REVISING THE EXTENSION UNIT ON SURGERY

1. REVISING THE EXTENSION UNIT ON SURGERY 19th century surgery

2. An operation in the early 19th century A painting showing a surgical operation in 1800 ………………………………………….. ……………………………………………………………………………………………….. TASK. Describe the problems faced by surgeons and patients at the beginning of the 19th century

3. Label your picture to show the key features of a modern surgical operation

4. How many of these did you get ? How many of these did you get ? • Sterilised instruments • Blood for transfusions • Trained doctors and nurses • Rubber gloves, plastic gowns , hats and masks • Germ – free ( aseptic operating room • Electrical power • Anaesthetics • Specialists to operate equiptment and nurses

5. The problems BLEEDING PAIN INFECTION

6. James Simpson – This is your life I have a problem- ether has an unpleasant smell and irritated peoples’ eyes and lungs and makes them sick. What can I use ? • Born in Scotland in 1811 • Trained as a doctor at Edinburgh University • Became professor of midwifery at Edinburgh in 1839 • Very concerned about the suffering of women during childbirth I know about laughing gas and about experiments using ether to numb pain

7. The solution – chloroform was discovered in 1847 Professor Miller, a neighbour called on Simpson the morning after the experiment in 1847. “the inhalers became bright-eyed and very happy. And then crash! On awakening Dr Simpson’s first thought was ‘This is far stronger and better than ether’

8. The Solution …….Chloroform A portable chloroform inhaler developed by John Snow in the 1850s

9. Opposition to Simpson’s work • It was new and untested . Was it safe ? • Doctor’s did not know what dose to give to different patients • There were moral and religious arguments – the use of anaesthetics was said to be ‘ unnatural’ and against God’s will

10. Opposition to anaesthetics was eventually overcome • Use of anaesthetics became a standard part of surgical practice • Surgeons carried out more operations • Surgeons carried out more complex operations • BUT ….surgery was not safer ! • Until the acceptance of germ theory in the 1860s surgeons did not take any precautions to protect open wounds from infection.This was still a key problem which led to loss of life .

11. Joseph Lister – This is your life • Born in 1827 in Yorkshire • Became Professor of Surgery at Glasgow University in 1860 • Read Pasteur’s writings • Read about the effects produced by carbolic acid upon the sewage of the town of Carlisle His father was a medical pioneer who developed improved microscopes. He tried out carbolic acid on compound fractures and it stopped infection He developed a carbolic spray which was used in operating theatres

12. Some opposition Many doctors believed that speed was the most important factor in surgery. The use of carbolic acid slowed them down and was seen as a nuisance – even dangerous Some doctors did not believe in germ theory ‘ Where are these little beasts? Show them to us? Some doctors did not like their hands and clothes being soaked in the acid Lister kept trying to develop his ideas – trying out more substances. People though he kept changing his mind because his methods were not working

13. RESULTS ……reading tables

14. Karl Landsteiner – This is your life • Discovered in 1901 that humans had 3 types of blood group which he called A, B and 0 • Only some of these could be transferred from a patient of one group to another

15. Other developments • Storing blood - in 1914 it was found that sodium citrate stopped blood clotting in a syringe • Blood cells were separated from the liquid part and were stored in bottles . They could be diluted with saline solution when needed • Large blood banks were set up in the US and Britain during the second world war • Transfusion service

16. Other key developments in surgery • Plastic surgery • Brain surgery • Transplant surgery • Keyhole surgery • Improved anaesthetics and antiseptics

17. Sample analysis question • How important was the development of anaesthetics to improvements in surgery in the 19th century?

18. Can you identify any of the following in the model answer? Find the link words Find the benefits of using anaesthetics Find the limitations of anaesthetics in the 19th c. Is this a balanced argument ? Is there an overall judgement ? What level would you give this ?

19. Anaesthetics was important in the history of surgery because without the problem of pain , patients were more willing to have operations to treat their illnesses and more operations were carried out . This meant that surgeons could develop more experience . Moreover , because patients were no longer wriggling about in agony and having to be held down all the time , surgeons did not have to operate so quickly and consequently they could spend longer on the operations without making mistakes . This led to more accurate operations . In addition this also resulted in more complicated operations being carried out and surgeons gained more knowledge about difficult operations .

20. However , the death rate was still high because until Joseph Lister developed antiseptics in the 1860s, only one of the problems of surgery had been solved. In fact the death rate actually increased because more complicated operations resulted in surgeons going deeper into the body and yet filthy conditions still existed and germs got into the wounds . This meant that many more people died of infections. In addition surgeons were still not sure about the dosage of the chemicals and how much chloroform to give patients . A young girl called Hanner Greener died from an overdose of chloroform whilst having her toe nail removed. Furthermore, no one had yet solved the problem of what to do when patients lost a lot of blood . This meant that blood transfusions could not be carried out until Karl Lanndsteiner discovered blood groups in 1901

21. Overall I think that the development of anaesthetics was important and without this many of the ‘ high tech’ developments in the 20th century would not have been possible . However I think this was only one of the key steps and that the development of antiseptics was more important. This led to a greater reduction in the death rate from people dying from infection . In conclusion , until the final problem of providing replacement blood was solved, surgery was still a very risky procedure .