A Dummies Guide to: The Revolution in Surgery
What was the revolution in surgery?
The term ‘revolution in surgery’ is used to describe a period of time when a series of breakthroughs led to surgery becoming cleaner, relatively pain free and much safer. Before this period surgery was quick, dirty and dangerous with patients having a large death rate due to blood loss, pain and infection. After the revolution in surgery each of these issues was minimised.
What period of time are we talking about?
Really open to interpretation here as some would argue that we’re still in this period. Here, I’m talking about surgery from about 1750 to about 1900.
What was surgery like before this period?
In simple terms: it was QUICK (it had to be to prevent blood loss); DIRTY (because people weren’t aware of the causes of infection) and PAINFUL (because there were few effective painkillers). Each of these three problems combine to make it very dangerous – though it was sometimes successful!
How was the problem of pain overcome?
Throughout time people have tried to overcome the problem of pain during surgery. They used things ranging from alchohol to hemlock to try and numb the pain, but numbing it was all that it really did. In the 19th century surgeons made some huge advances. Through experimentation they developed anaesthetics that meant that surgery became much less painful. Early attempts were the use of carbon dioxide (1820’s) and nitrous oxide (laughing gas) in 1846. Both had some pain relieving qualities but weren’t highly successful. Around the same time Crawford Long secretly made use of Ether on a patient. The same anaesthetic was then used by William Morton in 1846. News of his successful use of Ether led to it being tried by surgeons around the world. Ether had drawbacks though – patients sometimes vomitted as a result of being given it and it was highly flammable. The use of Ether was largely replaced by the use of Chloroform in the UK. This was first used by James Simpson in 1847 and became popular after it was made known that Queen Victoria had used it as a painkiller during childbirth.
Use of these painkilling anaesthetics developed. Local anaesthetics were introduced in 1877 and in the 20th century ways of inducing sleep and relaxing muscles were discovered.
How was the problem of blood loss overcome?
Surgeons had always known that loss of blood was a real problem and attempts had been made to replace it for some time. For example, in the 15th century Pope Innocent VIII had blood from 3 young boys infused into his body (basically pured down his mouth). It didn’t work – but the notion of transfusion was clearly recognised by some at that time. Experiments on animals and several humans took place throughout the 16th and 17th centuries with small amounts of blood from animals successfully being infused into several humans. All attempts to place large amounts of blood into people failed though. The first successful transfusion was in 1818 when James Blundell extracted 4 ounces of blood from his arm and successfully transfused it into his wife. Between 1825 and 1830 he carried out a further 10 transfusions and in 1840 he was part of the team who performed the first whole blood transfusion.
Even though they had worked out how to replace blood during surgery many patients still died. This was because the wrong kind of blood was often used. In 1901 Karl Landsteiner discovered blood groups. After this, surgeons could match blood groups and reduce the risk of there being a fatal reaction / rejection of the blood.
This just left the problem of having enough blood available. This problem has largely been solved through the development of blood banks and improved storage methods that have been developed over the past 100 years.
How was the problem of infection overcome?
The ultimate frustration for surgeons must have been to successfully operate, reduce blood loss and make sure that pain didn’t overcome the patient, only to see them die a few days later from an infection. Of course until Germ Theory was developed and accepted, surgeons weren’t sure what caused these infections and so they could only guess at what to do to limit the risk. One of the first to do so successfuly was Ignaz Semmelweiss. He insisted on cleanliness and had much better survival rates than other surgeons doing similar work – but he wasn’t able to convince others to do the same. The breakthrough came in 1867. Joseph Lister was a surgeon in Glasgow. He read about Germ Theory and realised that this was connected to the infections he saw. When he heard about a spray being used in sewers to reduce the risk of disease he decided to investigate. He quickly came to the conclusion that using Carbolic Acid to clean wounds and bandages would significantly reduce infections. His ideas were adopted by the German army in the Franco-Prussian war and the positive outcome helped to convince people that his methods were effective. Following this, Robert Koch worked on sterilisation of surgical equipment, which led to further improvements. This ‘big idea’ is antiseptic surgery – and antiseptics are still widely used today. These ideas have been developed so that nowadays not only are the bandages, wounds and equipment clean, so is the air! Modern operating theatres have filtered air streams and are ‘asceptic’ (ie totally clean).
Did everyone approve of the changes?
Some of these developments encountered lots of opposition. becase some of them were quite experimental they didn’t always work. This cast doubt over the merits of the ideas and until scientists ‘got it right’ there were many who doubted them. There are also moral and religious objections to some of these ideas, for example, Blood Transfusion.
