The Development of Modern Surgery

Question 1

What were the three big issues with surgery?

Answer 1

Pain, bleeding, infection.

Question 2

What had been used as pain relief?

Answer 2

Alcohol, opium (the opium poppy gives morphine), mandrake

Question 3

Who first suggested the use of nitrous oxide (laughing gas) as an anaesthetic?

Answer 3

Humphrey Davy in 1799 - but he was ignored.

Question 4

What was nitrous oxide being used as?

Answer 4

A fairground novelty.

Question 5

Who next tried to use nitrous oxide for a medical purpose?

Answer 5

Horace Wells, in 1845, wanted to demonstrate use in dentistry - but his patient was unaffected by nitrous oxide, so he was ignored too.

Question 6

Who discovered the anaesthetic properties of ether?

Answer 6

Crawford Long, 1842, but he did not publish his findings.

Question 7

Who carried out the first public demonstration of ether as an anaesthetic?

Answer 7

William Morton 1846

Question 8

What are the problems with using ether as an anaesthetic?

Answer 8

It is an irritant, and also explosive.

Question 9

Who found an alternative to ether as an anaesthetic?

Answer 9

James Simpson, in 1847

Question 10

What alternative to ether did James Simpson find?

Answer 10

Chloroform.

Question 11

What is the problem with chloroform?

Answer 11

It sometimes causes the heart to stop, causing sudden death

Question 12

What was chloroform used for?

Answer 12

As an anaesthetic for operations, and for pain relief during child birth.

Question 13

Why is local anaesthetic better than general anaesthetic?

Answer 13

General anaesthetic is very risky for the patient.

Question 14

Who first investigated using local anaesthetics?

Answer 14

William Halstead, in 1884

Question 15

What substance did William Halstead use for local anaesthetic?

Answer 15

Cocaine

Question 16

What happened to William Halstead as a result of his experiments into using cocaine as a local anaesthetic?

Answer 16

He became addicted to cocaine.

Question 17

What was people’s reaction to anaesthetics?

Answer 17

Some were very suspicious of doctors putting them to sleep. Others had religious objections, especially to the use of pain relief during child birth,

Question 18

What was the surgeon’s reaction to the availability of anaesthetics?

Answer 18

They could perform longer, more complicated operations.

Question 19

What happened to the death rates after the introduction of anaesthetics?

Answer 19

They went up, as bleeding and infection had not been overcome.

Question 20

What was the “black period” of surgery?

Answer 20

The period between 1846 and 1870, when the death rate after surgery was very high as anaesthetics had been introduced but bleeding and infection were still a big problem.

Question 21

Where were operations carried out?

Answer 21

Even in patients own houses, as no one had any idea of hygiene.

Question 22

What did the surgeons do that caused deaths?

Answer 22

They did not wash their coats, a coat covered in blood was a badge of honour; they did not wash the instruments between patients.

Question 23

What is the name for methods that kill germs?

Answer 23

Antiseptic.

Question 24

What is the name for methods that exclude germs?

Answer 24

Aseptic.

Question 25

Who first started using antiseptic methods to reduce infection rates?

Answer 25

Semmelweis used chloride of lime as a hand wash for the doctors to control the spread of puerperal fever (an infection of women after giving birth).

Question 26

Why was Semmelweis idea not much used?

Answer 26

Chloride of lime is very unpleasant.

Question 27

What gave Lister the idea of using carbolic acid in operating theatres?

Answer 27

He had seen carbolic acid sprays being used in sewage works to reduce the smell.

Question 28

When did Lister start using carbolic acid in operating theatres?

Answer 28

early 1860s.

Question 29

When did Lister refine his technique?

Answer 29

He heard about germ theory in 1865, and realised germs could be on the instruments and on peoples hands, He started using carbolic on instruments and bandages.

Question 30

What did Lister's techniques do to the death rate?

Answer 30

It went down from about 50% to about 15%.

Question 31

Why didn't all doctors use carbolic acid?

Answer 31

It is very unpleasant to get on your skin or to breathe in.

Question 32

Why is asepsis used in modern operating theatres?

Answer 32

It reduces the need for powerful chemicals.

Question 33

What is done to keep modern operating theatres germ free?

Answer 33

Instruments sterilised before use (steam at 120°C); staff sterilise their hands; staff wear sterile clothes; theatres kept very clean; sterile, filtered air used.

Question 34

What was the problem with blood transfusions?

Answer 34

Sometimes they worked, sometimes they did not.

Question 35

Why was there a need for blood transfusions?

Answer 35

Surgery causes bleeding, and it can be very heavy.

Question 36

When were the first blood transfusions done?

Answer 36

Certainly in the 17th century.

Question 37

What discovery made blood transfusions possible?

Answer 37

The discovery of blood groups.

Question 38

What happens to blood stored outside the body?

Answer 38

It clots.

Question 39

Who discovered blood groups?

Answer 39

Karl Langsteiner, in 1900.

Question 40

What was found to stop stored blood from clotting?

Answer 40

Sodium citrate

Question 41

What event made blood transfusions very important?

Answer 41

The first world war, 1914-1918.

Question 42

When was the first blood bank set up?

Answer 42

1917, at a battle.

Question 43

When was the National Blood Transfusion service set up?

Answer 43

1946

Question 44

Who discovered X-rays?

Answer 44

Wilhelm Roentgen

Question 45

When did Roentgen discover X-rays?

Answer 45

1895.

Question 46

What is the value of X-rays?

Answer 46

They pass through soft tissue, but not bone, and affect photographic film, so can be used to get pictures of the skeleton.

Question 47

What is a CAT scan?

Answer 47

A scanner rotates 180° around the body, aiming x-rays at receptors on the opposite side. A computer analyses the results and produces a 3D simulation of the body.

Question 48

What is CAT short for?

Answer 48

Computerised Axial Tomography. Or Pet Cat.

Question 49

Who discovered radioactivity?

Answer 49

Becquerel and the Curies - 1896-1898.

Question 50

What is the medical use of radioactivity?

Answer 50

Radiotherapy to treat cancer; immunosuppression; tracers in diagnosis

Question 51

What is a tracer?

Answer 51

A substance is "tagged" by including an radioactive element, then the activity of the part of the body using the substance can be observed... eg glucose shows active parts of brain; iodine shows thyroid gland

Question 52

What is keyhole surgery?

Answer 52

Surgery through very small incisions.

Question 53

Why is keyhole surgery popular?

Answer 53

Less pain; quicker recovery; smaller scars.

Question 54

How is keyhole surgery done?

Answer 54

Surgeon watches the operation on screen, via an endoscope which is put into the body. He then introduces instruments through other small holes. Usually still requires a general anaesthetic.

Question 55

When was keyhole surgery first done?

Answer 55

1980s. Scar on your Dad's back would be about 1cm if he'd had the op a couple of years later.

Question 56

What is transplant surgery?

Answer 56

Replacement of worn out body parts - either transplanted from a donor, or artificial (eg hip joint).

Question 57

When was the first transplant done?

Answer 57

1905 - the cornea of the eye.

Question 58

What transplants were done in World War 1?

Answer 58

Skin was transplanted from one part of the body to another, wounded part, to encourage healing.

Question 59

What organ was first successfully transplanted?

Answer 59

Kidney

Question 60

Who did the first successful heart transplant?

Answer 60

Cristiaan Barnard.

Question 61

How successful was the first heart transplant?

Answer 61

The patient lived for 18 days, then died of pneumonia.

Question 62

Why were heart transplants stopped for a time?

Answer 62

The patients did not live for long.

Question 63

What is the big problem for transplants from a donor?

Answer 63

The body's immune system recognises the proteins on the surface of the cells as foreign, and will attack and kill the donated organ. This is known as rejection.

Question 64

What can be done to stop rejection?

Answer 64

Immunosuppressant drugs are used.

Question 65

What is the problem with immunosuppressants?

Answer 65

They leave the patient too vulnerable to other infections - like the first heart transplant patient who died of pneumonia.

Question 66

What drugs were first used as immunosuppressants?

Answer 66

Corticosteroids.

Question 67

What is cyclosporin?

Answer 67

A modern immunosuppressant derived from a fungus.

Question 68

What was the effect of war on plastic surgery?

Answer 68

Development sped up, facial injuries needed to be repaired.

Question 69

What major step was during the First World War plastic surgery?

Answer 69

Use of pedicle tubes. The idea is that skin is partially removed from the patient, still attached on one side, and then stretched over a tube - as there is still a blood supply it grows. When it is big enough it is attached to the damaged area, and eventually detached from the graft area.

Question 70

What sort of patient needed facial surgery in World War 2?

Answer 70

Pilots who had been trapped in burning aircraft.

Question 71

What advance made plastic surgery, especially on burns, possible?

Answer 71

Antibacterial drugs, burns are very prone to infection.

Question 72

What other advances were caused by war?

Answer 72

Prosthetic limbs; blood transfusions; mobile X-ray units; brain surgery.