The Surgical Revolution: Anaesthetics and Antiseptics

Surgery was held back by three killers - pain, infection and blood loss - and the 19th century finally overcame the first two, with anaesthetics and then antiseptics.

The 3 barriers

Surgery was limited by three problems:

• Pain - without pain relief patients had to be held down, so operations were rushed and kept to quick procedures. Tackled first with anaesthetics.
• Infection - tackled next with antiseptics.
• Blood loss - not solved until blood groups were understood in the next century.

Beating pain with anaesthetics

• Early gases gave some relief. Nitrous oxide (laughing gas) was tried on teeth in 1844, and ether was used in surgery in 1846, though ether was flammable and made patients vomit.
• In 1847 James Simpson, a Scottish doctor, found that chloroform put patients safely to sleep, and he promoted it for childbirth as well.
• There was opposition: a patient died under chloroform in 1848, and some argued that pain in childbirth was God's will.
• The opposition faded after Queen Victoria used chloroform to give birth in 1853.

Beating infection with antiseptics

• Surgery could now take longer, but that meant more infection, and for a time death rates actually rose.
• Joseph Lister read Pasteur's germ theory and used carbolic acid to kill germs during operations, spraying it in the air and soaking the dressings in it.
• His infection deaths fell sharply, from around 45% to 15%, after he began in the 1860s.
• Many surgeons resisted at first, because the acid stung their hands, the spraying slowed them down, and they still doubted germ theory.

Towards aseptic surgery

• From the 1890s surgeons moved on from killing germs to keeping them out altogether, which is called aseptic surgery.
• Instruments were sterilised with steam, and surgeons wore sterilised gowns, masks and rubber gloves.
• Ignaz Semmelweis had pointed the way back in 1847, cutting deaths on a maternity ward by making doctors wash their hands, though he was ignored at the time.