Surgery Edexcel

1) Laughing Gas (nitrous oxide):

• Sir Humphrey Davey, 1799
• Discovered that laughing gas reduced the sensation of pain 
• Suggested it might be useful in dentistry and surgical operations
• Patients were still conscious

2) Ether:

• William Morston, 1846
• Put patients to sleep for a short amount of time, no pain felt
• It irritared the eyes and lungs
• It caused coughing and sickness
• It could catch fire if close to a flame and was stored in a heavy container

• James Simpson, 1847
• He realised that it was a very effective anaesthetic for women in childbirth and other surgeries
• Simpson wrote and  published articles and many surgeons began to use it

Oppostion:

• It was untested so no one knew the side effect (short or long term)
• Many people opposed pain relief in childbirth as it was a gift from God
• Surgeons used to pain to ensure their patient was still alive
• People were not aware of the dosage
• The Black Period (1850-1870)- doctors attempt more complex, in-depth surgeries which may have led to an increase in death rate

Overcoming opposition:

• In 1857, Queen Victoria used chloroform in the birth of her 8th child and she publically praised "that blessed chloroform

• Without antiseptic from 1864-66, the death rate was 45.7%, however, with antiseptics from 1867-70 the death rate was 15%

Joseph Lister and his developments:

• Experimented with fractures where the bone breaks through the skin resulting in open wounds leading to infection
• Lister applied carbolic acid to the wounds and used bandages soaked in carbolic acid
• He insisted that doctors and nursed wash their hands with carbolic acid before operations to avoid infection from their hands
• He developed a carbolic spray
• He invented an antiseptic ligature to tie up blood vessels and prevent blood loss 
• Operating theatres were cleaned 
• From 1887, all instruments were steam sterilised 
• Surgeons were to wear surgical gowns, masks and rubber gloves

Lister's personality:

• He kept changing his methods so many doctors thought that he was unsure of his ideas
• When he said he acheived good results first time, doctors didn't believe him
• He was sometimes seen as aloof at demonstrations

Scientific thinking:

• Some doctors didn't accept the idea that microbes caused infection 
• Using carbolic acid stopped the bodies defensive mechanisms
• Some surgeons had good results without carbolic acid

Practical Problems:

• Soakig the whole operating theatre seemed extreme
• Carbolic acid irritated the surgeons hands
• Nurses disliked extra work and doctors didn't always do it properly
• The equipment was expensive and it slowed things down leading to blood loss

Koch's discoveries leading to a breakthrough:

• Robert Koch discovered the bacteria that caused septicaemia and many people then believed Lister
• In 1878, steam sterilisers were invented by Koch leading to Aseptic sugery 

Keywords for infection:

• Antispetic surgery- there are germs in the operating theatre but surgeons carry out methods like carbolic acid (antiseptics) to kill the germs 
• Aseptic surgery- cleaning and sterilising ALL equipment in order to prevent any germs entering the operating theatre

The problem before 1845:

• bleeding made it more difficult for the surgeon to see and there was a problem of shock
• many proffesionals believed that bleeding people was an effective treatment
• during the 1600's, there were experiments with blood transfusions using blood from animals as well as humans

Controlling blood loss: 

• Cautery was an extremely painful process 
• Pare had invented ligatures in the 16th century however these didn't always work if they were not tied properly

• James Blundell saw that human tranfusions could stop a mother from dying in childbirth
• Blundell face three problems: clotting, availability and immune response
• In 1901, Karl Lansteiner discovered three blood types- A, B and O
• Another group (AB) was added in 1902 by two other scientists
• Landsteiner's findings showed that some blood types were incompatible so they couldn't be mixed
• There was still a problem at this point that a live donor was needed
• In 1915, Richard Lewisohn found that adding sodium citrate to blood stopped it clotting
• Richard Weil used refridgerators to sotre it for longer 
• In 1916, Francis Rous and James Turner added citrate glucose to blood so it could be stored for longer

The nature of wounds:

• a lot more new munitions such as machine guns meant that wounds were deeper and infection was more common
• artillery shells removed limbs and rifle bullets had the power to break major bones and pierce vital organs 
• over 41,000 men had limbs amputated

Infection:

• fragments of muddy clothing and soil could get into wounds
• they could only use simple antiseptic dressings
• many people had to lie in trenches leaving more time for infection to spread
• gangrene wasn't seen much before so people didn't know how to deal with it

Mobile X-ray machines:

• Marie Curie 
• Surgeons had the ability to locate shrapnel faster and therefore made surgery more effective
• Reduced death rate

Treating wounds and infection:

• Went back to antiseptic methods because many wounds were already infected when casualties were treated
• Systems of tubes keeping chemicals flowing
• Deeper surgery was needed to be carried out  

Plastic surgery:

• Skin grafts- taking skin from one part of the body and grafting it to the wound
• New techniques such as jaw splint, wiring and metal plates as 'replacement' cheeks
• Harold Gillied was known as the 'Father of Plastic Surgery'

Brain Surgery:

• Not a lot of brain surgery had been carried out before 1914
• Little was known about how the brain worked
• Surgeons had to try new ideas
• Harvey Cushing developed a surgical magnet to extract bullets from head wounds

Impact of Germ theory:

• infection controlled by using Lister's carbolic spray, sterilisng equipment, wearing rubber glowers and using catgut for ligatures
• in the move to aspetic surgery, gowns and face masks were also used and the operating theatre was a close environment

Impact of X-rays:

• Wilhelm Roentgen in 1895 discovered x-rays 
• X-rays made surgeons more confident about internal operations, x-rays spread very quickly 
• Roentgen did not take out a patent so people were free to copy his ideas

Improvements in chemistry:

• Surgeons were more willing to try more complex operations for example removing tumours
• Chemistry was needed in order to store blood

Surgical Equipment:

• Chloroforn was first administered by inhaling a few drops
• This meant that it was difficult to get the dosage right
• John Snow developed an inhaler that was much safer
• Steam Steriliser
• Hypodermic needle

Spreading Ideas:

• Many scientists were beginning to spread their methods and ideas in medical journals such as the Lancet 
• They used photographs and artwork of several key events such as the first use of ether
• The newspapers also recorded a lot of new work to show the public
• Surgeons and scientists travelled to visit each other