccessful due to a lack of knowledge of blood groups. Infection was not
resolved until the work of Lister and later, Fleming, Florey and Chain with
Penicillin.
Anaesthetics
Most surgery was limited to amputations and removing growths which
would be carried out as quickly as possible to save the patient pain.
Occasionally patients would attempt to be hypnotised in order to ignore the
pain.
Developments in Chemistry in the late-18th Century led to Joseph Priestly
discovering oxygen as a gas (1772) and in 1799, Humphrey Davy discovered
nitrous oxides' pain relieving properties, however it was ignored by the
medical profession. Instead in 1842 Crawford Long discovered ether.
In 1845, when Horace Wells attempted to demonstrate nitrous oxide to gain
support he did not know that some people were not affected by it and by
chance his volunteer was one of those thus rendering his attempt useless.
In 1846, there was a frenzy of regained support for anaesthetics. William
Thomas Green Morton removed a tumour painlessly from a patient's neck in
public and Robert Liston amputated a leg only to find his patient sitting up
and asking Liston when he would begin.
in 1847, James Simpson, Professor of Midwifery at Edinburgh University
was looking for an anaesthetic as ether irritated the lungs.
While testing substances with two assistants he came across chloroform and
the next thing he knew of it, he was waking up after collapsing on the floor.
He tested it on over 50 patients and was pleased with its success as it was
stronger and quicker than ether.
However there was opposition to the use of anaesthetics inexperience of the
doctors in dealing with chloroform could be dangerous (Hannah Green died
from overdose in 1848), some believed that they were meant to feel pain
such as in childbirth, people were fearing of being under total control of the
surgeon.
When Queen Victoria used it in 1853, it became widely accepted, until
chloroform was found to damage the liver and people reverted back to ether
in the 20th Century.
In 1884, cocaine was used as the first local anaesthetic and finally in 1942
curare was used as a muscle relaxant ­ it is still used today.

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Antiseptics
Between 1846 and 1870, due to advances in anaesthesia, over-confidence in
surgeons meant that many patients died from infection, as Pasteur had not yet
proved his germ theory.
In 1847, Igor Semmelweiss suggested that doctors washed their hands with
chloride of lime in between dealing with patients in order to cut infection. It
worked and this demonstrates how a development was made through careful
observation.…read more

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