Surgery: Problems and solutions

Why was surgery so dangerous in the early 1800s?

• Surgery was dangerous and painful. Surgeons had to work quickly.

• There was no way of relieving the pain suffered by the patient.

• Robert Liston a famous London Surgeon, once amputated a leg in two and a half minutes, but worked so fast that he accidently cut off his patient’s testicles as well. During another high speed operation Liston amputated the fingers of his assistant.

• Infection was the greatest danger to patients after an operation. Germs might enter a wound and cause blood poisoning.

• Almost half of all patients who had leg amputations died from blood poisoning.

Problem 1 - Pain

• All operations were carried out as quickly as possible to reduce the pain suffered by the patient.

• With the advancement of medical knowledge, some surgeons felt that if patients could be knocked out, then there would be no resistance and surgeons would have more time to operate.

• In 1799 Sir Humphrey Davy discovered laughing gas (ether) reduced the sensation of pain. However ether had drawbacks as it irritated the lungs, causing the patient to cough during the operation. Soon surgeons were looking for alternatives.

Chloroform

• James Simpson and several colleagues were experimenting with different chemicals.

• Simpson poured some chloroform into glasses and his colleagues and himself inhaled the vapours.

• They all fell off their chairs and into a deep sleep and were found by Simpson’s wife.

• Simpson realised that Chloroform was an effective anaesthetic and soon other surgeons were using it in surgery

Opposition to anaesthetics

• People were worried that there may be long term side effects on the minds and bodies of the patients. They didn’t understand what doses to give different patients. There was even a death due to too much chloroform.

• Anaesthetics were dangerous as with patients asleep the doctor could attempt more complex operations, thus carrying infections deeper into the body.

• Religious and moral reasons were cited as it was believed to be unnatural for pain to be eased especially during childbirth.

Why were anaesthetics accepted?

• Simpson reminded people of Ambroise Pare and how he managed to reduce the suffering of people with his ligatures and ointment and compared it with the discovery of chloroform.

• The final breakthrough came 10 years later when Queen Victoria accepted the use of chloroform during the delivery of her eighth baby in 1857. She publicly praised and blessed chloroform. The support of anaesthetics by the Queen meant that they became a standard part of surgery.

Problem 2 - Infection• Anaesthetics made surgery less painful

but it was not safer. Until 1860 surgeons did not accept Germ Theory and so did not take precaution to protect open wounds from infection.

• Doctors reused bandages, spreading infection.

• Doctors didn’t wash their hands before operating.

• Doctors wore the same clothes that they had been wearing out in the dirty streets.

• Doctors used instruments that hadn’t been sterilised and that had been used on previous patients so had crusty pus and blood on them.

Why was infection so common in nineteenth century surgery?

Antiseptic – Chemicals used to destroy bacteria and prevent infection.

Joseph Lister

• Lister had seen carbolic spray used to treat sewage and get rid of a parasite that caused an infection in cattle. He decided to use carbolic spray during operations.

• He found by spraying a thin mist of carbolic acid over a wound then covered with bandages would limit the spread of gangrene (the infection of dead tissue).

James aged 11 years was admitted to Glasgow infirmary on Aug 1865, with a wound caused by the wheel of an empty cart passing over the limb. The wound was an inch and a half long and three quarters of an inch broad. Lister used the spray during the operation and then afterwards a piece of lint dipped in Carbolic acid was laid on the wound, and splints padded with cotton wool were applied. It was left undisturbed for 4 days and when examined it showed no signs of pus. For the next few days the wound was dressed with lint soaked with a solution of water and carbolic acid and olive oil which further prevented irritation of the skin. No pus was present and by the end of the six weeks the wound was gone.

How did Joseph Lister help medical development?

Opposition to Lister

• Carbolic spray soaked the operating theatre which was dangerous.

• It cracked the surgeon’s skin • It smelt.• Made operations slower.• Made operations more expensive and

less pleasurable for surgeons.

Copy the bullet points into your books

How did Lister change operations?

• Operating theatres were cleaned up• From 1887 all instruments were

steam- sterilised.• In 1894, sterilised rubber gloves

were used for the first time.

Problem 3 - Blood loss

• Often during operations blood clotted and resulted in patients dying.

• Lister also made a contribution on the problem of bleeding. He improved on Pare’s ligatures by using sterilised cat-gut (a strong cord made by twisting the dried intestines of animals) to tie up any veins or arteries

• It was not until the 20th century that a solution was found for this problem.

Study the source. 'Illustration of man having leg amputated around 1800'

What dangers faced patients during and after operations at the beginning of the nineteenth century? Using the source and your knowledge to explain your answer.