The development on Anaesthetics

1799 Davy discoverd laughing gas, he did not publicise his findings very well so the discovery was not taken up

1845 the speed surgeon Listen used Ether. It was nasty to breath so patientds were reluctant to use it.

1847 simpson used chloroform. It was more pleasent to breath and queen victoria used it for the birth of her eighth child in1853. This gave the royal seal of approval to anaesthetics overcoming religious opposition because she was head of the church.

Esther was used extensively as the century went on, but there were problems: anaethetics did not relax the muscles; this caused greater loss of blood

1846-1865 was the 'black period' in sugery. the absence of pain meant that more people agreed to have operations. However the death rate went up as many still died afterwards from infection.

Opposition to anaethetics.....

• christians belived that pain was given by god and so people should feel it
• people believed that the pain of childbirth improved the moral character of women
• army surgeons believed their soldiers should be tough and take the pain
• chloroform caused deaths from heart attacks, especially in young and fit people

• people died from the side effects of chloroform in minor operations( like hannah greener for an in growing toenail) which made peole think it would be better to cope with the pain and live
  .
• people were reluctant to use the new , untested chemicals
• surgeons could now do longer, more complex and internal operations and so made more mistakes
• they still didnt know how to stop infection so the number of people dying increased.

•  in the 1980's semmelweiss suggested that doctors were the ones spreading infection and they should wash their hands before touching a patient. All the people working for him washed in Chloride of lime. His success rate was higher but the meathods he used were not used by others.
• joseph lister read pasteur's work on germ theory. he learnt from a friend that the smell from sewage works had been killed using carbolic acid. Hospital theatres seled like sewage works so lister cleaned his theatre with carbolic acid.

• Lister also developed the donkey or lister spray to carbolic acid onto the patient throughout the operation. this was called ANTI-SEPTIC as the carbolic killed "septics"(germs) , The spray reduced deaths during the operations by 50% but was difficult to use. it got into incisions and made instruments slippery to handle.
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Lister had successful operations, but why was there so much opposition?

• it takes time for people to accept new ideas
• the new ideas meant more work for the surgeons and nurses e.g sterrilising equipment ect.
• new ideas can make those who did things the old wat look sily or foolish or uncaring
• surgeons did not accept pasteur's germ theory initially
• lister kept changing his techniques so other surgeons lacked confidence in him.
• lister was not very good at communicating his ideas ( he had a stutter)
• the anticeptic spray cracked the hands of the surgeons and nurses and caused allergic reactions

• 1880's robert Koch cultered the pus from patients wounds. he showed that the pus was caused by germans on other surgeons hands. This paved the way ASEPTIC surger : the whole operation theatre, equipment, clothes were germ-free before the operation stared
• 1889 william halstead of baltimore used rubber gloves, later special gowns,hats and face masks.

But there was still no succesful way of dealing with loss of blood untill 1901

loss of blood was the last of 3 problems that faced surgeons...

• in the 19th century some surgeons tried direct blood transfusions from a donor lying next to the paitent. they were confused as sometimes it worked, and sometimes the patients died
• in 1901, karl landsteiner discoverd blood groups and so the explanation for earlier success and failure.At first there was no easy way for the doctor to find or contact matching donors. this meant that landensteine's discovery was not widely used. Not being able to store blood meant that blood had to be drawn into a syringe and injected ito the patient. in this way, the doctor knew how much blood had been given, but it was a slow process.

• 1914-18 World war one increased the need for blood, and soldiers were forced to give it. This meant that there could be blood banks. the addition of sodium citrate to the blood to prevent it clotting was discoverd by richard lewisohn in 1915.
  This meant that the blood could be stored. it was also now possible to store blood for several week during the first world war blood banks set up using blood from soldiers.

examples from the 19th century that helped surgery ...

• snow's chloroform inhaler
• xrays ( discoverd by Rontgen in 1895)
• Listers anticeptic spray (called donkey)

Examples from 20th century technologie developments that helped surgery are..

• Mobile xrays developed during world war one
• plastic surgery- Harold Gillies developed the waltzing tube pedicles to treat burn victims

examples that helped from the 19th century...

• chemicals used as anaethetics ( chloroform , ether, nitrous oxide)
• carbolic acid used as an antiseptic
• Pasteur's germ theory

examples from 20th century yhat helped surgery...

• Carrell-dakin solution developed as an antiseptic during world war one
• sodium citrate was discoverd by richard lewiohn in 1915 to allow blood to be stored from transfusions
• Karl landsteiner identified blood groups in 1901 which meant patients would not die from being given the wrong blood