There were four big problems with surgery. They were, unfortunately, solved in the wrong order.

The problem of lack of anatomical knowledge

Dissection was forbidden for religious reasons right through from Ancient Egypt through to before the Renaissance, except for in certain places for narrow periods of time. Even when dissection did become acceptable, most professors were too wrapped up in wanting to believe Galen than actually looking for themselves. Combined with the fact that it was often untrained menials who did the dissections, little progress was made.

All this changed when Vesalius came on the scene and wrote The Fabric of the Human Body, published in 1543. It was a complete anatomical map of the human body.

This was all very good, but it didn't help much at the time because of the other three problems. However, when these were overcome, it was invaluable.

The problem of lack of anaesthetics

There had always been very crude anaesthetics such as alcohol, opium and mandrake, but there was always a chance of death carried with these. They weren't that useful.

In 1799, nitrous oxide (laughing gas) was identified as a possible anaesthetic by Humphry Davy, but due to the obscure name of the paper he published ("Nitrous oxide"), it was ignored by most surgeons.

In 1845 a dentist did a public demonstration with nitrous oxide, but due to incredibly bad luck he picked a patient who was unaffected by the gas! Nitrous oxide was once again ignored.

In 1846 John Warren did a public demonstration of the anaesthetic qualities of ether. However, it's an irritant and is fairly explosive, so there was a move towards chloroform instead. But it turned out chloroform caused liver damage, so there was a return to ether.

Local anaesthetics based on cocaine were developed in 1884.

The problem with the discovery of anaesthetics at this point in the history of medicine was that the dangers of bleeding and infection were still very much at large. This meant that surgeons were carrying out operations that they never should have attempted because of the anaesthetic, leading to an increased death rate. This time is sometimes referred to as the "Black Period" of surgery.

The problem of bleeding

Despite Ambroise Pare's ligature technique, bleeding was still a major problem. Ligatures were prone to lead to infection, so they weren't that practical.

Blood transfusions were being carried out as early as the 16th century, often cross-species. But as no knowledge of blood groups existed back then, they were rarely successful. Blood groups were discovered in 1900 and tranfusions finally became a success, meaning the problem of bleeding was foiled.

The problem of infection

The original chemicals used to combat infection were antiseptic, meaning they aimed to kill germs near the wounds. Joseph Lister pioneered the use of carbolic acid in the operating theatre in the 1860s, which caused a huge reduction in death rates. Following the germ theory (1865) he also began to use it on instruments and bandages, causing a further decrease in the death rate.

Carbolic acid wasn't ideal, though, because it was very unpleasant to get on your hands or breathe in.

Asepsis reduced the need for nasty chemicals. Aseptic surgery involves creating a completely germ-free environment in which to carry out surgery. Instruments are carefully sterilised and the operating theatres are fed with sterile air. Modern surgery is aseptic.

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