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The Transformation of Surgery 1845-1918

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on 3 December 2013

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Transcript of The Transformation of Surgery 1845-1918

The Transformation of Surgery 1845-1918
Revision Summary

Blood Loss
Blood loss was a very common reason for
death
in the 19th century, amputations were the
most common form of surgery
and they were performed very
dangerously
without barely any medical knowledge.
Surgery was
extremely painful
for the patient,
hot oil or hot irons
were used in an attempt to "seal blood vessels". They also tried tying them off with painful threads called
Ligatures
.
Blood transfusions (replacing lost blood) used to be performed with
animals and humans
, and there was a
very low success rate
.
KARL LANDSTEINER was the man who
identified blood groups
A, B, O and AB. He showed that
blood transfusions
had to be between
people of the same blood group
to be successful.
But
blood typing was little help
. Surgeons had to test the patients blood type and then find someone with the same blood type who was willing to take part in a transfusion. Doctors also had to find a way to stop blood clotting for storage.
RICHARD LEWINSON was a doctor who had been using
Sodium Citrate
to thin blood during transfusions suggested using it to store blood to set up blood banks for war surgeons. It had to be used quickly but it saved many lives.
Sodium Citrate treated blood seemed to keep fresher for longer when refrigerated.
ROUS AND TURNER found that
adding glucose to blood made it last longer,
so the army could now call on public donations to prepare for wars and when they were about to attack.
In 1917, the first blood bank was set up
in Cambria and it used 0 type blood, which had been proven safe to transfuse to all blood types.
Infection
Infection was the greatest killer until the Germ Theory of 1861 was understood.
Death rate was very high, approx 50%. Surgeons performed in blood stained aprons, used unwashed surgical equipment, re-used the same bandages and some didn't even wash their hands. Overall, there were extremely poor hygiene standards.
LOUIS PASTEUR 1861 invented the GERM THEORY - which linked
bacteria to decay.
He demonstrated that organisms were responsible for souring
wine and beer
, and how this bacteria could be killed by boiling and then cooling again - (now called
Pasteurization
)
He then proved that these bacteria were introduced from the
environment.
Many people opposed
his theory because they believed that bacteria could
spontaneously generate
, and did not believe that such a
small organism could kill larger ones
(humans).
But the French Academy of Science later accepted his results.
Pasteur later extended his theory to explain the causes of many diseases such as Cholera, Smallpox and Anthrax.
JOSEPH LISTER believed in the
Germ Theory,
and thought that
this bacteria was the same bacteria that settled on wounds ad caused infection.
He had seen
Carbolic Acid
used to treat sewage as it killed germs so during an operation he sprayed the patients wound with
Carbolic Acid spray - this was the first Antiseptic.
Opposition to Lister - Carbolic acid was an irritant, made their skin crack. It also slowed down operations and created more work. Results were not always the same. Many surgeons still refused the Germ Theory, still believing in miasmas (microbes in air).
ROBERT KOCH
directly linked a specific microbe to a specific disease,
which neither Lister or Pasteur could do. He linked microbes to Anthrax (animals) at first, then moved on to human diseases.
Pain
Before 1845, there was no reliable anesthetic.
Patients were held down during operations -
speed was the essence
which led to mistakes.
Death from Shock was fairly common.
Only
basic
surgery was possible.
First development of Anesthetics:
Laughing Gas
- Dental Anesthetic - HORACE WELLS -
Didn't knock you out properly - No serious operations
Ether
- Dental Anesthetic WILLIAM MORTON then Amputations ROBERT LISTON -
Flammable, heavy, damaged lungs, effects last for days
Chloroform
- Most Reliable Anesthetic - JAMES SIMPSON -
Long lasting, allowing more serious operations
. -
But this often made the chances of infection afterward greater.
JAMES SIMPSON
-
Famous experiment with chloroform at a dinner party, his friends and himself went unconscious. Soon used Chloroform to
ease pain of childbirth
- wrote articles so others could copy his ideas.
Opposition - Chloroform was new and untested. Long term side effects? Some people died after having using it. Many religious people felt that pain (especially during childbirth) was God's intention and so should not be tampered with. It was difficult to get the exact dosage right. Chloroform could affect the heart.
Chloroform also led to the
Black Period of Surgery
. The death rate actually went up. Surgeons could now take their time in more complicated operations, but the potential for infection without the later understanding of the Germ Theory was massive!
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