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Surgery

Surgery. Improvements in the Nineteenth Century. Problems before 19 th Century. Your chances of surviving any operation before the 19 th Century were slim: Pain No anaesthetics to knock you out. You were conscious throughout the operation (unless you passed out due to the pain) Infection

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Surgery

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  1. Surgery Improvements in the Nineteenth Century

  2. Problems before 19th Century • Your chances of surviving any operation before the 19th Century were slim: • Pain • No anaesthetics to knock you out. You were conscious throughout the operation (unless you passed out due to the pain) • Infection • No understanding of the Germ Theory and how germs were responsible for infection • Blood Loss • Difficulties in controlling bleeding and the inability to replace lost blood

  3. Problem 1: Pain • Read Source 2 page 134 • Problems of pain for the doctor • Patient kicking and flailing • Successful doctors were fast doctors • Shock • The patient could die from the effects of the operation

  4. Overcoming the problem of Pain • General Anaesthetics • Ether (laughing gas) • Discovered in 1799 • Medical students used to have laughing gas parties! • Dentists used the gas first • John Warren was the first to use it in an operation in the USA in 1846. • Problems with Ether • Irritated the lungs (causing coughing in many patients) • Could combust and even explode easily

  5. Overcoming the problem of Pain • General Anaesthetics • Chloroform • In 1847 James Simpson and some assistants experimented with some chemicals to try to find a safer anaesthetic • When they awoke unconscious from under the table, they realised that they had found the right ingredients • Problems with Chloroform • The dosage had to be regulated – too much could kill the patient • The doctor had to be careful not to anaesethize himself • The successful knocking out of the patient meant that doctors could try more complicated operations • Carry infection deeper into the body • More blood loss • Royal Assent • When Queen Victoria used chloroform during childbirth in 1857, opposition to the use of it dropped away.

  6. The Problem of Infection • Pre Germ Theory • No-one could explain how infection was caused • Look at Source 1 page 134 • Note down all the possible sources of infection • Even with an anaesthetist infection was still possible

  7. Overcoming the problem of Infection • Ignaz Semmelweis • Hungarian Doctor • Women and Childbirth • He noticed that death rate was lower for midwives than for doctors coming from the Post-Mortem room • In 1847 he posted a sign (page 137) that said that ALL doctors had to wash their hands before entering the maternity ward.

  8. Overcoming the problem of Infection • Joseph Lister • Influenced by Pasteur’s Germ Theory • Anti-Septics • Carbolic Spray • Lister had seen that it was used to treat sewage • He used it together with careful bandaging • Effects graph page 138 source 15 • Aseptic Operating Theatres • Koch discovers the germ that carries septicaemia in 1878 • Lister applied this knowledge to cleaning operating theatres and hospitals to remove all traces of the germ

  9. The Aseptic Hospital

  10. The Problem of Blood Loss • Bleeding was difficult to control • Tourniquet • Raise wound • Direct pressure • Lost Blood could not be replaced • Transfusions failed • Clotting • Blood Types not understand • Infection was often introduced when trying to control blood loss • Eg Pare’s ligatures

  11. Overcoming some of the problems of Blood Loss • Joseph Lister (Again) • Uses sterilised Catgut for ligatures • Infection cut down • Blood loss could be controlled during and after the operation

  12. The Impact of the First World War on Surgery • Plenty of Practice! • New Industrial Warfare • Bullet Wounds • High powered Rifles • Machine Guns • Artillery Rounds • Shrapnel • Filthy living conditions • The Surgeon was kept busy! • Generals wanted their soldiers back in the line ASAP • Invested money, personnel and expertise

  13. X-Rays - X marks the spot! • Discovered in 1895 by Wilhelm Rontgen • He noticed that some Cathode Rays passed through paper, wood and even flesh • However, they did not pass through metal or bone • Hospitals experimented with the new machine before World War One • The War proved their true worth • Surgeons could quickly and accurately locate bullets and shrapnel • They did not need to do explorative surgery

  14. Blood Transfusion • 1901 – Blood groups discovered • However Transfusions had to be done immediately or the blood clotted • Battlefield • Immediate transfusions often impractical • They needed to find a way to store blood • Plasma discovered • The liquid part of the blood could be separated from the clotting particles of the blood. • Just add warm saline and the plasma is ready to use as blood!

  15. Fighting infection • Gangrene a terrible problem for wounded soldiers • Surgeons discovered that if they cut away all infected tissue and soaked the wound in saline, they could prevent the spread of gangrene. • This was the only way to deal with gangrene – no medicines could yet kill any infections!

  16. Other Advances • Skin grafting improved • Eye surgery improved • Broken bone setting improved • ENT surgery improved • Brain surgery attempted • First attempts at dealing with Post-Traumatic Stress Disorder

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