Changes in Surgery

Ambroise Pare

• Died in 1590 but was a huge influence in the field of surgery.
• Used ligatures to stop bleeding.
• Made a special mixture to help healing on gunshot wounds instead of pouring oil on them.

pre-1845

• Barber-surgeons performed operations in dirty conditions.
• Speed was a sign of a good surgeon.

A Barber Surgeon's sketchings

1845-1900

• This short period of time oversaw 'radical progress' within surgery.
• Discoveries to combat pain and infection happened within this time frame.

1858 General Medical Council Established

Problem 1

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• 1847 Ether was used by J.R. Liston in London during a leg amputation.
• Ether caused coughing and sickness and was dangerous around fires and too heavy to carry.

James Simpson and Chloroform, 1847

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• James Simpson was Professor of Midwifery at Edinburgh University.
• He used chloroform regularly and showed other doctors how to use it.
• Queen Victoria used it during childbirth and this made more people confident of surgery.

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• In 1850s, coca leaves from South America were used to produce cocaine that could be used as a local anaesthetic.
• Anaesthetics did not make operations safer and it was difficult to get the dosage right.

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• 1870s = 'Black period' of surgery as the death rate increased.
• Anaesthetics improved and this led to more complex surgery, but deeper infections.
• Anaesthetics developed to include local anaesthetics which didn't knock you out.

Problem 2

Infections: the biggest danger in surgery

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• Doctors had used wine and vinegar to keep wounds clean for centuries.
• Before Pasteur's germ theory nobody knew what was causing infection.
• Bandages were reused spreading gangrene from patient to patient.
• Surgeons wore blood soaked clothes.

Ignaz Semmelweis

Ignaz Semmelweis 1847

• Realised that women whose babies were delivered by midwives rather than medical students were less likely to die.
• Medical students came from morgue.
• He put notices up asking people to wash their hands!
• Death rate on his ward reduced from 35% to 1%

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Joseph Lister and Carbolic Acid

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• Joseph Lister applied carbolic acid to the wound and soaked bandages in it.
• He found wounds healed and did not develop gangrene.
• Faced opposition to ideas from other surgeons who complained at cost but also at fact they had let patients down.

Lister's results 1867

• Hand washing with carbolic acid before operations.
• A carbolic spray to kill germs in the air around operating theatre.
• An antiseptic ligature to tie up blood vessels and prevent blood loss.

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• Lister reduced mortality rate fron 46% to 15% in his operations.
• In 1871 he developed a machine that sprayed carbolic acid over the operating theatre.
• Lister became known as the 'father of antiseptic surgery.'

Aseptic surgery

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• In 1878 Robert Koch discovered that disease was spread not in air but by contact with an infected surface.
• This led to attempts to create a germ free environment in which to carry out operations.

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• 1881 Charles Chamberland, a French biologist, invented a steam sterilser for medical instruments. He discovered that heating instruments in water for 140 degrees completely sterilised them.

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• Operating theatres and hospitals were rigorously cleaned.
• From 1887 all instruments were steam sterilised.
• Surgeons wore surgical gowns and face masks.
• 1894, sterilised rubber gloves used for the first time.

The 1st heart op was carried out in 1896

There was a revolution in surgery which meant more patients would survive surgery.

Problem 3

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• 1901, Karl Landsteiner discovered the 4 blood groups.
• Blood transfusions became possible as long as long as donor and patient were in the same place.

war and Surgery

X-Rays

• Discovered 1895 but developed in WW1
• Surgeons needed to locate bullets and shrapnel deep within wounded men.
• Governments ordered making of more X-ray machines and they were installed on all major hospitals on western front.

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• In France, scientist Marie Curie persuaded the government to pay for mobile X-ray machines that could be transported around the battlefronts.

Blood storage ww1

• Soldiers bled to death as blood could not be stored.
• Sodium citrate added to blood to prevent it clotting
• Scientists discovered how to separate and store the crucial blood cells and keep them in bottles. This led to blood banks.

October 1915

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• 1938 as preparation for war, the British Gov set up the Army Blood Supply Depot in Bristol.
• As many as 700,000 blood donors kept supplies up.
• 1940, it was discovered how to make blood plasma, making blood easier to store and transport

Fighting infection

• Wars often progress medicine due to the sheer volume of patients surgeons have to test their methods on.
• WW1 wounds were very deep and could have fragments of clothing.
• Surgeons learnt to cut away the infected tissue and protect the body with saline solution.

Improved anaesthetics

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• 1930s Helmuth Wesse developed anaesthetics that could be injected into blood stream, allowing more precise control of doses.
• This improved safety and allowed for longer operations.

Improved Antibiotics

Florey and Chain

• In 1941, Japanese attacked Pearl Harbour.
• US Government realised the potential of penicillin for treating wounded soldiers internal infections.
• Interest free loans given to US companies to buy equipment needed for mass production.
• British firms soon followed

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• Over 2.3 million doses were given to the allied soldiers on D-Day 1944.
• Modern antibiotics have saved over 200 million lives in less than 70 years.

Plastic Surgery

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• Terrible injuries of both wars led to rapid improvement in use of skin grafts.
• WW1, surgeons carried out over 11,000 plastic surgery operations on wounds caused by bullet and shell damage.

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• WW2 there were more burns cases in tanks and aeroplanes.
• McIndoe alone carried out 4000 operations on burns cases.

Sir Harold Gillies ww1

• By 1917, he had persuaded army to set up special hospital for facial repairs.
• Over 5000 servicemen treated.
• His techniques enabled him to reconstruct damaged faces.
• He is regarded as the pioneer of plastic surgery and was knighted after the war.

Skin Graft during ww1

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• Cousin of Gillies, worked alongside RAF
• Used skin grafts to reconstruct faces and hands.
• Helped patients psychologically deal with great changes in their appearance.

McIndoe Guinea Pigs