Lecture 3: History of Surgery PDF

CONFIDENTIAL Lecture #3: History of Surgery HSS 4109A – COMPUTER ASSISTED HEALTH APPLICATIONS CONFIDENTIAL Trephination (as far back as 6500 BC) 1. Surgical intervention in which a hole is drilled or scraped into the human skull. 2. Evidence has been found in prehistoric human remains from Neolithic...

CONFIDENTIAL Lecture #3: History of Surgery HSS 4109A – COMPUTER ASSISTED HEALTH APPLICATIONS CONFIDENTIAL Trephination (as far back as 6500 BC) 1. Surgical intervention in which a hole is drilled or scraped into the human skull. 2. Evidence has been found in prehistoric human remains from Neolithic times. 3. Cave paintings indicate the practice would cure epileptic seizures, migraines, and mental disorders. 2 1. The most accomplished of all medical researchers of antiquity. CONFIDENTIAL Galen (born 129 AD) Keen on disecting pigs - what was anatomy all about and how is it correlated to disease? 2. Contributed to anatomy, physiology, pathology, pharmacology, and neurology. 3. “Understanding structure and works of body is important to surgeons”. (Dissected animals). Galen, pictured in an engraving by Georg Paul Busch 4. Wrote many medical books which influenced medicine in the next 1500 years. 3 UK copyright. Science Museum Group. 2021 History of Surgery Overview Surgical procedures are among the oldest medical practices. But for a long time, they were also the last resort for most patients. Why? ….three problems had to be overcome 1. How to stop blood loss so the patient didn't bleed to death 2. How to deal with the excruciating pain of surgery 3. How to prevent life-threatening infections. Lecture #3: History of Surgery UK copyright. Science Museum Group. 2021 History of Surgery = 4 stories Lecture #3: History of Surgery CONFIDENTIAL Story 1 BLOOD LOSS Lecture #3: History of Surgery UK copyright. Science Museum Group. 2021 Blood Loss statistics 1. If the body loses >20% of its blood, haemorrhagic shock = heart slows down and can't circulate enough blood around the body. 2. If the body loses >40% of its blood, all the organs start to shut down and death is likely. Lecture #3: History of Surgery UK copyright. Science Museum Group. 2021 Blood Loss early manuals and techniques Historical documentation origniated from Middle Ages drawing solutions to contain blood loss through these depections next to each wound, you can see synopsis of how to treat the Inspired by wound battleground Lecture #3: History of Surgery drawings UK copyright. Science Museum Group. 2021 Blood Loss 4 solutions to prevent it still prevalent today evolved b/c of electricity but the nomenclature remained the same Lecture #3: History of Surgery UK copyright. Science Museum Group. 2021 Blood Loss Solution#1 Cauterisation To cauterise a wound, a metal tool was heated over a fire and applied to the wound, causing the blood to coagulate and seal off the damaged blood vessels. Used for warts, acne, bleeding noses Lecture #3: History of Surgery UK copyright. Science Museum Group. 2021 Blood Loss Solution#2 Ligation Ligation of the artery, where a piece of thread or wire called a suture is tied around a blood vessel to seal it. Known to ancient physicians such as Hippocrates and Galen, and rediscovered and updated by the 16th century French military surgeon Ambroise Paré. Lecture #3: History of Surgery UK copyright. Science Museum Group. 2021 Blood Loss Solution#3 Tourniquet Tourniquet, was a device or piece of material secured around a limb in order to limit the blood flowing down into the rest of the limb. Diagram important so physicians know how to position tourniquet to stop blood flow and begin the amputatiion tourniquet was used to temporarily stop the flow of blood, whereas the ligature was more permanent Lecture #3: History of Surgery UK copyright. Science Museum Group. 2021 Blood Loss Solution#4 Blood transfusion Over the centuries several attempts were made to replenish the blood supply, either with animal or human blood, but they generally failed. Safe blood transfusion only became possible after 1901, when Karl Landsteiner discovered that blood types had to be compatible in order for two people to share blood Lecture #3: History of Surgery THE ART OF ANAESTHESIA Lecture #3: History of Surgery CONFIDENTIAL Story 2 nurses ask pain level prior to giving medication to determine multiple things is it tolerable? Is it localized or everywhere? etc. 1. Surgery was dreaded: avoided surgery; pain. CONFIDENTIAL Early 19th Century Surgery: Pain patients 2. Patients delayed treatment allowed wounds and tumors to grow and fester. 3. Drugs like opium, hemp, hashish, whiskey *unpredictable, unsafe. 4. To the patient = speed was essential. Minimally invasive surgery is essential 15 CONFIDENTIAL Early 19th Century Surgery: Pain 1. Mortality was high: 19% amputations prior to 1850. 2. Notion of consent was different than today. 3. The surgeon would stand with his hands behind his back and would say to the patient, “Will you have your leg off, or will you not have it off?” 16 UK copyright. Science Museum Group. 2021 ANAESTHESIAwhat is it? Anaesthesia is the method of using substances, called anaesthetics, to reduce or block pain during surgery and other medical procedures. Patients can wake up in middle of surgery if this is not done correctly Different combinations of drugs and gases are used to create different levels of insensibility, from numbing one part of the body to making someone completely unconscious. Must consider: Are they taking medications or drugs? Do they have complications? Lecture #3: History of Surgery UK copyright. Science Museum Group. 2021 ANAESTHESIA4 types 1. Sedation ranges from feeling very relaxed to being very sleepy, but not unconscious. (minor surgical procedures or to relax patients). 2. General anaesthesia is a controlled state of total unconsciousness, used for major operations and surgical procedures. Used at dentist 3. Local anaesthetics are drugs used to numb parts of the body. They are injected directly around the operation site.4 Regional anaesthesia is used in major surgery, where the patient remains conscious. In this case local anaesthetics are injected near large nerves or the spinal cord. 4. Analgesia is pain relief rather than a form of anaesthesia, but the two often involve the same drugs and are used in combination (e.g. pain Lecture #3: History of Surgery killers and morphine) UK copyright. Science Museum Group. 2021 ANAESTHESIAinhaled vapors Vapour inhalation = ingesting medicines, especially for chest and respiratory complaints = acts far more quickly when inhaled than when drunk as a potion. The Islamic physician, Ibn Sīnā (980–1037), described sedative inhalation for surgery in The Canon of Medicine. The Canon describes a 'soporific sponge', soaked in or narcotic an herbal potion that is placed under the patient's nose during an operation to keep them sedated Lecture #3: History of Surgery UK copyright. Science Museum Group. 2021 ANAESTHESIAgases While working at the Pneumatic Institute in 1798, a young Humphrey Davy tested on himself, the effects of inhaling nitrous oxide gas. He noticed two things: the euphoric effect, which led him to call it laughing gas, and the fact that it alleviated the pain of his toothache. Lecture #3: History of Surgery UK copyright. Science Museum Group. 2021 ANAESTHESIAgeneral anaesthetics Ether (diethyl ether) was the first general anaesthetic to be used widely in surgery. William Morton experimented with ether on himself before using it as an anaesthetic in dentistry = first public demonstration in 1847 Trying to remove neck tumour - used ether to remove tumour removal Professor of Midwifery James Young Simpson used it for women during childbirth. Simpson discovered an alternative anaesthetic to ether—chloroform, a sweetsmelling, dense liquid. Lecture #3: History of Surgery Lecture #3: History of Surgery CONFIDENTIAL UK copyright. Science Museum Group. 2021 ANAESTHESIAvideo link click me JOSEPH LISTER'S ANTISEPSIS SYSTEM Lecture #3: History of Surgery CONFIDENTIAL Story 3 CONFIDENTIAL Impact of Civil War (1861-1865) 1. Civil war wounds notoriously destructive, due to changes in bullets and the technology of warfare. 2. Amputation was often the only alternative. 3. Important training ground. 4. Exposure to injuries and infections. 24 CONFIDENTIAL Impact of Civil War : The Rise of Hospitals (1800): 2 hospitals Pennsylvania Hospital New York Hospital (1821): Mass General Hospital #3 (1873): 178 hospitals (1909): 4359 hospitals 25 Post-surgical infection rises Crowded hospitals Infection in hospital Rodents were carriers of disease Increase in traumatic injuries Dirty, crowded, filthy, often more than one patient per bed Hospitals: rooms separated by walls, have windows to bring sunlight and fresh air, air ventilation, high ceilings so air can cirulcate at higher level and prevent infections Hospitalism Gangrene, erysipelas, pyema. Associated with large, old buildings. CONFIDENTIAL Impact of Civil War : Infection 26 UK copyright. Science Museum Group. 2021 Antisepsis what is it? Lecture #3: History of Surgery UK copyright. Science Museum Group. 2021 Antisepsis Germ theory Louis Pasteur speculated that the spread of microorganisms (called germs) in the body could explain infectious disease. This was known as the Germ Theory of Disease. Lister was introduced to Pasteur’s germ theory of disease, and he decided to apply it to the problem of surgical infections. = prevent germs from entering a wound by creating a chemical barrier—which he called an antiseptic—between the surgical wound and the surroundings. The chemical he chose to use was carbolic acid, which killed the poisnous germs on contact. Lecture #3: History of Surgery UK copyright. Science Museum Group. 2021 Antisepsis THE ANTISEPSIS SYSTEM Carbolic hand spray Prevent germs from coming into contact with the open wound = weak carbolic hand washes for surgical staff and carbolic acid baths for the instruments. =solutions of carbolic acid spray to reduce the level of germs in the air around the patient. Pushing down lever and spraying the environment, patient table and OR with carbolic acid, as well as anatomy of interest (ex. Open wound) Lecture #3: History of Surgery towels soaked in carbolic solution laid under patient or close to area being treated UK copyright. Science Museum Group. 2021 Antisepsis FROM ANTISEPSIS TO ASEPSIS By the 1890s, the German scientist Robert Koch demonstrated that dry heat and steam sterilisation were as effective as chemical antiseptics in killing germs. creation of sterile environment Lecture #3: History of Surgery UK copyright. Science Museum Group. 2021 Antisepsis – role of surgeon video link click me Lecture #3: History of Surgery UK copyright. Science Museum Group. 2021 Antisepsis – role of scrub nurse video link click me Lecture #3: History of Surgery SURGEONS AND SURGICAL SPACES Lecture #3: History of Surgery CONFIDENTIAL Story 4 UK copyright. Science Museum Group. 2021 Surgeons & Surgical Spaces Unexpected people and places in history Religious laws forbade physicians, who trained in religious universities, from shedding blood, so surgeons often worked outside the medical establishment. Your surgeon might be the Not the physicians local barber, putting his cut throat blades to extra use by offering small surgical procedures in addition to haircuts. Lecture #3: History of Surgery UK copyright. Science Museum Group. 2021 Surgeons & Surgical Spaces Unexpected people and places in history Barbers had their own craft guild and received higher payment than most surgeons. Wealthier barbers worked from shops, where, in addition to hair cutting, hairdressing and shaving, they offered a range of surgical procedures. In England, surgeons with little expertise in hair-cutting began to join guilds such as the Company of Barbers in order to earn more for their services until, in 1368, they formed their own Fellowship of Surgeons. Lecture #3: History of Surgery The red and white barber’s pole, still seen outside some traditional barber shops, is a reminder of the two services offered by the barber. UK copyright. Science Museum Group. 2021 Surgeons & Surgical Spaces Unexpected people and places in history first instance of woman practicing medicine Lecture #3: History of Surgery UK copyright. Science Museum Group. 2021 Surgeons & Surgical Spaces SURGICAL SCHOOLS AND A ROYAL COLLEGE The 16th and 17th century saw a surge in interest in anatomy. Hospitals offered new opportunities to dissect cadavers and access to surgical cases. And surgeons began to assert their credentials as men of science. Lecture #3: History of Surgery UK copyright. Science Museum Group. 2021 Surgeons & Surgical Spaces WOMEN SURGEONS AND MALE SPACES In 1800 the Royal College of Surgeons, England was established. The College set the qualifications required to become a surgeon and soon the universities began to offer these qualifications alongside physicians exams in their medical schools. Lecture #3: History of Surgery UK copyright. Science Museum Group. 2021 Surgeons & Surgical Spaces – role of the surgeon video link click me Lecture #3: History of Surgery UK copyright. Science Museum Group. 2021 Surgeons & Surgical Spaces Today Typically surgeries run between 7:30am and 3:30pm Efficiency is still a problem Lecture #3: History of Surgery