What were the problems in pre-20th century surgery?

What were the three main problems in surgery in the 19th century?

• Pain

• Infection

• Blood loss

• Robert Liston

famous for….

Early anaesthetics

• Laughing gas

• Ether

What were the problems with ether?

What is the connection between these two items?

What is happening in this picture?

James Simpson

Professor of Midwifery at Edinburgh University.

In 1847 he and his friends ‘discovered’ the benefits ofchloroform.

He used it during childbirth very successfully.

He wrote articles and other surgeons started to use it intheir operations.

Why opposition?

• Chloroform was new and untested.• Fear of long-term side effects.• Unknown dosages.• Hannah Greener’s death in 1848• It was unnatural to ease the pain of

childbirth.• God wanted women to suffer during

childbirth• Anaesthetics did not make operations

necessarily safer.

Why were they accepted?

• James Simpson presented a powerful case for anaesthetics.

• The final breakthrough was in 1857 when Queen Victoria accepted the use of chloroform for the birth of her 8th child.

• It was also used by Mrs Charles Dickens.

• They now became standard medical practice.

Joseph Lister 1827-1912

• Appointed surgeon at Glasgow Royal Infirmary in 1861

• Between 45% and 50% of his male amputation patients died from sepsis between 1861 and 1865

• He tried to encourage ‘clean healing’ with little effect. He then discarded the idea of direct infection from bad air and formed the idea of a ‘pollen-like dust’

Germ Theory• In 1865 Lister made the connection

between Pasteur’s Germ Theory and wound sepsis.

• In the previous year Lister had heard about the use of carbolic acid on sewage in Carlisle.

• He started to clean wounds and dress them using a solution of carbolic acid and in 1867 he announced that his wards had remained clear of sepsis for 9 months.

Why was there opposition to Lister?

• Opposition was mainly to Lister’s germ theory rather than ‘carbolic treatment’.

• Many surgeons wanted proof that antisepsis was a major advance.

• Lister kept improving his own techniques• Carbolic acid was unpleasant for surgeons

to use.• Other surgeons were not as careful as

Lister.

What is the development here?

Pioneers of plastic surgery…

• Harold Gillies in World War One in Aldershot and Sidcup.

• Archie McIndoe in World War Two at East Grinstead.

New techniques developed during WWI and WWII

• Setting broken bones• Treating head wounds, especially to eyes

and ears. Brain surgery.• Plastic surgery to treat and repair burned

skin.• Effective use of blood transfusion.• Improved use of X-rays• Improved methods of dealing with infection

after operations, especially penicillin in WWII.

Why does war improve surgery?

Why does WAR improveSURGERY?

In wartime industry devotes resources to developing new surgical equipment.

Surgeons do more operations and are prepared to work harder in wartime than in peacetime

In peacetime surgeons work alone and in competition with one another. In war they unite and share ideas to help their own soldiers

What things in this picture will help to make the operation successful?