The Transformation Of Surgery Flashcards
What was good and bad about nitrous oxide?
It reduced pain but had limited impact as it didn’t knock the patient out
What was good and bad about ether?
It made the patient unconscious
sometimes caused vomiting,
tended to irritate the lungs of the patient,
highly flammable – only form of light was artificial light from candles or gas lights,
it produced a very deep sleep which lasted for days,
had to be carried around in large heavy glass bottles which were difficult to carry into the home of the patient
Why did some people oppose using anaesthetic?
Religious - some people thought pain was part of gods plan for humans especially child birth, when queen V used it for giving birth to her eighth child in 1853 it became more acceptable
In 1848 hannah greener died while being given chloroform to remove one of her toenails
Anaesthetics encouraged surgeons to go deeper into the body but blood loss and infection had no be solved so the death rate increased
Some surgeons thought an unconscious patient was more likely to die
they didn’t trust them as they were new, and their effects were not fully understood
the number of patients dying increased
What were the things wrong before 1861?
They washed their hands in water that may be carrying infection
Instrument table and operating room would not have been cleaned
They would have worn coat with lots of old blood on it to show how experienced they were and as a status symbol
- Before antiseptics were used the use of anaesthetics meant that the operations could take longer and they could do more complex operations, but they did not understand about disease or infection and germs therefore the patient often died many days later due to infection
- They were often carried out in the patients home or hospital ward, this meant the conditions that the operation was carried out in were not hygienic, they would wear ordinary clothes
What were the breakthroughs in infection before 1861
Florence nightingale - ensured high hygiene standards among her nurses and insisted each hospital bed had one person
Ignaz semmelwesis - noticed medical students were more likely to kill in birthing ward than nurses, made them wash their hands in chlorinated water
How did they prevent blood loss before 1900
Cauterisation - using a hot iron to burn body tissue this sealed blood vessels and stopped bleeding
Ambroise paré - developed metal chips to clip blood vessels or hr tied them shut with silk threads called ligatures these caused infection and did not to the bleeding if they were not tied properly
What were the first anaesthetics?
Nitrous oxide and ether
What were the early experiments in blood transfusion?
After Harvey’s discovery people tries blood transfusions between sheep and humans, sometimes they were successful because only a tiny amount was transfused most times they were not
Human to human in 1795
Jame Blundell between 1825-30 gave blood transfusions to 10 people only half survived
James Blundell brought blood transfusions to Britain, he developed different kinds of syringes, pumps and tubes but he had three main problems – clotting, blood clots as soon as it left the body, avaliablilty – transfusions could only be done from donor to donor, immune response, transferring from a animals used to destroy human blood cells and often lead to death, red blood cells would clump together
Who discovered blood groups?
Karl Landstiener in 1900
He discovered that there was different blood groups and the different blood groups were incompatible because of the antigens on the surface of each blood cell was different therefore the antibodies attacked the foreign antigens
did not have an immediate impacy as the donor still needed to be there.
What were the problems with blood transfusions?
Blood would clot
Blood couldn’t be stored and the transfusion had to be done with the person there
What were the advances of blood transfusion during the war?
- In 1915 Richard Lewisohn found that adding sodium citrate stopped blood from clotting and the donor did not have to be there so more transfusions could take place, although the blood cells deteriorated if the blood was not used up soon afterwards
- Richard Weil found that blood could be stored in refridgerated conditions
- In 1916 James Turner and Francis Rous found that adding a citrate glucose solution allowed it to be stored for longer, the army could ask for donations and they were available to treat the wound
- Geoffrey Keynes a british surgeon developed a portable machine
- First blood o depot was established in 1917 for the battle of Cambrai
What was the impact of war on surgery?
Surgeons worked with a variety of wounds this meant that their training was broader
Surgeons gained experience quickly
Surgeons had to improvise this lead to rapid development
Explosive weapons meant soldiers had shrapnel embedded in them this lead to the development of saline to fight infection
First attempts at brain surgery
Plastic surgery was developed
- They had been given more experience as they had to deal with a wide range of injuries, for example they used rubber bands around patients heads to stop the bleeding and they used saline solution to wash out pulped brain they even used magnets to pull out shrapnel
- They suffered deep wounds, which caused infection surgeons found that cutting away infected tissue and soaking the wound with a saline solution was the best way of doing this
- They started doing plastic surgery
What was the impact of communications in surgery?
Many surgeons took careful notes and began to publish photographs
More scientists published their ideas in medical journals
Medical conferences started to take place
Newspapers reported notable operations
public was more interested
communicated problems - Hannah Greeners death in the Lancet
only published information that was based on good science
What was the impact of science and technology in surgery? impact of Pasteur
- Carbolic spray, sterilising instruments, wearing rubber gloves, catgut for ligatures, gowns, face maskes, based on pasteurs germ theory
What opposition did lister face?
To begin with surgeons were very critical as they didn’t like the smelly and corrosive carbolic acid
Didn’t accept the idea that microbes caused disease as you couldn’t see them without a microscope
Slowed down operations so blood loss became more of a problem
Didn’t copy listers ideas properly and the death rate didn’t change so they didn’t think it worked
Lister kept changing his methods to improve his work so doctors thought he didn’t know what he was doing
Equipment was very heavy and expensive
Some surgeons had good results without carbolic acid
Nurses resented extra work
but by 1890 most operations were carried out under antiseptic conditions
