Surgery through time

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  • Created by: TillyF
  • Created on: 16-01-17 05:21
Which three problems held back surgeons in the 1800s?
Pain, infection and blood loss
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Which six main factors helped problems in surgery to be overcome?
War, individuals, chance, science and technology, communications and attitudes
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What was the first anaesthetic that was discovered?
Laughing gas (nitrous oxide)
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Who discovered nitrous oxide?
Sir Humphry Davy, he suggested that it could be used in dentistry and surgery as a pain reliever
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What were the problems with nitrous oxide?
It did not completely make patients unconscious and so was not a complete answer to pain.
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What disaster occurred when using nitrous oxide?
Horace Wells, an American dentist, became convinced of the value of laughing gas after inhaling it at a fair but when he used it in a public demonstration his patient was in agony and this killed confidence in laughing gas as an anaesthetic.
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What was the second anaesthetic discovered?
Ether
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Who discovered ether and what was it first used for?
In 1846, John Collins Warren, an American surgeon, removed a neck tumour using ether as an anaesthetic.
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Who else used ether as an anaesthetic?
A famous English surgeon, Robert Liston, used ether to anaesthetise a patient during a leg amputation.
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What were the problems with ether?
ether irritated the eyes and lungs, causing coughing and sickness. It could catch fire if close to a flame and had a vile, clinging smell that took ages to go. Ether also came in a large heavy bottle that was heavy to carry around
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What was the third anaesthetic?
Chloroform
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Who discovered chloroform?
James Simpson, a professor at Edinburgh University
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How was chloroform discovered? When?
In 1847, James Simpson and several other colleagues experimented with different chemicals to see what anaesthetic effects they had, when they inhaled chloroform they passed out within one to two minutes
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What was chloroform used for by Simpson?
Childbirth and in operations
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Why did people create controversy towards chloroform (in terms of time)
In the early 1800s, surgeons prided themselves on how quickly they could perform surgery (as this reduced pain), but with anaesthetics, speed was no longer important
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Opposition towards chloroform? (untested)
Chloroform was untested: no one knew the potential long term effects on the bodies or minds of patients, in the beginning they did not know the correct dosage for each individual
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Opposition towards chloroform? (Hannah Greener)
In 1848, Hannah Greener died whilst being given chloroform during an operation to remove her toenail : fears from doctors towards use of chloroform
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Opposition towards chloroform? (holy pain)
Some people believed that the 'infliction (of pain) has been invented by Almighty God, pain may even be considered a blessing of the Gospel' - The Lancet 1849 (letter to medical journal)
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Opposition towards chloroform? (holy pain in childbirth)
Some people believed that anaesthetics were unnatural and according to The Lancet letter to the medical journal the pain of childbirth exerted an 'influence upon the religious and moral character of women'
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Opposition towards chloroform? (before antiseptics)
Doctors attempted more complicated surgery, causing deeper infection in the body and more blood loss. The 1870's is considered as surgeries 'black period' due to the high death rate
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What impact did Queen Victoria have on anaesthetics acceptance?
In 1857, Queen Victoria used chloroform during child birth of her eighth child and publicly praised it despite the fact that chloroform still had many improvements to be made.
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Positive impacts of anaesthetics?
Pain free surgery : reduced death from shock / more complex surgeries were able to take place / research into chloroform safely and effectively / local anaesthetics developed / research led to better anaesthetics that relaxed muscles as well
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What were some problems with chloroform?
It took surgeons time to find correct dosages / chloroform made people throw up/ surgeons still operated quickly/ surgeons undertook more complicated&longer surgeries : death / blood loss and infection were still problems and caused death
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Who was the doctor who first introduced washing hands before surgery?
The Hungarian doctor Semmelweiss, this cut death rates but many doctors disliked Semmelweiss.
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Who was Joseph Lister?
A famous surgeon, that introduced the use of carbolic acid as a disinfectant in surgery, as a result of his prior knowledge of Pasteur's germ theory.
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How did Joseph discover carbolic acid?
In 1864, he witnessed that carbolic acid prevented the smells of sewage and also the parasite's that fed on the sewage. Therefore, sparking an idea that carbolic acid could be used to prevent infection in surgery.
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What did Lister do to the carbolic acid and what affect did this have on his surgeries?
Lister applied carbolic acid to the wound and the bandages/dressings used for the wound. He found that the open wounds from surgery healed and didn't develop gangrene, saving his patients lives.
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What three improvements to cleanliness did Lister advise for surgeons?
- hand washing with carbolic before operations to avoid infection/ a carbolic spray to kill germs in the air around the operation/ an antiseptic ligature to tie up blood vessels to prevent blood los
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Opposition towards antiseptics? (carbolic spray)
Carbolic spray cracked surgeons skin and made everything smell. This made operations more expensive and less pleasant for surgeons.
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Opposition towards antiseptics? (speed) (results)
Some surgeons still believed speed was essential and Lister's methods slowed things down/ When surgeons copied Lister's methods they did not achieve the same results: they were less systematic/ thought antiseptics prevented body's defence mechanisms
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Opposition towards antiseptics? (Pasteur) (guilt)
Some surgeons didn't believe in the germ theory and that microorganisms caused disease / surgeons had to live with the fact that they were the reason why their patients died and felt Lister was criticising them for letting patients down
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Opposition towards antiseptics? (Lister) (methods)
Lister was not a showman and appeared cold, arrogant and aloof, many surgeons regarded him as a fanatic. / Lister constantly changed his methods to find a better substance than carbolic (no corrosion):critics said he changed methods - did not work
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How did Lister change surgery?
Lead to aseptic surgery in 1890's (removing germs from operating theatre) now: operating theatres rigorously cleaned, 1887< instruments steam sterilised, surgical gowns/ masks worn, 1894< sterilised rubber gloves
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Why did blood transfusions not work before blood types were discovered?
- different blood types were incompatible and therefore the blood transfusion would not work (it would only work by chance or if the patients were twins)
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Which doctor did a lot of work on blood loss in the 1800s?
James Blundell, a British doctor.
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Who discovered blood groups and when?
In 1900, Karl Landsteiner (a doctor from Austria)
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What did Landsteiner discover?
How to identify blood groups and that different blood groups were incompatible with one another and that each blood cell had antibodies which would react with those from another blood group: blood transfusions would only succeed with same blood type
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Who performed the first blood transfusion with blood typing?
Reuben Ottenburg, 1907, New York.
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What was the problem with blood transfusions before storing blood?
Patient and donor had to be in the same place as doctor, as blood clotted when doctors tried to store it before and so could not be used for transfusions.
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How did ww1 benefit the development of blood transfusions?
Casualty rates were higher/ greater need for blood transfusions from explosives and bullet wounds.
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What could be added to the blood to prevent clotting?
Sodium Citrate (prevented blood clotting) and citrate glucose solution (blood storage for first blood banks)
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What did scientists learn to do with blood cells?
Scientists learned how to separate and store crucial blood cell, which could be bottled and packed in ice,stored for when you need them.
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What benefits of blood transfusions are there?
- save money and lives in trenches and on an operating table ; lead to the supply of stored blood and blood banks/
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Who discovered the first x-rays?
A german scientist, Wilhelm Rontgen, in 1895
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How did Wilhelm Rontgen discover x-rays?
He realised rays of light in a covered tube that lit up a far wall, that could pass through black paper, wood and flesh. As a result he called them x-rays.
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What impact did WWI have on x-rays and why?
WWI, increased the use of x-rays as surgeons needed to locate bullets and shrapnel lodged deep within wounded men.
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What impact did the government have on x-rays?
The government organised the mass creation of x-ray machines and enabled them to be stored within all major hospitals on the Western Front.
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What impact did WWI have on surgery?
The terrible injuries of both World War's led to a rapid improvement in techniques of surgery eg. skin grafts and bullet/ shell damages. Increasing doctors experiences and knowledge in surgical procedures.
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Who performed the first heart transplant?
Dr Christiaan Barnard in South Africa
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Who discovered the different blood types?
Karl Landsteiner, making blood transfusions safer and more successful
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Who discovered chloroform?
James Simpson, saving patients from pain and therefore shock from blood loss
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Who discovered the first antiseptic used in surgery?
Joseph Lister, uses carbolic acid to kill bacteria in wounds and operating theatre's. = reductions in post surgery deaths
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Who first came up with the idea of using rubber gloves in surgery?
William Halstead, an American surgeon, had rubber gloves made for his nursing assistant. = gloves and masks used in surgery reduced chance of infection/
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How do we answer question 1? (6 marks) 'what can you learn' - using sources as evidence - infer and them reference to the source
Annotate and infer from the sources. 1. what does the source tell you, identify clues in source. 2. What do the sources suggest about surgery in the early 1800s? 3. What can I infer from this source about surgery in the early 1800s. (use key details)
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How to answer question 2? (8 marks) 'use source to show importance of an idea'
1. Annotate the source 2. Explain why the artist/ writer is aiming to create a specific impression by including 3 details (what they included or angle/ colour/ lighting of source) *stick to focus of question supported by references to source*
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How to answer question 4? (10 marks) 'evaluate the usefulness of sources, which is more useful' *using both sources*
You must evaluate the extent to which the information in each source would help a historian in a specific enquiry and how reliable the information is. (analyse the reliability and relevance)
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Question 4 *how to answer*
What do you learn? (source 1 is useful because...) What do you not learn (source 1 is not useful...) What is the nature of the source? What type of source is it? What are the origins of the source? Who wrote/ produced the source? When was it produced
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Q4 *how to answer*
What was the purpose of the source? Why was the source produced? How typical is the source?
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Q4 *how to answer*
Reach an overall judgement (end in a conclusion) How useful is the source (very/quite) Which source is more useful? What is your key reason for reaching this judgement?
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How to answer question 5? (16 marks) *judgement/ importance* *refer to ALL sources and use your own knowledge* (16 marks)
You get marks for - the clarity of your arguments - how well you explain your arguments - how effectively you support your arguments from the sources and your own knowledge - the clarity of your final conclusion
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Q5
-explore both sides of the argument before reaching a conclusion - use the sources and your own knowledge to support your answer (use knowledge and sources) - refer to specific sources(refer to all sources and refer to more than one source at a time)
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Q5 structure
Paragraph: explore evidence that supports the statement use sources and own knowledge paragraph 2: explore evidence against the statement what evidence from source and own knowledge Paragraph 3: conclusion and overall judgement (what extent)
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Q4 what extent does source "" challenge... (10 marks)
-identify key details and messages in each source -establish the overall message of each source -think carefully about the extent to which one source supports or challenges another source (do the sources contradict one another)
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Q4
-focus on the question -paragraph 1 (refer to source 1) -paragraph 2 (refer to source 2) -paragraph 3 (refer to whether or not the sources contradict one another/ reach an overall judgement about the extent to which source.. challenges source..)
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Q4
-make comparisons throughout the answer, compare sources throughout the source (do not just talk about one source and then talk about the other source without comparison)
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How to produce a good conclusion?
-focus on the question and use words or phrases from the question in your final paragraph -show that you recognise that there is evidence that agrees and disagrees with the statement 3. come to a strong overall judgement 4. explain judgement
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Card 4

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