History

19th-century surgery

Before the 19th century operations were horrific procedures, and most patients died from post-operative shock, infection, or loss of blood. In some London hospitals the death rate after operations was over 80 per cent.

The 19th-century up-turn in surgery actually pre-dated anaesthetics and antiseptics. Many new ideas were trialled in America (eg Dr Thomas McDowell performed an ovariotomy in 1809), with some success. One suggestion is that American surgeons were happier to try out new techniques on Black slaves.

The improvements in anaesthetics (to protect patients from pain) and antiseptics (to protect patients from infection) occurred because surgery without them was too traumatic, and patients couldn't survive it. New blood transfusion techniques also saved many lives.

Anaesthetics for pain

Surgeon pictured in USA c.1882, wearing an apron, but without surgical gloves or face mask

Surgeon pictured in USA c.1882, wearing an apron, but without surgical gloves or face mask

  • 1842: Crawford W Long (America) used ether as an anaesthetic while operating on a neck tumour (but did not publish details of his operation).
  • 1845: Horace Wells (America) tried unsuccessfully to demonstrate that laughing gas would allow him to extract a tooth painlessly.
  • 1846: Dr JC Warren (America) removed a tumour from the neck of Gilbert Abbott using ether.
  • 1846: Robert Liston (Britain) removed a leg using ether - 'this Yankee dodge'.
  • 1847: James Simpson (Britain) discovered chloroform.
  • 1884: Carl Koller (Germany) discovered that cocaine is a local anaesthetic.

Antiseptics and blood transfusions

For infection - antiseptics

  • 1847: Ignaz Semmelweiss (Hungary) cut the death rate in his maternity ward by making the doctors wash their hands in calcium chloride solution before treating their patients.
  • 1854: Standards of hospital cleanliness and nursing care rose rapidly under the influence of Florence Nightingale.
  • 1865: Joseph Lister (Scotland) - basing his ideas on Pasteur's Germ Theory cut the death rate among his patients from 46 to 15 per cent by spraying instruments and bandages with a 1-in-20 solution of carbolic acid.
  • 1890: Beginnings of aseptic surgery - surgeons started boiling their instruments to sterilise them - WS Halstead (America) started using rubber gloves when operating - German surgeons started to use face masks.

For blood loss - blood transfusions

  • 1901: Karl Landsteiner (Austria) - discovered blood groups. Transfusions had been tried before but usually killed the patient because of clotting. Matching blood groups stopped this happening.
  • 1913: Richard Lewisohn discovered that sodium citrate stopped blood clotting during an operation.
  • 1938: The National Blood Transfusion Service was set up in Britain.

More causes for improvements in surgery

The number of operations grew hugely through the century, and surgeons became skilled at internal operations (1880s: first appendectomy; 1896: first open-heart surgery) and even tried (unsuccessfully) to transplant organs such as thyroid glands and testicles. Various factors pushed the process along:

  1. The Industrial Revolution / inventions
    • Wilhelm Roentgen discovered x-rays - helped internal surgery.
    • Public demonstrations (eg of anaesthesia) allowed knowledge of new procedures to spread.
  2. Scientific knowledge
    • The scientist Humphrey Davy had first discovered that laughing gas was an anaesthetic when working on the properties of gases in 1800.
    • Joseph Lister lectured in King's College London, and published his findings in 'The Lancet'.
  3. Social factors
    • Queen Victoria gave birth to her children under anaesthesia (after which the general public's fear of anaesthesia lessened). Edward VII's appendectomy helped reduce fear of operations.
  4. War
    • The needs of army surgeons treating soldiers injured in battle (often requiring amputations) stimulated advance.
    • The Crimean War led to the development of nursing (Florence Nightingale at Scutari).
    • World War One led directly to the development of the National Blood Transfusion Service.

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