Surgery Flashcards
1
Q
Surgery in 1848
A
- In the mid 1840s, training for a doctor took 4 years.
- Surgery was extremely dangerous in the mid-19th Century
- Blood loss was common so a tourniquet was used
- There were three types of pain relief: opium, alcohol or being knocked unconscious
- By the 1840s there were only three operations that surgeons could carry out with some success: amputation, trephining, removal of superficial tumours
- All were carried out quickly and pain was ignored.
- Infection after the surgery was a real danger.
- Operations were carried out in the patients home, surgeons would wear old clothes, didn’t sterilise their equipment or even clean them and bandages were reused often. Almost half of patients with leg amputations died of blood poisoning
2
Q
Use of ether
A
- In 1846, an American dentist found that ether was stronger than laughing gas
- It was first used in 1847 by Robert Liston in Britain. The patient did not need to be held down and was unaware the surgery had happened
- John Snow began to administer ether for major surgeries
Limitations
- It caused vomiting, irritated the lungs and caused patients to cough during an operation
- It was unstable and flammable
3
Q
Simpson and chloroform
A
- In 1847, James Simpson discovered chloroform as an anaesthetic after being knocked unconscious by it
- He used it to relieve labour pains in childbirth and wrote articles that convinced other surgeons to use it
- Queen Victoria: She used it with the birth of her 8th child which increased acceptance for the anaesthetic. It was administered by John Snow
- In 1848, John Snow invented the chloroform inhaler to control the dosage
4
Q
Limitations of chloroform
A
- Christian opposition: The argument was that women should feel pain during childbirth because Eve was told so in the bible. So relieving pain was unnatural
- Medical arguments: Chloroform was new and untried. They did not know what dosages would be safe and Hannah Greener died after being given chloroform to remove her toenail
- Blood loss: It did not make surgery safer - it meant that surgeries were longer and deeper but with no hygiene, infection was spread further and quicker and loss of blood was more likely. The next few years were known as the ‘Black Period’ of surgery
- Infection: Surgeons were attempting more complex surgery but not using clean equipment meant that wounds could become infected and develop sepsis
5
Q
Problem of infection during surgery
A
- Until Germ Theory in the 1860s surgeons did nothing to prevent infection
- Doctors did not wash their hands, wore clothes covered in blood and pus
6
Q
1847 Semmelweiss and hand washing
A
- Semmelweiss made the link between hygiene and disease. He noticed doctors came from autopsies straight to delivering babies without washing their hands first
- He proposed that surgeons should wash their hands. He was regarded as a fanatic and laughed at
- Placed in asylum until death
7
Q
Jospeh Lister and aseptic technique
A
- The father of antiseptic surgery
- He researched gangrene and infection and picked up the work of Louis Pasteur
- He applied carbolic acid compounds as an antiseptic on surgical wounds. He started to clean the wounds with carbolic acid and soak dressing in antiseptic liquid as well
- He noticed a huge difference in mortality. In the years from 1864-66 the death rate for his patients was 45.7% this reduced to 15% between 1867-70
- Lister went on to develop a carbolic spray that was used in operating theatres
- Lister’s work revolutionised surgery once his antiseptic techniques were developed
- By the 1890s his antiseptic methods became aseptic surgery which meant removing all germs from the operating theatre
8
Q
Limitations of Joseph Lister and aseptic technique
A
- Carbolic spray could not be used for long because it damages the tissue
- Carbolic spray caused many problems if breathed in
- It cracked the surgeons skin
- It caused extra work and made surgery more expensive
- If a patient was bleeding, antiseptic methods just slowed things down
- Some surgeons did not follow his methods properly and then called his antiseptics ineffective
- There were arguments that the antiseptics prevented the body’s own defence mechanisms from operating effectively
- Pasteur’s Germ Theory was published in 1861 but the ideas spread slowly
- Lister was not a showman, was cold and arrogant which led to opposition to his ideas
- Lister was accused of constantly changing his ideas, in reality he was just looking for alternatives to the carbolic spray
9
Q
Aseptic surgery
A
- It is surgery performed under sterilised conditions. Operations were in clean theatres with no spectators. Surgeons wore clean clothes, masks and rubber gloves.
- Koch introduced ‘aseptic surgery’ after discovering hot steam could clean equipment. Surgeries now had strict hygiene rules.
- It led to rigorous cleaning of hospitals and operating theatres
- From 1887, all instruments were steam sterilised
- In 1894 sterilised rubber gloves were used for the first time
- In 1896, the first heart operation was performed
10
Q
Impact of aseptic surgery
A
- Lister’s discoveries changed surgeries forever
- More complex surgeries were now safer
11
Q
Problem of blood loss
A
Blood loss was a significant problem - operations had to be completed quickly before the patient bled out
12
Q
Lister and catgut
A
- Lister experimented with ways to reduce blood loss
- Usually pressure was put on the arteries to stop blood flow - afterwards any blood vessels would be cauterised
- Lister found that using catgut soaked in carbolic acid. The catgut would dissolve after 2-3 weeks and did not prevent the body from healing properly
13
Q
Blood groups and transfusions
A
- Until 1901, blood transfusions often resulted in death. Karl Landsteiner discovered human blood groups and transfusions became much safer
- This had a huge impact on surgery and helped people with blood disorders like anaemia leukaemia, liver problems
Limitations:
- Blood transfusions still had to be person to person and it was not always possible to find a donor of the right blood group
- Tubes in the transfusion could become blocked because it clots as soon as it leaves the body
- This was a significant discovery but needed more research for it to be truly helpful
14
Q
Development of x-rays
A
- In 1895, Roentgen discovered x-rays and published his findings
- By 1896, many hospitals had an x-ray machine installed
- X-rays could help surgeons spend less time searching inside a wound which reduced the risk of infection
15
Q
Problem of powerful guns
A
More powerful guns meant more severe wounds and deeper infections and the battlefield was dirty which carried further risk
