To be analysing the significance of each

To what extent had anaesthetics solved the death rate problem during surgery between 1845-1918?There has been drastic changes within surgery through the different scientific developments from 1845 to 1918. Surgery in the early 19th century mostly consisted of amputations.. At this time there was no anaesthetics discovered and most patients were conscious during an operation exposing them to the pain that surgery brought. Throughout my essay i will outline the different surgical techniques that were being used mid 19th century, the causes of the complications patients faced with surgery and how they were overcome through the different ideas and beliefs of surgeons. The uncontrollable problems such as blood loss and infection which were two key aspects that contributed to “50%” more deaths than any other factor. I will be analysing weather the introduction of anaesthetics was a significant turning point in the transformation of surgery and weather  it was a major area that reduced the death rate figures in surgery from 1845-1918. I will also look at other key factors that assisted  the decline of the death rate such as Louis Pasteur’s germ theory which helped inspire other further surgical developments. I will be analysing the significance of each development and its effect on surgeons and particularly patients. My essay will also consist of the benefits and problems that came with the different types of anesthesia methods that were put in place from 1845-1918 to help diminish the death rate figures, bringing in different perspectives to help support my argument. After hours of research I believe the germ theory had a much wider effect on the whole view of surgery and it was arguably the most significant reason that led to the decline of the death rate during surgery in the 19th century. I will be using relevant evidence to help support my argument on why the germ theory was the most significant development in relation to other factors in reducing the death rate figures.In the early 19th century surgery was at its worst point. Most patients that went through surgery died because of the lack of scientific knowledge at the time. Patients had to endure agonising pain as anaesthetics had not yet been discovered. There were number of issues with surgery during the mid nineteenth century which caused the passing of thousands of people. The main real issue with surgery in the nineteenth century was that hygiene wasn’t discovered. All surgeons had ordinary clothing during an operation exposing them to the germs which they could pass on to other people. Not only this surgeons had spectators watching the surgery being carried out which further increased the chances of more and more people becoming infected. Furthermore surgeons used the same knives and saws they had used on previous patients without sterilization which simply planted infections into open wounds of a patient.  This possibly contributed to a large number of deaths in the 19th century as surgeons were exposing people to extremely harmful infectious diseases. Another issue with surgery in the mid 19th century was that  surgeons didn’t find much importance in people staying alive and were more concerned with there own achievements in performing a successful operation. An example of this is from a man called Robert Liston. Robert Liston was a Scottish surgeon. He was mostly known for his ideas of using speed during an operation. He believes speed of an amputation was what ultimately determined the faith of the patient. He held the record for the quickest amputation of a limb at the time. “In one case he tried to beat his own record of amputation of a leg and accidentally cut of a patient’s testicles. He even cut of his assistants 2 fingers which ultimately lead to her death from infection.” This shows how some surgeons main priority during surgery wasn’t actually to perform a successful operation with the patient remaining alive. As Robert Liston saw more importance in his speed of the operation. This outlines the attitudes of some surgeons towards surgery which could account for the immense death rate figures in the 19th century. The final significant issue that surgeons faced during the 19th century that caused a staggering amount of deaths was the problem with blood loss. Most surgeries involved amputation which would lead to extreme levels of uncontrollable blood loss. With blood groups and blood transfusion not yet discovered this was a key issue that hindered surgeons success rate after an operation. Below i will discuss how these problems were solved and weather the amendments had any significant impact on the increasing number of deaths in the 19th century.1846. On October 16, William T. G. Morton (1819-1868) made history by being first in the world to publicly and successfully demonstrate the use of ether anesthesia for surgery. Nitrous acid was also discovered which helped reduce pain during an operation making it easier for surgeons to operate as the patient was no longer in agony. The gas Ether however was deemed the better anaesthetic to reduce pain during surgery as it lasted longer than nitrous acid. This discovery by William t.g. Morton was extremely significant in the transformation of surgery as it meant that surgeons could now be much more careful and spend more time on an operation as the patient was no longer screaming and moving in agony. Despite this it could be argued that ether was not as successful as it seems. This is because of many reasons such as ether had to be carried in large bottles which made it difficult for surgeons. Not only that ether often made patients vomit and cough even when they were under anaesthesia. The biggest problem surgeons faced with Ether was that it was highly flammable which was extremely dangerous in 1847 as the only form of light was a naked flame. Therefore death through the actual surgery was not the only risk surgeons faced at the time.  All these factors begin to indicate Morton’s theory was exaggerated to make it look more effective then it actually was.. As his discovery probably had little effect on the death rate simply because of other problems such as blood loss which ensured surgeons had to operate quickly even when patient were under anaesthesia. Which ultimately increases the chances of death during surgery as quick operations can lead to mistakes as less care is taken. Therefore although the anaesthetic Ether did help reduce pain for patients during surgery it had little effect on the death rates during surgery in the 19th century. A man named James Simpson knew the setbacks that ether had and wanted to discover a better and more effective anaesthetic then William Morton. To do this he invited some doctors over to his house and persuaded them to inhale a  chemical. When Simpson’s wife found all doctors unconscious Simpson realised he gave birth to a life saving anaesthetic called Chloroform. The thing that phased Simpson the most was that he realised his discovery was lacking the setbacks of William Morton’s Ether. Simpson first used chloroform in 1847 in London and more and more people become less fearful of chloroform when Queen Victoria used chloroform to give birth to her 8th child in 1853. The fact that the queen had a positive outcome with the use of chloroform meant that more and more people began to accept Simpson’s ideas. Although chloroform didn’t have the negative effects of ether it still had a dark side which was unveiling as it was used more and more in operations. The biggest issue with chloroform was the issue with dosage. Too little meant that the the patient would feel pain disrupting the operation.Too much would be fatal and potentially kill the patient. An example of this is Hannah Greener who died of a chloroform overdose whilst trying to remove one of her toenails. However, This was only an issue a huge issue until 1853. John Snow a British physician managed to discover a chloroform inhaler which controlled the dose of chloroform preventing an overdose or an underdose.. This is key as it managed to solve the only big issue with chloroform as now chloroform could be used with the right dosage without the risk of inhaling too much or too little. Statistically the death rate before the introduction of chloroform stood at 33% for amputations. “In the the years 1854-1855-1856 the death rate dropped to 28%”. A 5% decrease in the death rate figures because of James Simpson’s discovery. Although the figures hadn’t dropped by a substantial amount it still shows how Simpson’s discovery indicated that the transformation of surgery was taken off slowly and that it was only a matter of time until surgery was to be transformed completely.However things were made harder then they had to be as doctors and surgeons not only had to deal with issues with new inventions but society as a whole. Some people just didn’t want pain relief. ‘ The discovery of an effective anaesthetic was a major breakthrough in surgery since it meant the patient was not in pain, and it was welcomed by many. However, some people were slow to accept the idea of anaesthetics, and there were drawbacks to the use of both ether and chloroform.’This quote shows the attitudes toward anaesthetics and change at the time making life much harder for surgeons and doctors. As People were too religious and felt that pain relief was interfering with god’s will. Some people didn’t even understand the concept and effects of anaesthetics and therefore rejected the idea of them as a whole. Because something had never been discovered like it ever before people were hesitant. Therefore this could begin to show why there was only a 5% decrease in the death rate figures despite the introduction of an effective, useful anaesthetic called chloroform.  It’s also possible that chloroform was not used enough during 1854-56; surely such an effective discovery after ether should of reduced the death more than 5%.Extreme levels of pain during an operation was not the only problem surgeons faced during the 19th century. Arguably the most significant factor that was causing the most amount of deaths was the issue with infection. After the introduction of chloroform it was evident that chloroform had saved many lives and that surgeons were starting to become more successful. They still didn’t however understand the issue with infection and germs as hygiene was not yet discovered. As a result many patients did make it out alive after surgery, however many died from extremely harmful infectious diseases a few days later as the infection spread throughout the patient’s body. Working conditions were extremely unhygienic which also contributed to the death of many people including spectators. ‘In the 1940’s infectious diseases caused over a third of the deaths in Europe’. This quote Indicates how much of a problem infection was in the 19th century.  As over a third of deaths in europe were caused not because of pain but because of infection.Then came Ignaz Semmelweis, a Hungarian physician who was declared as the ‘saviour of mothers’. He found in 1848 that the amount of women that died during childbirth was significantly higher in the hospital where medical students were present then in home births were a non surgeon would deliver the baby. Surely professional surgeons should of had a higher success rate then midwives? The issue was that the medical students that were present at the hospital wards often returned from cutting up dead bodies which exposed them to germs. This issue got Semmelweis thinking. What could possibly be the reason as to why more mothers were dying at the hospital with professionals then at home? This period is when the actual transformation of surgery began. Ignaz Semmelweis had finally discovered infection and it’s drastic effects on the human body. He believed the medical students carried something with them from the dissecting room which was causing the deaths of women during childbirth. To test his hypothesis Semmelweis ordered the students to wash their hands in a solution of chlorinated lime before entering the hospital ward. As a result of this the mortality rates dropped from 18 % to 1.27% percent, and in march and august of 1848 no woman died in childbirth in Semmelweis’s hospital. This is a massive turning point as the figures show Ignaz Semmelweis theory was true and that washing hands before a surgical procedure can and will help reduce the amount of deaths during surgery.However, like every other surgeon Semmelweis also had his critics. Despite the fact that his theory was successful in reducing the death rate, doctors made fun of his ideas as they still couldn’t get their heads around the issue with infection and germs as scientific knowledge at the time was limited. He was eventually sacked from his hospital. Despite his sacking he still gave birth to a major issue within surgery and his ideas were used by other surgeons later on. An example of this is Louis Pasteur. Arguably the most significant man in the transformation of surgery. His discovery has forever settled his name into the history of medicine. It was 1856 when Pasteur was visited by a man called Bigo. Bigo worked in factories that produced alcohol with sugar beet. Bigo noticed that many of his tubs of beer stores in his factory were turning sour and eventually the beer was no longer safe to drink and thus it was thrown away.. This was when Bigo pleaded Pasteur to try and find a solution as to why his bear was going off as his business was suffering. This is when Pasteur used a microscope to closely inspect the tubs that the beer was stored in. After analysing for hours through his microscope Pasteur found that there were many tiny micro organisms that were taking up majority of the tub which couldn’t been seen by the naked eye. Pasteur became adamant that these microorganisms were the reason as to why Bigo’s beer was going off. At first Pasteur only brought upon his ideas through the use of liquids. Eventually he realised that possibly these microorganisms could also be causing the death of thousands of people and that liquids were not the only place the the newly discovered microorganisms possessed. As always it took time for Pasteur’s ideas to be accepted by scientists and for surgeons to reach proper understanding of infection as scientific knowledge was still limited despite the major breakthroughs of Ignaz Semmelweis and Louis Pasteur.  He did however eventually manage to prove that disease and infection were caused by microbes in the air through a man called Robert Koch a German physician. Because of this his name will be forever cemented in the history of Medicine. Louis Pasteur did manage to discover the cause of the infection in open wounds. Now the issue was preventing it. This Is when a man called Joseph Lister stepped up. He was extremely fascinated by Pasteur’s work on how germs and bacteria caused infection and thus came up with ideas of his own.  In 1864 Lister realised that a certain carbolic acid was used often to help kill parasites. Which was an effective method at the time. Because of this Lister came up with a plan. He thought possibly carbolic acid could be used to kill the microbes that were causing infection on open wounds. To test this lister decided to operate on an 11 year old boy with a fracture using carbolic acid to prevent any infectious diseases. The surgery was extremely successful. So successful that lister sent a letter to the young boys father. The letter read ‘Though I hardly expected any success I tried carbolic acid on the wound to prevent the formation of pus in the leg. Well it is now eight days since the accident and the patient has reacted just as if there had been no open wound’. This outlines how successful the surgery on the young boy was and that Listers ideas on carbolic acid helping the prevention of infection were working. To further prove this by 1865  ‘Lister cut the death rate among his patients from ‘46% to 15% by spraying instruments and bandages with carbolic acid’. Surgery was starting to become more and more antiseptic. The decrease in the death rate shows how much of a significant effect Louis Pasteur had on the number of deaths in the 19th century. As his theory is what inspired Joseph lister to introduce Carbolic acid during an operation. Compared to chloroform which was also a useful discovery In helping reduce the number of deaths, carbolic acid had much more of an effect then Chloroform. Chloroform decreased the death rate by just 5% in 1865. Whereas carbolic acid helped reduce the amount of deaths  in the 19th century by 31%. Indicating how Louis Pasteur and Joseph Lister’s ideas were the most significant discoveries/developments in reducing the number of deaths by 1865. Lister’s work brought upon a new identity of surgery. Again like every other surgeon Lister had his critics. Despite the fact that Lister’s thoughts were immediately accepted in Germany and America, a number of specialists in Britain were not convinced at first and joked about Lister and his cure for infection. Some found the entire procedure difficult as carbolic acid made the skin sore and irritation occurs,. Lister faced more fierce opposition when carbolic acid was started to be used more frequently. The main problem with Carbolic acid was that it slowed down an operation. This led to problems such as blood loss which would ultimately lead to the death of the patient. Lister was also criticised because of his lack of confidence. He often changed his methods and concepts to try and better surgery. This seems like a positive thing, however surgeons questioned weather he himself doubted his own ideas as they thought that could possibly be the only reason as to why he kept changing his methods.Despite this by 1878 steam sterilising was introduced to help surgeons transfer from antiseptic to aseptic surgery. Rather then trying to remove an infection on an open wound surgeons began to enter the operation with sterilised equipment to prevent infection in the first place. And by 1900 masks, costumes and closed doors meant that infection could no longer be spread from people to people. This was a huge turning point as it managed to reduce the death rate figures drastically as performing more complex surgeries was now be a possibility. However, again more complex operations meant that blood loss would increase as more time is taken during an operation. This seems to be a reoccurring factor that limits the transformation of surgery as blood loss was still not dealt with by the 1880’s. As soon as a step is taken towards transforming surgery, blood loss seems to be the only factor that hindered the transformation of surgery by 1880.This bring me to my final point. The issue with blood loss and how it was overcome. During the early 18th century blood loss was recognised as a serious issue. The lack of scientific knowledge at the time mean that ridiculous procedures were carried out in attempt to save a patient life. E.g blood transfusions were done from animals such as sheeps. This was working for some patients but more patients died much more than they survived. As a result the procedure was eventually banned. This is still significant as it outlines the desperate attempts of surgeons to keep as many people alive despite minimal scientific knowledge. Nothing was done after the procedure was banned to prevent the issue with blood loss and serious attention was only given after Louis Pasteur’s germ theory began to be more and more accepted. As now people were more keen than ever to get to the bottom of every issue with surgery. Especially because blood loss was the only major unsolved mystery left to solve. Early attempts to solve blood loss involvedCONCLUSION: