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History - Surgery - Antiseptics

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on 7 December 2013

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Transcript of History - Surgery - Antiseptics

Louis Pasteur 1861

Louis Pasteur invented the Germ Theory, which linked bacteria to decay.
Opposition to Joseph Lister

Surgeons did not like the fact that the carbolic acid was smelly and caused their skin to crack. This made their job more unpleasant.

Carbolic spray slowed down operations and created more work. Many surgeons still thought that speed was all important to stop bleeding, if the patient was to survive.

Some surgeons who copied Lister by using the carbolic spray did not get the same results so they stopped using it.

Many surgeons still refused to believe that infection was caused by microbes in the air – this still sounded ridiculous to them.

Joseph Lister
Lister read about the work done by Louis Pasteur, and he believed in his germ theory.
He thought that
THESE SAME GERMS WERE SETTLING ON WOUNDS AFTER AN OPERATION AND INFECTING THE PATIENT
. So somehow you had to prevent the germs getting into the wound - or kill the germs off.

He realised people who had been operated on were especially vulnerable as their bodies were weak and their skin had been cut open so germs could get into their bodies more easily.
The Transformation of Surgery 1845-1918
Infection - Antiseptics

Infection was the greatest killer before the Germ Theory (1861) was understood.

Death rate was approx
50%
. Surgeons practiced in blood-stained coats or in their own clothes and surgical instruments may not have been even washed. They didn’t even wash their hands and often re-used the same bandages. Operations were often observed by trainees (operating THEATRE) and the chances of spreading infection were greater.
Problems of Pre-1845 Surgery:
Infection

VERY POOR HYGIENE STANDARDS
Pasteur was able to demonstrate that organisms such as
bacteria were responsible for
souring wine and beer
, and that
this bacteria could be killed by boiling and then cooling again.
(This process is now called
Pasteurization
).

He then undertook experiments to discover where this bacteria
came from, and was able to prove they were introduced
from the
environment.

Opposition and
Acceptance
Opposition:
Many scientists disputed the idea of linking bacteria to the environment as they believed that bacteria could spontaneously generate.
Many also felt that such tiny organisms could not possibly kill larger ones such as humans.
Acceptance:
In 1864, the French Academy of Science accepted his results.

Pasteur's Achievements


In 1865, he was able to help the silk industry in France, where there was a silkworm epidemic. He identified parasitic infections as the cause and advocated that only disease free eggs should be selected. The industry was saved.

He later went on to extend his Germ Theory to explain the causes of many diseases, including Anthrax, Cholera, TB and Small Pox, and their prevention by vaccination.
What did he do?
Lister had seen
CARBOLIC SPRAY
used to treat sewage –- it killed all the germs. 
So,  during the operation on an eleven year old boy, he sprayed the wound with
Carbolic Acid
–- it was done using a spray bottle next to the operating table. This was the first ever ANTISEPTIC.
Then, after the operation, he covered the wound up with c
arbolic-soaked bandages
to stop any more germs getting in.  
Lister then developed his idea further by developing a spray machine
that pumped out a fine mist of Carbolic Acid into the air around an
operation.

The death rate of patients operated on by Lister fell dramatically.
Move to ASEPTIC (prevention of germs) Surgery
Lister can also be credited with a number of developments in aseptic surgery.

From the late 1880s, operating theatres and hospitals were rigorously cleaned.
From 1887, all instruments were steam-sterilised.

In 1894, sterilised rubber gloves were used, invented by
William Halstead
. He came up with the idea when his fiancee's hands became irritated from constant washings and antiseptics.

This encouraged the later inventions of sterile gowns, face masks and head caps for doctors and nurses. Closed operating theatre's and a sterile cloth also helped.

Was Lister Important?
NO YES
Robert Koch
Pasteur was convinced that microbes caused diseases
but was never able to directly link one microbe with a disease -
Robert Koch succeeded in doing this.

The first disease Koch investigated was Anthrax,
which seriously affected herds of farm animals.

He found out that the anthrax microbe produced spores that lived
on a long time after the animal had died. He proved these spores
could then develop into an Anthrax germ and could infect other animals.

Afterward, he moved onto germs that specifically affected humans.
He identified the germ tat caused blood poisoning and septicemia.
At the same time, he developed the steam sterilizer for surgical equipment,
which was an Aseptic advance.
Pasteur had come up with the ‘Germ theory’ in 1861.
Lister merely applied Pasteur’s ideas to surgery.

There was a lot of opposition to Lister.

It was Koch who gave a boost to Lister’s ideas. He was the one who found the bacterium to blood poisoning (septicaemia).

Before using antiseptic –67% of patients who had amputations died of infection after.
After using antiseptics only 15% died.

Even longer operations were now possible because there was less danger of infection - in the 1880s the first appendix operations were carried out and in 1896 the first heart operation took place.

Lister was given many awards and much
recognition.
How Lister was Able
to Make an Impact

Technology
–- Carbolic spray, Steam sterilizer.
Individual genius
- Lister’s determination that he was right despite all the doubters.
Scientific Thinking
–- The link with the Germ theory.
Chemistry
–- the use of carbolic acid.
Attitudes
-– Hindering factor. Very negative at first.
Full transcript