Surgery overview

Question 1

What are the three problems of early surgery?

Answer 1

> Pain
Blood loss
Infections

Question 2

What was Robert Liston famous for?

Answer 2

Fast amputation speed

Question 3

Why would surgeons operate so fast?

Answer 3

> To reduce the risk of the patient dying of shock

>Minimize pain

Question 4

What was discovered in 1799?

Answer 4

Nitrous Oxide by Humphrey Davy

Question 5

Name the positives (1) and negatives (2) about Nitrous Oxide

Answer 5

+Makes patients less aware

• Doesn’t make you unconscious-just less aware
• Doesn’t work on everyone

Question 6

What new anesthetic was developed in 1846?

Answer 6

In 1846 William Morton (a dentist) started used Ether.

Question 7

What was Ether the first anesthetic to do?

Answer 7

+Ether was the first anesthetic to make people unconscious

Question 8

What did Horace Wells use in a dental operation in 1845

Answer 8

Nitrous Oxide-left patient in agony

Question 9

What was wrong with Ether (5)?

Answer 9

• It irritated patients lungs (and surgeons) making them cough even when unconscious
• It caused vomiting
• Put people in a deep sleep that could last for days
• Was highly flammable-surgeons operated by candle light
• Contained in heavy glass bottles that were easy to smash and awkward to carry

Question 10

What did Robert Liston use in an amputation in 1846?

John Collin Warren used ** to remove a tumor in America the same year

Answer 10

Ether

Question 11

When was Chloroform discovered?

Answer 11

1847 by James Simpson, he wanted to ease the pain of childbirth

Question 12

Who famously died in 1848

Answer 12

Hannah Greener during an operation using chloroform, she was the first recorded death.

Question 13

What were the problems when using chloroform in surgery?

Answer 13

• It was difficult to get the dosage right;
• Too little meant patients felt pain
• Too much killed them (affected the heart)

Question 14

What were the positives of Chloroform

Answer 14

+Induced a state of unconsciousness without the side effects of Ether
+Meant surgery could be slower, and more careful
+Reduced death by shock

Question 15

Why did the Church oppose Chloroform/anesthetics (4) ?

Answer 15

> They thought pain was sent by god. In 1849 a letter was published in the Lancet protesting use of anesthetics.
People were against use of anesthetics in childbirth, thought the pain was penance for Eve’s sins.
Fear it would make women unladylike
Fear it would make men wimpy-spill their deepest secrets (army)

Question 16

Why did surgeons oppose Chloroform? (4)

Answer 16

> The fastest surgeons had the best demand-so made more money. Anesthetics got rid of the need for this skill-patient was unconscious.
Chloroform was a new development and people were wary.
Felt it was easier to die unconscious than awake and struggling.
Couldn’t explain rise in death rate (black period of surgery) and were put off. (Hannah Greener)

Question 17

Who solved the problem of dosage?

Answer 17

In 1848 John Snow developed an inhaler which made administering doses more precise

Question 18

Who helped normalize the use of Chloroform?

Answer 18

Queen Victoria, she used chloroform in the birth of her 8th child in in 1853. (Charles Dickens wrote about his wife using it also)

Question 19

When was the black period of surgery

Answer 19

1847 to 1877. Whilst patients were unconscious surgeons could try out more complicated operations, this lead to more people getting infections, losing blood and dying.
(discovery of chloroform-use of antiseptics)

Question 20

Give 3 reasons why Simpson didn’t help solve the problem of pain relief…

Answer 20

> Snow made Chloroform safe and usable (inhaler) Simpson’s chloroform had fatal side effects
Without Queen Victoria’s endorsement it would’ve been forgotten; opposition to chloroform meant it wasn’t used
Simpson wasn’t the first to develop pain relief (N.O and Ether)

Question 21

The Germ Theory was published in ** by *** ***. What did it say?

Answer 21

The Germ Theory was published in 1861 by Louis Pasteur. The germ theory stated that ‘infections’ (moldiness in wine) was caused by microbes also known as ‘germs’. The germs could be killed by heat.

Question 22

Who linked microbes to septicemia (infection). How did he originally propose to stop septicemia?

Answer 22

Joseph Lister. Started the use of antiseptics-used carbolic acid to soak wound and dressing (first used on a boy that had a compound fracture)

Question 23

After originally using carbolic acid as an antiseptic how did Joseph Lister change his methods?

Answer 23

Moved from antiseptics to aseptic. To prevent microbes from getting into the wounds he said the ‘surgery’ needed to be sterile and free from the microbes. Used a donkey pump to spray carbolic acid everywhere)

Question 24

Why did people oppose Lister himself and his theory? (6) (not the use of carbolic acid)

Answer 24

> Lister was viewed as a fanatic.
Didn’t believe in microbes or that they caused infections-Lister was a common joke.
Felt Lister was blaming them for their patients’ deaths.
Surgeons copied the method wrong which meant it didn’t work successfully-said it didn’t work at all.
Some surgeons had good success rates without carbolic acid.
Lister constantly changed methods-making improvements-made him seem unsure that they worked.

Question 25

Why did surgeons oppose the use of carbolic acid? (7)

Answer 25

> Believed antiseptics would compromise body defense system.
Carbolic spray was messy and went everywhere.
It was very expensive.
The donkey pump was awkward to use.
Carbolic acid damaged their hands.
Using carbolic acid slowed the operation down lots-had to spray everything.
Carbolic acid was originally used to treat sewage-made people unsure (was what gave Lister the idea)

Question 26

What else (equipment) helped promote the ‘aseptic’ environment?

Answer 26

Robert Koch invented the steam sterilizer in 1878; instruments were free of germs
Invention of rubber gloves; prevent microbes being introduced to wound by surgeons hands
People wore gowns and face masks

Question 27

How had people originally tried to stop blood loss?

Answer 27

Metal clips; tie arteries
Ligatures; tie blood vessels-still bleed if not tied properly
Cauterization (burning); hot oil/iron was poured on wound
Tourniquets
Blood Transfusion; banned-mortality rate was so high

Question 28

Who discovered blood groups?

Answer 28

Karl Landsteiner 1901. He also discovers that blood groups need to match for a transfusion to be successful

Question 29

Why did research into preventing blood loss suddenly increase in the early 20th century?

Answer 29

WW1… 1914-1918. Soldiers were dying of blood loss even if their wounds weren’t fatal.

Question 30

What three three things (name dates please) helped towards making transfusions a ‘thing’ (blood storage)

Answer 30

1914; Richard Lewisohn discovers Sodium Citrate stops blood clotting (still deteriorates)
1916; Richard Weil shows blood lasts longer when refrigerated
1916; Rous and Turner discover adding sodium glucose makes blood last even longer outside the body.
These developments mean the donor no longer has to be present during a transfusion -> blood depots!

Question 31

What was the first of its kind in the ‘Battle of Cambrai’

Answer 31

Blood depot-1917

Question 32

What made blood transfusions easier? (technology)

Answer 32

Hypodermic Needle

Question 33

Who was Harold Gillies?

Answer 33

Harold Gillies-father of plastic surgery. 2.1m men were injured in WW1-the use of bombs left many with shrapnel wounds. Harold Gillies set up a plastic surgery unit at Aldershot to treat those injured. He used pedicle grafts.

Question 34

What else was set up in WW1 to treat the injured?

Answer 34

> Triage system-prioritized cases (is still used)
Petite Curies-portable X-ray machines
Medical cards and records used ton communicate

Question 35

What new anesthetic was used in 1905?

Answer 35

Novocaine