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- purpose- causation- source evaluation for reliability (accuracy) or utility (usefulness)- 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.

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

Factors Positives Negatives Overall success

Give marks 1-5

with 5 being the

most successful

1799 Humphrey Davy

Nitrous oxide

(laughing gas)

When Horace Wells used it in a public

demonstration------------------

1846John

Collins Warren

Ether

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.

1846 Robert Liston

Communication

Successfully used ether to remove a

leg.1847 James

Simpson chloroform Chance, chloroform

Patients died because they got wrong dose.

John Snow chloroform Chloroform, technology.

Invented the chloroform inhaler. More people survived operations because they received the correct dossage.

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.

tt

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 SUFFER PAIN IN CHILD BIRTH.

SOME OFFICERS IN THE ARMY THOUGHT THAT THE USE OF ANAESTHETICS WAS “SOFT”.

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.

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)

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.

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 surgeons refused to accept Pasteurs ideas. Others still believed in speed and the carbolic spray slowed them down.

Antiseptic surgery was replaced by aseptic surgery (an entirely germ free operating theatre) towards the end of the 19th century.

Opposition to Lister!

Lister was not a showman giving impressive public displays. Indeed he appeared cold arrogant and aloof.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.

When Lister said he was achieving good results some surgeons became defensive feeling Lister was criticising them for their failures

Lister’s carbolic spray soaked the operating theatre, cracked the surgeon’s skin and made everything smell. The new

Lister continually changed his methods in the search for perfection and even for a

= 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.

Lister’s carbolic spray soaked the operating theatre, cracked the surgeon’s skin and made everything smell. The new

Lister continually changed his methods in the search for perfection and even for a

PLEASE COMPLETE THE TABLE BELOW.

DATE INDIVIDUALS CONTRIBUTION IMPORTANT FACTORS

OVERALL SUCCESS? GIVE A MARK BETWEEN 1-5 WITH 5 BEING THE MOST SUCCESSFUL!

1847 Ignaz Semmelweiss

He deducted that doctors were spreading the disease puerperal fever after dissecting bodies to new mums

Individual talent. 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.

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 immediately

Individual talent.War, technology, research teams etc (FIND OUT THE DETAILS)

Joseph Lister Lister was aware of the work of Pasteur. In addition he compared the smell of the

Communication, individual talent, development of

THE FIGHT AGAINST INFECTION .

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.

chemistry industry etc

Professor Gustav Neuber and Ernst von Bergman

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.

technology

Robert Koch Communication, science and technology.

1889 William S Halsted

Caroline Hampton complained that 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

Chance, industry.

well and he followed this by introducing caps, masks and gowns.

Antiseptics heads and tails

Match the heads and tails

Statement Comment

1Many patients died from infection after a ‘successful’ operation and the use of anaesthetics encouraged surgeons to try longer and more

AThis made Lister seem unsure of his ideas and suggested that he had made mistakes.

difficult operations.

2In 1861, Louis Pasteur published his germ theory.

BLister found that, if the dressing and bandages were soaked in carbolic acid before they were used, infection did not develop in the wound.

3Carbolic acid was used to treat sewage.

CThis was very effective at reducing infection but was very unpopular among surgeons and nursing staff because it created very unpleasant working conditions.

4Joseph Lister experimented with the use of carbolic acid on the dressings of open wounds

DNot all surgeons adopted Lister’s methods so the progress in surgery was limited at first.

5The survival rate among Lister’s patients was dramatically raised after he began to use carbolic acid.

EAs the understanding of microbes and infection improved, more attempts were made to prevent infection getting into the wound, by creating a sterile environment.

6A spray was developed to spread carbolic acid on to the instruments and the surgeons’ hands during an operation.

FSurgeons recognised the problem of the high death rate but thought it was due to weakness in the patient.

7 G

Many surgeons disagreed with Lister and some also had good survival rates even without the use of carbolic acid.

This was an easier way to prevent infection getting into the wound than using the carbolic acid spray.

8Lister constantly revised his methods.

HLister knew of Pasteur’s work and wondered if infection could explain the high death rate in surgery.

9Koch developed the steam steriliser.

ILister’s ideas gained a lot of attention, especially after he became Professor of Surgery at King’s College Hospital in London.

Breakthrough 3: BLOOD TRANSFUSIONSDoctors 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 tailsThe development of blood transfusions Significance

1Blood loss was a major problem in surgery because…

A… he had identified different blood groups.

2As the problems of pain and infection were overcome…

B… there was no way to replace the blood lost when the patient bled heavily and transfusions usually failed.

3Clamps and ligatures were used to restrict the flow of blood, but…

C… the blood groups of the patient and the donor need to match for a transfusion to be successful.

4In 1901, Karl Landsteiner announced that…

D… the donor needed to be present.

5Scientists and surgeons now understood that…

E… the first blood depot was set up, using Type O blood, which can safely be given to

all patients.

6Transfusions could now be carried out, but…

F… a person dies if blood does not circulate around the body, taking oxygen to different parts and organs.

7In 1915, it was found that adding sodium citrate stopped blood clotting and, in 1916, Francis Rous and James Turner found that…

G… more complex operations were attempted, but blood loss remained a problem.

8During 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 INDIVIDUALS PAIN INFECTION BLOOD LOSS FACTORS

1840s

1850s

1860s

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.