Revolution in sugery

• 3 main problems of surgery in the 19th century:

  • Pain
  • Infection
  • Blood loss
• Chloroform was discovered by James Simpson, who used it to anaesthetise women during childbirth.
• The discovery of ether led to the development of modern surgical techniques such as amputations and operations that would have been impossible without anaesthesia.
• Acceptance of chloroform:


  Modern anaesthetics took some time to be accepted:

  • Some people still said that the pain was sent from God.
  • Doses of chloroform varied and some patients died form having too much of the drug.
  • Acceptance by people like Queen Victoria in 1853 encouraged others.
  • Previously people had been too scared to have operations due to the pain. The introduction of anaesthetics changed this.
  • Anaesthetics allowed doctors to conduct surgeries more carefully with more time to complete them. More complex surgeries were being attempted.
• James Simpson (1811-70)


  an obstetrician (specialist in childbirth) and the pioneer of using chloroform as an anaesthetic. He became physician to Queen Victoria in 1847 and was the first person to deliver a baby using anaesthetic. He was notorious for experimenting on his friends and at one party he gave everyone a decanter of chloroform to test dose rates: the guests were found unconscious on the floor the next morning. Simpson worked tirelessly to make chloroform safer and more effective and his discovery was taken up all over Europe within weeks of him proving it worked.
•  

  Aseptic Surgery


  Germs are prevented form getting near patients.
•  

  Antiseptics

  Substances that prevent the growth of germs, preventing infection.
• Nitrous oxide


  • In 1795, Humphrey Davy experimented with inhaling nitrous oxide
  • 1800- published an account of how it made him laugh & feel giddy/relaxed
  • Became a fairground novelty, people paid to inhale it & laugh
  • 1844- an American dentist Horace Wells saw it as an anaesthetic & removed 1 of his own teeth
  • Failed to convince other doctors to use it
• Ether


  • 1846- William Morton helped give a public demonstration in a Boston hospital using ether to extract a tooth
  • Robert Liston was quick to try it in England & used it for a leg amputation
  • An effective anaesthetic had arrived at last
  • It was difficult to inhale, caused vomiting & was highly flammable
• Chloroform


  • Still a need for a safe & effective anaesthetic
  • Breakthrough came in 1847 when a Scottish doctor James Simpson discovered chloroform
  • Simpson & his friends came across chloroform which knocked them out to sleep
• Hannah Greener


  Problems came with the death of a young woman, Hannah Greener when she took chloroform during an operation to remove a toenail. Objections were overcome when Queen Victoria used it with the birth of her son, Leopold & after Dr John Snow worked out the correct quantities to administer to patients.
• Joseph Lister


  • Lister introduced new ideas on cleanliness in surgery in the later 1800s leading to the Revolution in Surgery. Before he introduced sterile surgery (surgery free from germs)people died from infection.
  • After reading Pasteur’s germ theory, Lister used carbolic acid to cover wounds & spray on surgical instruments to keep them clean. He insisted on hand-washing in surgery.
  • His ideas were taken on by many surgeons and infection rates dropped greatly as a result. This showed that germ theory was correct and that patients’ lives could be saved with attention to cleanliness.
• Antiseptic sugery


  Lister introduced the idea of Antiseptic surgery. This was through surgeons continually using carbolic acid to clean their hands and surgical tools. This led to a significant drop in infection. However, many surgeons still believed surgery should be done as quickly as possible and did not appreciate the time taken to disinfect tools as they worked.
• Aseptic sugery


  Antiseptic was then replaced in later years by Aseptic surgery. This was the process of ensuring that germs are never present in an operating theatre to begin with. Doctors would wear gloves, masks and aprons. Tools and surgical rooms would be cleaned thoroughly before and after surgery. As well as this surgical theatres were greatly reduced in size and viewing galleries were removed, this greatly reduced the risk of infection. 
• Problem of blood loss

  • Before 1901, early blood transfussions were often unsuccessful and more often than not fatal in humans
  • The first successful blood transfussion was performed by Richard Lower in 1655 on a dog
• Effects on WW on medicine:

  • New types of sugery were developed rapidly
  • Plastic sugery was introduced
  • Training of war surgeons
  • Expansion of hospitals
  • Government and funding increase
  • Surgeons took more risks
  • New weapons = new injuries