Four Major Problems with Surgery.
Infection During Surgery
Inferction After Surgery
Meaning of Pre- history- before development of writing. This lack of evidence means it can be difficult for us to be certain about what happenend during this period.
We base much of our understanding of groups of people who have changed little over many thousands of rs such as AUSTRLIAN ABORIGINES.
One Surgical procedure that we knopw was carried out successfully was TREPHINATION. This means drilling a hole in the skull. They probably did this to release evil spirits trapped in the body.
They knew about:
- Veins and Arteries
But there is no evidence that they knew what each part did e.g the heart is a pump.
No dissection of humans
They got much of the anatomical knowledge from trating wounded soldiers
Some of their knowledge could of come from removing organs during the embalming process
New better bronze instruments were made. Simple external surgery carried out.
He argued that the brain and heart were the most important organs in the body.
No effective anaesthetic
They could set bones and amputate limbs
They could also drian lungs. However there was little internal surgery.
Wonded soldiers gave Roman surgeones plenty to experience of dealing with external surgery.
Cladius Galen made a lot of important discoveries such as the brian controls speech and that veins and arteries carried blood. He did this through his work at Alexandria and by diddecting animals such as pigs. However becuase he could not dissect humans, he had to assume that they were the same as animals. Consequently he made errors.
Middle ages/ christian world No real changes
Dissections were used to prove Galen right.
Surgeons became skilled at bleeding patients.
Middle ages/ Islamic world.
Ibn Al Nafis suggested that blood did not move through the heart. However this was not proven until Renasissance.
This literally means re-birth of learning. In Europe people began to look for scientifi explantions for things, rather than just relying on old ideas such of those of Galen.
Dissection was allowed.
Andreas Vesalius- Challenged Galen. He proved that blood does not move from one side of the heart to the other. He also showed that the human jaw has one bone not 2.
William Harvey- Showed that blood circulated around the blood and that the heart acted like a pump. This dispelled Galen's idea that blood simply burnt up in the body.
Ambroise Pare made major breakthroughs in surgery. He stopped using boiling oil to treat gun shot wounds and instead used his own mix of oil and roses, egg yolk and turpentine. He also used Ligatures to tie up blood vessels instead of cauterising them.
Development of Anaesthtics-
Sir Humphrey Davy- Nitrous oxide "laughing gas" 1799- it didn't make patients completely unconscious and sometimes didn't work.
William Morton- Ether 1846- Very flammable. Also cause irritations to eyes and lungs.
James simpson- Chloroform 1847- Smells and tastes bad if you used to much it can cause vomiting.
Opposition to Chloroform why?
Confusion about correct doses and side effects
High death rate from more complex surgery
Accidental deaths Hannah Greener died whilst having a toenail removed
Pain was God's invention and therefore a good thing (child birth)
Pain was actually healthy.
Why did this change?
Queen Victoria used chloroform durnig the birth of the eighth child in 1857. People were likely to follow her lead.
Louis Pasteur- did not believ in spontaneous generation or harmful miroboes.
Surgeons like lister used this research to influence their own work. Knowing about germs that they could try to prevent infection.
In 1847 Ignaz Semmelweiss an Austrian doctor ordered that people should was their hands. He noticed that babies delivered by mid wives had a much higher surival rate than those delivered by doctors.
In 1865- Joseph lister used carbolic Acid to treat wounds to kill infections. Theew was still opposition to this.
Eventually lister's ideas caught on his antisptic techniques were replaced with aseptic techniques. This means making the operation area sterile before you start.
Opposition to carbolic acid. why?
It slowed operations down
Some people used it worng
Joseph lister himself. Some surgeones did not like him. They thought he was arrogant and was criticising them.
At the turn of the twentieth century Wilhelm Rontgen discovered x-rays. World war one 1914-1918 urged goverments to spend money on x-ray mechines to scan wounded men.
Marie Curie Radiation Therapy
Marie Curie Continued research in to X-rays and discovered Radium. This has been used to diagnose Cancers and treat them reducing the need for intrusive surgeries.
1928- aLEXANDER FLEMING went on hoilday left petri dishes containing bacteria out. He noticed it could killed germs but he could not produce enough quickly.
1938- HOWARD FLOREY & ERNST CHAIN managed to grow enough penicillin to treat one man with an infection. He got better however they ran out before he had fully recovered and got ill again and died.
The british goverment would not fund their work. But us goverment did becuase of world war 2.
1902 Karl Landsteiner discovered blood groups.
During world war one 2 major breakthroughs.
- Fristly sodium cirate added to prevent clotting
- Later scientists discovered how to store blood cells 4 furture use.
Had been trialled many years earlier but was limited by pain and infection. During the 2 world wars new techniques improved rapidly particularly skin grafts due to horric explosion and burn injuries.
Transplant, keyhole and Mirco-surgery
- Kindneys 1954
- Liver 1963
- Heart 1967
- Bone Marrow 1980
- Hear and lungs 1982
Keyhole surgery- To aviod trauma to a patient, surgeons can now perform sugery by making only a small incision. This requires great skill, cameras and fantastic equitment.
Micro surgery - surgeons can now rejoin blood vessels and nerves and sometimes re attach severed limbs. This is due to improvements in technology
1930'S Helmut Wasse developed anaesthetics that could be injected into the blood stream making does more precise.
Pain Solution found
Blood Loss Solution found
Infection During Surgery Solution found
Inferction After Surgery Solution Found