1. Improvements in the Nineteenth Century
Surgery
Improvements in the Nineteenth Century

2. Problems before 19th Century
Your chances of surviving any operation before the 19th Century were slim:
Pain
No anaesthetics to knock you out. You were conscious throughout the operation (unless you passed out due to the pain)
Infection
No understanding of the Germ Theory and how germs were responsible for infection
Blood Loss
Difficulties in controlling bleeding and the inability to replace lost blood

3. Problem 1: Pain Read Source 2 page 134 Problems of pain for the doctor
Patient kicking and flailing
Successful doctors were fast doctors
Shock
The patient could die from the effects of the operation

4. Overcoming the problem of Pain
General Anaesthetics
Ether (laughing gas)
Discovered in 1799
Medical students used to have laughing gas parties!
Dentists used the gas first
John Warren was the first to use it in an operation in the USA in 1846.
Problems with Ether
Irritated the lungs (causing coughing in many patients)
Could combust and even explode easily

5. Overcoming the problem of Pain
General Anaesthetics
Chloroform
In 1847 James Simpson and some assistants experimented with some chemicals to try to find a safer anaesthetic
When they awoke unconscious from under the table, they realised that they had found the right ingredients
Problems with Chloroform
The dosage had to be regulated – too much could kill the patient
The doctor had to be careful not to anaesethize himself
The successful knocking out of the patient meant that doctors could try more complicated operations
Carry infection deeper into the body
More blood loss
Royal Assent
When Queen Victoria used chloroform during childbirth in 1857, opposition to the use of it dropped away.

6. The Problem of Infection
Pre Germ Theory
No-one could explain how infection was caused
Look at Source 1 page 134
Note down all the possible sources of infection
Even with an anaesthetist infection was still possible

7. Overcoming the problem of Infection
Ignaz Semmelweis
Hungarian Doctor
Women and Childbirth
He noticed that death rate was lower for midwives than for doctors coming from the Post-Mortem room
In 1847 he posted a sign (page 137) that said that ALL doctors had to wash their hands before entering the maternity ward.

8. Overcoming the problem of Infection
Joseph Lister
Influenced by Pasteur’s
Germ Theory
Anti-Septics
Carbolic Spray
Lister had seen that it was used to treat sewage
He used it together with careful bandaging
Effects graph page 138 source 15
Aseptic Operating Theatres
Koch discovers the germ that carries septicaemia in 1878
Lister applied this knowledge to cleaning operating theatres and hospitals to remove all traces of the germ

9. The Aseptic Hospital

10. The Problem of Blood Loss
Bleeding was difficult to control
Tourniquet
Raise wound
Direct pressure
Lost Blood could not be replaced
Transfusions failed
Clotting
Blood Types not understand
Infection was often introduced when trying to control blood loss
Eg Pare’s ligatures

11. Overcoming some of the problems of Blood Loss
Joseph Lister (Again)
Uses sterilised Catgut for ligatures
Infection cut down
Blood loss could be controlled during and after the operation

12. The Impact of the First World War on Surgery
Plenty of Practice!
New Industrial Warfare
Bullet Wounds
High powered Rifles
Machine Guns
Artillery Rounds
Shrapnel
Filthy living conditions
The Surgeon was kept busy!
Generals wanted their soldiers back in the line ASAP
Invested money, personnel and expertise

13. X-Rays - X marks the spot!
Discovered in 1895 by Wilhelm Rontgen
He noticed that some Cathode Rays passed through paper, wood and even flesh
However, they did not pass through metal or bone
Hospitals experimented with the new machine before World War One
The War proved their true worth
Surgeons could quickly and accurately locate bullets and shrapnel
They did not need to do explorative surgery

14. Blood Transfusion 1901 – Blood groups discovered Battlefield
However Transfusions had to be done immediately or the blood clotted
Battlefield
Immediate transfusions often impractical
They needed to find a way to store blood
Plasma discovered
The liquid part of the blood could be separated from the clotting particles of the blood.
Just add warm saline and the plasma is ready to use as blood!

15. Fighting infection Gangrene a terrible problem for wounded soldiers
Surgeons discovered that if they cut away all infected tissue and soaked the wound in saline, they could prevent the spread of gangrene.
This was the only way to deal with gangrene – no medicines could yet kill any infections!

16. Other Advances Skin grafting improved Eye surgery improved
Broken bone setting improved
ENT surgery improved
Brain surgery attempted
First attempts at dealing with Post-Traumatic Stress Disorder