Changes in Surgery

Surgery was extremely dangerous in the mid 19th century!

• Surgeons had to work very quickly 
• There was no way of relieving pain completely 
• Infection after surgery was dangerous as germs entered the wound.  Almost 1/2 the patients who had leg amputations died from blood poisoning!  

By the 1880's, only 3 operations were carried out with some success:

• Amputation of the limbs 
• Trephining - cutting into the skull
• Removal of superficial tumours

All were carried out quickly and the patient's pain was ignored!

• 1779 - Humphery Davy discovered 'Laughing Gas' which reduced the sensation of pain. 1840 - Dentists began to use it for tooth extraction.
• 1847 - Ether was used by J R Liston but it was limited to use as it irritated the lungs &     caused the patient to cough during the operation.  Produced inflammable vapour. 

James Simpson & Chloroform

• 1847 - James Simpson discovered anaesthetic 'Chloroform'  it quickly gained recognition
  • 1848 - Hannah Greener died under chloroform during an operation on her toenail.
  • 1850's - Opposition to Chloroform & other anaesthesia as nobody knew the side effects or what dosages were safe.  
  • 1857 - Anaesthetics were winning wider acceptance, however, when Queen Victoria successfully used chloroform for the birth of her 8th child & highly rated it, it soon became standard practice in surgery.

Before Germ Theory in 1860s, surgeons took no precautions to protect open wounds from infection.  They reused bandages (spreading gangrene & skin infections), doctors did not wash hands before operations nor sterilize equipment.  

• 1847 - Ignaz Semmelweiss launched hand-washing crusade after noticing more women died after childbirth when delivered by medical students: due to them not washing their hands after body dissection.  
• He was regarded as a fanatic & a crank so people did not take him or his ideas seriously.

Joseph Lister

• Lister had read Pasteur's work on microbes.
• Told that carbolic acid was used to disinfect sewage & realized that it was killing the microbes responsible for the decay & smell. In 1865 He used it to help prevent infection!
• He developed carbolic spray for during an operation preventing microbes to enter an open wound & in the 1890s he began to use solution for aseptic techniques.
• Between 1866-1870, the death rate for patients fell from 45% to 15%
• However, he received some opposition: it slowed down operations & some surgeons did not follow his methods systematically, therefore claiming his methods weren't effective. 

The discovery of antiseptics in 1865 was a huge breakthrough but it didn't kill all germs! 

• 1878: Koch discovered bacteria in the blood caused septicaemia which = more support for antiseptic use
• Koch introduced aseptic surgery after discovering hot steam killed more germs than carbolic acid.  It ensured all germs removed from operating theatres & soon became a routine: by 1887 all bandages, instruments & clothes were sterilised.
• Infection also spread through surgeons' hands & nails = introduction of rubber gloves in 1894

Surgeons could now attempt more complex surgery: 

X-Rays- Discovered: 1895 by William Rontgen- realised cathode rays could pass through flesh

• Installed X-Ray machines in hospitals within 6 months 
• WW1 confirmed their importance in surgery to remove deeply lodged billets & shrapnel.  More machines were quickly manufactured & installed in hospitals along Western Front.  

Blood Transfusions - first tried in the 19th century but not always effective

• 1901- Karl Landsteiner discovered the blood groups so donors had to match receivers.
• WW1 needed vast amounts of blood & many soldiers bled to death before blood got to them
• Discovered in the 1910s that if you refrigerate the blood it could store for longer.
• 1916 - Cpn Oswald Robertson set up the first blood bank

Infection- On battlefield, it was hard to prevent infection (bacteria infecting open wounds causing gangrene)

• To prevent - they cut away the infected tissue & soaked wound with a saline solution. 
• However- limited improvement & were aware of how helpless it was against infection!

Blood Transfusions - movement from fairly primitive to well-refined service by the end of war

• Dr. Charles Drew's = discovery of blood separation into plasma & cells.  Plasma could be frozen separately = blood stored for longer & less likely contaminated!

Skin Grafts & Burns - Major development in WW2 for those who received severe wounds.

• Archibald McIndoe - pioneering work with plastic surgery on war pilots 'the guinea pig club'
• Deep burns damaged pilots muscles & nerves so they couldn't move or feel the burnt areas. Also caused disfigurement to patient's appearance = psychological problems. To help burns, he placed them in saline baths and operated on them.
• Vladimir Filatov (Russian) - pioneering the work on skin grafts and 'biogenic agents' to help healing and regrowth of damaged area. 

Widespread use of Penicillin - look at earlier notes on penicillin 

• 1942 - USA entered the war they agreed to give $80 million to mass produce penicillin.
• 1943 - Mass production began
• 1945 - US army used 2 million doses a month
• The antibiotic saved millions of lives with the prevention of infection