10 The revolution in surgery 10.1 How have operations changed? Before Surgery in the early 19th century is dangerous and painful. There is no way to relieve the pain felt by patients during operations. Surgeons do not yet know how to control blood loss or infection, and operating theatres are dirty and dangerous places to be. Some surgeons superstitiously prefer to wear their ‘lucky’ coat in the operating theatre – a coat worn during a successful operation in the past. They do not wash their ‘lucky’ coat between operations in case this breaks their run of luck. The operating table is often blood-stained. The fl oor around it is sprinkled with sawdust to stop the surgeon from slipping on blood and other waste as he speeds around the table, carrying out his operation at breakneck speed! Surgery is usually a last resort, and the most common operations are amputations, which can be completed quickly. Robert Liston amputated a leg in two and a half minutes. Unfortunately, such was his haste that he cut off the patient’s testicles as well. Patients are lucky to survive operations without any harmful side effects. TIMELINE William Morton Joseph Lister pioneers Archibald McIndoe uses ether antiseptic surgery 1867 –70 develops plastic surgery AD 1800 AD 1820 AD 1840 AD 1860 AD 1880 AD 1900 AD 1900 AD 1920 AD 1940 AD 1960 AD 1980 AD 2000 James Simpson William Halsted introduces Christiaan Barnard performs the uses chloroform protective surgical clothing first heart transplant 116 OCR GCSE History A: Medicine Through Time After Modern operating theatres are clean and safe. State-of-the-art equipment helps surgeons to perform delicate and intricate operations using techniques like keyhole surgery. Some surgeons are experimenting with robotic parts to help them carry out operations. High- technology scanners enable surgeons to probe deep inside parts of the body. Surgeons today can carry out operations that could only have been dreamt of 40 to 50 years ago. Although the fi rst human heart transplant operation only took place in 1967, heart transplants are carried out quite frequently now. Transplants of other body organs are common. Many people agree to donate their organs when they die so that they can be used for transplants, helping other people to recover from illness and to stay alive. Some medical scientists hope that it will become possible to clone human organs for transplants. AcTiViTies 1 Look at the pictures. One shows an operation in about 1790. The other shows an operation in the early 21st century. What are the main similarities and differences between the two operations? Make a detailed list. This chapter will help you to Key Words understand the changes that brought about modern surgical techniques. Amputation – cutting off (all or part of a limb or 2 Some scientists want the government to change digit of the body) through surgery. the laws on organ donation to make it easier for Clone – to make an exact copy (a genetically identical doctors to obtain organs from patients who have copy) of cells or an organism. In recent years, scientists died in hospital. This is a controversial subject. have been able to clone animals such as sheep. What do you think are the arguments for and Keyhole surgery – operating through a very small against these proposed changes? You might incision, perhaps only a few centimetres in size. organise a class debate. TIMELINE William Morton Joseph Lister pioneers Archibald McIndoe uses ether antiseptic surgery 1867 –70 develops plastic surgery AD 1800 AD 1820 AD 1840 AD 1860 AD 1880 AD 1900 AD 1900 AD 1920 AD 1940 AD 1960 AD 1980 AD 2000 James Simpson William Halsted introduces Christiaan Barnard performs the uses chloroform protective surgical clothing first heart transplant The revolution in surgery 117 10.2 Developments in anaesthetics (1) LeArninG oBJecTiVes GeTTinG sTArTed In this lesson you will: What do you think surgery was like in the early 19th • fi nd out how the problem of pain in operations had century? From your knowledge of medicine at that started to be tackled by 1846 time, which four things do you think would have improved operations for patients and doctors? • check the reliability of sources as evidence for a particular enquiry. The problem of pain Key Words Surgeons had long had to face the problems of pain, infection and bleeding. This was still true in the early 19th century. There were no Anaesthetics – drugs given to effective anaesthetics. To help numb the pain during an operation, patients to prevent them feeling surgeons gave their patients drugs like opium and mandrake, or pain. There are two types. tried to get them drunk. A few surgeons used ‘mesmerism’ General anaesthetics are (hypnosis), hoping this would lead the patient to ignore the pain. usually inhaled and make the Surgery had to be quick. Deep internal operations were out of the patient unconscious. Local question. Most surgery was limited to removing growths or anaesthetics are usually injected amputating limbs. Even so, many patients died from the trauma of and have the effect of numbing the excruciating pain. the feeling in one particular part of the body, such as a tooth. During the late 18th century the science of chemistry had made some They do not make the patient progress. In 1772 Joseph Priestley (1733–1804), an English chemist, unconscious. discovered that oxygen was a gas. Other chemists were also investigating the properties of different substances. In 1799 Humphrey Davy (1778–1829) discovered that pain could be relieved by inhaling nitrous oxide (‘laughing gas’). SOURCE A He wrote a pamphlet saying that nitrous oxide might be successfully used by surgeons as an anaesthetic. The medical profession ignored his suggestion. AcTiViTies 1 What problems of surgery are shown in Source A? 2 How reliable is Source A? 3 Imagine you are a relative of the person having the operation. Write an entry in your diary describing what you see, hear and smell during the operation. A cartoon drawn by Thomas Rowlandson, showing an operation in 1793. 118 OCR GCSE History A: Medicine Through Time early successes Voice your opinion! During the early 1840s a number of experiments were made to fi nd an effective anaesthetic. In 1842 What impression does Source A give of operations in an American doctor, Crawford Long, found that the late 18th century? ether was a useful anaesthetic, but he did not publicly announce his discovery. SOURCE B On 10 December 1845 an American dentist, Horace Wells (1815–48), watched people inhaling nitrous oxide as an amusement at a fair. He noticed that, under the infl uence of the gas, they could injure themselves and feel no pain. The next day, Wells had a tooth painlessly taken out after inhaling the gas. He tried to demonstrate painless tooth extraction to some medical students at a hospital in Boston, USA. What he did not know was that some people are not affected by nitrous oxide. Wells’ volunteer yelled as the tooth was taken out and the students left the demonstration shouting ‘Humbug! Humbug!’ On 16 October 1846 William Thomas Green Morton (1819–68) persuaded Warren’s operation on Gilbert John Warren, the head surgeon at Boston Hospital, to carry out an Abbott, 16 October 1846, painted operation in public, using ether as an anaesthetic. Morton gave the ether by Robert Hinckely in 1882. through an inhaler to the patient, Gilbert Abbott. Then Warren removed a tumour painlessly from Abbott’s neck. Warren turned to his audience and announced, AcTiViTies ‘Gentlemen, this is no humbug!’ 4 Before the introduction of anaesthetics, operations News of Warren’s success spread quickly to tended to be simple and quick. The most common Europe. By 18 October, Dr Bigelow, who had seen operations performed were amputations. After the operation, had published an article about it. anaesthetics were introduced, the death rate during On 3 December a steamship carried a letter from operations increased at fi rst. Why do you think that was? Bigelow to Dr Boot in London. By 19 December Dr Boot had extracted a tooth using ether – and 5 Copy a chart like the one below to record the details had written an article about this. On 21 December you have learnt about the experiments people made the surgeon Robert Liston successfully amputated with anaesthetics. the leg of Frederick Churchill (a butler), using date event person(s) Was this work successful ether as an anaesthetic. Liston removed the leg in involved in tackling pain? 26 seconds! With the leg already on the fl oor, Churchill raised his head and asked Liston when he was going to begin the operation. GradeStudio Enquiry Examiner’s tip Study Source B. Questions like this will appear on Unit A951 and A952 of the examination. Such questions This is a painting require you to check how far you can trust the source to be accurate or truthful about the completed after events it represents. To do this well, you need to do these things: the event. Is it a i Check the content. Does it seem truthful? Is it exaggerated? Does it hide any facts? reliable source of Does the content match other information that you can fi nd about this operation from evidence for an other sources, or from your own knowledge? historian? Explain ii Look at the type of source it is and when it was produced. Source B is a painting your answer. produced 36 years after the event. Does this make it more or less reliable? iii Work out who produced the source. Can you fi nd out anything about the artist and why he painted the picture? Do your answers to these questions have a bearing on the reliability of the source? The revolution in surgery 119 10.3 Developments in anaesthetics (2) LeArninG oBJecTiVes GeTTinG sTArTed In this lesson you will: By 1846, the problems of • investigate how opposition to anaesthetics was overcome overcoming pain during operations had been solved.