transformation of surgery c1845 - c1918

• surgery was dangerous and painful.Surgeons had to work quickly to prevent too much bloodloss
• Robert Liston, famous surgeon,worked fast but made mistakes
• Infection - major problem,Germs could enter wound and cause blood poisoning
• Most common operations - amputations.
• Mostly people died from infection and bloodloss
• Until mid 19th century there were no anaesthetics but alcohol or opium was given to ease the pain but patients could feel everything so operations had to be quick.
• Operations:assistants would have to hold the patients still,spectators would watch,Tourquinet would be around the thigh to stp the flow of blood to the leg.

Discovery of anaesthetics was a major breakthrough in surgery.Surgeons could take their time and work more carefully.

• 1799 - discovered nitrous oxide it made you less aware of pain
• 1844 - 1845 Horace wells used it when extracting a tooth
• 1846 - William Morton found that ether was a more long lasting anaesthetic,Robert Liston used it while amputating a leg.

Problems in the use of ether:

• Made patients vomit
• irritated lungs so they coughed even when unconcious
• highly flammable so it would be dangerous near gas lights and candles
• caused deep sleep which could last for days
• it had to be carried in heavy glass bottles, which was difficult to carry to patients home.

James simpson discovered chloroform by accidently inhaling it.

• After the use of chloroform by Queen Victoria for child birth it was more widely accepted 

Problems:

• difficult to get the dose of chloroform correct,too little patient could wake up,too much could be fatal
• death of Hannah Greener after being given anaesthetics
• some people did not want anaesthetics because they were religious and they thought that pain relief was interfering with Gods plan,God told Eve childbirth would be painful
• anaesthetics were distrusted because they were new and the effects were not fully understood.
• number of deaths increased 
• effects of ether and chloroform remained in the body  

Pain:

• painful operations only 3 operations were carried out successfully: amputation of limbs,trephining and removal of superficial tumours.
• Operations carried out quickly,doctors thought if patients were knocked out there would be no resistance so more time could be taken.
• Humphry Davy discovered laughing gas which reduced the sensation of pain,dentist used it to ease the pain of tooth extractions

Opposition to anaesthetics:

• Ether used by J.R.Liston for a leg amputation,severe drawbacks;irritated lungs,patients coughed during operation & produced inflammable vapour.
• Chloroform : relieved pain,untested gas,unknown long time side effects,unknown dosage,moral and religious arguments

Anaesthetics made surgery more dangerous because doctors attempted more complex operation & carried infections deeper in the body and more blood loss.

Infection:

• Germ theory accepted in 1860,before that surgeons did not take any precautions to protect open wounds,they re - used bandages,spreading gangrene and skin infection.Doctors did not wash hands, sterilise equipment and clothes contained pus stains.
• Ignaz Semmelweiss observed that women whose baby's were delivered by midwives less likely died from infection than those by medical student because they had been dissecting bodies and did not wash their hands.
• Joseph Lister read the work of Pasteur and germ theory, he found out that carbolic spray limited infection.

• carbolic spray cracked surgeons skin and made everything smell,everything more expensive and less pleasant for surgeons.
• Pasteur's ideas spread slowly it was difficult to accept that micro organisms caused disease.
• surgeons thought that speed was still essential and bleeding was still a problem, Lister's antiseptics slowed down operations.
• others said that antiseptics prevented the body's own defence mechanism from operating effectively.
• Lister kept changing his techniques.

   In 1878 Koch found bacterium caused septicemia, this gave a boost to listers ideas.Late 1890s his antiseptics surgery became aseptic surgery; operation theaters were cleaned,1887 instruments were steam sterilised,1894 sterilised rubber gloves were used. 

Problem 3: Bleeding

• Operations were carried out at patients homes or hospital - not hygienic
• Operation Theaters unhygienic  - surgeons wore dirty clothes,tables were dirty
• This was called the black period of surgery
• Florence Nightingale set high standards of hygiene, she did not understand infection but believed in the miasma theory - disease was caused by poisonous vapours   
• 1861 Louis Pasteur proved that microbes caused decay and infection.