Surgery c.

1845-1918, a review
(almost)

1846
Key Figure: Robert Liston 21st December, first use of ether in an operation outside the US of A when it was used in 1842 (damn Yanks). This was the first real use of a proper anaesthetic in the UK, other previous attempts had included getting so smashed you couldnt feel anything, hypnosis, and being knocked stone cold by your friendly surgeon.

1847
Key figure: James Simpson He first used chloroform, which was soon to fully replace ether as a safe anaesthetic for the majority of people. Its first major use though was to relieve labour pains in women, which angered Christians (like most progressive things do). Supposedly to develop this he and some friends got together in his house and inhaled various mind altering chemicals to see which would knock them out the easiest. Nowadays that would be very illegal, but back then it was just progress, oh how times have changed.

Opposition to anaesthesia
As always the most vocal of opinions was that of the church, with the reasons least based in fact. In fact their entire argument stems from one bible verse from Genesis; 3:16 which says I will greatly increase your pains in childbearing; with pain will you give birth to children which is great, if you want to put women down (like the majority of the bible does) but then compare it to other things mentioned in Genesis, which include Gen 19:8 Look, I have two daughters who have never slept with a man. Let me bring them out to you, and you can do what you like with them said by Lot, who was then deemed worthy of rescue from Sodom, because he offered his virgin daughters to be raped, great moral guidance. And afterwards his wife was killed because she was sceptic, again, great moral and scientific guidance. Other opposition included safety claims because people were dying because they were holding back and inhaling too much at once when they did breathe it in it overwhelmed their system, slowed their heart too much and caused a quick death, with quite a chloroform high.

How the introduction of anaesthesia was a factor for influencing change

It allowed for much more advanced surgery, and although this had higher mortality rates to begin with the possibilities of cures meant that the people helped by modern surgical procedures outweighed the initial increase in mortality massively. It also dented the churchs reputation a bit when it was once again proved to be wrong, this also meant that the church mainly stayed out of medical and surgical debates up until the recent AIDS/condoms debate, which they are again losing, badly. It meant also that people were more accepting of surgeons and surgery in general, mainly because it wasnt as associated with gruesome pain anymore.

1853
Key figure: Alexandrina Victoria, Queen of the United Kingdom and Ireland, Defender of the Faith and Empress of India. Queen Victoria used chloroform for the birth of Prince Leopold, hugely popularising it at the time because she was a public icon, like what happens whenever one of the monarchy do something. This basically ended any/all opposition to anaesthetics because the evidence of how it was a positive factor in change was easy to see.

Back to 1848
Key figure: Ignaz Semmelweis This contemporary genius understood that there was an obvious link between the doctors moving from the morgue and the spread of infection, that the infection itself was perhaps being carried (shock horror) by the doctors themselves. He introduced the rule of antisepticising both hands and instruments before autopsy work and seeing patients. Because of his controversial views his critics eventually got the better of him and he eventually quit in 1850 and left to die in a lunatic asylum.

1867
Key figure: Joseph Lister His belief was that carbolic acid (phenol) would be effective as antiseptic, much like Semmelweis did. He published his ideas in the Lancet in 1867, and in his report he insisted on two points; the first being that germs, Pasteurs bugs, caused and spread infections; and for all the ideas about laudable pus infection and pus formation were not inevitable, still less beneficial, stages in wound healing.

1870-1
Key event: Franco Prussian War This was a perfect opportunity to test out Listerian practices in a practical solution and a large scale. The German medical staff arguably showed the greater hindsight and adopted some of Listers ideas in treating gunshot and battle wounds, and as a direct result of this they achieved much superior mortality rates and outcomes to the French, who neglected Lister completely. It can be argued that the adoption of these surgical practices were a key factor in the German victory. As a result of this there was change in military medical practices to try to emulate the outcomes of the Germans, which also affected civilian practices.

1881
Key figure: Robert Koch After research Koch urged the use of heat sterilisation in addition to more widely used chemical sterilisers, such as carbolic acid. The gradual uptake of his ideas meant that the post operation infection rate dropped again because there was even less chance of microorganisms surviving on the surgical instruments.

Antiseptics as a factor for influencing change.

Mainly more people began to survive after surgery, which increased the reputation of the branch of medicine and people were less likely to be wary of the subject and regard it as butchery. In wars before this was introduced infected wounds was almost as deadly as the enemy in killing soldiers, but with sterilisation of the wounds many soldiers were able to survive and fight for their country whereas before their wounds would have got infected which could have lead to amputation or death.

1902
Key figure: Edward VII He himself didnt contribute much to surgery, but his influence did, because just before his coronation his appendix erupted and he had to have surgery to remove it. Just like his mother with anaesthesia, he popularised what is now known as modern surgery with the general population, meaning that a lot more people were willing to have more invasive surgery performed.

Nobel prize in surgery.

1909: Theodor Kocher received it for his work on the Thyroid gland, which was controversial at first but helped reduce mortality rates for this type of surgery. 1911: Alexis Carrel received it for his studies of tissue culture (useful for many different types of surgery today) and techniques of suturing blood vessels.

1895-1900
Key figure: Wilhelm Rontgen He discovered X-rays which would prove to be incredibly useful in future medical treatment and surgical practice, because now doctors and surgeons could look inside patients for broken bones, shrapnel and foreign bodies without surgery until absolutely necessary.

WW1
Harold Gillies and others started using plastic surgery as part of treatment for soldiers, and because this was war the field of surgery which dealt with it evolved very quickly into something we can recognise as almost modern surgery. The war ended in 1918, and thats where the course ends so you dont need to know anything past this point.

Sources for revision; use of Listers carbolic spray in surgery, 1858; (A)

Source; Victorian surgical instruments; (B)

 Using the previous 2 sources A and B and your own knowledge answer the following question (9) What can you learn about Victorian surgery from these sources, and what do they suggest it was like?