1. Surgery 27 February 2007

2. Why was surgery so dangerous in the 19 th Century?  Surgeons in the 19 th century had to work quickly – in 1812 Napoleon’s surgeon amputated 200 limbs in 24 hours at the Battle of Borodino.  Infection was the greatest danger – germs could enter the wound and cause blood poisoning.  Almost half of all patients who had leg amputations died from blood poisoning.

3. Robert Liston On 21 December 1846, the first British operation under anesthesia was undertaken by Robert Liston at University College Hospital. Liston used ether to amputate the leg of a butler, Frederick Churchill. The amputation took 28 seconds. Liston's admirers claimed that "the gleam of his knife was followed so instantaneously by the sounds of sawing as to make the two actions appear almost simultaneous".

4. Speed  Sometimes operations went dreadfully wrong. Robert Liston once amputated a leg in 2 ½ minutes but worked so fast that he accidentally cut off his patients testicles as well.  During another high-speed operation Liston amputated the fingers of his assistant and slashed the coat of a spectator who, fearing he had been stabbed, dropped dead with fright.

5. Task  On the picture you have in front of you label all the dangers and sources of infection you can see.  Read through the 2 sources on the back of the sheet. Underline any words or phrases that show that surgeons have copied the ideas of Pare.

7. Pain, Bleeding and Infection  There were 3 main problems with surgery in the 19 th Century:  Pain  Bleeding  Infection

8. Pain  In 1799 Sir Humphry Davy discovered that laughing gas reduced the sensation of pain.  In 1800, ether was used by J R Liston, however this had severe side effects surgeons were searching for a better alternative.

9. Anaesthetics  James Simpson discovered chloroform.  He invited several colleagues to his home and they sat around the table experimenting with different chemicals.  He poured some chloroform into tumblers and they inhaled the vapours and were ‘all under the table’ in a minute.  Simpson wrote articles about his discovery, and he started using it to help women during childbirth.  Soon other surgeons started to use chloroform in their operations.

10. Opposition to anaesthetics  Chloroform was a new and untested gas.  No-one knew if there would be any side affects.  They did not know what dose they should be giving patients. – Hannah Green died whilst being given chloroform during an operation to remove her toenail.  There was also opposition from religious people who believed that pain had been invented by God and should be considered a blessing.

11. Acceptance  Anaesthetics were finally accepted when in 1857 Queen Victoria accepted the use of chloroform during the birth of her 8 th child.  She publicly praised ‘that blessed chloroform’.  From then on anaesthetics became a standard part of surgical practice.

12. Task  Using the information on pages 135 - 136  Explain why each factor played a role in encouraging or opposing the development of anaesthetics. Government Chance Queen Victoria Individual Genius War Religion Factors

13. Infection  Until the acceptance of the Germ Theory in the 1860s surgeons did not take any precautions to protect open wounds from infections.  Surgeons would reuse bandages, spreading gangrene.  They would not wash their hands before operating.  Their equipment was not sterilised and the same knife would be used through several operations without being cleaned.  Some surgeons operated wearing old clothes, that had been stained with blood and pus from previous operations.

14. Semmelweiss  Ignaz Semmelweiss was a Hungarian doctor working in Austria.  He became concerned about the deaths of apparently healthy women after childbirth.  Semmelweiss observed that women whose babies had been delivered by midwives were more likely to survive than those delivered by medical students.  He believed this was because medical students came straight to the delivery rooms after they had been dissecting dead bodies.

15. Semmelweiss  Semmelweiss suggested that doctors and students should wash their hands before treating a patient to stop the spread of infection.  At the time Semmelweiss was called a crank and a fanatic, and was even said to be mentally unstable.  It was many years before his sensible ideas were adopted by others.

16. Task  Could Semmelweiss have known about Pasteur’s germ theory in 1847?  Who do you think did more to help women in childbirth: Simpson or Semmelweiss?  Give a reason for your opinion.

17. Lister and Antiseptics  Joseph Lister was one of the most important surgeons of the 19 th Century.  He had read Pasteur’s work on germ theory published in 1861.  Lister had seen carbolic spray used to treat sewage.  He experimented and found that a thin mist of carbolic spray over the wound during surgery limited infection.

18. Task  Write a news report telling people of Lister’s amazing new discovery – Carbolic Spray  Use the information on page 138.  Describe in detail the measure Lister has taken to reduce infection.

19. Task  Every time a new idea was developed there was huge opposition to it.  The use of antiseptics was no exception  Use the information on page 139 to find 5 reasons why people opposed the use of antiseptics.

20. Opposition to antiseptics  The carbolic spray cracked the surgeons hands and made them painful.  Using carbolic spray slowed down the time it took to operate.  Some argued that antiseptics stopped the body’s own defence mechanisms from working.  People expected their patients to die. They did not like someone questioning the way they operated.  Lister kept changing his techniques to find another antiseptic. Critics said he was changing his ideas because they did not work.

21. How did Lister change surgery?  Lister’s methods marked a turning point in surgery.  In 1877 he moved to London to train other surgeons.  By the late 1890’s his antiseptic methods became aseptic surgery – means that all possible germs are removed from the operating theatre.

22. New Measures  To ensure absolute cleanliness new measure were introduce:  Operating theatres were religiously cleaned.  From 1887 all instruments were steam- sterilised.  In 1894, sterilised rubber gloves were used for the first time.

23. Success  With some of the basic problems now solved, surgeons began trying more difficult operations.  The first successful operation to remove an infected appendix came in the 1880s.  The first heart operation was carried out in 1896 when surgeons repaired a heart damaged by a stab wound.

24. Bleeding  The third great problem was bleeding.  Lister improved Pare’s ligatures by using sterilised catgut.  Other surgeons experimented with blood transfusion but despite many attempts it often failed.  The explanation for this would not be found for another 20 years.

25. Task  Draw a timeline in your books from 1850 – 1900.  Above the line mark the important dates of Pasteur and Koch.  Below the line mark the important dates in the development of surgery.

26. Timeline  1847 – Simpson discovers chloroform  1861 – Pasteur published his germ theory  1857 – Queen Victoria uses chloroform  1869 – Lister publishes his work on carbolic acid  1875 – 78 – Koch’s research into anthrax  1879 – Chicken cholera vaccine discovered  1881 – Anthrax vaccine  1882 – Rabies vaccine  1882 – Tuberculosis found  1883 – Cholera found  1887 – Instruments are steam-sterillised  1894 – Rubber gloves worn  1896 – First successful heart operation

27. Timed Essay – next lesson  The discovery of the causes of diseases in the 19 th Century was due to individual genius. Do you agree? (12)  The discovery of the causes of disease in the 19 th Century was due to many factors. Individuals such as….

28. Mark Scheme 12 marks = 18 minutes  1-3 Simple answer agreeing with the statement. May not give any examples of individuals but only generalisations e.g. individuals found that germs were in the air.  4-6 More detailed answer, giving examples of at least 2 individuals e.g. Pasteur and Koch. May start to look at other factors.  7-9 Detailed answer looking at importance of key individuals with supporting evidence. Will also look at other factors.  10-12 As above. Will also look at other factors in detail with supporting evidence e.g. technical advances – microscopes, Government funding. Pupils will also prioritise factors.