History - Surgery

There were no anesthetics until the mid 19th century. Some doctors gave patiens alcohol or opium, so they were less aware of the pain. The pain, and the shoch and the blood loss that came with it, meant doctors avoided operations. When they had to operate, other people held the patient down and doctors worked as fast at they could

The most common surgery in the 19th century was amputation. Surgeons also cut out stones from the bladder, which is not very deep in the body.

The first suggested anaesthetic was nitrous oxide ('laughing gas'). Humphrey Davy discovered that it made you less aware of pain and suggested its use in surgery. It was first used as a dental anaesthetic by Horace Wells in 1844.

Ether was first used as an anaesthetic in September 1846. William Morton, a dentist in the USA, showed teeth could be painlessly extracted with it. He then successfully operated on a neck tumour. The first amputation to use ether as an anaesthetic was performed by Robert Liston in December 1846.

Ether had problems. It sometimes made patients vomit and irritated the lungs, causing coughing even when unconcious. Patients often stayed unconcious for days. It was difficult to use because it was very flammable and needed to be transported in large, heavy glass bottles.

Chloroform was first used as an anaesthetic by James Simpson, a doctor in Edinburgh, in 1847. Queen Victoria popularised its use in childbirth when she used in in 1853 for the birth of her eight child. However, it affected the heart and exact dosage was difficult. Some patients died of heart problems.

The chloroform inhaler, invented by Dr John Snow, controlled the dosage of chloroform, reducing the number of deaths from heart problems.

Some people did not welcome anaesthetics. Some believed God wanted people to feel pain, especially in childbirth. The number of deaths after operations rose at first, as doctors needed experience to get the dosage right. Some people distrusted them because they were new and not all effects were known.

Cocaine was used as an anaesthetic in Europe from the 1850s, but was addictive. In 1884 it was found it could be used as a local anaesthetic, applied to the part of the body the surgeon wanted to numb. Novocaine, a version of cocaine that could be used as a local anaesthetic, was discovered in 1905.

Infection was a huge problem in early 19th century operations. Surgeons wore old, bloodstained clothes. Everyone else wore ordinary clothes. The surgeon might wash his hands (or not), even his instruments, but nothing was germ free.

The 'Black Period' of surgery (1850s - 1870s) was when anaesthetics led to rise in the number of operations because surgeons could use anaesthetics and so operate more easily. The death rate rose because doctors performed more complicated internal operations and there was a high infection rate.

Ignatz Semmelweiss, of Vienna General Hospital, notices in 1846 that the death rate from infection after giving birth was much higher in the ward students worked on(often after dissecting corpses). He said the students were passing on the infection. He amde them wash their hands in a chlorinated solution before touching the women. The death rate dropped, but no one accepted his ideas; he even lost his job.

In 1861, Pasteur's germ theory linked germs and decay. Joseph Lister applied the idea to surgical infections, saying germ-ridden conditions caused infection. He said doctors should use antiseptic methods to fight germs. These methods used carbolic acid (which he had seen kill parasites in a sewage works) on bandages and in a spray.

Lister first used bandages soaked in carbolic acid in 1865, on the broken leg of an 11-year-old boy. He used bandages and the spray in his wards in Glasgow, and, in 1867, said his wards were free of sepsis. In 1877, he moved to London and used his methods at King's College Hospital. 

Lister's methods were quickly adopted in Germany and the USA, but many doctors in Britain opposed them. The strength of the solution was difficult to get right. The acid left skin cracked and sore. The equipment was expensive and, especially at first, heavy. Using the methods slowed down operations, so blood loss problems increased.

In 1878, Robert Koch identified the bacteria that caused blood poisoning, confirming the link between germs and disease. At the same time he developed the steam steriliser for surgical instruments (an aspectic advance).

The move to aseptic surgery was helped by the use of rubber gloves (1890, William Halstead), sterile gowns, face masks and head caps for doctors and nurses. Closed operating theatres and a sterile cloth over the patient also helped.

Loss of blood was a common reason for death in the 19th century. Surgeons performing amputations tried to cut off the flow of blood to the limb beforehand with a clamp of tourniquet. Then they tried to stop blood loss by either sealing the blood vessels with heat (either hot oil or a hot ion) or tying them off with threads called ligatures. 

Blood transfusions replaced lost blood. Doctors had tried transfusions since the 17th century. Early transfusions were from animals to humans. They failed. Until blood types were discovered, human to human blood transfusions also had a low success rate.

Blood types were first suggested by Karl Landsteins in 1901. He suggested three types; A, B and O. A fourth type, AB, was added in 1902.

Blood typing was little help to surgery at first. Surgeons who wanted to perform a blood transfusion had to test for the patient's blood type and then find someone willing to five blood who was off the same blood type - fast. Often this just wasn't possible in time. Doctors needed to find a way to stop blood clotting so they could store it.

During the First World War (1914-1918) a doctor from the USA, Richard Lewisohn, who had been using sodium citrate to thin blood during transfusions, suggested using it to store blood to set up blood banks for war surgeons. The blood had to be used quite quickly, but the stored blood still saved thousands of lives.

Sodium citrate-treated blood was found to keep longer when it was refrigerated. In 1916, Rous and Turner found that adding glucose to the blood meant it lasted longer, so the army could call on the public to make blood donations when they were planning an attack.

The first blood depot was set up in 1917, just before the Battle of Cambrai. It used type O blood, which had been proved to be safe to transfuse to all blood types.