THE TRANSFORMATION OF SURGERY c.1845-c.1918.
This is your Source Enquiry and it is worth 25% of your final mark. The Source Enquiry consists of six to
eight sources and five questions testing your skills in using sources as evidence. You do, however, also
need to have a good knowledge of the important changes and the factors responsible for both progression
and regression between c1845-c1918.
http://www.bbc.co.uk/learningzone/clips/surgery-in-the-19th-century/3322.html
The examination questions in this unit usually follow a pattern testing the following skills:
- inference
- portrayal
- source analysis
- source evaluation for reliability (accuracy) or utility (usefulness)
- cross referencing of sources
- using sources and your own knowledge to make a judgement
The Background Information
This is an important part of the paper and should not be overlooked. Study it carefully, even if you know
the topic really well, because you can use it to put sources in the paper into context. Highlight important
points and identify the theme of the paper.
Timing.
The marks for each question are shown in brackets. Use this as a guide to how much time to spend on
each question.
It is important to time yourself carefully. Some students run out time because they spend too long on the
first two questions and don’t have time for the higher mark questions that come later. So stick to a plan
like this:
- APPROX 5 MINS: READING ALL THE QUESTIONS,THE BACKGROUND INFORMATION AND SCAN
THE SOURCES SO THAT YOU PICK UP THE THEME OF THE PAPER AND HOW THE QUESTIONS
SHOULD AND SOURCES RELATE TO EACH OTHER .
- NO MORE THAN 2O MINS: QUESTIONS 1 AND 2 (14 MARKS)
- APPROX 25 MINS: QUESTIONS 3 AND 4 (20 MARKS)
- APPROX 20 MINS: QUESTION 5 (16 MARKS)
- APPROX 5 MINS: CHECK YOUR ANSWERS.IF TIME IS REALLY SHORT CHECK YOUR ANSWER TO
QUESTION 5 FIRST. THIS IS WERE THE EXAMINER WILL BE LOKKING PARTICULARLY CLOSELY
AT YOUR SPELLING, PUNCTUATION AND GRAMMAR.
Problems in Surgery c1800.
There were and still are three main problems associated with surgery: pain, infection, and blood loss.
BREAKTHROUGH 1 - THE DISCOVERY OF ANAESTHETICS.
Please complete the table below.
ANAESTHETICS-AN OVERVIEW
Date
Who?
Anaesthetic
1799
Humphrey
Davy
Nitrous oxide
(laughing gas)
Factors
Positives
Negatives
When Horace Wells used it in a
public demonstration-----------------
Overall
success Give
marks 1-5
with 5 being
the most
successful
1846
John Collins
Warren
1846
Robert
Liston
1847
James
Simpson
chloroform
John Snow
chloroform
It irritated the lungs, causing
sickness. It could catch fire if
close to a flame. It had a nasty
smell and it came in a large
heavy bottle that was difficult
to carry around.
Ether
Successfully used
Communication ether to remove a
leg.
Chance,
chloroform
Invented the
chloroform inhaler.
More people
Chloroform,
survived operations
technology.
because they
received the
correct dossage.
Patients died because they got
wrong dose.
Despite the fact that the problem of pain had been solved the period between 1846 and about 1870 has been called” the
black period of surgery. Surgeons became over confident and they performed many operations that they would not
have done before. However operations were still carried out in unhygienic conditions, by surgeons wearing dirty coats.
Instruments were not sterilised between operations etc.
SOME PEOPLE WERE WORRIED
THAT ANAESTHETICS PLACED
PATIENTS UNDER THE CONTROL
OF SURGEONS. WHAT IF A
SURGEON DID SOMETHING
AGAINST THE PATIENT’S WILL?
SOME CHRISTIAN GROUPS WERE
OPPOSED BECAUSE THEY SAID
THAT ACCORDING TO THE BIBLE
(GENESIS) WOMEN SHOULD
tt
SUFFER PAIN IN CHILD BIRTH.
SOME OFFICERS IN THE
ARMY THOUGHT THAT
THE USE OF
ANAESTHETICS WAS
“SOFT”.
OPPOSITION TO
ANAESTHETICS
IN 1848 HANNAH GREENER DIED
WHILST BEING GIVEN
CHLOROFORM. THIS SCARED
SURGEONS. IN ADDITION, THERE
WERE INSTANCES OF EXPLOSIONS
IN THE OPERATING THEATRE.
(ETHER)
IN THE EARLY 1800s SURGEONS PRIDED
THEMSELVES ON HOW QUICK THEY COULD
OPERATE. (REDUCE PAIN). ANAESTHETICS
MEANT THAT SPEED WAS NO LONGER SO
IMPORTANT.
SOME ANAESTHETICS WERE UN
TESTED. NO ONE KNEW IF THERE
WOULD BE LONG TERM SIDE EFFECTS.
SURGEONS DID NOT KNOW WHAT
DOSAGE TO GIVE THE PATIENT.
BREAKTHROUGH 2: ANTISEPTICS AND THE FIGHT AGAINST INFECTION.
Joseph Lister is credited with introducing antiseptic surgery. He was determined to kill the germs in the
operating theatre. Statistics seem to prove that there was a higher survival rate among patients who had
been operated on using antiseptics. For instance between 1864-66 the % of patients who died after an
amputation, when antiseptics were not used, was 45.7. Between 1867-70 when antiseptics were used the
% of patients who died was 15.
Antiseptic surgery was replaced by aseptic surgery (an entirely germ free operating theatre) towards the
end of the 19th century.
Some surgeons who attempted
to copy his methods were not as
systematic and they did not
achieve the same results. As a
consequence they criticised
Lister.
Lister was not a showman giving
impressive public displays. Indeed he
appeared cold arrogant and aloof.
When Lister said he was
achieving good results some
surgeons became defensive
feeling Lister was criticising
them for their failures
Opposition to Lister!
Lister’s carbolic spray soaked the
operating theatre, cracked the
surgeon’s skin and made
everything smell. The new
precautions caused extra work
making operations more
expensive.
Some surgeons refused
to accept Pasteurs ideas.
Others still believed in
speed and the carbolic
spray slowed them down.
Lister continually changed his methods
in the search for perfection and even
for a replacement for carbolic acid.
Critics said he was changing his
methods because the did not work
= OPERATING THEATRES AND HOSPITALS WERE RIGOROUSLY CLEANED
= FROM 1887, ALL INSTRUMENTS WERE STEAM-STERILISED.
= SURGEONS ABANDONED OPERATING IN THEIR ORDINARY CLOTHES AND WORE SURGICAL
GOWNS AND FACE MASKS.
= IN 1894, STERILISED RUBBER GLOVES WERE USED FOR THE FIRST TIME. FOR HOWEVER WELL
SURGEONS HANDS WERE SCRUBBED, THEY COULD STILL HOLD BACTERIA IN THE FOLDS OF THE
SKIN AND UNDER THE NAILS.
PLEASE COMPLETE THE TABLE BELOW.
THE FIGHT AGAINST INFECTION .
DATE
INDIVIDUALS CONTRIBUTION
IMPORTANT
FACTORS
1847
Ignaz
Semmelweiss
He deducted that doctors were
spreading the disease puerperal
fever after dissecting bodies to
new mums
Individual talent.
1861
Louis Pasteur
He discovered the germ theory
which was a turning point in the
history of medicine. It led to the
development of further vaccines
and the science of bacteriology.
Not everyone accepted his ideas
Individual talent.
War, technology,
research teams
etc (FIND OUT
THE DETAILS)
OVERALL SUCCESS? GIVE A
MARK BETWEEN 1-5 WITH 5
BEING THE MOST SUCCESSFUL!
2/5. Not many doctors agreed with
him and resented washing their
hands in a solution of chloride and
lime. Most doctors thought
miasmas were to blame and
rejected his ideas.
Joseph Lister
Professor
Gustav Neuber
and Ernst von
Bergman
Robert Koch
immediately
Lister was aware of the work of
Pasteur. In addition he compared
the smell of the operating
theatre to a sewage works in
Carlisle. He noticed the
remarkable effects of using
carbolic acid upon the sewage. He
then used Carbolic acid first
soaked in bandages and then in a
spray to treat wounds during
surgery.
The idea of scrupulous cleanliness
originated in Germany with
Professor Gustav Neuber and was
developed by Ernst von Bergman.
Surgeons hands,clothes and
instruments were all sterilised. A
chamber was used to pass
superheated steam over the
instruments thus killing the
germs without the need for
disinfecting chemicals.
Communication,
individual talent,
development of
chemistry industry
etc
technology
Communication,
science and
technology.
1889
William S
Halsted
Caroline Hampton complained that Chance, industry.
the antiseptic chemicals were
harming her hands. Halsted asked
the Goodyear rubber company to
make some gloves. He soon
realised that they protected the
patient as well and he followed
this by introducing caps, masks
and gowns.
Antiseptics heads and tails
Match the heads and tails
Statement
Comment
1
Many patients died from infection after a ‘successful’
operation and the use of anaesthetics encouraged
surgeons to try longer and more difficult operations.
A
This made Lister seem unsure of his ideas and
suggested that he had made mistakes.
2
In 1861, Louis Pasteur published his germ theory.
B
Lister found that, if the dressing and bandages
were soaked in carbolic acid before they were used,
infection did not develop in the wound.
3
Carbolic acid was used to treat sewage.
C
This was very effective at reducing infection but
was very unpopular among surgeons and nursing
staff because it created very unpleasant working
conditions.
4
Joseph Lister experimented with the use of carbolic
acid on the dressings of open wounds
D
Not all surgeons adopted Lister’s methods so the
progress in surgery was limited at first.
5
E
The survival rate among Lister’s patients was
dramatically raised after he began to use carbolic
acid.
As the understanding of microbes and infection
improved, more attempts were made to prevent
infection getting into the wound, by creating a
sterile environment.
6
A spray was developed to spread carbolic acid on to
the instruments and the surgeons’ hands during an
operation.
F
Surgeons recognised the problem of the high death
rate but thought it was due to weakness in the
patient.
7
Many surgeons disagreed with Lister and some also
had good survival rates even without the use of
carbolic acid.
G
This was an easier way to prevent infection getting
into the wound than using the carbolic acid spray.
8
Lister constantly revised his methods.
H
Lister knew of Pasteur’s work and wondered if
infection could explain the high death rate
in surgery.
9
Koch developed the steam steriliser.
I
Lister’s ideas gained a lot of attention, especially
after he became Professor of Surgery at King’s
College Hospital in London.
Breakthrough 3: BLOOD TRANSFUSIONS
Doctors first attempted to give blood to humans from dogs, sheep and cows until the practice was banned in the
1670s.The first human to human transfusions started in the 1790s in America. A British doctor, James Blundell did
a lot of work trying to solve the problem of blood loss in the 1800s. The third problem to be solved was the
discovery of blood groups in 1901 by Karl Landsteiner.
Add the following points to the topic web below, in order to create a summary of the roles played
by different factors in the development of blood transfusions, then explain which factor you think
played the most important role.
1. During the First World War many soldiers died from loss of blood even though their wounds were
not fatal.
2. A great deal of research took place during the 19th century into chemistry and the effects of
chemicals on the human body.
3. In 1901, Landsteiner proved that there were different blood groups.
4. In 1915, it was found that adding sodium citrate stopped blood from clotting.
5. In 1916, it was found that blood could be stored in refrigerated conditions.
6. In 1916, Rous and Turner developed better ways of storing blood.
7. The hypodermic needle made it easier to carry out a transfusion.
8.The first blood depot was set up as part of the preparations for the Battle of Cambrai .
Blood transfusion
Match the heads and tails
The development of blood transfusions
Significance
1
A
Blood loss was a major problem in surgery
because…
… he had identified different blood groups.
2
B
As the problems of pain and infection were
overcome…
… there was no way to replace the blood
lost when the patient bled heavily and
transfusions usually failed.
3
C
Clamps and ligatures were used to restrict
the flow of blood, but…
… the blood groups of the patient and the
donor need to match for a transfusion to
be successful.
4
D
In 1901, Karl Landsteiner announced
that…
… the donor needed to be present.
5
E
Scientists and surgeons now understood
that…
… the first blood depot was set up, using
Type O blood, which can safely be given to
all patients.
6
F
Transfusions could now be carried out,
but…
… a person dies if blood does not circulate
around the body, taking oxygen to different
parts and organs.
7
G
In 1915, it was found that adding sodium
citrate stopped blood clotting and, in 1916,
Francis Rous and James Turner found
that…
… more complex operations were
attempted, but blood loss remained a
problem.
8
During the Battle of Cambrai in 1917…
H
… adding a citrate glucose solution
allowed the blood to be stored for longer
periods without the cells deteriorating as
quickly.
DEVELOPMENTS IN SURGERY: AN OVERVIEW.
Please complete the table below
DATE
1840s
1850s
1860s
INDIVIDUALS
PAIN
INFECTION
BLOOD LOSS FACTORS
1870s
1880s
1890s
1900s
1910s
ANSWERS TO THE HEADS AND TAILS OF ANTISEPTICS
1F, 2H, 3J, 4B, 5I, 6C, 7D, 8A, 9G, 10E.
ANSWERS TO THE HEADS AND TAILS OF BLOOD TRANSFUSION.
1F, 2G, 3B, 4A, 5C, 6D, 7H, 8E.