Antiseptics Recap Before 1860 – Known as the Black period of surgery, death rates went up because although anaesthetic was invented, the risky operations meant people died of infection. 1850s work of Semmelweiss – Discovered that dirty hands passed on disease, but, people did not believe him. He told people to wash hands with chloride of lime but many surgeons saw this as time consuming and irrelevant. Lister’s discovery – Lister published his ideas on carbolic acid in1867, he developed his idea from washing hand in the substance, changing it to a pump spray. He later developed catgut stitches sterilised with carbolic acid. 1860s/1870s opposition to Lister – surgeons thought Lister didn’t have confidence in changing his ideas because kept adapting them, people did not accept the idea of germ theory (published 1861), his ideas took too long to implement, people were jealous and saw him as a threat. Aseptic surgery - By 1890s much of surgery was aseptic! Operating theatres were rigorously cleaned. From 1887 all instruments were steam cleaned. Surgeons stopped wearing their ordinary clothes and wore face masks. 1894 sterilised rubber gloves were used for the first time ever.

DEALING WITH BLOOD LOSS: Controlling blood loss Learning objective: 1) To be able to identify the key stages in which the dealing with the problem of blood loss was overcome 2) To evaluate the role played by war, science and technology in overcoming the problem of blood loss

Why was blood loss such a problem? Blood loss has always been a major problem in surgery. Bleeding makes it difficult for the surgeon to see what he is doing, but there is also the problem that if the patient loses too much blood, the blood pressure drops, which affects the heart meaning the body cannot function properly causing death.

The battle to find a solution… What people understood about blood loss was that it was difficult to control. What people didn’t understand was about blood itself! During the 17th Century experiments to ‘replace’ lost blood took place (called a blood transfusion). However, with blood being viewed as simply a ‘red liquid’ necessary for survival, the first transfusions to take place came from a most unlikely source!..........

Of transfusion NOT work? Baaaaaaaaaa! Believe it or not, the very first transfusions were tried using the blood from sheep! Sometimes blood from other animals, such as pigs was also used. But the survival rate was very poor. So poor in fact that the procedure was banned!! Why does this kind Of transfusion NOT work?

Early Transfusions 5 mins Based on what you have just heard, explain what form early transfusions took and why they failed. 5 mins

19th century context: Two down…one to go The number of patients dying as a result of blood loss remained quite high. The discovery of anaesthetics and antiseptics (although still in their early stages of development) increased a patients rate of survival and there was now a renewed hope of finding a solution to solving the blood loss problem.

Method 1: Cautery Cautery was the process of sealing a wound using heat, to stop the bleeding. Usually, this was done with a hot iron, as shown here (different shapes and sizes depending on the wound) But occasionally it could also involve the wound being ‘dipped’ into hot oil or tar.

Method 2: Ligatures In the 16th century a French surgeon named Ambroise Paré developed metal clips to place in arteries during surgery. He also tried using silk thread to tie blood vessels after an amputation rather than cauterising – which was far less painful for the patient. These threads or clips became known as ligatures, but they did not always stop the bleeding if not tied or used correctly, and furthermore – a surgeon with dirty hands trying to actively touch the blood vessels of a wound would increase the risk of infection.

Method 3: The Torniquet Amputation of the leg at the thigh. The tourniquet deadened the pain as well as reducing the flow of blood but was likely to cause serious tissue damage. From Illustrations of the Great Operations of Surgery by Charles Bell (London, 1821).

Check your understanding: 1. In your own words (you may use pictures and diagrams too if you find them useful) describe what is meant by the following terms: Cautery Ligature Torniquet 2. Explain why early attempts at blood transfusions were unsuccessful. 15 mins

20th Century breakthrough (1) Unlike anaesthetics and antiseptics, which were well on their way to being developed by the end of the 19th century, it would not be until the start of the 20th century that big developments in dealing with blood loss were really made. In 1901 Karl Landsteiner discovered that blood was actually different types: A, B and O. And in 1902 a fourth group (AB) was added. This was a major breakthrough, as it was now understood that blood transfusions had to take place between people of the same blood group, or they would die.

Getting you thinking: 5 mins Why was Landsteiner’s discovery of different blood groups so important? Remember to explain his idea in your answer. 5 mins

Far from a perfect solution The picture shows how early blood transfusions took place. What is happening? How is this different to modern day transfusions? 5 mins

Why do you think a better solution was needed with the outbreak of WWI?

World War One The horrors of World War One are well known, but a lot of soldiers died from wounds that on their own were not actually fatal. Many soldiers died from blood loss – even if they were lucky enough to be rescued and taken to the field hospital for treatment. In the midst of war, it was practically impossible to have a blood donor present at all times to help replace lost blood.

20th Century breakthrough (2) In 1915 American doctor Richard Lewisohn discovered that adding sodium citrate to blood stopped it from clotting. This meant that the donor no longer had to be present to give blood. It was by no means a perfect solution – the blood still had to be used within days of being given, but it saved the lives of thousands of soldiers who might otherwise of died.

20th Century breakthrough (3) In 1915 Richard Weil discovered that blood could be refrigerated. Francis Rous and James Turner found out in 1916 that adding a citrate glucose solution to the blood allowed it to be stored for longer. This meant that when the army had a big attack planned they could ask for blood donations from the public so that wounded soldiers could be treated. In 1917 the first blood depot was set up (for the Battle of Cambrai). It was full of blood group O – the only blood type that can be given to everyone safely.

Getting you thinking: 15 mins How did the roles of War and science impact upon developments in dealing with blood loss? 15 mins

Question Time Based on what you have learnt so far this module, you need to come up with a series of questions to ask your classmates. These will be used in keyword bingo tomorrow.