Transformation of Surgery

- Also know as Nitrous Oxide

- Fist used by Sir Humphry Davy

- Originally used by surgeons and dentists 

- Didn't make patients completely unconsicious 

- Horace Wells used it in a public demonstration and it failed

-First used by John Collins Warren 

-Used by Robert Liston in 1847 during a leg amputation

Problems:

• Irritation to eyes and lungs
• Caused coughing and sickness
• Highly flammable
• Vile smell
• Not very mobile 

-First used by James Simson during experiments with colleagues at Edinburgh University

- Simpson started using it to help women during child birth

Problems:

• Countered the idea of 'speedy surgery'
• Could cause death
• Pain was seen as something God wanted for humans
• Untested 

- Many Paitents died from infections after an operation

- Surgeons wore clothes covered in blood and pus. Some washed their hands, but only with water

-The theatres and equipment used for operations weren't hygenic

- Louis Pasteur developed germ theory between 1860 and 1864

- Lister used carbolic spray to anesthetise wounds. He originally did this on compound fractures

- Lister always washed his hands with carbolic acid

- Lister would spray equipment and areas for surgery with carbolic spray

- Lister would tie up blood vessels with antiseptic ligatures 

Antiseptic surgery- there are germs in the operating theatre but surgeons use methods to stop open wounds being infected

Aseptic surgery- Cleaning and sterilising methods prevent there being any germs in the operating theatre

- Aspetic surgery became more popular from the 1890s. It included:

• Rigorous cleaning of theatres
• All instruments sterilised from 1887 usin Robert Koch's steam steriliser
• Surgeons must wear surgical gowns and face masks
• 1894- intro of streilised gloves
• Sterilised cloths covered surfaces

• Seemed very extreme. Had to soak everything and it stank
• It was the opposite of traditional ideas- speed 
• People didn't apply Lister's method correctly, thus assuming that they didn't work
• Not everyone believed in Germ theory strait away
• Some thought it was too good to be true 
• Lister didn't communicate his techniques, making it appear like he doubted his own methods

- Blood made it difficult for the surgeon to see what he/she was doing

- If a patient lost too much blood, they would die

- During the 17th Century, blood transfusions were attempted using animal blood. Most patients died so it was banned

- Cautery was the usual way of dealing with wounds/amputation 

- Once anaesthetics and antiseptics made complex surgery possible, surgeons tried more to find solutions

- 16th Century- Ambroise Pare developed metal clips to place on arteries during operations as well as silk thread to tie blood vessels; silk ligatures didn't always stop bleeding

- Any developments were futile before Germ theory as infection was leading to a higher death rate

- Lister thus developed Pare's ligatures in the late 19th Century

- Blood loss control had been partially solved prior to 1900

- 1901, Karl Landsteiner discovered blood types A, B, and O. AB was added in 1902

- Blood transfusions could happen, but only with the same blood type 

- Blood couldn't be stored therefore the donor had to be present during the surgery

- Many soldiers died fromm blood loss

- 1915: Richard Lewisohn found that adding sodium citrate to blood stopped clotting, and therefore it could be stored

- Richard Weil found that this blood could be stored in refrigerated conditions

- 1916: Francis Rous and James Turner found that adding citrate glucose to blood extended its lifespan

- 1917: First blood depot established for the Battle of Camrai using blood group O ( Which can be given to any blood type)