Medicine Topic 3 - Surgery

Question 1

Problems in 1848

Answer 1

Pain - only alcohol or opium used, the best surgeons just carried out the surgery as quick as possible
no knowledge of germ theory so high chance of infection
blood loss - blood transfusions hadn’t been developed yet

Question 2

Anaesthetics 1840’s and 50’s

Answer 2

1846 - Liston experimented with ether in a leg amp - but irritates lungs
1847 - john snow used ether in st george’s hospital
1847 james simpson experiments with chloroform but struggles with dosage
1848 - John snow invented the chloroform inhaler and uses it to help Queen Victoria deliver her 8th child in 1853
However, more complex surgery meant more extreme problems for the unsolved parts of surgery like blood loss and infection.

Question 3

Antiseptics 1840’s and 50’s

Answer 3

1847 semelweiss launches a hand washing campaign, no real antiseptics however so as surgery developed, the black period of surgery emerged

Question 4

Antiseptics 1860-70

Answer 4

1860’s Joseph Lister reads germ theory and experiments with carbolic acid, tries cleaning wounds with it
1864-67 death rate for Lister’s patients falls from 45% to 15%
Lister’s techniques so revolutionary his ideas are still used now
However, these methods were expensive and time consuming and therefore were resisted, carbolic acid also made skin crack so was rejected

Question 5

Anaesthetics 1870-1905

Answer 5

1874 - first general anaesthetic used
Cocaine used in 1884 as local anaesthetic but addictive
1897 first spinal anaesthetic
1905 - safer version of cocaine (novocaine) discovered
So more complex surgery could be carried out as pain was no longer a problem - blood loss is though

Question 6

Aseptic surgery 1880’s and 90’s

Answer 6

1878 Kock developed a steam steriliser to kill germs on surgical equipment
1887-94 aseptic surgery developes under sterilised conditions
More complex surgery could be carried out, first ever heart opertaion to repair a stab wound in 1896
However, blood loss still a problem leading to many deaths

Question 7

Blood loss 1880-1905

Answer 7

1881 - Lister experiments with catgut soaked in carbolic acid as a ligature
1901 - Landsteiner developed blood groups
However, no way of storing the blood or stopping it clotting

Question 8

X-rays 1895-1914

Answer 8

1895 - William Rontgen experiments with cathode rays and discovered x-rays
by 1896 many hopsitals had x-ray machines to show details of broken bones
WW1 - marie curie - le petite curies - however glass tubes in the machine overheated frequently - less effective

Question 9

Blood loss 1910-1920

Answer 9

1910 - anticoagulant discovered to help storage
1914 - Alber Hustin performs first non-direct transfusion
1915 - discovered adding sodium citrate would stop clotting - could be stored
1916 - glucose citrate increased storage time
1917 - Roberston establishes first blood bank on western front - blood could be stored on ice for 28 days

Question 10

Fighting Infection WW1

Answer 10

Carrel-Dakin method - sterilised salt solution could treat gangrene
However time consuming so often amputation was the only solution

Question 11

Thomas Splint WW1

Answer 11

Developed splint for broken femurs
at beginning of war 80% died
at end 80% lived
reduced need for amputations

Question 12

Plastic Surgery WW1

Answer 12

Harold Gillies setup a hospital for plastic surgery in Sidcup. It treated 2000 patients after battle of somme
in 1916 - Vladimir Filatov developed skin grafts - so flaps of skin could be used from other areas of body
However, before antibiotics properly improved infection was still a risk.

Question 13

Brain Surgery WW1

Answer 13

head injuries common even after steel helmets introduced 1915
american neurosurgeon experimented with magnets to get pieces of metal out of peoples wounds
However, WW1 halted more research as 14k doctors left for war demands

Question 14

Plastic Surgery between WW1 and 2

Answer 14

Filatov developed methods of grafts and transplants for eyes
1920 - Harold Gillies published Plastic surgery of the face book which was important in stressing importance of how to carry out proper surgery

Question 15

Blood loss between WW1 and 2

Answer 15

First academic institution devoted to blood transfusion founded in moscow in 1925
- soviet union set up national system of blood banks in 1930’s
1930’s - research led to discovery that blood could be seperated into plasma and red blood cells, and stored more effectively with less chance of contamination

Question 16

Blood loss WW2

Answer 16

Army Blood supply depot setup in Bristol
4 blood blanks for civilians setup in London in

Question 17

Plastic Surgery/Burns in WW2

Answer 17

Pilots who survived got deep burns
Archibald McIndoe introduced saline baths, and set up the guinea pig club to reintroduce burn victims into the local community