Antiseptics in surgery notes


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Antiseptics in surgery notes

  1. 1. Antiseptics The facts Surgery was a dangerous prospect for a patient in the 19th century. If the shock caused by the pain and loss of blood did not kill the patient during the operation, it was very likely that infection from blood poisoning afterwards would. Although people had made a connection between dirt and disease, this knowledge was not applied to the operating room. Surgeons wore coats A surgical operation showing covered with the pus, blood and germs carbolic spray in use in Aberdeen in 1880 of countless operations! Who was Joseph Lister (1827-1912)? Antiseptics were first developed by Joseph Lister in 1865. Joseph Lister was appointed Professor of Surgery at Glasgow University in 1860. He was appalled at the filthy condition of the hospital wards. He noticed from his visits to hospitals in Edinburgh that they were far cleaner and that more patients seemed to survive surgery. Initially he tried to improve the cleanliness of operations but in the early 1860s he became aware of the research of Louis Pasteur in France. Lister read about Pasteur’s discovery of germs in 1861 and started his own experiments to try and keep surgical wounds free of microbes. He realised that germs needed to be destroyed in order to prevent infection, this became known as 'antisepsis'. Lister had noticed the similarity between the smells of sewers and operating rooms. He knew that carbolic acid was used to treat sewers and he tried a weaker version of it on wounds. This reduced the risk of septicaemia (another word for infection). In August 1865, Lister operated on an 11 year old boy who had suffered a compound fracture. The wound was cleaned with carbolic acid, stitched with catgut soaked in the acid and then covered with a dressing soaked in acid. At regular intervals the wound was cleaned and dressed and within 6 weeks the wound was completely healed. The only side effect was burnt skin from using the acid solution. The number of deaths during Lister's own operations 1
  2. 2. fell from 50 to 15 percent in two years. In 1867 Lister published his findings in the Lancet and over the next 10 years, more surgeons started to adopt his methods and achieve similar results. These figures show the death rates in Newcastle Infirmary before and after the introduction of antisepsis in the nineteenth century: Before antisepsis: 59.2% After antisepsis: 4.0% Lister continued to refine and improve his methods and in 1867 he developed a spray to be used in the operating theatre. However, the use of carbolic spray was extremely unpleasant for everyone in the operating theatre and the search continued for alternatives to the use of carbolic acid. Throughout his career, Lister continued to operate in his normal clothes and without gloves! Memory time... • Only 150 years ago, over 50% of patients would die from septicaemia and gangrene, following an operation • Joseph Lister successfully used carbolic acid as an antiseptic in 1865 • Joseph Lister introduced an antiseptic spray in 1867 • Lister made the connection between the smell of sewers and operating theatres and this led him to experiment with carbolic acid. • Lister was aware of the work and research of Louis Pasteur. Aseptic surgery The use of carbolic acid did not kill all germs and it was extremely unpleasant to use. In 1878, Robert Koch a German scientist discovered the bacterium that caused septicaemia. At first this discovery helped to justify Lister’s methods and insistence on cleanliness but Koch went on to prove that steam killed more germs than carbolic acid and this marked the beginning of aseptic surgery. In aseptic surgery, the emphasis is on eliminating all possible sources of infection before the operation rather than rely on the use of antiseptics. From 1887, all surgical instruments were steam sterilized. 2
  3. 3. In 1894, the American surgeon William Halstead pioneered the use of rubber gloves in operations and by the early twentieth century these were widely used. They were followed by the introduction of surgical masks and clothing. An operating theatre in Melbourne, Australia in 1924 Now Wash Your Hands! Ignaz Semmelweis (1818-1865) Semmelweis was a Hungarian doctor who worked at the Vienna General Hospital in the 1840s. At the time the maternity clinic here was the largest in the world. The clinic was split into two wards and Semmelweis noticed there was a marked difference in the mortality rates in the two wards. In Ward One, the mortality rate from child bed fever or puerperal fever as it was known was 29% whereas in Ward Two it was around 3%. This infection seemed to occur suddenly in mothers a few days after a perfectly normal birth for no apparent reason. Semmelweis noticed that in Ward Two all births were handled by midwifery students but in Ward One deliveries were done by medical students. 3
  4. 4. The students were made to switch wards and the mortality rates followed the medical students. Semmelweis suspected that the medical students were somehow infecting the mothers during delivery. He believed that as medical students often came directly from autopsies without washing their hands or their instruments and that this was the cause of the infection. On 15th May 1847 he insisted that all personnel in the maternity clinic were to wash their hands with chlorinated water before deliveries and the mortality rate plummeted. The mortality rate in the maternity wards fell from 18% to 2% within months. However, Semmelweis’s methods and his personality upset his colleagues and his contract was not renewed in 1850. Semmelweis returned to Hungary in 1851 where he became head of the obstetric division of St. Rochus Hospital in Budapest. He introduced a similar procedure and the mortality rate fell to less than 1%. In 1861, Semmelweis published his findings on the possible cause of childbed fever but he could not explain what it was that caused the infection in the patients. He encountered widespread opposition to his theories from medical colleagues and he died a disillusioned figure in 1865, unaware of Pasteur’s publication of his germ theory in 1861. An artist’s impression of Ignaz Semmelweis at work in Vienna in 1847 4
  5. 5. Improvements in Nineteenth Century Surgery 1. What skills were needed by a surgeon at the start of the nineteenth century? 2. Why were many operations still done at home in the nineteenth century? 3. Why were some surgeons initially opposed to the use of anaesthetics? 4. Why did the use of anaesthetics in some cases make operations more dangerous? 5. Why did some doctors still prefer to operate without anaesthetics? 5
  6. 6. 6. How is Queen Victoria linked to the development of anaesthetics? 7. Why were the ideas of Ignaz Semmelweis not readily accepted by his fellow doctors? 8. Why did some surgeons oppose Lister’s use of antiseptics? 9. What is the difference between antiseptic and aseptic surgery? 6
  7. 7. Improvements in Nineteenth Century Surgery Timeline Find the dates using pages 134-139 in the Dawson and Coulson textbook. Write a statement to explain what happened in each year and how it links to improvements in surgery. 1799 1846 1846 1847 1847 1848 1853 7
  8. 8. 1857 1861 1865 1878 1887 1894 8