part 4: impact of war & technology on surgery

Question 1

impact of war

Answer 1

• many injuries caused by shrapnel, machine guns and shell fire
• millions injured
• enabled money to be spent on research and testing
• increased urgency for effective medicine
• gov more likely to fund scientific developments if it would help war effort
• more opportunities to experiment
• rationing on homefront emphasised importance of eating a healthy diet as cheap as possible
• faced extreme problems that required rapid solutions

Question 2

harold gillies

Answer 2

• new zealand doctor
• joined british army as surgeon in ww1
• worked initially on front line
• set up a ward a queen mary’s hospital in kent to treat patients with facial injuries

Question 3

plastic surgery

Answer 3

• had been carried out centuries earlier but limited by danger of infection and pain
• used to repair wounds caused by bullets and shrapnel
• gillies pioneered new skin graft techniques
• one technique is that he moved a patch of skin on face called a pedicle
• left the veins attached to it so it still had a blood supply and could be attached to a different part of the face
• McIndoe ww2 carried out over 4000 operations on burn using skin grafts

Question 4

francis derwent wood

Answer 4

• sculptor
• worked in hospitals treating injured soldiers
• designed and made lifelike facial masks for soldiers who had suffered severe facial injuries
• helped them regain confidence, supported mental health, aided reintegration into normal life

Question 5

blood transfusions after 1900

Answer 5

• karl landsteiner discovered blood groups in 1901
• so blood transfusions could be done successfully
• however couldn’t be stored as it clotted
• albert hustin found that adding sodium citrate and glucose stopped blood from clotting during ww1
• meant it could be stored for a short period and taken to field hospitals close to frontline
• later in war, discovered how to separate and store blood cells from plasma and keep in a blood bank

Question 6

blood transfusions before 1900

Answer 6

• often failed as scientists didn’t know people had different bloodtypes
• infections could be passed on through transfusions

Question 7

x-rays before ww1

Answer 7

• 1895 wilhelm rontgen discovered x-rays
• before ww1 x-rays used to help identify broken bones and disease
• 1901 radiotherapy used to treat cancer

Question 8

x-rays during ww1

Answer 8

• technology widely used, especially on battlefield
• marie curie developed mobile x-ray machines which were transportable
• allowed surgeons to identify where shrapnel or bullets were in a wounded soldier on front line
• meant surgery could be better planned and was safer
• found quicker, removed easier and completely so reduced infection
• by 1916 all major british army hospitals used x-rays
• marie curie played vital role in getting 200 x-ray units into field hospitals and 20 mobile x-ray vehicles

Question 9

amputation & prosthetic limbs

Answer 9

• thousands of soldiers had limbs amputated due to nature of injuries suffered
• new and more sophisticated prosthetic limbs designed

Question 10

james edward hanger

Answer 10

• became an amputee during american civil war
• prosthetic limb didn’t fit well and was painful
• designed a new one that could bend at the knee and ankle and fit better using engineering experience
• state gov commissioned him to manufacture improved prosthetic limbs for other wounded soldiers
• travelled to europe to observe effects of trench warfare to design better prosthetics
• as a result his new company received contract with both england and france to supply artificial limbs

Question 11

antiseptic techniques

Answer 11

• experimented with new ways to prevent infection in wounds
• Carrel-Dakin method kept a chemical solution continually flowing through wound to fight infection
• continuous use, more effective than one-off
• so less amputations led to infection

Question 12

Carrel-Dakin method

Answer 12

• dilute sodium hypochlorite
• chemically sterilised wound and acted as a solvent against remaining necrotic tissue and pus
• didn’t damage healthy tissue unlike carbolic acid
• technique was a major breakthrough for fighting infection
• 1915 battle of Champagne 80% wounded were infected
• a year later when technique applied it was 20%

Question 13

Archibald McIndoe

Answer 13

• cousin of harold gillies
• worked with soldiers who had suffered from severe facial injuries in ww2, especially from burns
• treated physical injuries
• also supported those who had difficulties with mental health as a result of severe disfigurement from injuries
• patients formed a support network known as Guinea Pig Club
• organised social events
• helped recovering soldiers adapt to civilian life and learn to live with injuries

Question 14

blood transfusions ww2

Answer 14

• charles drew came up with new methods to store and transport blood
• put in charge of a campaign called blood for britain
• involved US civilians donating blood which was transported to britain using his techniques
• then used to treat injured

Question 15

home front

Answer 15

• health services reorganised to cope with both soldier and civilian causalities
• 1940 campaign launched to get all children immunised against diptheria
• rationing and evacuation led to improvements in diet and lifestyles
• gov posters educated people about basic hygiene
• people in rural areas shocked at levels of poverty in some of evacuated urban children
• led to support for social reform and a commitment to help families in need
• helped paved way for foundation of NHS

Question 16

transplants

Answer 16

• 1967 christiaan barnard, south african cardiac surgeon, carried out first heart transplant
• 1986 davina thompson first patient to successfully receive a heart, lung and liver transplant
• 2005 first partial face transplant in france
• 2010 first full face transplant in spain
• means people can live for longer

Question 17

accepting transplant organs

Answer 17

• often rejected by immune system as recognised as foreign
• immunosuppressant drugs can stop rejection
• 1970 roy calne developed an immunosuppressant which stopped body rejecting transplanted organs

Question 18

injected anaesthetics

Answer 18

• easier to control dosage which meant less accidental deaths
• more precise dosage improved safety so longer operations occurred
• enabled patients to remain unconscious for longer
• 1950 william bigelow performed first open heart surgery made possible by anaesthetics

Question 19

robotic surgery

Answer 19

• surgeons can now use robots to carry out some operations
• more precise and controlled

Question 20

scanning machines

Answer 20

• built on foundations of x-rays
• CT scanners take thousands of x-ray readings in a second
• produces a 3D image, useful in examining internal structure
• MR uses magnets and radio waves, can detect cancer cells

Question 21

keyhole surgery

Answer 21

• means surgeon could perform complex operations through small incisions
• made possible because of miniature instruments and fibre-optic cameras

Question 22

open-heart surgery

Answer 22

• heart / lung machine designed to bypass heart and maintain blood circulation while surgery is carried out on stopped heart
• enabled surgeons to replaced diseased valves or repair defects in walls between chambers

Question 23

radiation therapy

Answer 23

• advanced in 20th cent by henri becquerel and marie curie
• surgeon uses high-energy radiation on a patient with cancer
• helps surgeons kill cancer cells and reduce size of tumours
• techniques developed to target cells more precisely

Question 24

x-rays impact

Answer 24

• made surgery more effective
• could identify what was wrong with a patient before and during surgery to make more effective

Question 25

laser surgery

Answer 25

- first used in 1987 in eye surgery - also help treat skin conditions, control bleeding and help remove blockages in arteries