20th Century Surgery notes


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20th Century Surgery notes

  1. 1. Twentieth Century Surgery Developments X-RAYS The Facts Wilhelm Rontgen, A German scientist, discovered X-rays by chance in 1895. Rontgen discovered that X-rays (electro-magnetic radiation) could penetrate solid substances and be recorded onto photographic plates in the same way as light. Rontgen published his findings in December of 1895, and by the next year, X-ray machines were being installed in hospitals. In 1901 he was awarded the Nobel Prize. For the first time, doctors were able to view the insides of the body without having to perform surgery. X-ray machines became immediately popular and were essential tools for surgeons operating on wounded soldiers during the First World War. Portable machines were taken into the battlefield and were used to locate bullets and shrapnel from exploded bombs. Memory time…. • X-rays, or electro-magnetic radiation, were discovered by chance by Wilhelm Rontgen • During the First World War, X-ray machines were important tools for locating bullet and shrapnel wounds • Rontgen was awarded the Nobel Prize in 1901 for the discovery of X-rays. Marie Curie (1867-1934) and Pierre Curie (1859-1906) Karl Wilhelm Rontgen (1845-1923) astounded people with the first X-rays in 1895; this was followed three years later by the discovery of radium by Pierre and Marie Curie. Who were the Curies? In 1894, Marie and Pierre Curie met while studying in Paris. Their marriage on 25 July 1895 marked the start of a partnership, which was to receive worldwide recognition. What brought them to prominence? The Curies discovered radium, a radioactive substance, in uranium oxide ore. They developed techniques for extracting it, but first did not fully understand its properties. Pierre Curie used to carry radium around in his waistcoat pocket and could not understand why he was developing a massive sore on his chest. This would -1-
  2. 2. have been fatal, but Pierre’s life was cut short in 1906 when he was knocked down and killed by a horse and cart in the street. From then on, Marie devoted herself to completing the work that they had begun together. Why did they win the Nobel Prize? Marie and Pierre Curie were awarded a joint Nobel Prize for Physics in 1904, for their research into radioactive materials followed up by a second Nobel Prize in Chemistry for Marie in 1911 for her discovery of radium and polonium. Their research was crucial in the development of X-rays in surgery. During World War 1 Marie Curie helped to equip ambulances with X-ray equipment, which she drove to the front lines. The International Red Cross made her head of its Radiological Service and she held training courses of medical orderlies and doctors in the new techniques. What happened to Marie Curie? Despite her success, Marie faced great opposition from male scientists in France and she never received the recognition she deserved. She died in 1934 from leukaemia, due to exposure to high- energy radiation used in her research. Radiation has since been used to treat cancer worldwide. Marie Curie was the first woman to win a Nobel Prize. She is remembered for her huge contribution to the fight against cancer and improving the quality of human life. Marie was renowned for her work with radioactivity, and it was that work that would eventually end her life. Stage One (1867-1891) She was born Maria Skiodowska in Warsaw Poland on November 7, 1867. Her father was a freethinker and her mother was a Catholic. Her family valued education, and so she began her education early. She possessed a remarkable memory. She graduated from Secondary School when she was sixteen receiving a gold medal for her work. Unfortunately, her father made some bad investments and she had to go to work at a young age as a teacher, postponing the continuance of her own education. At the age of 18, she became a governess and put her sister, Bronia, through school with the agreement that Bronia would return the favour and she did. Stage Two (1891-1897) In 1891, at the age of 24, Skiodowska went to Paris to study mathematics, physics and chemistry at the Sorbonne. She studies hard and survived almost entirely on bread, butter and tea. During the years there she changed the spelling of her name to the French version, Marie. She met Pierre Curie in Paris while she studied there, and they soon married in a civil ceremony. Marie and Pierre Curie devoted themselves to the study of radioactivity, and were among the first to work with radium and polonium. Curie’s choice of a thesis topic was influenced by two recent discoveries of other scientists. In December 1895, about six months after the Curies married, German physicist Wilhelm Rontgen discovered a kind of ray that could travel through solid wood or flesh and yield photographs discovered a kind of ray that could travel through solid wood or flesh and yield photographs of living people’s bones. Rontgen dubbed these mysterious rays X-rays with X standing for unknown. Stage Three (1897-1904) -2-
  3. 3. The Curies became research workers at the School of Chemistry and Physics in Paris and there they began their pioneering work into invisible rays given off by uranium – a new phenomenon which had recently been discovered by Professor Becquerel. He had shown that the rays were able to pass- through solid matter, fog photographic film and caused air to conduct electricity. Marie worked to isolate radium in its pure state which she and one of Pierre’s students, Mr Debierne, accomplished. Together with her husband, Marie was awarded half of the Nobel Prize for Physics in 1903, for their study into the spontaneous radiation discovered by Becquerel, who was awarded the other half of the Prize. Also in the same year Marie was the first woman to receive a doctorate in France. It was Marie Curies who coined the term radioactivity, and she named Polonium after her country of Poland. Throughout her life, Curie actively promoted the use of radium to alleviate suffering. Stage Four (1903-1905) Despite being awarded her doctorate, France was less forthcoming than other countries when it came to honouring the Curies’ work. In early June 1903 both Curies were invited to London as guests of the prestigious Royal Institution. Custom rules out women lecturers so Pierre alone described their work in his ‘Friday Evening Discourse.’ He was careful to give great attention to describing Marie’s crucial role in their collaboration. The audience included representatives of England’s social elite. Stage Five (1906-1910) In 1906, Pierre Curie, who health had begun to fail due to the work with radioactivity, was hit by a car and killed. Marie did not learn the news that would transform her life until that evening. In shock, she began to attend to the necessary arrangements. Only after Pierre’s older brother, Jacques, arrive the next day from Montpellier did she break down briefly. This was a deep tragedy for the family, but it strengthened Marie’s resolve to continue their work. On May 13, she was appointed to fill Pierre’s position and became the first female professor at the Sorbonne. Few people manage to create an entirely new institution from scratch, single-handed. That is what Marie Curie set out to do – establish a lab worthy of Pierre’s memory. She had her fame, her friends, and her fierce determination. A substantial grant in 1907 from an American philanthropist enabled her to assemble a research staff, but that was only a start. Stage Six (1910-1919) In 1911 Marie Curie won the Nobel Prize for her achievement of isolating radium and examining its chemical properties. She was the first person ever to receive two Nobel Prizes. In 1911 she received a second Nobel Prize, this time in Chemistry, in recognition of her work in radioactivity. In 1914 she co-founded the Radium Institute in Paris and was its first Director. Three German bombs fell on Paris on September 2, 1914, about a month after Germany declared war on France. By that time construction of the Radium Institute was complete. Curie’s researchers had gone to war like all other able-bodied Frenchmen. X-rays could save soldiers’ lives, she realized, by helping doctors see bullets, shrapnel, and broken bones. She convinced the government to allow her to set up France’s first military radiology centres. During the First World War, Curie and her daughter, Irene, taught a team of 150 nurses to use X-rays. Stage Seven (1919-1934) In 1920 Curie and a number of her colleagues created the Curie Foundation, whose mission was to provide both the scientific and the medical divisions of the Radium institute with resources. Over the next two decades the Curie Foundation became a major international force in the treatment of cancer. Under Curie’s direction the Radium Institute in Paris became a world centre for the study of radioactivity (there were only a few others on the same level one being the Cavendish Laboratory in Cambridge, England). Between 1919 and 1934, scientists at her Radium Institute published 483 -3-
  4. 4. works, including 31 papers and books by Curie herself. Until the end of her life she continued research to isolate, concentrate, and purify polonium and actinium. Stage Eight (1934) Marie Curie died of leukaemia at the age of 67 on the 4th July 1934. Unknown then, her years of exposure to high levels of radiation were what killed her. Her cremated remains are kept in the Pantheon in Paris. She was the first woman to be honoured in this way for her personal achievements. After her death the Radium Institute was renamed the Curie Institute. -4-
  5. 5. THE ACHIEVEMENTS OF MARIE CURIE Childhood Student in Paris Research breakthrough Recognition and Disappointment Tragedy and adjustment Recovery and war duty Radium Institute The Legacy -5-
  6. 6. Did the First World War advance medical practice in anatomy and surgery? The First World War interrupted general medical research, but it created other opportunities for surgeons and doctors. New techniques were needed to deal with the terrible carnage of the battlefields. Surgeons had to develop new skills quickly and instead of competing with each other, they now worked together to find answers. Governments devoted industrial resources to provide equipment and medicine. The machine gun, high-explosive shells and poison gas created huge numbers of casualties. One important advance was the creation of portable X-ray machines, which helped surgeons locate bullets lodged inside the body. This dramatically increased their success at removing them. However, surgeons were hindered by the poor sanitary conditions of the trenches, where infections caused gangrene. Another major advance was that it became possible to store blood; saved many lives. Discoveries about the four main blood types had been made in 1900, and army surgeons in the First World War were able to exploit this knowledge to perform successful transfusions. This eventually led to the setting up of ‘blood banks’ in 1938. About ten per cent of war wounds were to the head, so eye, face, ear, nose and throat surgery developed rapidly. Also, because of the degree of shelling in trench warfare many soldiers suffered massive injuries, as a consequence, major advances were made in the development of artificial limbs. Think about this: • The war presented new challenges for doctors: injuries were very severe and likely to need what we now call ‘plastic surgery’ and skin grafts • New types of head injuries would require precise and skilful surgery • Better technology was required to develop artificial limbs. Medical Progress and the First World War -6-
  7. 7. This section of work is based on pages 150 – 153 in the SHP textbook and the information in this booklet. Questions 1. Who discovered X-rays and why are they so called? 2. What is the link between X-rays and the work of Marie and Pierre Curie? 3. Why were X-ray machines of great help to surgeons during the First World War? 4. Before blood transfusions could be successfully given to soldiers in the First World War, what further discovery was necessary? 5. What types of surgery made the greatest improvement during the First World War? 6. Despite advances in surgery techniques, why did many soldiers continue to die from their wounds? Essay Task ‘The First World War helped more than it hindered developments in medicine.’ Do you agree with this statement? Was morphine available to medical staff in the First World War? Morphine is derived from the opium poppy. The name opium comes from the Greek word opion or poppy juice. The first recorded use of opium as a painkiller is 6000 years ago by the Sumerians. Babylonian and Egyptian writings also contain many references. In nineteenth century Britain morphine known as laudanum was a popular panacea and was available from grocers and markets. In the 1820s, the chemically produced form of morphine was produced from opium. The introduction of the hypodermic syringe in the 1850s encouraged greater use of the drug. As doctors became aware of its addictive properties, restrictive legislation was introduced and prescription only drugs were gradually introduced. In 1898 the German company Bayer introduced heroin (diacety/morphine) which they said had the ability of morphine to relieve pain, yet is safer! Morphine was widely used by the medical services in the First World War and it did lead to an increase in post war morphine addiction amongst ex-soldiers. Hermann Goering is a famous example of someone who developed a life long addiction to morphine following his treatment for war time flying injuries. Tetanus and the First World War -7-
  8. 8. Another success, proved by the First World War, came with tetanus. This extremely dangerous disease (the death-rate is above 40 per cent) is caused by tetanospasmin, a toxin secreted by the bacterium Clostridium tetani which lives in the soil. The bacillus enters the body through agricultural cuts and battlefield wounds, and the toxin travels along nerve fibres towards the spinal cord. Sweating and headaches are followed by increasingly severe muscular spasms in the head and neck (lockjaw). Through known to Hippocrates, nothing could be done until the bacteriological era. The tetanus bacillus was discovered, like so many others, in the 1880s. Arthur Nicolaier (1862-1942) produced it in mice by inoculating them with garden earth; Kitasato grew it in a pure culture in Koch’s laboratory in 1889, leading to the production of antitoxin. (He also found it grew when deprived of oxygen, an early example of the anaerobic bacteria group, discovered in 1861 by Pasteur.) Tetanus became a serious problem at the outset of the 1914-1918 war, when the bacillus entered the body through gaping shell wounds. From 1915 practically every wounded soldier received antitoxin, and tetanus was dramatically reduced. The First World War decisively advanced skin transplants. Shells caused horrific facial injuries. Harold Gillies set up a plastic surgery unit in Aldershot and dealt with 2000 cases of facial damage after the Battle of the Somme. Skin from other parts of the patient’s body was used to cover facial damage and to encourage facial skin to grow back again. Gillies’ cousin, Archibald McIndoe, joined the work in the 1930s, and then treated 4000 airmen from the battle of Britain in WW2. McIndoe called his work reconstructive surgery as he took years and many operations to slowly give men back their hands and faces. These advances marked a shift in people’s thinking about surgery – no longer was it just about “cutting things out” but now began to be about restoring and replacing what was already there. First World War sailors with successful skin grafts. -8-
  9. 9. Blood transfusions and transplants The facts Blood transfusions were a critical breakthrough at the beginning of the 20th century. In 1900, Karl Landsteiner discovered that blood was divided into four main groups and that certain blood types could not be mixed. Transfusions became possible at last and the loss of blood through operations or injuries could be addressed. During the late 20th century, increasingly complicated organ transplants have been carried out. Transplants are carried out when an organ is so badly damaged that it no longer works properly. Other major transplants followed: the cornea, a part of the eye, in 1905, followed in 1954 by a kidney transplant, a liver in 1963, a heart in 1967, lung in 1982 and brain tissue in 1987. Since the 1980s, one of the most well-known transplants has been bone marrow for leukaemia sufferers. For transplants to be possible there must be organ donors – people who are willing for parts of their bodies to be given to others. For a transplant to be successful the tissues of the donor must be compatible with those of the patient receiving the organ. If not, the patient’s immune system tries to reject the organ by treating it very much like an infection. Sometimes the organs are not human, but come from pigs and apes. Some people object to the use of animal organs on ethical grounds they argue that it is wrong to forfeit an animal’s life. Memory time… • Karl Landsteiner discovered the differences between the main blood groups in 1900. • During the First World War, sodium citrate was used to stop blood clotting during transfusions. • The first major heart transplant was performed in 1967. Christian Barnard (1922-2001) Just 50 years ago operations on the heart were rarely performed because of the risk of death and heart transplants were unheard of. Christian Barnard pioneered the first successful organ transplants. Who was he? Christian Barnard was born in South Africa and worked as a surgeon at the Groote Schuur hospital in Cape Town. After, further training in America, he became a leading heart surgeon. -9-
  10. 10. What brought him to prominence? Barnard studied heart surgery at the University of Minnesota in the US and returned to South Africa to set up a cardiac unit in Cape Town. In 1967 he transplanted the heart of a road accident victim into a 59 year old man, Louis Washkansky. This was the first operation of its kind. Unfortunately, Washkansky died 18 days later from pneumonia. The drugs used to prevent the body rejecting the new heart adversely weakened his resistance to infection. Was Barnard successful? One of Barnard’s patients lived for over a year and a half after surgery, but patients needed drugs to prevent the body rejecting the donor heart. These left them open to infection and many died, just like Louis Washkansky. After a while, all heart operations stopped because the risk of failure was considered too high. Asked to describe his feelings after the Washkansky transplant, Barnard said: "Not very much. It was a natural progression of open heart surgery. We did not think it was a great event and there was no special feeling. I was happy when I saw the heart beating again. We did not stand up or cheer or something like that. I didn't even inform the hospital authorities that I was going to do the operation." In 1974 a researcher working in Norway discovered a new drug called cyclosporin. This drug helped to overcome the body’s rejection of the donor organs and protected the patient against infection. Subsequent heart transplants were more successful and since the late 1980s, majority of patients have survived for more than two years after surgery. Why is he so well known? Barnard had demonstrated that heart transplants were possible. Even though many of his patients died soon after their operation, he had taken the first steps into a new form of surgery which is now routine in medical practice. - 10 -