Edexcel GCSE History B SHP Unit 3 The transformation of Surgery c1845-1918
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How significant was the transformation of surgery 18451918?
Key Enquiries
● In a Nutshell: How did surgery change 1845-1918?
● What factors help us to understand change and continuity in Surgery
developments 1845-1918?
● Developing understanding: Depth studies –dealing with pain,
infection and blood loss
● Cracking the Puzzle – Preparing for revision and assessment.
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Language and Literacy
Key Terms and their meanings in Surgery 1845-1918.
amputation
anaesthetic
antiseptic
aseptic
bacteria
The cutting off of a limb-arm or leg
A drug given to reduce pain or produce unconsciousness
Chemicals used to destroy bacteria and prevent infection
Sterile, free from microbes which cause infection
Micro-organisms that cause disease
cauterise
Use of a hot iron to burn body tissue to seal wounds and stop
bleeding
gangrene
When body tissue dies, can be caused by infection or bad
circulation
haemorrhage
infection
ligature
plastic surgery
sepsis
sterilise
bleeding
Deterioration of condition caused by germs or microorganisms
A thread tied around a blood vessel to stop bleeding
Surgery carried out to alter the appearance of a patient
Bacteria on flesh causing infection
To destroy/remove all living micro-organisms from surfaces
and surgical instruments
tournequet
Something tied around a part of the body to put pressure on
the blood vessel and stop blood loss
transfusion
Blood given from one person to another
tumour
A swelling caused by cells reproducing at an increased rate.
Edexcel GCSE History B SHP Unit 3 The transformation of Surgery c1845-1918
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In a Nutshell: How did surgery change 1845-1918?
The key features and concepts
Students should have knowledge and understanding of:
● The main problems of surgery before 1840; pain, infection and blood loss.
● Developments in anaesthetics; nitrous oxide, ether, chloroform, Simpson, opposition and the
‘Black period’ of surgery.
● Developments in antiseptics; Lister, opposition, aseptic surgery
● Dealing with blood loss; blood types, Landsteiner, storing blood
Students should be aware of the impact of different factors on surgery; science and technology, war
and communications.
Activity 1 : initial imaging
Your teacher will give you a sheet with two images on it. Consider what the two images provided reveals
about the nature of surgery in both 1845 and 1918, and the changes which took place across this period.
Activity 2 – On your marks…
Colour code the developments on your copy of the timeline; use blue for those addressing pain, yellow for
those addressing infection and red for those addressing blood loss.
Developments in Surgery c1845-1918
1846 Morton and Liston
tried using ether to
numb the pain in
dentistry and surgery
1853 Queen Victoria
influenced others when
she used Chloroform in
childbirth
1865 Lister tried
carbolic spray to kill
germs during surgery,
despite general
scepticism
1901 Landsteiner
suggested different
blood groups. Direct
transfusion could now
work successfully
1845-1855
1855-1870
1870-1900
1900-1918
1847 James Simpson
used Chloroform as an
anaesthetic, but faced
opposition.
1850-1860s The ‘black
period’; anaesthetics
meant surgeons took
longer but didn’t
understand germs
After 1877 Lister had
widespread influence. By
1890 most operations
were in antiseptic
conditions
1915 Sodium Citrate
and Citrate Glucose were
found to stop clotting, so
blood could be stored.
Blood donation began
Your teacher may ask you to create your own, more detailed, surgery timeline, as your
carry out research into this topic. You may wish to do this in your exercise book, in a
programme like publisher or online, using a site such as weebly.com. Your teacher may
choose to set this work as part of your homework through this topic.
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Edexcel GCSE History B SHP Unit 3 The transformation of Surgery c1845-1918
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What factors help us to understand change and continuity in Surgery
developments 1845-1918?
Focus : Factors of change and continuity in Medical developments 1750-1900.
What do we need to focus on?
Students should have knowledge and understanding of
● The nature of surgery in c.1840 and attitudes to surgery at this time
● Developments in dealing with the three main problems: pain, infection and blood loss
● Factors which help explain both change and continuity
Activity 1 – The dangers of surgery up to 1840
Explain why surgery was so dangerous up to 1840. Use DC SHP Medicine p116 and/or WB History B
p108-9
Why was surgery so dangerous up to 1840?
The problem of pain
The problem of infection
Attempts to address problem
Attempts to address problem
The problem of blood loss
The problems with working quickly
Attempts to address problem
Attempts to address problem
Activity 2: What could you expect from a surgeon in 1845? Use WB HistoryB p108
Training
 Anatomical understanding has improved and surgery was more scientific by the 1840s.
 Surgeons trained through observing surgery in ‘operating theatres’ in hospitals, attending
lectures and dissecting bodies.
 The position or status of surgeon was still below that of the top physicians
Types of operation available:
 …
 …
Risks:
 …
 …
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Activity 3: Factors that help us to understand why change took place in Surgery 18451918. Copy this as the centre of a mindmap. Add examples from your timeline from
lesson 1 and WB HistoryB p106-7. Add further examples as you study the surgery unit.
Role of Individuals
New Ideas
Role of Government
FACTORS OF CHANGE
1845-1918
Science and Technology
War
Communication and
Education
Activity 4: Factors that help us to understand why continuity took place in Surgery 18451918. Copy this as the centre of a mindmap. Add examples from your timeline from lesson 1
and WB HistoryB p106-7. Add further examples as you study the surgery unit.
Role of Individuals
Old Ideas
Role of Government
FACTORS OF CONTINUITY
1845-1918
Science and Technology
War
Communication and
Education
Activity 5: What could you expect from a surgeon by 1918?
Training:

Surgeons had detailed surgical training in universities and hospitals.
 The position of surgeon was becoming the highest regarded medical profession
Types of Surgery:

Amputations, growth removal, repairing broken bones etc- as in 1840s

Bullet,(foreign object), tumour, kidney, bladder and gallstone removal

Plastic/reconstructive surgery, skin grafting

Improved eye, ear, nose and throat surgery

Some basic brain surgery
However, couldn’t do organ transplants yet
Risks:

Risk of death and infection dramatically reduced.
However, anaesthetics still breathed in until the 1930s, so still difficult to control dosage. Also, if
infection did develop, no way to effectively get rid of it until penicillin in the 1940s.
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Focus 1: Dealing with Pain -The development of Anaesthetics
Activity 1: gaining an insight-videoclip
Watch the first 30mins of Scream-The History of Anaesthetics, or The History of
Surgery episode 5, Parts 4 and 5 .Record key developments and keep a note of the
factors which contributed to each development. Also record information about attitudes to
the developments
Activity 2: Developments in Anaesthetics
Describe, explain and analyse each development in the path to dealing with the problem of
pain. Complete the following table using BDL Edexcel p204-205 and/ or WB SHP Medicine
p110-111
Anaesthetic
Description
+ve
Laughing Gas
1799 Humphrey Davy
Explain and analyse the
effectiveness
+ve
-ve
1844 Horace Wells
Ether
1846 William Morton
+ve
-ve
1846 Robert Liston
Chloroform
1847 James Simpson
+ve
-ve
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Activity 3: Opposition to Anaesthetics
Describe the medical and religious arguments against the introduction of anaesthetics, using
DBL Edexcel p205 and/or WB SHP Medicine p111
Opposition to
Anaesthetics
Explanations for opposition
Medical Arguments
(Science and
technology/Attitudes
and Beliefs)
1
2
3
Religious Arguments
(Attitudes and
Beliefs)
1
2
3
Activity 4: The development of the use of Anaesthetics
Using DBL Edexcel p204-205 and WB SHP Medicine 110-111, identify why anaesthetics
were commonly used by 1860.
You should consider the causal factors of; individuals, science and technology,
communications and attitudes and beliefs. You could present this as a mind map, or under
causal factor headings.
Once you have identified examples and explanation of each causal factor, examine how
the factors interrelate and which factor you believe played the most significant role.
Be prepared to justify your judgement.
Activity 5: Why was the period 1850s-1870s the ‘Black Period of surgery’?
Use your notes from focus 1 to explain, including the following points:
-Length of operations and nature of operations
-Risk of infection/death with statistics
-Blood loss
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Activity 6: How far did the development of Anaesthetics impact on surgery in the period
1845-1918?
Analyse how far the development of Anaesthetics impacted on surgery by plotting your own living graph and
labelling some of the significant points related to changing ideas on it.
1799
Sir Humphrey Davy
discovered laughing
gas(Nitrous Oxide) relieves
pain.
1846
Morton and Liston found that
ether was more long lasting
and effective in relieving
pain, but it had even more
significant drawbacks for
both patient and medical
practitioners.
1850s -1870s Called the
‘Black Period of Surgery’ due
to the increased numbers of
deaths. In fact this occurred
because surgeons were
attempting longer deeper
surgery, without the problems
of infection or blood loss
having been resolved.
1844
Horace Wells used Nitrous
Oxide when extracting teeth.
However, it had numerous
limitations; was not very
powerful and work off quickly
1847
Simpson discovered the
powers of chloroform. The
difficulties of dosage were
partly solved by Snow with
his inhaler in 1848.
Significant opposition existed
1853
Queen Victoria used
chloroform for the birth of
her 8th child. Opposition
almost disappeared.
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Activity 7: How far did Anaesthetics impact on surgery between 1845 and 1918?
Using Activities 1-6, organise your thoughts and answer the question using either of the suggested thinking
frames below.
Thinking frame 1
Intro: Whilst there were some improvements in surgery as a result of the development of Anaesthetics
during the period 1845-1918, there were many practices that remained the same.
Part 1: There were some significant changes in the practice of surgery during the period 1845-1918 as a
result of the development of Anaesthetics. For example…
Part 2: However many problems and practices within surgery remained the same in the period 1845-1918
despite the introduction of Anaesthetics. For example….
Thinking frame 2
Intro: Whilst there were some continuities in surgery after the introduction of Anaesthetics during the
period 1845-1918, there were many significant improvements.
Part 1: There were some ideas that continued in surgery despite the introduction of Anaesthetics during
the period 1845-1918. For example…
Part 2: However there were many significant improvements in the development of surgery as a result of
the introduction of anaesthetics in the period 1845-1918. For example….
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Focus 2: Dealing with infection-The development of Antiseptic and
Aseptic surgery.
Activity 1 –gaining an insight-videoclip
Watch The History of Surgery episode 5, part 5 and Last part . Record key developments
and keep a note of the factors which contributed to each development. Also record
information about attitudes to the developments
Activity 2-Developments in Antiseptics and Aseptic Surgery
Describe, explain and analyse each development in the path to dealing with the problem of
infection. Complete the following table using DBL Edexcel B p212-213 & 215 and/or WB SHP
Medicine p117-118, 121.
Anaesthetic
Description
Explain and analyse the
effectiveness
Washing hands in
chlorinated water
1846 Ignaz
Semmelweiss
+ve
Carbolic Spray
1865 Joseph Lister
+ve
-ve
-ve
Aseptic Surgery
1894 William Halsted
+ve
-ve
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Activity 3: Opposition to Antiseptics
Describe and explain the arguments against the introduction of antiseptics, using DBL
Edexcel p214 and/or WB SHP Medicine p120.
Opposition to
Antiseptics
Practical/Scientific
Reasons
1
Explanations for opposition
1
2
2
3
Attitudes and Beliefs
1
2
Role of Individual
1
2
Activity 4: The development of Antiseptic and Aseptic surgery
Using DBL Edexcel B p212-215 and WB SHP Medicine p117-120, identify why antiseptics
were commonly used by 1880 and aseptic surgery was routine by 1895. You should consider
the causal factors of; individuals, science and technology, communications and attitudes and
beliefs. You could present this as a mind map, or under causal factor headings. Once you
have identified examples and explanation of each causal factor, examine how the factors
interrelate and which factor you believe played the most significant role. Be prepared to
justify your judgement.
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Activity 5: How far did the development of Antiseptics impact on surgery in the period 184
5-1918?
Analyse how far the development of Antiseptics impacted on surgery by plotting your own living graph and
labelling some of the significant points related to changing ideas on it.
1847 Ignaz Semmelweiss
crusade to get surgeons to
wash their hands in chlorinated
water.
1861 Germ Theory began to
shift understanding of the
causes of disease. Took a
while to be accepted.
Significant opposition to
antiseptics until 1870s.
1867 Joseph Lister publicises
findings on the use of carbolic
spray as an antiseptic
1880a and 1890s Measures
widely taken to introduce
sterilizing and the development
of aseptic surgery.
However, if infection
developed, couldn’t be treated.
Couldn’t prove, as no
knowledge of germs. Was
dismissed as a zealot and a
madman
1840s and 1850s Miasma
Theory of disease prominent
1878 Robert Koch provides
evidence of the bacteria for
septicaemia. This results in a
much wider acceptance of the
reasoning behind antiseptics
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Activity 6: How far did Antiseptics impact on surgery between 1845 and 1918?
Using Activities 1-5 organise your thoughts and answer the question using either of the suggested thinking
frames below.
Thinking frame 1
Intro: Whilst there were some improvements in surgery as a result of the development of Antiseptics
during the period 1845-1918, there were many practises that remained the same.
Part 1: There were some significant changes in the practise of surgery during the period 1845-1918 as a
result of the development of Antiseptics. For example…
Part 2: However many problems and practices within surgery remained the same in the period 1845-1918
despite the introduction of Antiseptics. For example….
Thinking frame 2
Intro: Whilst there were some problems that continued in surgery following the introduction of Antiseptics
during the period 1845-1918, there were many significant changes.
Part 1: There were some problems that continued in surgery despite the introduction of Antiseptics during
the period 1845-1918. For example…
Part 2: However there were many significant improvements in the development of surgery as a result of
the introduction of Antiseptics in the period 1845-1918. For example….
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Focus 3: Dealing with the problem of bleeding-The development of
blood transfusions.
Activity 1 –gaining an insight-videoclip
Watch The History of Surgery episode 5, part 5 and Last part . Record key developments
and keep a note of the factors which contributed to each development. Also record
information about attitudes to the developments
Activity 2-Developments in Blood Transfusions
Describe, explain and analyse each development in the path to dealing with the problem of
blood loss. Complete the following table using DBL Edexcel B p218-219 and WB SHP Medicine
p126-7
Developments in Blood
Description
Explain and analyse the
transfusion
effectiveness
Discovery of blood
groups & Direct
transfusion
1901 Karl Landsteiner
+ve
-ve
1907 Reuben Ottenberg
Indirect transfusion
1915 Richard Lewishon
+ve
-ve
Longer storage of blood
1916 Rous and Turner
+ve
-ve
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Activity 3: The development of blood transfusion
Using DBL Edexcel B p218-219 and WB SHP Medicine p126-127, identify why blood
transfusions were commonly used in surgery by 1920. You should consider the causal
factors of; individuals, science and technology, communications and attitudes and beliefs.
You could present this as a mind map, or under causal factor headings. Once you have
identified examples and explanation of each causal factor, examine how the factors
interrelate and which factor you believe played the most significant role. Be prepared to
justify your judgment.
Activity 4: How far did the development of blood transfusion impact on surgery in the
period 1845-1918?
Analyse how far the development of blood transfusion impacted on surgery by plotting your own living graph
and labelling some of the significant points related to changing ideas on it.
Doctors attempted blood
transfusions from animals until the
practice was banned in the 1670s
1900 Karl Landsteiner identifies 1915 Richard Lewisohn
blood groups
discovered sodium citrate
stopped blood clotting allowing
indirect transfusions
The First human to human
transfusions started in 1790s.
James Blundell carried these out
in Britain in the 1820s. However,
not all worked and some died.
1907 Reuben Ottenberg
performed 1st blood transfusion
using blood typing
1916 Rous and Turner
discovered that adding a citrate
glucose solution, allowing for
longer storage
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Activity 5: How far did blood transfusion impact on surgery between 1845 and 1918?
Using Activities 1-5 organise your thoughts and answer the question using either of the suggested thinking
frames below.
Thinking frame 1
Intro: Whilst there were some improvements in surgery as a result of the development of blood
transfusion during the period 1845-1918, there were many practices that remained the same.
Part 1: There were some significant improvements in the practice of surgery during the period 1845-1918
as a result of the development of blood transfusion. For example…
Part 2: However many problems and practices within surgery remained the same in the period 1845-1918
despite the introduction of blood transfusion. For example….
Thinking frame 2
Intro: Whilst there were some continuities in surgery in the context of the introduction of blood
transfusion during the period 1845-1918, there were many significant improvements.
Part 1: There were some continuities in surgery despite the introduction of blood transfusion during the
period 1845-1918. For example…
Part 2: However there were many significant improvements in the development of surgery as a result of
the introduction of blood transfusion in the period 1845-1918. For example….
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Trigger Memory Activity for Surgery 1845-1918
Trigger Words
Trigger Picture
Add Trigger Points from your notes
Problems in
●
surgery before
●
1840
●
Anaesthetics
●
●
●
●
●
Opposition to
●
anaesthetics
●
●
●
Factors in dev of
●
anaesthetics
●
●
●
Black period for
●
surgery
●
●
●
Antiseptics
●
●
●
●
Opposition to
●
antiseptics
●
●
●
Factors in dev of
●
antiseptics
●
●
●
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Dealing with Blood
●
loss
●
●
●
Factors in dev of
●
blood transfusion
●
●
●
Surgery by 1918
●
●
●
●
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Trigger Memory Story Surgery 1845-1918
The story must be very imaginative. It must involve you seeing, talking and doing things.
It must link the ten trigger words together in the form of a continuous story. You should
then rehearse the story and commit it too your long term memory to be recalled when
necessary. This will take some effort but will be very useful! Use different colours to write
the trigger words in your story.
I was...
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Assessment for Learning
Puzzle practise : Surgery 1845-1918
There are many excellent websites which can be used to revisit the material covered so
far. These include www.schoolhistory.co.uk/revision/medicine.shtml
www.sciencemuseum.org.uk/broughttolife.aspx
www.channel4.com/explore/surgerylive/history.html
www.historyworld.net/wrldhis/listhistories5.asp
www.wellcomecollection.org
www.educationforum.co.uk/gcseSHPchron.htm
Exam Technique- Format of Exam
Q1 Target :Comprehension and inference. (6) 9mins
e.g. What can you learn from the source A about X?
Q2 Target :Recall and selection of knowledge, key features and characteristics of periods studied, analysis
of representations of history. (8) 12mins
e.g. What was the purpose of this representation? Explain your answer, using Source B and your own knowledge.
Q3 Target : Knowledge recall and selection, causation within a historical context. Source comprehension.
(10) 15mins
e.g.Why was the problem of infection so great in the 1860s? Explain your answer, using Source C and your own
knowledge.
Q4 Target :Recall and selection of knowledge,key features and characteristics of period studied, evaluation
of sources for reliability. (10) 15mins
e.g.How reliable are Sources D and E as evidence of the success of Lister’s antiseptic methods? Explain your
answer, using Sources D and E and your own knowledge.
Q5 Target:Knowledge recall and selection, consequence within a historical context, reaching a judgement on
representations and interpretations of history. (16 +4 SPAG) 24mins
e.g.Study sources B, F and G.
‘Resistance to change was the main reason for opposition to Lister’s methods’ How far do you agree with this
statement? Use your own knowledge, sources D, E and F and any other sources you find useful to explain your
answer.
(20)
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Exam Technique Guidance
Q1 Target :Comprehension and inference. (6) 9mins
e.g. What can you learn from the source A about X?
Use DBL Edexcel B p 200-201 for guidance of how to tackle question 1. You could apply the question to
both sources 1 and 2 on these pages .There is further guidance in WB p 112-113.
Suggested structure and sentence starters:
From Source A , I can infer…because it shows…
I can also infer…because it shows.
Q2 Target :Recall and selection of knowledge, key features and characteristics of
periods studied, analysis of representations of history. (8) 12mins
e.g. What was the purpose of this representation? Explain your answer, using Source B and
your own knowledge.
There is some initial guidance about how to analyse a representation in DBL Edexcel B p208-210. You
could apply the question to sources 1 or 2 on these pagesHowever the exam now words the question;
What was the purpose of this representation? And expects you to also use your own knowledge of the
period to analyse the representation
For this question it is important to

Identify how the event/person etc is portrayed in the representation and what the purpose
appears to have been (V and W in structure below)

Explain how the selection of source content is used to create this impression (X in structure
below)

Explain how the treatment of the material (eg language used, layout, colour etc) is used to
create this impression (Y in structure below)

Explain why they portrayed it in this way, in terms of the purpose of the representation and
given what you know about the period from your own knowledge. (Z in structure below)
Suggested structure and sentence starters:
The author/artist creates the impression of V in order to W
Firstly the author/artist mentions /shows X
Secondly, the author uses language/symbols such as Y
Finally, they are clearly trying to present it as V because of Z
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Q3 Target : Knowledge recall and selection, causation within a historical context. Source
comprehension. (10) 15mins
e.g.Why was the problem of infection so great in the 1860s? Explain your answer, using
Source C and your own knowledge.
This is a new question type for the surgery exam, so the textbooks don’t give direct guidance on how
to answer it. You could try answering this using source 1 in DBL Edexcel B p 209
Do a mind map of reasons/points you can think of from your own knowledge of the period. A good
number of reasons is 3, but don’t worry if you can only identify one or two at this point.
Then analyse the source for clues to reasons/points. Add points inferred from the source to the
mindmap.
Use your own knowledge or information from the source to note down 1-2 bits of evidence or examples
for each point.
Suggested structure and sentence starters:
There are three main reasons which help to explain why X that interlink and vary in
significance.
Least significant is (Use PE,C,K)
More significant is (Use PE,C,K)
The most significant is (Use PE,C,K)
These factors interlink
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Q4 Target :Recall and selection of knowledge,key features and characteristics of period
studied, evaluation of sources for reliability. (10) 15mins
e.g.How reliable are Sources D and E as evidence of the success of Lister’s antiseptic
methods? Explain your answer, using Sources D and E and your own knowledge.
This is also a new question type. You could use sources 1 and 2 in DBL Edexcel B p216, to
practice how to analyse for reliability.
Source D
Source E
How does the origin of the source affect its
Strengths
Strengths
reliablilty?
Because it was
Because it was
Things to consider first:
produced…This means…
produced…This means…
Limitations
Limitations
However, because it
However, because it
was…this means…
was…this means…
How does the nature of the source affect
Strengths
Strengths
its reliability?
Because it ….this means
Because it ….this means
Things to consider first:
that….
that….
 What was the purpose of the source?
It does show…
It does show….
Limitations
Limitations
However, because it …this
However, because it …this
limits..
limits..
Also it does not show…
Also it does not show…
 Who wrote/produced it?
 When was it produced?
How does this affect it’s reliability?
Is it representative or unusual for its time?
Is it authoritative?
 What type of source is it?
How does this affect its accuracy?
Is it comprehensive?
How does it compare with what you know from
your own knowledge?
Suggested structure and sentence starters:
Source D and E have strengths and limitations in their reliability for an historian enquiring
about X. It is argued that E is most reliable.
Source D is partially reliable. For example, it was produced…Another reason it is reliable is
it…However its reliability is extremely limited because….(Use PE,C,K)
Source E is more reliable. For example it was produced….Another reason it is reliable is…..This
reliability is only partially limited by...(Use PE,C,K)
Overall source E is more reliable than source D for someone enquiring into X because….
Edexcel GCSE History B SHP Unit 3 The transformation of Surgery c1845-1918
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Edexcel GCSE History B SHP Unit 3 The transformation of Surgery c1845-1918
24
Q5 Target:Knowledge recall and selection, consequence within a historical context, reaching a
judgement on representations and interpretations of history. (16 +4 SPAG) 24mins
e.g.Study sources B, F and G.
‘Resistance to change was the main reason for opposition to Lister’s methods’ How far do you
agree with this statement? Use your own knowledge, sources D, E and F and any other sources
you find useful to explain your answer.
(20)
Use DBL Edexcel B p 222-225 for guidance of how to tackle question 5. The only new element is that
there are an additional 4 marks for Spelling, Punctuation and Grammar. This means that this question
is worth questions 3 and 4 put together, and far more than questions 1 and 2. Make sure you keep to
your timing so you have plenty of time for this question. There is further guidance in WB p 138-141.
Suggested structure and sentence starters:
There is some evidence to support the view that …. . However, overall there is greater
evidence to challenge it.
There is evidence to support the view. For example….(Use PE,C,K). However, there are
limitations to this evidence because…
There is greater evidence to challenge this view and argue that…Y For example….(Use PE,C,K) ..
This evidence is persuasive because…
In conclusion it is evident that…..
Edexcel GCSE History B SHP Unit 3 The transformation of Surgery c1845-1918
24