Surgery: 19th & 20th Century

• Throughout the 19th and 20th centuries surgery was revolutionised with significant changes to tackle the problems that previously existed.

  The work of Simpson and Lister developed both anaesthetics and antiseptics to tackle pain and infection, whilst WW1 played a significant role in improving surgery. Nowadays all forms of modern surgery can take place.
• Industrial Period


  19th century - 1800s
• Industrial Period


  • Numerous problems at the start such as pain, infection and blood loss
  • Discovery of anaesthetics and antiseptics help to tackle these problems
  • A period of significant improvement in terms of surgery with more complex operations
• Modern Period


  20th century onwards - 1900s
• Modern Period


  • Both WW1 and WW2 have a major impact in helping to develop surgery
  • New discoveries such as x-rays and skin grafts help to improve surgery forward
  • More complex surgery developed with new types such as transplant, plastic and keyhole surgery
• What was the situation with surgery in 1800?

  •In 1800 there were numerous problems with surgery due to a lack of scientific understanding, equipment and knowledge.

  •There were still no proper anaesthetics and antiseptics so pain and infection were major problems in surgery.

  •Operations tended to be relatively simplistic, had to be completed quickly and were quite ineffective.

  •There was greater regulations in terms of the requirements to be a surgeon, but training was still comparatively lacking.

  •Consequently success rates were low and death rates high
• Modern surgery


  • Developed rapidly with new types of surgery
  • Different illnesses and injuries can be successfully treated
• Plastic surgery


  • Became a major field of surgery in the 20th century
  • Used for healing wounds and for cosmetic purposes
  • Work of Harold Gillies in developing skin grafts played a major role
• Microsurgery and keyhole surgery

  • Reduced the risk of infection
  • Reduced recovery time
  • Reduced scarring
• Transplant surgery


  • One of the most successful and life saving developments
  • Continuing to be pioneered and progressed today
  • First kidney transplant took place in 1952
  • First heart transplant took place in 1967
• New forms of technology

  • CAT scans
  • MRI scans
  • Endoscopes
• Pain


  Major problem in surgery, limited the types of surgery that could take place
• New techniques used in operations

  1. Laughing gas

  2. Ether
• James Simpson


  Scottish surgeon who used chloroform to reduce pain in childbirth
• Chloroform use faced some opposition
• James Simpson


  • Particularly used chloroform to help women during childbirth
  • Gradually popularised the use of anaesthetics on humans
• Queen Victoria used chloroform to reduce pain during childbirth


  1853
• Queen Victoria used chloroform


  It was good enough for anyone
• Joseph Lister


  One of the outstanding surgeons of the nineteenth century, determined to tackle the problem of infections in surgery
• Lister's use of antiseptics

  1. Saw carbolic spray used to treat sewage

  2. Found that a thin mist of carbolic spray limited infection

  3. Used this to sterilise surgical equipment

  4. Treated wounds in the same way
• Lister's use of antiseptics was the first use of antiseptics
• Mortality rates in Lister's operations dropped from 46% to 15%
• Lister built on Semmelweiss' work to emphasise the importance of cleanliness in hospitals
• Lister is recognised as a pioneer of aseptic surgery in the nineteenth century
• How does war improve surgery?

  1.In peacetime surgeons often work alone and in competition against one another. In war they unite and share ideas to improve practice.

  2.Wartime industry devotes increased resources to developing new surgical equipment.

  3.Surgeons have more patients and therefore do more operations, learning quickly and experimenting on their patients to enhance medical understanding.

  One of the best examples of this in the modern period is the impact of WW1 on surgery
• How World War 1 helped the development of surgery

  1. X-rays improved success rate of removing deeply lodged bullets and shrapnel

  2. Surgeons developed new techniques to repair broken bones

  3. Surgeons discovered cutting away infected tissue and using saline solution helped fight infections

  4. Discovery of blood groups and matching for transfusions

  5. Improved skin grafting techniques formed basis for plastic surgery

  6. Improved surgery of eye, ear, nose and throat

  7. Successful attempts at brain surgery
• 1. rays


  Discovered by Wilhelm Rontgen in 1895, could pass through human flesh but not bone or metal
• 1. rays immediately improved the success rate of surgeons in removing deeply lodged bullets and shrapnel which would otherwise have caused fatal infections
• Surgeons in the war faced hundreds of thousands of casualties that helped them to learn quickly
• Surgeons discovered that if they cut away infected tissue and soaked the wound with a saline solution, there was a far greater chance of fighting off an infection
• In 1901 scientists discovered that there were different blood groups, and realized that transfusion only worked if matching blood groups were used
• Surgeons improved methods of grafting the skin in surgical operations, which later formed the basis for plastic surgery
• Surgeons improved surgery of the eye, ear, nose and throat
• Surgeons successfully attempted brain surgery