Sir James Simpson (1811 – 1870) and Anaesthetics
1847 – Prof of Midwifery at Edinburgh University – wanted to find an alternative anaesthetic to Ether, which would not
irritate the lungs. One evening, he and some friends inhaled some Chloroform. Simpson was the first to awake, finding his
friends unconscious, but otherwise well, on the floor. He began to use it with great success to relieve the labour pains of
women in childbirth.
Mistakes were made with the new anaesthetic in the years following – overdoses put the patients to sleep permanently!
(e.g. death of Hannah Greener (1848)) Some objected to its use for religious (pain during childbirth had been created by
God) and surgical (surgeons needed to work quickly) reasons – Simpson faced much criticism in spite of his high position in
the medical profession – he was the first doctor to receive a knighthood (1866) for his contribution to medicine.
1848 – Dr John Snow invented Chloroform inhaler to make administering doses safer.
1857 – Queen Victoria used Chloroform (administered by Dr John Snow) during the birth of her 8th child – this encouraged
doctors and patients to trust Chloroform, but Ether remained in common use.
1870 – Simpson’s funeral – 100,000 people lined the streets in Edinburgh – the day was a national holiday in Scotland.
1905 – Novocaine developed - safer than Chloroform and less likely to cause bad side-effects, such as liver damage.
(Today – modern anaesthesia is an exact science, carried out by a specialist anaesthetist, who has access to a wide range of
anaesthetics. The drug Curare is used to relax the muscles so effectively that only a light anaesthesia is often required, further
reducing the undesirable side-effects of anaesthesia.)
Sir Joseph Lister (1827 – 1912) and Antiseptics
1861 – Prof of Surgery at Glasgow University – concerned about the level of cleanliness in operating theatres and hospitals
in general. (Nightingale’s work from 1854 onwards had drawn public attention to this). At that point, he, like other doctors,
believed a ‘poisonous miasma’ (bad smells in the air) might cause wounds to turn septic.
1865 – Learned of Pasteur’s work on microbes (scientific knowledge which Semmelweiss never had in 1847 when he had
experimented with Calcium Chloride to reduce deaths in hospitals). Lister realised that germs in the air and on surgical
dressings might be causing infection. He knew that Carbolic Acid was used to clean out sewers and guessed that it reduced the
smells in sewers by killing bacteria. He carried out an experiment on an 11 year old boy who had fractured his leg,
exposing the bone. He cleaned the wound and dressed in a bandage soaked in Carbolic Acid. The boy recovered – no gangrene
developed.
1867 – Lister knew that germs were still in the air and could get into the wound during surgery. He invented the Carbolic
Spray Pump – it created an antiseptic environment in the operating theatre.
Amputations done by
Lister
1864-66
1867-70
TOTAL CASES
35
40
RECOVERED
19
34
DIED
16
6
1877 - Prof of Surgery at Kings College, London. Many surgeons, doctors and nurses still did not accept his teachings, but
later Lister was awarded a knighthood (1883), honouring him for his contribution to surgery and gained international
recognition in 1892 when he and Pasteur were jointly honoured at a scientific convention at the Sorbonne University in Paris.
Finally he was made a lord, Baron Lister, in 1897.
(Today the history of surgery is commonly divided into two different periods: Before Lister & After Lister – such was the
significance of his work.)
Blood Transfusion: The Final Element in the Revolution in Surgery
The only ways of preventing blood loss before transfusion was by being a quick surgeon, using a cautery (hot oil or iron to
seal the wound) or by tying up the veins with silk threads immediately after an operation (Paré’s Ligature Method).
1667 – Blood transfusion attempted for the first time – direct transfusion from vein to vein – did not always work;
sometimes caused blood clots; patients died, no one knew why.
Throughout 19th Century – transfusion continued to be an unpredictable procedure and so was discouraged among surgeons,
but solving the problems of pain and infection made the need to address blood loss more pressing – longer, more complex
operations were leading to greater blood loss.
1902 – An Austrian doctor, Karl Landsteiner, discovers that blood falls into four main blood groups (O, A, B, AB) – this
explained why some transfusions failed. (Received Nobel Prize for this in 1930 – the importance of his work was not
recognised at first).
First World War (1914-18) - Methods for storing large quantities of blood were developed (refrigeration) – needed for
huge casualties – now loss of blood could be compensated for. Lewisohn (American doctor) discovered adding Sodium
Citrate to blood stopped it clotting (donor no longer needed to be present). In 1916, Rous and Turner worked out how to
refrigerate blood by adding a citrate glucose solution to it. In 1917 the first blood depot was set up for the Battle of
Cambrai, dispensing group O blood, which could be given safely to all patients.
THE FIRST WORLD WAR AND SURGERY
Faced with massive casualties and difficult conditions surgeons were forced to take risks and improvise new techniques and
therefore war accelerated improvements in surgery.
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The First World War 1914 – 18 - there was a huge need to treat wounded soldiers on the Western Front in France – so
hospitals were built and equipped with X ray machines to allow surgeons to spot bullets and shrapnel inside the body –
and remove them.
Better way to mend broken bones.
Repairing skin by skin grafting – this led to the development of ‘plastic surgery’. e.g. the New Zealand doctor, Harold
Gillies, repaired the skin of over 2000 men injured in the Battle of the Somme 1916. He developed the new technique of
pedicle tubes where a narrow layer of skin was lifted up from the body and stitched into a tube at one end. The other end
was still attached to the body and continued to grow. When the tube had grown long enough it could be stitched in place to
the new site. He helped to improve plastic surgery so that a more normal appearance could be maintained. He also kept
careful records of his work.
Other developments in surgery as a result of the First World War include:
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Improved surgery of the eye, ear and throat.
The first brain surgery: surgeons found themselves having to make early attempts at brain surgery because of the nature
of some of the wounds that were received.
Between 1914 and 1921 over 41,000 men in the British armed forces lost a limb. Advances in prosthetic limbs
included use of light metal alloys and new mechanisms but there were long waiting lists for these.
The use of explosive weapons meant that many soldiers suffered deep wounds and, when fragments of clothing entered
the wound, it caused infection. Surgeons found that cutting away infected tissue and soaking the wound with a saline
solution was the best way of dealing with this. ‘Gas gangrene’, which could reduce skin to an oily substance, required
similar treatment. (They could still not deal with serious infection until antibiotics were developed long after the war).
SCIENCE AND SURGERY
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Chemistry played an important part in developing anaesthetics (ether, laughing gas, chloroform and novocaine) and
antiseptics (carbolic acid). Chemistry also helped in the development of a suitable technique to store blood until it was
needed for transfusions.
Infection was controlled by using Lister’s carbolic spray, sterilising the instruments, wearing rubber gloves and by
using sterilised catgut for ligatures. This was all based on Pasteur’s germ theory and through an understanding of
chemistry and biology.
The discovery of X-rays by Wilhelm Roentgen in 1895 made surgeons more confident about internal operations.
Roentgen did not take out a patent on his discovery and so everyone could use x-ray machines free of charge. As a result
the use of x-rays spread very quickly – the London Royal Hospital had its first x-ray machine in 1896. X-rays allowed
surgeons to locate bullets and shrapnel from inside the body without the need to dig around inside a wound. This reduced
the problem of bleeding and infection.
TECHNOLOGY AND SURGERY
Developments in science are closely related to those in technology in the improvements of surgery:
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In 1848 Dr John Snow invented the chloroform inhaler which helped to deliver an accurate and controlled dose to the
patient.
The invention of the hypodermic needle by Alexander Wood in 1853 made it possible to measure an injection of a drug
or a withdrawal of blood.
In 1878 Koch developed the steam steriliser to ensure that instruments were free from germs.
In 1865 Joseph Lister invented the carbolic spray which was being used in operations in the 1880s.
In the First World War blood could be refrigerated and the first blood depot was set up.
Mobile X-ray machines and mobile sterilised surgical kits were also developed for use in WW1.
COMMUNICATIONS AND SURGERY
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The emphasis on scientific methods and approaches led many scientists to publish their ideas:
During the 19th century there were many scientific and medical journals (such as ‘The Lancet’) which encouraged the
discussion of new ideas and problems. For example the death of Hannah Greener was reported in ‘The Lancet’.
Pasteur published his germ theory in 1861 and Lister read this work and applied it to his attempts to reduce infection. In
this way, Lister built on Pasteur’s ideas.
The reason why surgeons were able to make use of Röntgen’s discovery about X-rays and that his ideas spread so quickly
was because he did not take out a patent to prevent other people from copying his ideas.
Surgeons often wanted their work to be recorded so we have photographs and art work of key events such as field
surgery in the First World War.
The public were interested in developments in surgery so the newspapers reported the first use of anaesthetics, Queen
Victoria’s use of chloroform and the removal of King Edward VII’s appendix.
Sometimes surgeons and scientists would travel to meet each other. Lister travelled through Germany and around
America discussing his ideas and he met Pasteur in 1892 at a conference of 2,500 scientists in which Lister paid tribute to
the importance of Pasteur’s work.