REVISING THE EXTENSION UNIT ON SURGERY

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REVISING THE EXTENSION UNIT ON SURGERY
19th century surgery
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An operation in the early 19th century
A painting showing a surgical operation in 1800
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TASK. Describe the problems faced by surgeons
and patients at the beginning of the 19th
century
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Label your picture to show the key features of a
modern surgical operation
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How many of these did you get ?

• How many of these did you get ?
• Sterilised instruments
• Blood for transfusions
• Trained doctors and nurses
• Rubber gloves, plastic gowns , hats and masks
• Germ free ( aseptic operating room
• Electrical power
• Anaesthetics
• Specialists to operate equiptment and nurses

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The problems
BLEEDING
PAIN
INFECTION
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James Simpson This is your life
I have a problem- ether has an unpleasant smell
and irritated peoples eyes and lungs and makes
them sick. What can I use ?

• Born in Scotland in 1811
• Trained as a doctor at Edinburgh University
• Became professor of midwifery at Edinburgh in
  1839
• Very concerned about the suffering of women
  during childbirth

I know about laughing gas and about experiments
using ether to numb pain
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The solution chloroform was discovered in 1847
Professor Miller, a neighbour called on Simpson
the morning after the experiment in 1847. the
inhalers became bright-eyed and very happy. And
then crash! On awakening Dr Simpsons first
thought was This is far stronger and better than
ether
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The Solution .Chloroform
A portable chloroform inhaler developed by John
Snow in the 1850s
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Opposition to Simpsons work

• It was new and untested . Was it safe ?
• Doctors did not know what dose to give to
  different patients
• There were moral and religious arguments the
  use of anaesthetics was said to be unnatural
  and against Gods will

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• Opposition to anaesthetics was eventually
  overcome
• Use of anaesthetics became a standard part of
  surgical practice
• Surgeons carried out more operations
• Surgeons carried out more complex operations
• BUT .surgery was not safer !
• Until the acceptance of germ theory in the 1860s
  surgeons did not take any precautions to protect
  open wounds from infection.This was still a key
  problem which led to loss of life .

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Joseph Lister This is your life

• Born in 1827 in Yorkshire
• Became Professor of Surgery at Glasgow University
  in 1860
• Read Pasteurs writings
• Read about the effects produced by carbolic acid
  upon the sewage of the town of Carlisle

His father was a medical pioneer who developed
improved microscopes.
He tried out carbolic acid on compound fractures
and it stopped infection He developed a carbolic
spray which was used in operating theatres
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Some opposition
Many doctors believed that speed was the most
important factor in surgery. The use of carbolic
acid slowed them down and was seen as a nuisance
even dangerous
Some doctors did not believe in germ theory
Where are these little beasts? Show them to us?
Some doctors did not like their hands and clothes
being soaked in the acid
Lister kept trying to develop his ideas trying
out more substances. People though he kept
changing his mind because his methods were not
working
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RESULTS reading tables
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Karl Landsteiner This is your life

• Discovered in 1901 that humans had 3 types of
  blood group which he called A, B and 0
• Only some of these could be transferred from a
  patient of one group to another

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Other developments

• Storing blood - in 1914 it was found that sodium
  citrate stopped blood clotting in a syringe
• Blood cells were separated from the liquid part
  and were stored in bottles . They could be
  diluted with saline solution when needed
• Large blood banks were set up in the US and
  Britain during the second world war
• Transfusion service

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Other key developments in surgery

• Plastic surgery
• Brain surgery
• Transplant surgery
• Keyhole surgery
• Improved anaesthetics and antiseptics

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Sample analysis question

• How important was the development of anaesthetics
  to improvements in surgery in the 19th century?

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Can you identify any of the following in the
model answer?

• Find the link words
• Find the benefits of using anaesthetics
• Find the limitations of anaesthetics in the 19th
  c.
• Is this a balanced argument ?
• Is there an overall judgement ?
• What level would you give this ?

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• Anaesthetics was important in the history of
  surgery
• because without the problem of pain , patients
  were more willing
• to have operations to treat their illnesses and
  more operations
• were carried out . This meant that surgeons
  could develop more
• experience . Moreover , because patients were no
  longer
• wriggling about in agony and having to be held
  down all the time ,
• surgeons did not have to operate so quickly and
  consequently
• they could spend longer on the operations
  without making
• mistakes . This led to more accurate operations .
  In addition this
• also resulted in more complicated operations
  being carried out
• and surgeons gained more knowledge about
  difficult operations .

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• However , the death rate was still high because
  until Joseph Lister
• developed antiseptics in the 1860s, only one of
  the problems of
• surgery had been solved. In fact the death rate
  actually increased
• because more complicated operations resulted in
  surgeons going
• deeper into the body and yet filthy conditions
  still existed and
• germs got into the wounds . This meant that many
  more
• people died of infections. In addition surgeons
  were still not sure
• about the dosage of the chemicals and how much
  chloroform to
• give patients . A young girl called Hanner
  Greener died from an
• overdose of chloroform whilst having her toe nail
  removed.
• Furthermore, no one had yet solved the problem
  of what to do
• when patients lost a lot of blood . This meant
  that blood
• transfusions could not be carried out until Karl
  Lanndsteiner
• discovered blood groups in 1901

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• Overall I think that the development of
  anaesthetics was
• important and without this many of the high
  tech
• developments in the 20th century would not have
  been
• possible . However I think this was only one of
  the key
• steps and that the development of antiseptics was
  more
• important. This led to a greater reduction in
  the death
• rate from people dying from infection . In
  conclusion ,
• until the final problem of providing replacement
  blood
• was solved, surgery was still a very risky
  procedure .