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History - Medicine through Time > The Development of Modern Surgery > Flashcards

The Development of Modern Surgery Flashcards

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1
Q

What were the three big issues with surgery?

A

Pain, bleeding, infection.

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2
Q

What had been used as pain relief?

A

Alcohol, opium (the opium poppy gives morphine), mandrake

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3
Q

Who first suggested the use of nitrous oxide (laughing gas) as an anaesthetic?

A

Humphrey Davy in 1799 - but he was ignored.

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4
Q

What was nitrous oxide being used as?

A

A fairground novelty.

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5
Q

Who next tried to use nitrous oxide for a medical purpose?

A

Horace Wells, in 1845, wanted to demonstrate use in dentistry - but his patient was unaffected by nitrous oxide, so he was ignored too.

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6
Q

Who discovered the anaesthetic properties of ether?

A

Crawford Long, 1842, but he did not publish his findings.

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7
Q

Who carried out the first public demonstration of ether as an anaesthetic?

A

William Morton 1846

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8
Q

What are the problems with using ether as an anaesthetic?

A

It is an irritant, and also explosive.

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9
Q

Who found an alternative to ether as an anaesthetic?

A

James Simpson, in 1847

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10
Q

What alternative to ether did James Simpson find?

A

Chloroform.

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11
Q

What is the problem with chloroform?

A

It sometimes causes the heart to stop, causing sudden death

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12
Q

What was chloroform used for?

A

As an anaesthetic for operations, and for pain relief during child birth.

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13
Q

Why is local anaesthetic better than general anaesthetic?

A

General anaesthetic is very risky for the patient.

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14
Q

Who first investigated using local anaesthetics?

A

William Halstead, in 1884

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15
Q

What substance did William Halstead use for local anaesthetic?

A

Cocaine

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16
Q

What happened to William Halstead as a result of his experiments into using cocaine as a local anaesthetic?

A

He became addicted to cocaine.

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17
Q

What was people’s reaction to anaesthetics?

A

Some were very suspicious of doctors putting them to sleep. Others had religious objections, especially to the use of pain relief during child birth,

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18
Q

What was the surgeon’s reaction to the availability of anaesthetics?

A

They could perform longer, more complicated operations.

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19
Q

What happened to the death rates after the introduction of anaesthetics?

A

They went up, as bleeding and infection had not been overcome.

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20
Q

What was the “black period” of surgery?

A

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.

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21
Q

Where were operations carried out?

A

Even in patients own houses, as no one had any idea of hygiene.

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22
Q

What did the surgeons do that caused deaths?

A

They did not wash their coats, a coat covered in blood was a badge of honour; they did not wash the instruments between patients.

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23
Q

What is the name for methods that kill germs?

A

Antiseptic.

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24
Q

What is the name for methods that exclude germs?

A

Aseptic.

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25
Q

Who first started using antiseptic methods to reduce infection rates?

A

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).

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26
Q

Why was Semmelweis idea not much used?

A

Chloride of lime is very unpleasant.

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27
Q

What gave Lister the idea of using carbolic acid in operating theatres?

A

He had seen carbolic acid sprays being used in sewage works to reduce the smell.

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28
Q

When did Lister start using carbolic acid in operating theatres?

A

early 1860s.

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29
Q

When did Lister refine his technique?

A

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.

30
Q

What did Lister’s techniques do to the death rate?

A

It went down from about 50% to about 15%.

31
Q

Why didn’t all doctors use carbolic acid?

A

It is very unpleasant to get on your skin or to breathe in.

32
Q

Why is asepsis used in modern operating theatres?

A

It reduces the need for powerful chemicals.

33
Q

What is done to keep modern operating theatres germ free?

A

Instruments sterilised before use (steam at 120°C); staff sterilise their hands; staff wear sterile clothes; theatres kept very clean; sterile, filtered air used.

34
Q

What was the problem with blood transfusions?

A

Sometimes they worked, sometimes they did not.

35
Q

Why was there a need for blood transfusions?

A

Surgery causes bleeding, and it can be very heavy.

36
Q

When were the first blood transfusions done?

A

Certainly in the 17th century.

37
Q

What discovery made blood transfusions possible?

A

The discovery of blood groups.

38
Q

What happens to blood stored outside the body?

A

It clots.

39
Q

Who discovered blood groups?

A

Karl Langsteiner, in 1900.

40
Q

What was found to stop stored blood from clotting?

A

Sodium citrate

41
Q

What event made blood transfusions very important?

A

The first world war, 1914-1918.

42
Q

When was the first blood bank set up?

A

1917, at a battle.

43
Q

When was the National Blood Transfusion service set up?

A

1946

44
Q

Who discovered X-rays?

A

Wilhelm Roentgen

45
Q

When did Roentgen discover X-rays?

A

1895.

46
Q

What is the value of X-rays?

A

They pass through soft tissue, but not bone, and affect photographic film, so can be used to get pictures of the skeleton.

47
Q

What is a CAT scan?

A

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.

48
Q

What is CAT short for?

A

Computerised Axial Tomography. Or Pet Cat.

49
Q

Who discovered radioactivity?

A

Becquerel and the Curies - 1896-1898.

50
Q

What is the medical use of radioactivity?

A

Radiotherapy to treat cancer; immunosuppression; tracers in diagnosis

51
Q

What is a tracer?

A

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

52
Q

What is keyhole surgery?

A

Surgery through very small incisions.

53
Q

Why is keyhole surgery popular?

A

Less pain; quicker recovery; smaller scars.

54
Q

How is keyhole surgery done?

A

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.

55
Q

When was keyhole surgery first done?

A

1980s. Scar on your Dad’s back would be about 1cm if he’d had the op a couple of years later.

56
Q

What is transplant surgery?

A

Replacement of worn out body parts - either transplanted from a donor, or artificial (eg hip joint).

57
Q

When was the first transplant done?

A

1905 - the cornea of the eye.

58
Q

What transplants were done in World War 1?

A

Skin was transplanted from one part of the body to another, wounded part, to encourage healing.

59
Q

What organ was first successfully transplanted?

A

Kidney

60
Q

Who did the first successful heart transplant?

A

Cristiaan Barnard.

61
Q

How successful was the first heart transplant?

A

The patient lived for 18 days, then died of pneumonia.

62
Q

Why were heart transplants stopped for a time?

A

The patients did not live for long.

63
Q

What is the big problem for transplants from a donor?

A

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.

64
Q

What can be done to stop rejection?

A

Immunosuppressant drugs are used.

65
Q

What is the problem with immunosuppressants?

A

They leave the patient too vulnerable to other infections - like the first heart transplant patient who died of pneumonia.

66
Q

What drugs were first used as immunosuppressants?

A

Corticosteroids.

67
Q

What is cyclosporin?

A

A modern immunosuppressant derived from a fungus.

68
Q

What was the effect of war on plastic surgery?

A

Development sped up, facial injuries needed to be repaired.

69
Q

What major step was during the First World War plastic surgery?

A

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.

70
Q

What sort of patient needed facial surgery in World War 2?

A

Pilots who had been trapped in burning aircraft.

71
Q

What advance made plastic surgery, especially on burns, possible?

A

Antibacterial drugs, burns are very prone to infection.

72
Q

What other advances were caused by war?

A

Prosthetic limbs; blood transfusions; mobile X-ray units; brain surgery.

History - Medicine through Time (12 decks)

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