Copy of Surgery.docx - History at Tallis. Supporting …historyattallis.weebly.com/.../4/5/7/9/4579542/surgery_.docx · Web viewDepth studies –dealing with pain, infection and blood

Edexcel GCSE History B SHP Unit 3 The transformation of Surgery c1845-19181

How significant was the transformation of surgery 1845-1918?

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.

amputationThe cutting off of a limb-arm or leg

anaestheticA drug given to reduce pain or produce unconsciousness

antisepticChemicals used to destroy bacteria and prevent infection

asepticSterile, free from microbes which cause infection

bacteriaMicro-organisms that cause disease

cauteriseUse of a hot iron to burn body tissue to seal wounds and stop bleeding

gangreneWhen body tissue dies, can be caused by infection or bad circulation

haemorrhagebleeding

infectionDeterioration of condition caused by germs or micro-organisms

ligatureA thread tied around a blood vessel to stop bleeding

plastic surgerySurgery carried out to alter the appearance of a patient

sepsisBacteria on flesh causing infection

steriliseTo 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.


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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 imagingYour 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 1900-19181847 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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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 1840Explain 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

Attempts to address problem

The problem of infection


The problem of blood loss


The problems with working quickly


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 physiciansTypes of operation available:

… …

Risks: … …

Activity 3: Factors that help us to understand why change took place in Surgery 1845-1918. Copy this as the centre of a mindmap. Add examples


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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 CHANGE1845-1918

Science and Technology War Communication and Education

Activity 4: Factors that help us to understand why continuity took place in Surgery 1845-1918. 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 professionTypes 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.

Focus 1: Dealing with Pain -The development of Anaesthetics

Activity 1: gaining an insight-videoclip


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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 AnaestheticsDescribe, 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

Explain and analyse the effectiveness

Laughing Gas

1799 Humphrey Davy

1844 Horace Wells

+ve

-ve

Ether

1846 William Morton

1846 Robert Liston

+ve

-ve

Chloroform

1847 James Simpson

+ve

-ve

Activity 3: Opposition to AnaestheticsDescribe the medical and religious arguments against the introduction of anaesthetics, using DBL Edexcel p205 and/or WB SHP Medicine p111

Opposition to Explanations for opposition


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Anaesthetics

Medical Arguments(Science and

technology/Attitudes and Beliefs)

1

2

3

Religious Arguments(Attitudes and

Beliefs)

1

2

Activity 4: The development of the use of AnaestheticsUsing 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 lossActivity 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.


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1799 Sir Humphrey Davy discovered laughing gas(Nitrous Oxide) relieves pain.

1846Morton 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.

1844Horace Wells used Nitrous Oxide when extracting teeth. However, it had numerous limitations; was not very powerful and work off quickly

1847Simpson discovered the powers of chloroform. The difficulties of dosage were partly solved by Snow with his inhaler in 1848.Significant opposition existed

1853Queen Victoria used chloroform for the birth of her 8th child. Opposition almost disappeared.

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


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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 2Intro: 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

-ve

Carbolic Spray1865 Joseph Lister

+ve

-ve

Aseptic Surgery1894 William Halsted

+ve

-ve

Activity 3: Opposition to AntisepticsDescribe and explain the arguments against the introduction of antiseptics, using DBL Edexcel p214 and/or WB SHP Medicine p120.


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Opposition to Antiseptics

Explanations for opposition

Practical/Scientific Reasons 1

2

Attitudes and Beliefs

1

2

Role of Individual 1

2

Activity 4: The development of Antiseptic and Aseptic surgeryUsing 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.

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.


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1847 Ignaz Semmelweiss crusade to get surgeons to wash their hands in chlorinated water.

Couldn’t prove, as no knowledge of germs. Was dismissed as a zealot and a madman

1861 Germ Theory began to shift understanding of the causes of disease. Took a while to be accepted.

Significant opposition to antiseptics until 1870s.

1878 Robert Koch provides evidence of the bacteria for septicaemia. This results in a much wider acceptance of the reasoning behind antiseptics

1840s and 1850s Miasma Theory of disease prominent

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.

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


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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 2Intro: 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-videoclipWatch 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 TransfusionsDescribe, 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 transfusion

Description Explain and analyse the effectiveness

Discovery of blood groups & Direct transfusion1901 Karl Landsteiner1907 Reuben Ottenberg

+ve

-ve

Indirect transfusion1915 Richard Lewishon

+ve

-ve

Longer storage of blood1916 Rous and Turner

+ve

-ve


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Activity 3: The development of blood transfusionUsing 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 blood groups

1915 Richard Lewisohn 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 2Intro: 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

●●●●

Dealing with Blood loss

●●


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●●

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.shtmlwww.sciencemuseum.org.uk/broughttolife.aspxwww.channel4.com/explore/surgerylive/history.htmlwww.historyworld.net/wrldhis/listhistories5.aspwww.wellcomecollection.orgwww.educationforum.co.uk/gcseSHPchron.htm

Exam Technique- Format of ExamQ1 Target :Comprehension and inference. (6) 9minse.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) 12minse.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) 15minse.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) 15minse.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) 24minse.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)

Exam Technique GuidanceQ1 Target :Comprehension and inference. (6) 9minse.g. What can you learn from the source A about X?


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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) 12minse.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 XSecondly, the author uses language/symbols such as YFinally, they are clearly trying to present it as V because of ZQ3 Target : Knowledge recall and selection, causation within a historical context. Source comprehension. (10) 15minse.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


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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

Q4 Target :Recall and selection of knowledge,key features and characteristics of period studied, evaluation of sources for reliability. (10) 15minse.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 EHow does the origin of the source affect its reliablilty?Things to consider first: Who wrote/produced it? When was it produced?

How does this affect it’s reliability? Is it representative or unusual for its time?

StrengthsBecause it was produced…This means…

LimitationsHowever, because it

StrengthsBecause it was produced…This means…

Limitations


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Is it authoritative? was…this means… However, because it was…this means…

How does the nature of the source affect its reliability?Things to consider first: What was the purpose of the source? 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?

StrengthsBecause it ….this means that….It does show…

LimitationsHowever, because it …this limits..Also it does not show…

StrengthsBecause it ….this means that….It does show….

LimitationsHowever, because it …this limits..Also it does not show…

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….Q5 Target:Knowledge recall and selection, consequence within a historical context, reaching a judgement on representations and interpretations of history. (16 +4 SPAG) 24minse.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.Edexcel GCSE History B SHP Unit 3 The transformation of Surgery c1845-1918

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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…..


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Documents

Copy of Surgery.docx - History at Tallis. Supporting …historyattallis.weebly.com/.../4/5/7/9/4579542/surgery_.docx · Web viewDepth studies –dealing with pain, infection and blood