Surgery - Replacing/Controlling blood loss/Infection

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Early attempts to control infection
Ignaz Semmelweiss worked at Vienna General Hospital in Austria. In 1846 he was concerned that the
death rate among women in childbirth was higher in the hospital, in the ward were medical students
were involved, than in home births or in wards where midwives delivered the baby. The medical
students often came from the dissecting room, cutting up bodies, to the childbirth delivery room.
Semmelweiss found that making the students wash their hands using a chlorinated soloution reduced
the death rate dramatically.
Despite the change in death rate, many other doctors made fun of Semmelweiss' ideas. Eventually
he was sacked from the hospital and left Vienna.
JAMES SIMPSON copied Semmelweiss' ideas when he was professor or Midwifery in Edinburgh Uni
and later when he came to London. However these ideas were not accepted for some time.
Meanwhile, FLO NIGHTINGALE set high standards of hygiene in her work in hospitals and the training
of nurses. For example, she insisted on ONLY ONE PERSON PER BED. However she did not understand
on how infection occurred. She believed that disease was caused by poisonous vapours. In fact the
idea of MIASMA led to wounds being tightly bandaged ­causing the temperature to increase and
ultimately encourages the growth of bacteria.
IT WAS NOT UNTIL 1861 that the French doctor Louis Pasteur conducted experiments that proved
that decay and infection were caused by microbes in the air. It took time for Pasteur's ideas to be
accepted by scientists and even longer for his ideas to be applied to medicine.
Lister tired various methods to encourage wounds to heal cleanly without infection. But had little
success. He became interested in Pasteur's work and especially the idea that microbes were
responsible for infection in a wound. In 1864 he found that the carbolic acid was used in the sewage
works at Carlisle and that it killed parasites. Lister thought that carbolic acid could be used to kill the
microbes causing infection. In 1865 he tested his ideas on an 11 year old boy who was brought to
hospital with a compound fracture. At this time, the infection would almost certainly lead to death.
Lister soaked the bandages in carbolic acid and watched the wound carefully. There was no sign of
pus or infection. After 6 weeks the fracture and the wound had healed.
Lister now used a solution of carbolic acid to clean wounds, equipment and bandages. In 1867 he
announced that his wards had been free from sepsis in 1867. Around 1877 he carried out an
operation on a kneecap under antiseptic conditions. This operation became widely publicised and
other surgeons began to copy his ideas.
At this time, silk was used as stitches. However, silk did not absorb carbolic acid and therefore could
not be sterilised. A thread had to be left hanging out the wound so the stitches could be pulled out
once the wound had healed. BOTH OF THESE PROBLEMS CAUSED INFECTION.
Lister introduced the use of catgut, which could be sterilised and this could reduce the chance of
infection. He developed catgut so it would dissolve after several days in the body. So there was no
need to leave thread dangling.
In recognition the Lister Medal is the highest honour that can be given to a British Surgeon.

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Although Lister's ideas were quickly accepted in Germany and the USA, many doctors in Britain were
at first unconvinced and joked about `Mr Lister Germs'. Some doctors did not accept his ideas as the
microbes could not be seen with a microscope. Using a carbolic acid solution slowed down the whole
operations which could lead to blood loss.…read more

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BLOOD LOSS
This has always been a major problem in surgery. Bleeding makes it difficult for the surgeon to see
what he is doing. But there is also the problem that if a patient loses too much blood, his blood
pressure drops, which affects his heart and then his body cannot function and he dies.
Once anaesthetics and antiseptics made it possible to perform complex operations, there was a
renewed drive to find a way to dealing with the two problems of blood loss.…read more

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In WW1 surgeons often treated wounded soldiers close to the front line of fighting where difficult
conditions and large numbers of injuries put them under pressure. Surgeons therefore gained a great
deal of experience and sometimes had to improvise new techniques. In this way, war can be said to
have accelerated their training.
The use of explosive weapons meant that many soldiers suffered deep wounds. And when
fragments of clothing entered the wound it became infected.…read more

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