Topic 8 – Modern Surgery Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Modern Surgery Surgery and Anatomy Anaesthetics Major surgery had not yet been possible due to the absence of effective pain killers. Surgery through time had used anaesthetics such as opium which allowed minor surgery. However, many patients would die from the trauma. Throughout this time there were many developments in anaesthetic. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Modern Surgery Surgery and Anatomy Individual and Year Discovery Consequence Joseph Priestly 1772 Made the discovery of laughing gas Was able to discover how best to receive anaesthetics Humphrey Davy 1799   Discovered laughing gas, or using nitrous oxide to relieve pain Davy wrote on the use of nitrous oxide in surgery, through it was ignored Crawford Long 1842 Discovered that ether could be used as pain killer No consequences as he did not publish his findings. Ether was highly flammable. …. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Modern Surgery Surgery and Anatomy Individual and Year Discovery Consequence Horace wells 1845   Observed a group of people on nitrous oxide at a fun fair and saw they did not feel pain. Wells then used nitrous oxide on a tooth extraction at his dental practice. The tooth was removed without any pain but he had not realised that the effects did not work on everyone and in a public display to the press his patient screamed in pain, discrediting Wells and the use of nitrous oxide. William Thomas Green Morton 1846 Asked the head surgeons of Boston Hospital, John Warren, to use ether in his public demonstration Warren asked the patient to breathe in the ether in gas form and was then able to remove a tumour without causing any pain, making the anaesthetic a popular choice. James Young Simpson 1847 Simpson did not like ether because it was flammable and caused excessive coughing. He wanted a better painkiller that could be used in childbirth. Simpson and two other doctors found the chemical chloroform. Chloroform was faster and easier to use. You also did not need to use as much as you needed to use with Ether. …. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Modern Surgery Surgery and Anatomy Opposition to Anaesthetics The eighteenth and nineteenth centuries had been a great success in the development of anaesthetics and pain—free surgery. However, some people were still against their use. Many opposed anaesthetics because the surgeons were not properly trained with them and had little experience, and were therefore worried that they could be given too much and experience long—term side effects In 1848 a girl, Hannah Greenan, died from being too much chloroform, which fuelled the arguments of the opposition Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Modern Surgery Surgery and Anatomy Another argument was that use of an anaesthetic was a cowardly option, which put people off and was particularly believed in the army where the feeling started. Much of the opposition vanished after the royal family endorsed the use of chloroform. Queen Victoria had used it during childbirth in 1853 and had written about its excellence in pain relief. People then used it acceptably a lot more. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Modern Surgery Surgery and Anatomy If too much chloroform was administered then this could result in a patient dying. This meant that the number of deaths increased after chloroform, this was known as the Black period. It was not until John Snow released the Chloroform inhaler that the amount of chloroform given was monitored and the amount of deaths reduced. William Halstead was a big supporter of anaesthetics and used them in his work, including the first gall bladder surgery in 1882, and to administer one of the first blood transfusions in America. His experimentation with cocaine as an anaesthetic, though successful, resulted in his being sent to a sanatorium where they tried to cure his cocaine addiction with morphine. He was known for great surgical triumphs, such as the first mastectomy to remove breast cancer, and his ability to stop bleeding. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Modern Surgery Surgery and Anatomy Antiseptics There had been a large increase in attempted surgery after the development of anaesthetics that often failed due to their ambitious nature and lack of hygiene. This led to the period (1846-1870) being named ‘black period’ of surgery. It wasn’t until Pasteur discovered the germ theory in 1861 that people understood that germs created disease. This meant that the hygienic state of the operating theatre and the sterilising of instruments became an important part of successful surgery. Before this was understood, many people died post—operation from infection. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Modern Surgery Surgery and Anatomy The first attempt to understand the causes of mortality in relation to germs was made by Semmelweiss in 1847. He found that women who had died of an infection after childbirth were being looked at by doctors and their germs were being carried over to women who had just given birth. The result was that these women then also died. Semmelweiss concluded that the doctors were passing the infection on Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Modern Surgery Surgery and Anatomy This was true and after asking doctors to wash their hands with chloride of lime to sanitise them. The death rate fell significantly, but doctors were reluctant to adopt the changes required. The link came with Joseph Lister who had read Pasteur’s works and realised that germs caused infections. He decided that he needed to kill all germs in the operating theatre and that he would do this by using carbolic acid, a type of disinfectant. He then perfected its use in the operating theatre by creating a machine that would spray it into the air constantly, killing airborne germs, whilst wetting the surgeon’s hands and patient. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Modern Surgery Surgery and Anatomy Aseptic Surgery There was problem with antiseptic surgery however. The skill of the surgeon was greatly reduced because of the burning carbolic acid sprayed over him during surgery. This led Professor Gustrv Neuber to develop the idea of asepsis; the idea of preventing germs from ever entering the operating theatre rather than trying to kill them once they were there. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Modern Surgery Surgery and Anatomy To achieve this rigorous level of cleanliness in the operating theatre, Ernst Von Bergmann suggested the sterilisation of the following of the following before entering the theatre: The steam used to clean the surgical instruments would be so hot that germs would be killed without any burning disinfectants. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Modern Surgery Surgery and Anatomy In 1989 William Halstead’s nurse complained of damage to her hands through antiseptic chemicals. Halsted decided to commission some rubber gloves from a rubber company. By studying the effects of the glove surgery, he became aware that not only were the nurse’s hands protected, the patient benefited as well. He then added gowns, caps and masks to the surgeon’s uniform to give greater protection against germs. This is still very true today and aseptic surgery is practised in every operating theatre, with the addition that even the air is sterilised before entry. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Modern Surgery Surgery and Anatomy Surgical Advances Blood Transfusions had been being successfully attempted since the 1670s. Blood transfusions are the attempt at transferring the blood from one person to another. However, they only became properly possible during the Second World War. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Modern Surgery Surgery and Anatomy Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Modern Surgery Surgery and Anatomy Plastic Surgery War made it necessary for surgeons to attempt heart surgery and it also led a rise of plastic surgery. The First and Second War saw new weapons and therefore new injuries. The key developments in plastic surgery were: 1917: Gillies helped set up a hospital in London to treat the facial wounds of soldiers fighting in the First World War. Gillies’ cousin and his team used skin grafts to improve the appearance of the patients. 1940s: Gillies’ cousin, Archibald McIndoe, had helped Gillies in the First World War. He set up his own plastic surgery unit in Sussex during the Second World War and treated thousands with disfiguring burns. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Modern Surgery Surgery and Anatomy Today plastic surgery is sued for all sorts of reasons, from the medical to the purely cosmetic. In 2005 the first partial face transplant was carried out in France, and in 2010 Spanish doctors performed the first full face transplant, but there are still concerns about how ethical it is to perform surgery simply to improve someone’s appearance. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Modern Surgery Surgery and Anatomy X-rays In 1895 William Rontgen was experimenting with a Crookes tube 9a tube of electrical discharge where electrons were discovered) when he found an unknown radiation coming from it. He called the radiation X—rays as he did not know what the radiation was. He realised that the rays passed through everything in his room, including his wife. By placing her and on photographic paper with x rays Rontgen produced the fist x ray of a human. X—rays became very popular and companies started to make Crookes tubes for the scientific purpose of producing x—rays. They were very unreliable and were stopped in about 1920, though the use of x-rays to photograph the internal body continued. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Examination Practice Part A’s They are worth 5 marks. You should spend 5 minutes on this question. You should identify 5 key points/ideas. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Briefly describe the problems faced by surgeons in the eighteenth century. pain infection loss of blood For example: The main problem faced by surgeons was that they had no way of stopping the pain during an operation. This meant the patient was jumping around making it very difficult. It also meant that deep internal operations could not take place because of the pain. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Davy and Wells with laughing gas Liston and ether For example: Briefly describe attempts at using anaesthetics in the nineteenth century before Simpson discovered chloroform. Davy and Wells with laughing gas Liston and ether For example: There were lots of attempts to use anaesthetics. Liston tried to use ether but it made patients cough in the operation and so was no good. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Describe the work of Simpson. carried out an experiment to discover chloroform as a useful anaesthetic realised that an alternative to ether was needed used chloroform during childbirth wrote articles supporting its use and persuaded other doctors to use it Queen Victoria had chloroform for the birth of her eight child Deaths from chloroform Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Examination Practice Part B’s They are worth 7 marks. You should spend 10 minutes on this question. You should identify 3 reasons why. Each reason should start a paragraph. There should be another 2-3 sentences explaining the reasons. Remember to include a WOW fact! Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Explain why some people in the nineteenth century opposed the use of anaesthetics. pain was created by God childbirth was meant to be painful Chloroform was untested and side-effects not known they did not know what the correct dosage was some patients died when chloroform was used it did not make surgery safer Cowardly Ether irritated the lungs unpleasant smell awkward to carry around Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Explain why work of Lister was important in the later nineteenth century. many patients were dying from infection, antiseptics, carbolic spray, insisted surgeons cleaned clothes and equipment with carbolic realises it is not the air but the microbes in the air doing the damage developed antiseptic ligatures his methods were copied all over Europe and the USA. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Explain why work of Lister was important in the later nineteenth century. For example: Lister was important because before his work many people died during surgery. This was because of infections. The operations were carried out in dirty conditions and the patients would die from gangrene. Lister’s methods reduced the death rate in operations. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Explain how the problem of bleeding during surgery was overcome. Harvey’s discovery of circulation of blood, discovery of blood groups, blood transfusions, found ways of storing blood, found out how to separate the plasma from the corpuscles donating blood Blood banks Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Explain how the problem of bleeding during surgery was overcome. For example Bleeding during operations was a big problem and people used to die because they had lost too much blood. When they were cut open they would bleed and this was a problem for the surgeon. Blood transfusions stopped this. They meant that people could be given blood to replace the blood they were losing. This could be done during the operation so that people did not die from losing too much blood. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

Examination Practice Part C’s They are worth 8 marks. You should spend 15-20 minutes on this question. You need to produce a balanced answer with two sides. It is an argument, so pick one side, even if you do not believe it! Think of 2-3 reasons for each side and remember the WOW factors! To achieve the highest marks, you must come to a justified conclusion. The examiners will reward anyone the marks, as long as you explain your judgement. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

‘Simpson is more important than Lister in the history of medicine ‘Simpson is more important than Lister in the history of medicine.’ How far do you agree with this statement? Explain your answer. Simpson problem of pain in surgery unsatisfactory nature of other methods of anaesthetics discovery of Chloroform acceptance because used by Victoria later development of anaesthetics opposition to Simpson’s ideas Lister death rate through infection carbolic spray aseptic surgery cleaning operating theatres sterilising instruments and rubber gloves opposition to his ideas Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

‘Simpson is more important than Lister in the history of medicine ‘Simpson is more important than Lister in the history of medicine.’ How far do you agree with this statement? Explain your answer. Possible conclusion The work of Simpson was very important. A big problem in surgery was pain. Several attempts at anaesthetics had been used but they all had something wrong with them. For example ether irritated the lungs making patients cough in the operation. Operations could not take place if patients were jumping around with pain and this is why Simpson’s discovery of chloroform was so important. It didn’t have side effects and was soon widely used. This meant surgery could develop. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

use of carbolic acid/spray he was opposed Work of Simpson before him ‘There was no major progress in surgery in the nineteenth century until the work of Lister.’ How far do you agree with this statement? Explain your answer. antiseptic medicine use of carbolic acid/spray he was opposed Work of Simpson before him Death rate in surgery before and after him. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*

‘There was no major progress in surgery in the nineteenth century until the work of Lister.’ How far do you agree with this statement? Explain your answer. For example Lister’s work led to a lot of progress because he worked in his own ordinary clothes which could have been dirty. It was left to other people to develop and use rubber gloves and surgical gowns. He did not develop any new operations. It is wrong to say that there was no major progress until him because this implies he did make major progress, but he didn’t. Learning Outcomes By the end of this lesson you will be able to… Describe the key features of an exam questions and the time period. E-D Explain how to answer an exam question and the technique required. C-B Judge the significance of key features in the time period. A-A*