Surgery

Dealing with pain- important people?

Sir Humphrey Davy, John collins Warren, Robert Liston, James Simpson, Queen Victoria, John Snow, Hannah greener

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Dealing with infection- important people?

Florence Nightingale, Ignaz Semmelweis, Joseph Lister

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Dealing with blood loss- important people?

Ambrose Pare, Philip Sung Physick, James Blundell, Karl landsteiner, Reuben Ottenberg, belgian doctor

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Problem of pain?

Treatment could result in more pain, No painkillers, No specialised doctors and Poor conditions/equipment

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Problem of Infection?

Can cause more harm, No proper knowledge, Non-sterilized equipment, No proper doctors, No medicine and Risk of contamination

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Problem of Blood Loss?

Risk of death/contamination, No proper equipment/knowledge, No specialists, No blood transplants, Poor hygiene and No after care

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Advantages of Laughing Gas (Nitrous Oxide)?

Reduced pain, could be used in operations and by dentists

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Disadvantages of Laughing Gas (Nitrous Oxide)?

Didn't make patient completely unconscious and some patients were still in agony

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Advantages of Ether?

Allowed people to sleep through operations

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Disadvantages of Ether?

Irrated eyes, lungs, caused sickness, easily flammable, awful smell

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Advantages of Chloroform?

Helped women who were in childbirth and in operations

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Disadvantages of Chloroform?

Wasn't properly tested and still caused death

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Opposition to the use of anaesthetics?

Some devout Christians thought that pain (childbirth) was part of God's plan/ or a blessing, the Hannah Greener case, complex operations meant that in the 1870s the death rate reached a new high and unconscious patient more likely to die than awake

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When did John Snow develop the chloroform inhaler and what was it?

1848, which regulated dosage, reducing deaths.

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When and Explain the 'black period' of surgery?

1850s-1870s, when deaths linked to surgery increased, despite use of anaesthetics, this was due to doctors undertaking more complex operations, unhygienic conditions (gangrene and sepsis) and continued problem of blood loss

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How did Semmelweis reduce death rate?

Semmelweis reduced death rate dramatically by making the students wash their hands in a chlorinated solution

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When did Lister find out that Carbolic acid could be used to kill microbes?

1864, Lister found that carbolic acid killed parasites and thought it could be used to kill microbes causing infection (interested in Pasteur's work)

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When did Lister test carbolic acid on a child with a broken leg?

1865, the carbolic soaked bandage meant that the wound healed cleanly within six weeks

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What is Catgut (Lister's discovery)?

Which could be sterilised to stitch wonds instead of silk (which couldn't be sterilised) Then he developed a type of Catgut which dissolved in the body after a few days snd didn't have to be removed

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Opposition to Lister's work?

Some doctors didn't think microbes caused infection. Some doctors didn't copy his ideas properly, so when the death rates didn't improve they said his ideas were wrong, he kept changing his methods, slowed down operation and was smelly

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What did Koch develop and when?

1878, Koch developed the use of a steam steriliser to ensure that instruments were free from germs.

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Define Aseptic Surgery?

Preventing bacteria from being near a wound, using rubber gloves, masks, sterile equipment, and closed operating theatres.

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Define Cauterisation?

The process of sealing blood vessels and stop bleeding using heat - a hot iron or oil.

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What did Ambrose pare do?

He started treating his pateints by clipping blood vessels with metal clips, or by tying them shut with silk threads called ligatures. This wasn't terribly successful but better than cautery, lister then developed pares silk ligatures by using catgut

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What is a Tourniquet?

Something that is tied around a part of the body to put pressure on a blood vessels and stop the loss of blood

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What was a clamp used for for preventing blood loss before 1900?

To reduce the blood flow to the area being operated on

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Problem of blood transfusions?

The donor needed to be present to provide the blood. This was not practical, so Landsteiner's work did not have a big immediate effect on surgery.

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What impact did lister's discovery have?

Death rate cut to 15%

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Impact of x-ray machines?

WW1 had a major impact on X-rays and allowed surgeons to locate bullets/shrapnel and making surgeons more confident with internal operations

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Describe process of separating the blood cells from the actual blood

These could be stored, packed in ice and diluted with saline to create usable blood. This made transfusions possible for thousands of wounded soldiers on the front lines

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What did Rou and Turner do and when?

1916, They found that adding a citrate glucose solution allowed blood to be stored for longer. This meant they would ask the public for blood donations before the army carried out an attack.

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Why did WW1 (1914-1918) accelerate surgeon's learning?

Surgeons often treated soldiers on the front line, where they would get a lot of experience in a wide range of injuries, and sometimes had to improvise new techniques.

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key features of plastic surgery

Harold Gilles, he used pedicle tubes to grow healthy skin for another part of the body. At the start of WW1, he asked for permission to set up a plastic surgery unit in the British Army.

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Bacteriology

This is a new science, helped doctors to understand what caused disease and infection

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How were Hydodermic needles useful?

1853, useful in administering a measured dose of a drug. They were later used in blood transfusions

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Impact of WW1 on the development of surgery?

Deep wounds from shrapnel led to surgeons developing the use of saline to fight infection, first attempts at brain surgery, plastic surgery to treat disfiguring injuries, training broader as they worked with wide variety of wounds, improvise

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Impact of communication on the development of surgery?

Many surgeons took careful notes- lister recorded the impact of carbolic acid over several years, which helped him to prove it worked, publishing their ideas (lancet), medical conferences and newspapers (Queen Elizabeth)

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Impact of science and technology on the development of surgery?

bacteriology, X-rays, mechanism for spraying carbolic acid, steam steriliser both helped to keep germs out of suregry (lowering infection rates) and hyperdermic needles

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Features of Queen hospital becasue of Gillies?

Opened in June 1917, over 1,000 beds. More than 11,000 operations were performed on over 5,000 men (mostly soldiers with facial injuries, usually from gunshot wounds).

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Major impact of Lister?

In 1889, Caroline Hampton (operating nurse) developed a skin infection on her hands, surgeon William Halstead made her wear thin rubber gloves. A year later Halstead spread the word of wearing rubber gloves during an operation

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Surgery

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