Two of the most important advances in surgery were anesthesia and antiseptic technique. These dramatically reduced the pain and infection associated with operations. After their acceptance, longer and more complicated surgeries became possible, and a whole new set of problems needed to be sorted out. How can you work with the body cavity open, without the blood starting to clot? How can you work on the heart that is constantly beating? How can you see the tiny structures in order to repair them?

Surgeons on T.V. ask for this all the time. What do they want? They want the instrument that cuts, the one with the razor-sharp blade that slices so cleanly through your flesh, exposing your insides to the outside world.

Since 1925 scalpels have had detachable disposable steel blades. Since around 1960, laser scalpels are sometimes used instead of regular scalpels. With these, a concentrated beam of high-energy light is used to slice through tissue and bone.

Having extra blood on hand during a surgery, to replace what the patient loses, is something that only became practical in the 1930s. Early transfusions of blood were person-to-person. That is, the blo Read More
Two of the most important advances in surgery were anesthesia and antiseptic technique. These dramatically reduced the pain and infection associated with operations. After their acceptance, longer and more complicated surgeries became possible, and a whole new set of problems needed to be sorted out. How can you work with the body cavity open, without the blood starting to clot? How can you work on the heart that is constantly beating? How can you see the tiny structures in order to repair them?

Surgeons on T.V. ask for this all the time. What do they want? They want the instrument that cuts, the one with the razor-sharp blade that slices so cleanly through your flesh, exposing your insides to the outside world.

Since 1925 scalpels have had detachable disposable steel blades. Since around 1960, laser scalpels are sometimes used instead of regular scalpels. With these, a concentrated beam of high-energy light is used to slice through tissue and bone.

Having extra blood on hand during a surgery, to replace what the patient loses, is something that only became practical in the 1930s. Early transfusions of blood were person-to-person. That is, the blood donor was right there in the room hooked up to the recipient.

There were several problems that stood in the way of safe and practical blood transfusions:
  1. an understanding of blood types and compatibility
  2. a way to store blood for long periods without clotting or deteriorating
  3. setting up blood banks and getting donors
This is how blood is packaged now: in a bag. Blood bags were invented in the late 1940s, partly because of the demand for blood during wartime. Glass blood bottles were becoming a problem. They were hard to keep sterilized because the inside came into contact with the air. There was also the danger of accidentally introducing air into the veins of the recipient. They could break during transport, and they took up a lot of space. Plastic bags were an obvious solution to these problems, but designing a blood bag was not easy. Just finding a suitable kind of plastic required years of research. The plastic had to:
  • not leach toxics into the blood
  • not damage the cells that contacted the wall of the bag
  • withstand heat sterilization and freezing.

© CSTM & UHN 2002. All Rights Reserved.

Scalpel

Scalpel

Canada Science and Technology Museum, University Health Network Artifact Collection

© CSTM & UHN 2002. All Rights Reserved.


Blood tranfusion bottle

Blood tranfusion bottle

Canada Science and Technology Museum, University Health Network Artifact Collection
1946 - 1955
© CSTM & UHN 2002. All Rights Reserved.


Blood Packets

After blood is collected from a donor, it is separated into blood, plasma, and platelets.

Photo courtesy of Canadian Blood Services

© Canadian Blood Services


The fact that blood clots when exposed to air is usually a good thing, because it keeps you from bleeding to death when you cut your leg skateboarding. However, it is not such a good thing when you are trying to perform surgery. If a great deal of blood is exposed to air, clots can form and travel to the lungs, and this can be fatal. An anti-clotting substance called heparin was discovered in 1916, but no one knew how to produce a pure, safe supply of it.

Toronto researcher Charles Best (1899-1978) took on this problem in 1928. First he tried to extract heparin from beef liver, then from lung and intestines. It was smelly work because the first part of the process was letting the meat go bad! By 1936 Best and his team were successful. Heparin became readily available, and opened the door for developments in vascular and open-heart surgery.

Brain surgery is probably older than you think. Anthropologists have found skulls with holes in them, suggesting that ancient peoples drilled holes in their heads. Maybe they did this to relieve pressure due to swelling, or to let evil spirits escape. Today there are different kinds of saws that can do the job, but a commo Read More
The fact that blood clots when exposed to air is usually a good thing, because it keeps you from bleeding to death when you cut your leg skateboarding. However, it is not such a good thing when you are trying to perform surgery. If a great deal of blood is exposed to air, clots can form and travel to the lungs, and this can be fatal. An anti-clotting substance called heparin was discovered in 1916, but no one knew how to produce a pure, safe supply of it.

Toronto researcher Charles Best (1899-1978) took on this problem in 1928. First he tried to extract heparin from beef liver, then from lung and intestines. It was smelly work because the first part of the process was letting the meat go bad! By 1936 Best and his team were successful. Heparin became readily available, and opened the door for developments in vascular and open-heart surgery.

Brain surgery is probably older than you think. Anthropologists have found skulls with holes in them, suggesting that ancient peoples drilled holes in their heads. Maybe they did this to relieve pressure due to swelling, or to let evil spirits escape. Today there are different kinds of saws that can do the job, but a common early model was circular, like a cookie-cutter. When it was rotated on the skull, it cut a round section of bone, which could be lifted off. One interesting thing about brain surgery today is that the patient can be awake during the operation. Imagine that.

A device was invented by George Klein, a talented engineer at the National Research Council. (He also invented an electric wheelchair .) It is a stapler. Surgeons were finding it difficult to stitch together the arteries or veins that were cut during surgery. Often these blood vessels were quite small, and stitching the two tiny edges together with needle and thread was a real challenge. Sometimes the force of the blood would rip the stitches out. Klein devised a way to securely fasten the two ends of a vein together using tiny staples and a few simple moves.

A surgeon really needs to see what she's doing. There have been a number of inventions to help in this area. Often the surgeon has to work with very small structures like tiny veins, or parts of the eye. These magnifying glasses were a simple way for a surgeon to see all that small stuff.

© CSTM & UHN 2002. All Rights Reserved.

Heparin vial

Heparin vial, 1937-1949

Canada Science and Technology Museum, University Health Network Artifact Collection
1937 - 1949
© CSTM & UHN 2002. All Rights Reserved.


Trephine

Trephine, around 1906

Canada Science and Technology Museum, University Health Network Artifact Collection
c. 1906
© CSTM & UHN 2002. All Rights Reserved.


Klein's Suturing System

Klein's Suturing System

Canada Science and Technology Museum, University Health Network Artifact Collection
c. 1960
© CSTM & UHN 2002. All Rights Reserved.


Binocular Magnifier

Binocular Magnifier

Canada Science and Technology Museum, University Health Network Artifact Collection
1920 - 1939
© CSTM & UHN 2002. All Rights Reserved.


It's difficult to work on something that's constantly moving, and full of blood. Before the 1960s, surgeons had great difficulty repairing defects on a constantly-beating heart. Then the heart-lung machine was invented. The blood from the patient is pumped to the machine, which oxygenates it and pumps it back into the body, essentially doing the work of the heart and lungs. Further, an injection can stop the heart from pumping. This leaves an empty, still heart, so the surgeon can properly see the inside and make the necessary repairs.

Microscopes have been adapted for use in the operating room: these can help in the delicate work of reattaching a severed hand. There are also tiny cameras that can be sent into the recesses of the body, and send an image back to a television screen, so a surgeon can see what he's doing without making a huge incision (and without leaving a big scar).

Imagine you're a surgeon in the operating room. There is a bright light overhead, but when you bend over the patient, your body casts a shadow and you can't see well anymore. How frustrating!

The light in the operating room should be bright, but should not cast shadows Read More
It's difficult to work on something that's constantly moving, and full of blood. Before the 1960s, surgeons had great difficulty repairing defects on a constantly-beating heart. Then the heart-lung machine was invented. The blood from the patient is pumped to the machine, which oxygenates it and pumps it back into the body, essentially doing the work of the heart and lungs. Further, an injection can stop the heart from pumping. This leaves an empty, still heart, so the surgeon can properly see the inside and make the necessary repairs.

Microscopes have been adapted for use in the operating room: these can help in the delicate work of reattaching a severed hand. There are also tiny cameras that can be sent into the recesses of the body, and send an image back to a television screen, so a surgeon can see what he's doing without making a huge incision (and without leaving a big scar).

Imagine you're a surgeon in the operating room. There is a bright light overhead, but when you bend over the patient, your body casts a shadow and you can't see well anymore. How frustrating!

The light in the operating room should be bright, but should not cast shadows. Therefore the light should come from many directions. Before electricity, the operating room was often located on the top floor of the hospital, because there it could have a sky-light or a large window. Now most operating rooms have no windows at all (because windows can let in bacteria from outside). They are equipped with special electric lights, which often have several light bulbs aimed in slightly different angles, to minimize shadows.

© CSTM & UHN 2002. All Rights Reserved.

Heart-lung Machine

Heart-lung machine in use at Toronto General Hospital, late 20th century.

Canada Science and Technology Museum, University Health Network Artifact Collection
late 20th Century
© CSTM & UHN 2002. All Rights Reserved.


A Surgical Microscope

A surgical microscope in use at the Royal Victoria Hospital (Montreal), 1980.

Photo courtesy of McGill Universality Archives
1980
© McGill Universality Archives


Sternum Shears

This instrument looks like a hedge clipper but is really a bone clipper. It is used to cut through large bones like the sternum (that bone in the middle of your chest where your ribs come together). The sternum or ribs are often cut to get at the heart or the lungs that are underneath. So this is another, though rather crude, method that surgeons can use to get a better view of the body.

Canada Science and Technology Museum, University Health Network Artifact Collection
Early 20th Century
© CSTM & UHN 2002. All Rights Reserved.


Operating Room Over Time

An operating room at the Vancouver General Hospital in early 1900s and another operating room at the Vancouver General Hospital in 1965.

Photos courtesy of British Columbia Archives

© British Columbia Archives


Learning Objectives

The learner will:
  • Observe evolution of hospitals, tools and treatments throughout the twentieth century;
  • Identify the evolution of medical technology and discuss its contribution to treatment and medical care;
  • Illustrate concepts in biology, identify specific diseases and treatments offered (past and present).

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