Discovery is often the result of a chain of experimentation.
Royal approval helped bring about the acceptance of anaesthesia.
The administration of anaesthesia required expertise and standards before being accepted.
Did the first world war advance medical practice in anatomy and surgery?
The First World War interrupted general medical research, but it created other opportunities for surgeons and doctors. New techniques were needed to deal with the terrible carnage of the battlefields. Surgeons had to develop new skills quickly instead of competing with each other, they now worked together to find answers. Governments devoted industrial resources to provide equipment and medicine.
The machine gun, high-explosive shells and poison gas created huge numbers of casualties. One important advance was the creation of portable X-ray machines, which helped surgeons locate bullets lodged inside the body. This dramatically increased their success at removing them. However, surgeons were hindered by the poor sanitary conditions of the trenches, where infection caused gangrene,
Another major advance was that it became possible to store blood; this saved many lives. Discoveries about the four main blood types had been made in 1901, and army surgeons in the First World War were able to exploit this knowledge to perform successful transfusions. This eventually led to the setting up of “blood banks” in 1938.
About 10 per cent of war wounds were to the head, so eye, face, ear, nose and throat surgery developed rapidly. Also, because of the degree of shelling in trench warfare many soldiers suffered massive injuries, as a consequence major advances were made in the development of artificial limbs.
The war presented new challenges for doctors; injuries were very severe and likely to need what we now call “plastic surgery” and skin grafts.
New types of head injuries would require precise and skilful surgery.
Better technology was required to develop artificial limbs.
High Technology medicine
As technology has advanced, so has innovation in the treatment of medicine. Keyhole surgery enables operations to be performed with the help of a miniaturised camera, while developments in micro surgery allow the finest of blood vessels to be reconnected.
Keyhole surgery uses an endoscope based on fibre optic technology. Using miniaturised tools, including a tiny flexible camera, the surgeon can operate remotely, using a television monitor to see what is happening. Many operations can now be performed without making an incision in the body at all – the surgeon can reach the upper parts of the body through the mouth and the lower part through the rectum.
Advances in micro surgery mean that using powerful microscopes, surgeons can now rejoin nerves and very small blood vessels. Micro surgery is now routinely used in ear, eye and larynx operations as well as in reconnecting severed limbs.
Advances in modern technology, and in particular, miniaturisation, have revolutionised surgery.
Keyhole surgery uses an endoscope with a small camera attached to probe organs and perform surgery, sometimes using lasers.
Micro surgery magnifies the area to be operated on, enabling surgeons to rejoin tiny nerves and blood vessels.
Anaesthetics
In the 18th century, due to the severe pain faced by patients during operations, surgeons were restricted in the types of operations they could carry out. Surgery had to be performed in the quickest time possible in order to avoid unnecessary suffering; however, this meant that mistakes were often made. It was usual for a surgeon to require the help of several assistants to hold the patient down.
Surgeons were anxious to find a method of knocking their patients out and began to explore the use of chemicals.
In 1799 Humphry Davy discovered that nitrous oxide, or “laughing gas”, relieved the sensation of pain; his findings were not widely publicised though. One year later, Robert Liston successfully anaesthetised a patient while conducting an amputation using ether. But there were drawbacks to early anaesthetics as patients had been known to die when too strong a dose had been administered; additionally, ether was known to cause lung irritation.
The real breakthrough came in 1847 when James Simpson, a Scottish doctor, discovered the anaesthetic properties of chloroform.
Simpson began to use chloroform to relieve pain during child birth, although this practice was only widely accepted 10 years later when Queen Victoria accepted chloroform during the birth of her eighth child. With modern anaesthetics, an anaesthetist continually monitors the gas mixture so that the patient is administered the correct amount.
In 1799, Humphry Davy discovered that nitrous oxide, or “laughing gas”, could relieve the sensation of pain.
In 1800, Robert Liston used ether to successfully anaesthetise a patient.
In 1847 James Simpson discovered chloroform.
Antiseptics
Surgery was a dangerous prospect for a patient in the 19th century. If the shock caused by the pain and loss of blood did not kill the patient during the operation, it was very likely that infection from blood poisoning afterwards would. Although people had made a connection between dirt and disease, this knowledge was not applied to the operating room. Surgeons wore coats covered with the pus, blood and germs of countless operations!
Antiseptics were first developed by Joseph Lister in 1867. he realised that germs needed to be destroyed in order to prevent infection, this became known as “antisepsis”. Lister had noticed the similarity between the smells of sewers and operating rooms. He knew that carbolic acid was used to treat sewers and he tried a weaker version of it on wounds. This reduced the risk of septicaemia (infection). The number of deaths during Lister’s own operations fell from 50 to 5 percent in two years.
These figures show the death rates in Newcastle Infirmary before and after the introduction of antisepsis in the nineteenth century; before antisepsis: 59.2%
After antisepsis: 4.0%
Only 150 years ago, over 50% of patients would die from septicaemia and gangrene, following an operation.
Joseph Lister introduced antiseptic spray in 1867
Lister made the connection between the smell of sewers and operating theatres and this led him to experiment with carbolic acid.
James Young Simpson (1811-1870)
In the early 19th century surgical operations were dreaded by patients. Anaesthetic was not discovered until 1842, so patients had to endure excruciating pain. In an amputation, the patient would be held down while the surgeon cut through all the soft tissue and bone. He horror of pain forced surgeons to work quickly, often leading to mistakes and a low survival rate. The first successful steps in the conquest of pain were taken by James Simpson.
Who was JS?
Simpson was the youngest son of a Scottish village baker. He trained as a doctor and became Professor of Midwifery at Edinburgh University. Simpson wanted to cut down the suffering of his patients in childbirth. He often used ether, but disliked it because of its strong smell which make his patients cough.
How did he become well known?
In 1847, simpson and two assistants experimented with a new anaesthetic, chloroform, which had none of the side effects of ether. Within a month he had used it successfully on over 50 patients.
Was there any opposition to simpson’s ideas?
Unfortunately, the use of chloroform was not without risks. Some doctors did not know how to use it properly and in 1848, Hannah Green, aged 15, died from an overdose of chloroform. There was opposition from those who saw chloroform as unnatural and members of the Calvanist Church of Scotland claimed its use was forbidden in the bible.
Why was chloroform accepted?
In 1853 Queen Victoria was successfully anaesthetised during the birth of her eighth child. This turned the tide and from then on chloroform became widely accepted. However, its effects sometimes meant that surgeons spent too long on operations and patients could still die from blood loss and infection.
What was simpson’s legacy to medicine?
Although his name is always mentioned in books as the developer of anaesthetics, chloroform was only used until around 1900 when it was discovered that it could damage the liver. From then on surgeons returned to using ether. Today, surgeons use a complex mix of drugs administered by a qualified anaesthetist. Simpson’s use of chloroform helped to gain popular suppose for the use of anaesthetics.
Ambroise Paré (1510 – 1590)
At the beginning of the 16th century many surgical and medical treatments had not changed for hundreds of years. The main method of stopping a wound bleeding for example, was to cauterise or seal it with a hot iron. This technique had been developed by Muslim doctors 500 years earlier. The man who stumbled upon a better method was Ambroise Paré.
Who was AP?
Paré originally trained as a barber-surgeon and later joined the French army as a surgeon. The French were involved in many wars during the 16th century so Paré gained a great deal of practical experience.
How did he make his breakthrough?
It was by chance that Paré made his important discovery about the treatment of soldiers’ wounds. In an attempt to stop soldiers bleeding to death, wounds were usually scorched with burning oil or a hot iron to seal them. Paré had run out of oil in the battlefield so had to try an alternative method. He made a dressing of egg whites, oil of roses and turpentine, which he applied to a wound. The dressing successfully sealed the wound and provided relief from pain. Paré also developed the use of a ligature to stop bleeding after an amputation. He realised that by tightening a belt around an artery the blood supply could be stemmed/
Was he accepted by the medical establishment of his day?
Few surgeons adopted Paré’s ideas. He had no formal university medical training and this meant that many other physicians did not take his ideas seriously. However, Paré did enjoy a long medical career, during which he made other advances to help wounded soldiers, including the design of artificial limbs. Paré was also interested in obstetrics; he wrote a book on midwifery and founded a school for midwives in Paris.
How important was Paré?
Paré’s ideas were important as he developed an alternative to cauterization which was a major breakthrough in wound treatment. Despite opposition from the medical establishment, his case studies were published with the support of the King.
Louis Pasteur (1822-1895)
For centuries doctors had tried to find out how disease was caused. In the mid-19th century, many people in Britain still believed in Miasma, the idea that disease was caused by polluted air. The real breakthrough in understanding the cause of disease was made not by a doctor, but a chemist called Louis Pasteur.
Who was Louis Pasteur?
Louis Pasteur was a French chemist working as a teacher in a university. He was asked by a wine company to explain why some wine turned sour whilst it was being made. Pasteur’s research discovered that there were germs in the air that could cause liquids to go off.
What did he do next?
Having discovered that “bad” wine had germs in it which could be seen through a microscope, Pasteur developed a process for killing the germs by boiling the wine and then cooling it down. He called this process “pasteurisation”. Pasteur then set about proving that the germs came from the air and could therefore be prevented from entering the liquid in the first place. He demonstrated this by sealing a quantity of a liquid in an airtight jar and leaving another quantity exposed to the air. Pasteur now used his discovery to help treat diseases. He knew that the British doctor Edward Jenner had developed a process of vaccination against the killer disease, small pox. Pasteur believed that his germ theory could be used to explain how vaccination worked. He examined the blood of healthy people and compared it with the blood of people with various diseases. He observed that when people were infected with disease their blood contained lots of germs. He examined the blood of healthy people and compared it with the blood of people with various diseases. He observed that when people were infected with disease their blood contained lots of germs.
What new ideas did Pasteur develop?
The process of boiling a liquid to destroy germs is still used today; most dairy products are pasteurised. Pasteur went on to discover vaccinations for chicken pox, cholera, diphtheria, anthrax and rabies. However, not all of Pasteur’s ideas were accepted. He recommended that surgical instruments be boiled before an operation to kill any germs on them, but most surgeons ignored this advice. This had to wait until aseptic surgery developed in the 20th century.
How important was Pasteur?
Pasteur’s work was revolutionary in discovering the link between germs and disease. This led the way for Robert Koch to later discover how each type of germ caused specific disease and who established a complete germ theory of disease.
Joseph Lister (1827-1912)
If a patient did not die from the pain of an operation in the early 19th century, there was a good chance that infection would finish them off. In many cases gangrene set in before the wound healed and there was little that could be done about it. There are stories of patients having repeated amputations on a leg in an effort to stop the infection reaching the body, to no avail. The first method of preventing infection during an operation was developed by Joseph Lister.
Who was Joseph Lister?
Lister was Professor of Surgery at Glasgow University. He was concerned about the number of patients who died from infection and blood poisoning after operations. He set about trying to reduce this by improving the cleanliness of operations.
Where did his ideas come from?
The French chemist Louis Pasteur was a major influence on Lister. Lister read about Pasteur’s discovery of germs and decided that to prevent infection, he needed to ensure that the germs present in the air did not get into wounds. Lister conducted an experiment on an 11 year old boy, who had been run over by a cart and had fractured his leg, leaving the bone exposed. Once Lister had cleaned the wound, he placed a dressing covered with carbolic acid over it. Lister knew that carbolic acid had been used to disinfect drains and cesspools and therefore thought that it may have the power to kill germs. The boy survived and did not suffer from the gangrene that was common with these types of injuries.
Following on from his success, Lister decided to develop his theory further by inventing a carbolic spray which could be used to spray the operating area. In addition, Lister insisted that the operating theatre was kept clean, that the surgeon wore clean clothes, and that instruments were regularly disinfected.
How important was Lister?
At first Lister was regarded as an eccentric and nurses resented the extra work that his obsession with cleanliness caused. But deaths from blood poisoning and gangrene were reduced and before he died, Lister’s services to medicine were recognised and he was awarded a knighthood. Today the terms, “Before Lister” and “After Lister” are used to describe surgery.