The Development of Modern Surgery Flashcards
What were the three big issues with surgery?
Pain, bleeding, infection.
What had been used as pain relief?
Alcohol, opium (the opium poppy gives morphine), mandrake
Who first suggested the use of nitrous oxide (laughing gas) as an anaesthetic?
Humphrey Davy in 1799 - but he was ignored.
What was nitrous oxide being used as?
A fairground novelty.
Who next tried to use nitrous oxide for a medical purpose?
Horace Wells, in 1845, wanted to demonstrate use in dentistry - but his patient was unaffected by nitrous oxide, so he was ignored too.
Who discovered the anaesthetic properties of ether?
Crawford Long, 1842, but he did not publish his findings.
Who carried out the first public demonstration of ether as an anaesthetic?
William Morton 1846
What are the problems with using ether as an anaesthetic?
It is an irritant, and also explosive.
Who found an alternative to ether as an anaesthetic?
James Simpson, in 1847
What alternative to ether did James Simpson find?
Chloroform.
What is the problem with chloroform?
It sometimes causes the heart to stop, causing sudden death
What was chloroform used for?
As an anaesthetic for operations, and for pain relief during child birth.
Why is local anaesthetic better than general anaesthetic?
General anaesthetic is very risky for the patient.
Who first investigated using local anaesthetics?
William Halstead, in 1884
What substance did William Halstead use for local anaesthetic?
Cocaine
What happened to William Halstead as a result of his experiments into using cocaine as a local anaesthetic?
He became addicted to cocaine.
What was people’s reaction to anaesthetics?
Some were very suspicious of doctors putting them to sleep. Others had religious objections, especially to the use of pain relief during child birth,
What was the surgeon’s reaction to the availability of anaesthetics?
They could perform longer, more complicated operations.
What happened to the death rates after the introduction of anaesthetics?
They went up, as bleeding and infection had not been overcome.
What was the “black period” of surgery?
The period between 1846 and 1870, when the death rate after surgery was very high as anaesthetics had been introduced but bleeding and infection were still a big problem.
Where were operations carried out?
Even in patients own houses, as no one had any idea of hygiene.
What did the surgeons do that caused deaths?
They did not wash their coats, a coat covered in blood was a badge of honour; they did not wash the instruments between patients.
What is the name for methods that kill germs?
Antiseptic.
What is the name for methods that exclude germs?
Aseptic.
Who first started using antiseptic methods to reduce infection rates?
Semmelweis used chloride of lime as a hand wash for the doctors to control the spread of puerperal fever (an infection of women after giving birth).
Why was Semmelweis idea not much used?
Chloride of lime is very unpleasant.
What gave Lister the idea of using carbolic acid in operating theatres?
He had seen carbolic acid sprays being used in sewage works to reduce the smell.
When did Lister start using carbolic acid in operating theatres?
early 1860s.
When did Lister refine his technique?
He heard about germ theory in 1865, and realised germs could be on the instruments and on peoples hands, He started using carbolic on instruments and bandages.
What did Lister’s techniques do to the death rate?
It went down from about 50% to about 15%.
Why didn’t all doctors use carbolic acid?
It is very unpleasant to get on your skin or to breathe in.
Why is asepsis used in modern operating theatres?
It reduces the need for powerful chemicals.
What is done to keep modern operating theatres germ free?
Instruments sterilised before use (steam at 120°C); staff sterilise their hands; staff wear sterile clothes; theatres kept very clean; sterile, filtered air used.
What was the problem with blood transfusions?
Sometimes they worked, sometimes they did not.
Why was there a need for blood transfusions?
Surgery causes bleeding, and it can be very heavy.
When were the first blood transfusions done?
Certainly in the 17th century.
What discovery made blood transfusions possible?
The discovery of blood groups.
What happens to blood stored outside the body?
It clots.
Who discovered blood groups?
Karl Langsteiner, in 1900.
What was found to stop stored blood from clotting?
Sodium citrate
What event made blood transfusions very important?
The first world war, 1914-1918.
When was the first blood bank set up?
1917, at a battle.
When was the National Blood Transfusion service set up?
1946
Who discovered X-rays?
Wilhelm Roentgen
When did Roentgen discover X-rays?
1895.
What is the value of X-rays?
They pass through soft tissue, but not bone, and affect photographic film, so can be used to get pictures of the skeleton.
What is a CAT scan?
A scanner rotates 180° around the body, aiming x-rays at receptors on the opposite side. A computer analyses the results and produces a 3D simulation of the body.
What is CAT short for?
Computerised Axial Tomography. Or Pet Cat.
Who discovered radioactivity?
Becquerel and the Curies - 1896-1898.
What is the medical use of radioactivity?
Radiotherapy to treat cancer; immunosuppression; tracers in diagnosis
What is a tracer?
A substance is “tagged” by including an radioactive element, then the activity of the part of the body using the substance can be observed… eg glucose shows active parts of brain; iodine shows thyroid gland
What is keyhole surgery?
Surgery through very small incisions.
Why is keyhole surgery popular?
Less pain; quicker recovery; smaller scars.
How is keyhole surgery done?
Surgeon watches the operation on screen, via an endoscope which is put into the body. He then introduces instruments through other small holes. Usually still requires a general anaesthetic.
When was keyhole surgery first done?
1980s. Scar on your Dad’s back would be about 1cm if he’d had the op a couple of years later.
What is transplant surgery?
Replacement of worn out body parts - either transplanted from a donor, or artificial (eg hip joint).
When was the first transplant done?
1905 - the cornea of the eye.
What transplants were done in World War 1?
Skin was transplanted from one part of the body to another, wounded part, to encourage healing.
What organ was first successfully transplanted?
Kidney
Who did the first successful heart transplant?
Cristiaan Barnard.
How successful was the first heart transplant?
The patient lived for 18 days, then died of pneumonia.
Why were heart transplants stopped for a time?
The patients did not live for long.
What is the big problem for transplants from a donor?
The body’s immune system recognises the proteins on the surface of the cells as foreign, and will attack and kill the donated organ. This is known as rejection.
What can be done to stop rejection?
Immunosuppressant drugs are used.
What is the problem with immunosuppressants?
They leave the patient too vulnerable to other infections - like the first heart transplant patient who died of pneumonia.
What drugs were first used as immunosuppressants?
Corticosteroids.
What is cyclosporin?
A modern immunosuppressant derived from a fungus.
What was the effect of war on plastic surgery?
Development sped up, facial injuries needed to be repaired.
What major step was during the First World War plastic surgery?
Use of pedicle tubes. The idea is that skin is partially removed from the patient, still attached on one side, and then stretched over a tube - as there is still a blood supply it grows. When it is big enough it is attached to the damaged area, and eventually detached from the graft area.
What sort of patient needed facial surgery in World War 2?
Pilots who had been trapped in burning aircraft.
What advance made plastic surgery, especially on burns, possible?
Antibacterial drugs, burns are very prone to infection.
What other advances were caused by war?
Prosthetic limbs; blood transfusions; mobile X-ray units; brain surgery.
