SURGERY

Question 1

How did Christianity help Surgery in the Middle Ages?

Answer 1

• Built hospitals.
• The Church supported the idea of supernatural causes and cures for disease.
• The Church helped set up Universities and Medical Schools.
• The Church thought it was important to care for the sick but not to cure for them as it would go against Jesus.

Question 2

How did Christianity hinder Surgery in the Middle Ages?

Answer 2

• Believed illness was a punishment from God.
• Care over cure for patients.
• The Pope condemned new ideas that challenged the Bible.
• The Church controlled education.
• The Church controlled the training of doctors in Oxford and Cambridge.
• The Church tried to control knowledge and stopped some ideas circulating.

Question 3

How did Islamic ideas help Surgery?

Answer 3

•Did not allow human dissection.
•Ibn-Al-Nafis → Galen was wrong about how the heart worked
↓
No dissection=couldn’t prove it.
•His books were not read in the west.

Question 4

How did Islamic ideas help Surgery?

[ISLAMIC DOCTORS] [Rhazes]

Answer 4

•Found the difference between smallpox and measles.
•Wrote “Doubts About Galen”.
•Careful observations.
•Was a Galen fan.
BUT
Also encouraged and supported improvements.

Question 5

How did Islamic ideas help Surgery?

[ISLAMIC DOCTORS] [Avicenna]

Answer 5

Wrote “Canon Of Medicine” - an encyclopaedia on different remedies.

Question 6

How did Islamic ideas help Surgery?

[ISLAMIC DOCTORS] [Abulcasis]

Answer 6

• Considered “Father of Modern Surgery”.
• Invented 26 new surgical instruments.
• Used new procedures.

Question 7

What was Medieval Surgery like?

Answer 7

Was a risky business for the patients because surgeons:
•operated without effective painkillers
•had no idea that dirt carried disease
•could not help patients with deep wounds to the body
•sometimes thought pus in a wound was good

• NO ANTISEPTIC → RISK OF INFECTION
• NO ANAESTHETIC
• NO WAY TO STOP THE LOSS OF BLOOD

Question 8

Claudius Galen:

Who was he and what did he do?

Answer 8

ACCURATE:
•Discovered that the brain controls the nerves in the body.
•Urine was made in the kidneys.
•Respiratory system operated by the muscles.
•Discovered the difference between motor neurones and sensory neurones.

INACCURATE:
•Liver produces an infinite amount of blood.

•He believed that every organ in the body has a function, so he used dissection to prove it.
↓
He only dissects animals due to Christian beliefs.
↓
He worked in gladiators- so he had experience.

•No one can question Galen as he did his dissections publicly and the Church supported his ideas.

Question 9

What were some of the procedures that a medieval surgeon would perform?

Answer 9

• Bloodletting
• Amputation
• Cauterisation
• Trepanning

Question 10

Medieval Surgeons:

[Abulcasis]

Answer 10

Location- Islamic Empire
Time- 1000
Book- Al Tasrif
Ideas- Created 26 new surgical instruments, new procedures (e.g. cauterisation)

Question 11

Medieval Surgeons:

[John Of Arderne]

Answer 11

Location- Medieval England (London)
Time- 1363
Book- Guild Of Surgeons (1368), Surgical Manual Practica (1376)
Ideas- Specialised in operations for anal abscess. Survival rate was over 50%. Charged the rich as much as he could, did not charge the poor. Discouraged the reading of Galen. Developed his own painkillers- hemlock, opium and henbane.

Question 12

Medieval Surgeons:

[Hugh Of Lucca and his son Theodoric]

Answer 12

Location- Italy
Time- 1267
Ideas- Contradicted that pus was needed for a wound to heal. Used wine on wounds to reduce the chance of infection (through observation). Used the ideas of Hippocrates.

Question 13

Medieval Surgeons:

[Guy De Chauliac]

Answer 13

Location- France
Time- 1363 (Middle Ages)
Book- Great Surgery
Ideas- Opposed Theodoric of Lucca’s ideas about preventing infection.

Question 14

Medieval Surgeons:

[Mondino de Luzzi]

Answer 14

Location- Italy
Time- 1300s (14th Century)
Book- Anathomia (1316)
Ideas- Led the new interest in anatomy, and supervised in a public dissection.

Question 15

Medieval Surgeons:

[Frugardi]

Answer 15

Location- Italy
Time- 1180
Book- The Practice Of Surgery
Ideas- Warned against trepanning, tried ambitious operations on the chest and attempted to remove bladder stones.

Question 16

[RENAISSANCE]
Andreas Vesalius:
Who was he and what did he do?

Answer 16

•He corrected over 200 of Galen’s mistakes.
•His book “Fabric Of The Human Body” (1543) was translated into English, taken to England to be used by barber surgeons.
↓
•circulated throughout Europe.
•Studied the work of Galen in France.
•Stole bodies (BREAKING THE LAW) to practice dissection.
•Was the first person to challenge/question Galen’s ideas of human anatomy based on animal dissection.
•He publicly dissected bodies to show people the body was not wrong.

Question 17

[RENAISSANCE]
Ambroise Paré:
Who was he and what did he do?

Answer 17

• He was a barber surgeon.
• He was a battlefield surgeon (1537).
• He’s considered one of the fathers of surgery.
• He was the official royal surgeon to 4 French Kings:
  
  • Henry II
  • Francis II
  • Charles IX
  • Henry III
• When he ran out of oil on the battlefield, he used a mixture of egg whites, oil of roses, and turpentine to apply on wounds as a dressing.
• His patients would die (bleed to death) before he could boil the oil.
• Silk thread was used to stop blood loss.
• He was not accepted by the medical established and many opposed his ground breaking methods.
• People wouldn’t take him seriously - he had no experience.
• He read the works of Andreas Vesalius
• His book was called “Works On Surgery” (1575).
• WHAT DID HE DO?
  
  • Ointment
  • Artificial/prosthetic limbs
  • Ligatures → FIRST USED BY ABULCASIS

Question 18

[RENAISSANCE]
William Harvey:
Who was he and what did he do?

Answer 18

• He was an English doctor.
• His book was called “The Motion of the Heart and Blood” (1628).
• He is famous for discovering the circulation of blood around the body by the heart, and correcting Galen’s previous mistakes.
• Studied human hearts.
• Observed the slow-beating hearts of cold-blooded animals to understand how the muscles worked.
• Experimented by trying to pump liquid the wrong way through valves in the veins, proving that blood can only flow one way.
• He had no explanation on why blood flowed around the body.
• Could not explain why blood in the arteries was a different colour to blood in the veins.
• Could not explain how blood moved from the arteries to the veins, but suggested that it was absorbed by the veins.
• He was a careful scientist who drew conclusions from methodical observations and experimentations.

This led to … to happen:
•Blood transfusions
•Heart transplants
•Discovery of Blood groups -1901

Question 19

What were the reactions to Harvey’s discovery?

Answer 19

• Some doctors rejected his theory because he was contradicting Galen, who had been the authoritative voice on how blood worked.
• French anatomist- Jean Riolan -called Harvey a “circulator” : this slang for a travelling quack (an unqualified, often useless doctor).
• In 1636, Professor Casper Hofmann watched Harvey demonstrate his theory, but then he dismissed his calculations about the body’s amount of blood as “the mere trick of an accountant”.
• His theory was accepted by many within his lifetime, but it took another 50years before the University of Paris taught it to medical students.

Question 20

John Hunter:

Who was he and what did he do?

Answer 20

•Removed tumours
•Used corpses (like Vesalius) to learn about anatomy.
•Tried out transplant surgery on animals (like Vesalius) - observations and experimenting.
• Used ligatures like Paré.
•Found a way to restrict the aneurysm
-tied off arteries instead of amputating.
•Everything was public (like Vesalius and Galen) to gain attention.
•Collected a huge number of anatomical specimens.
•Royal College of Surgeons - 1768

Question 21

How did World War One have an impact on Surgery and Health?

Answer 21

BROKEN BONES:
•The Army Leg Splint (also known as the Keller-Blake Splint) was developed, which elevated and extended the broken leg “in traction”.
•This helped the bones to knit together more securely.

PLASTIC SURGERY:
•Harold Gillies- plastic surgery hospital in 1915, treated men severely suffering from shrapnel wounds.
•Queen’s Hospital in Kent opened in 1917 and by 1921 provided over 1000 beds for soldiers with severe facial wounds.
•Gillies and his colleagues treated over 5000 servicemen by 1921.

X-RAYS:
•Were discovered in 1895.
•Mobile x-ray machines were used near battlefields to find out exactly where in the body the bullets or pieces of shrapnel had lodged.

Question 22

How did World War Two have an impact on Surgery and Health?

Answer 22

NHS SET UP:
•In 1942, a civil servant, William Beveridge, proposed a free National Health Service for all.

BLOOD TRANSFUSIONS:
• Advances in storing blood started after the First World War.
•This led to the British National Blood Transfusion Service opening in 1938.
•Large blood banks were developed in both the USA and Britain during World War 2.

PLASTIC SURGERY:
•a doctor from New Zealand, Archibald McIndoe (a cousin of Harold Gillies), used new drugs such as Penicillin to prevent infection when treating pilots when treating with horrific facial injuries.

HEART SURGERY:
•Progressed during the Second World War.
•American army surgeon, Dwight Harken, cut into beating hearts and used his bare hands to remove bullets and bits of shrapnel.
•His findings helped heart surgery develop greatly after the war.