Surgery

• surgery before 1850: pain

  surgery=agonizing so quicker=better. only simple operations were possible e.g. amputation. many died from shock of the pain. some sedatives available- alcohol, opium. Moore's clamp- screw twisted to squeeze nerves & stop them sending messages of pain to brain. 2-6 men would hold patients down
• surgery before 1850: bleeding


  patients could die from loss of blood. ligatures used to tie blood vessels post-operation- not always successful and could cause infection. 19th century- human blood to humans, sometimes worked but no knowledge of blood types or how to store it
• surgery before 1850: infection


  infection=biggest cause of death. few precautions taken to keep wounds clean. gangrene and blood poisoning were common. death rate following amputation=25-40% in hospitals. people payed to watch operations- unsanitary
• who was James Simpson

  Professor of Midwifery at Edinburgh University. 1847- experimented with chemicals and discovered anaesthetic effect of chloroform. used it to help women in childbirth and other operations. wrote articles about his discovery
• Humphrey Davey


  discovered Nitrous Oxide's anaesthetic effect
• John Warren


  trialled ether for the first time in the USA in 1846. this was then used in 1847 by Robert Liston in London
• positives of chloroform


  stronger than ether so operations could be more precise. ether irritated the patient's eyes and lungs and was flammable and smelly. Queen Victoria popularized chloroform as she was given it during childbirth of her 8th child- "that blessed chloroform"
• negatives of chloroform


  black period of surgery- this stronger anaesthetic meant more time could be taken in operations but this also meant there was more time for bleeding and infection. death rate before anaesthetic= under 40%, after=50%. allergic reaction to chloroform caused deaths. e.g. Hannah Greener.
• chloroform conclusion


  many surgeons returned to ether. it could be very dangerous as surgeons did not know the correct dosages. new chemicals could relax muscles and had fewer side effects.
• who was Joseph Lister

  Professor of Surgery in Glasgow. read Pasteur's early writings in 1865, learnt that rotting is caused by bacteria. 1865- smeared James Greenlees' compound fracture with carbolic acid and dressed it with bandages soaked in it. later removed bandages with no sign of infection. 11/12 survival rate. developed antiseptic ligatures & carbolic spray
• positives of Lister's work

  1864-66=45.7% mortality rate. 18867-70=15% mortality (antiseptics had been developed)- end of black period of surgery. furthers developments as a result of Lister's work such as general cleaning, sterilisation of instruments (1887), sterilised rubber gloves (1894)
• negatives of Lister's work

  carbolic spray had issues e.g. irritated skin, expensive. surgeons still believed speed was essential and Lister's methods slowed operations down. 1897- Koch carried out experiments which showed not all germs on surgeon's hands are killed with carbolic acid. showed that boiling equipment was more effective. this lead to aseptic surgery (kill ALL germs in the room)
• issues with bleeding


  patients could die from shock (loss of blood)- pale, gasping, low blood pressure. no way of replacing blood or knowing how much to put in
• Karl Landsteiner


  discovered that blood can be grouped into different types, A, B, AB and O in 1901
• sodium citrate


  stops blood from clotting when storing it
• how did the 1st world war accelerate progress in storing blood

  developed storage solutions quickly as it was impractical to have the donor in the same place as the patient in the war.