3 barriers to successful surgery

1847

• James Simpson discovered chloroform when he was researching for a better drug than ether due to limitations (causes irritation to the eyes and lungs and is highly flammable plus often causes vomiting)
• experimenting by inhaling various chemicals to observe the effects they had (experimentation and chance)
• chloroform stops you from feeling pain but doesn't have the negative side effects like Ether. First barrier to successful surgery has been overcome. less people are likely to die due to pain in operations as they won't go into shock
• they can now do more complicated surgery to help people/ cure more illnesses/ dig deeper into the body
• articles in books and papers meant that other surgeons started to use anaesthetic so the idea became more widespread (communication) but was not fully accepted until queen victoria used it during the birth of her 8th child
• but there was opposition
• some patients died because the dosage was hard to contol (hannah greener was having her toenail removed and died after recieving chloroform)
• this lead to the develpment of an inhaler to regulate dosage (technology) by John Snow
• distrusted due to side effect and untested on long term side effects
• caused black period as more people died from infection (some people thought this was due to chloroform but it was due to surgeons digging deeper in the body
• going deeper into the body showed surgeons skills were not good enough- this lead to developements in better and more extensive training turning it into a proper and well respected profession
• patients still died as there was still 2 barriers to overcome (infection and bloodloss)

1865

• 1861- germ theory (communication)
• Joseph Lister discovered carbolic acid (experimentation) tested it on an 11 yr old boy who had a compound fracture. he soaked the bandages and the wound in carbolic acid and it healed without infection
• later a spray was developed to diliver the carbolic acid in the correct amount (technology)
• stops patients from dying from infection second barrier to successful surgery overcome
• leads to aseptic conditions in surgery (completely germ free environment) (eg/ the use of a steam steriliser, rubber gloves and face/ mouth mask)
• but patients still died due to blood loss
• longer surgery due to no pain or worry of infection meant blood loss was an increasing problem
• nurses resented the extra work (still in the process of being developed into a profession by florence nightingale key individual)
• equipment was expensive and heavy
• doctors resented it as they didn't believe that germs (which they couldn't see) caused infection
• lister kept changing his meathods to improve his work but other doctors thought this meant he was unsure of his ideas
• acid irritated the skin- this leads to the development of rubber gloves (Caroline Hampton had Eczema)
• Lister was accepted because in 1878 Robert Koch identified the blood poisoning germ (key individual)

1901

• Landsteiner discovered 3 different blood groups (A, B and O)
• a 4th blood group (AB) was added in 1902
• allows you to replace the blood loss during an operation
• but the transfusion requires a donor to be present (therefore it did not have an immediate effect on surgery as this was not practical especially in ww1 but this was overcome due to developments in ww1)

1916

• Rober Weil found blood could be stored in refrigerators (technology)
• Rous and Turner added citrate glucose to blood to stop it from clotting (science- store blood for longer- ask for blood before major battles in ww1 without a donor needing to be present)
• eventually will become benificial for the ordinary people having surgery because they can have a transfusion without a person/ donor needing to be present

1917

• first blood bannk set up before the battle of Cambrai
• having enough blood to store/ getting people to donate
• religious objectors (jehovah's witnesses will not accept a blood transfusion)