WALT: How were the three big problems overcome in surgery during the 19th century?
WILFS: Can describe in detail what operations were like at the start of the 19th century (C)... Can explain how pain, infection and blood loss were conquered in the 19th century (B)... Can evaluate who was important in creating safe, clean and pain free modern surgery (A)
Research then write an essay which answers
1. What was surgery like at the start of the 19th century
2. How was pain, infection and blood loss overcome
3. Whose contribution in the 19th century was most significant and why?
1. Round Table
a) How was pain conquered in the 19th century?
b) What was surgery like at the start of the 19th century?
c) How was infection conquered in the 19th century?
d) How was blood loss conquered in the 19th century/20th century?
e) Who made the most significant contribution to suegery in the 19th century?
2. Watch the film embedded below and take notes for the essay
3. Quiz Quiz Trade - questions from Mr Walker
4. Use this page, the links from it and your notes to write your essay
5. Plenary: Paraphrase passport today's WALT
In 1800 surgery was an extremely dangerous business. There were no effective anaesthetics; patients were often given alcohol in the hope of reducing the pain. There was no attempt to control the spread of infection during or after surgery. Without any knowledge of germ theory, surgeons saw no need to clean their equipment, clothes or operating theatres. In addition to this, there was no way to replace blood lost during surgery. So overall a patient who agreed to a surgical operation was more likely to die from the procedure than to survive. By 1920 however this situation had totally changed and safe effective surgery could be practised.
Developments in anaesthetics came first
Anaesthetics were vital for effective surgery
Until surgeons had an effective and safe anaesthetic they could not carry out detailed and careful surgery such as amputations. Operations had to be done as quickly as possible, and only problems on the surface of the body such as tumours or amputations could be attempted.
A number of gases were tried
The first gas to be tried was Nitrous Oxide, discovered by Humphrey Davy in 1799. This was not adopted however as it was only effective on some patients, as was displayed in the failed attempt by Horace Wells to display its effectiveness at a public lecture in Boston, USA in 1845.
The second gas to be tried was Ether. Although this was effectively demonstrated in 1846 by John Warren at the same Boston hospital, it was an unpleasant gas that was flammable and irritated the lungs of those who inhaled it.
The search was still on for a safe but effective gas
The final breakthrough came in 1847 when the Scottish Doctor James Simpson discovered the effectiveness of Chloroform. Simpson was a Professor of Midwifery in Edinburgh, and wanted an anaesthetic for his patients. Although there was much initial opposition to his discovery, he had found an effective and safe anaesthetic that removed pain and allowed operations to be completed over longer periods of time.
The next developments came in antiseptics
Patients died after operations from the spread of germs
Even if a patient survived an operation without anaesthetic in 1800 they were just as likely to die from an infection later. There was no attempt to keep cleanliness in hospitals, and with no knowledge of germ theory doctors and nurses saw no reason to do this. Until infection could be stopped the development of anaesthetics was of little value.
The work of Ignaz Semmelweiss was the first success at stopping the spread of infection
Ignaz Semmelweiss was a Hungarian doctor working in Vienna Hospital in the 1840s. He was appalled to see that women were dying in huge numbers after childbirth from an infectious disease (Puerperal Fever). Semmelweiss believed that doctors examining the women were spreading the disease on their unwashed hands after dissecting the corpses of women who had died of the fever. He successfully cut the death rate by ordering doctors entering his ward to wash their hand in a solution of chloride of lime. This was an effective antiseptic and killed the bacteria. However Semmelweiss could not prove this, as Pasteur's Germ Theory was not discovered for another 20 years. His ideas were dropped when he left Vienna Hospital in 1848 and the death rates rose again.
The work of Joseph Lister revolutionised surgery
The cause of the spread of infection after surgery was shown to be germs by the English Doctor Joseph Lister in 1867. He used his scientific skills to analyse Pasteur's work on Germ Theory and developed a Carbolic Acid spray which filled the air with the chemical and killed all the germs in the operating theatre. Although it was unpleasant for surgeons, he cut the death rate in his Glasgow hospital from 46% to 15% in 3 years. With Lister's Carbolic Acid surgeons were able to perform safe surgery where their patient would not die of infection afterwards.
Aseptic Surgery took Lister's ideas one step further
Although effective, Carbolic Acid was unpopular because it was damaging to doctors' skin and lungs. This problem was overcome through the combined efforts of the Germans Professor Neuber and Ernst Bergman, and the American William Halstead. Neuber and Bergman insisted that all surgeons' clothes, hands and instruments were sterilised before use. Halstead developed rubber gloves for all doctors and nurses to wear to avoid contact and spread of germs to patients. This removed all germs from the operating theatre.
So by 1889 surgeons could operate without the risk of infection to their patients either by following Lister's use of Carbolic Acid as an anaesthetic, or by using the new technique of Aseptic surgery.
The final problem of blood loss remained to be solved
Even if patients felt no pain and were protected from infection, their blood could not be replaced
Blood transfusions were tried in the 19th century, but normally failed. This was because surgeons and doctors did not know about blood groups. Therefore patients rejected a donor's blood, and usually died from the reaction to it.
Blood groups were discovered in 1900
A German doctor named Karl Landsteiner discovered the different blood groups in 1900. Once this was done it was possible for doctors to make sure they did not give a patient the wrong blood and kill him. However there was no effective way of storing blood so a donor had to be in the same room as the patient. This reduced the viability of the procedure.
Sodium Citrate overcame this problem
During World War I the demand for blood transfusions was huge. British doctors developed the chemical Sodium Citrate. This stopped blood from clotting when it came into contact with air. With this new chemical blood could now be stored and given to a patient away from a donor. This meant that patients could be given blood transfusion during surgery as required.
By 1920 Surgeons were able to overcome all of the problems they had faced in 1800. With effective anaesthetics they could take time and care over operations. They were also able to carry out procedures inside the body that had never been possible before. With the developments of antiseptics and asepsis surgeons could keep their patients safe from infection, and so increase survival rates. With the development of blood transfusions, surgeons could replace blood lost during surgery and so complete more dangerous and complex procedures.