1. Transformation of surgery revision

2. Dealing with pain BREAKTHROUGH NUMBER 1
Before anaesthetics it was difficult to operate on a patient in pain, so operations had to be fast, simple and not involve going too deep into the body. The most common type of operation was amputations. However, this problem was solved by 1900.
BREAKTHROUGH NUMBER 1

3. The first anaesthetics
Nitrous oxide (or laughing gas) discoveries to have anaesthetic properties by Sir Humphrey Davy in some surgeons had some success with it and it reduced pain but did not knock them out, meaning that its impact was limited. In 1846, American surgeon named John Collins Warren used ether as an anaesthetic. It was bit better than laughing gas as made patient unconscious – famous British surgeon and showman Robert Liston used ether as amputation in However, ether was an irritant that caused coughing and sickness and also very liable to catch fire

4. James Simpson
Simpson, after inviting friends over who inhaled various chemicals (including chloroform), released chloroform was very effective anaesthetic and started using during an operation in 1847.
It become popular after Queen Vic used it during childbirth of her 8th in 1853
John Snow invented a special inhaler to regulate doses, which helped prevent heart problems some patients found affected them after using chloroform
Even though it was difficult to get dose right and some people died during surgery after being given too much, still enormous breakthrough – Simpson = 1st man to receive knighthood for his contribution to medicine

5. Why some people were opposed to the use of anaesthetics
Some devout Christians thought pain, particularly childbirth pain, was part of God’s plan for human beings – we are supposed to feel pain – some knew saw pain as a blessing. Queen Vic approval helped the public accept chloroform more willingly.
1848 – Hannah Greener died while given chloroform during operation to remove a toenail – 1st death from using chloroform scared surgeons
New anaesthetic encouraged surgeons to carry out more complex procedures and go deeper into the body but since problems of infection and blood loss not solved, not a good thing and in 1870’s the death rate from surgery reached a new high
Some doctors thought an unconscious patient was more lively to die than one who was awake and screaming blue murder

6. Dealing with infection
Following the development of anaesthetics, deaths from surgery increased. This was because surgeons did more and more complex operations but had not solved the problem of infection. In the 1980’s surgeons still had very little understanding of how germs spread and what causes gangrene and sepsis – both big killers of surgical patients. Even after the germ theory was published in 1861 it took 6 years to apply it to surgery and the treatment of patients. It was Joseph Lister who made the breakthrough and developed the first effective antiseptics and helped solve the problem of infection
BREAKTHROUGH NUMBER 2

7. Breakthroughs in dealing with infection before 1861
The way surgeons used to operate was pretty disgusting
Might have washed their hands in water (water itself may have carried infection)
The instruments, table and operating room would not have been cleaned
Surgeons usually wore their oldest oats as status symbol – covered in blood to show how experienced they were
Some people had made the link between cleanliness and better survival rate in hospitals.
Florence Nightingale ensured high standards of hygiene among her nurses and insisted that each hospital bed held only 1 patient. In 1846, Ignaz Semmelweiss had noticed that women who were attended by midwives when they gave birth for less likely to die from infection than those attended by med students. This did not make sense, so he followed students who attended birth straight from dissecting dead people. So Semmelweiss put bowls of chlorinated water all around the hospital and insisted that med students wash their hand, infection rate fell dramatically. People thought he was weird, because he could not explain why it helped. Also, chlorine was really smells. Semmelweiss was eventually sacked, However, some surgeons copied his ideas – James Simpson .

8. Joseph Lister
Joseph Lister discovered that carbolic acid reduced infection, he championed antiseptic conditions in surgery.
Lister = surgeon, who read a lot if medical books, always wondered what caused infection and read Pasteur’s Germ Theory (published 1861)- thought a lot about it, trying to work out how to lower the rate of infection suffered by his patients
Got the ideas from the use of carbolic acid in treating sewage, it was used to kill parasites at sewage works
He tested it on a child 1st with a broken leg, the carbolic-soaks bandages meant that the wound, though very bad, healed cleanly within 6 weeks
Excited about his success, Lister started washing his equipment in carbolic acid, and treating air around patient during operation with carbolic spray
Death rate following operation dramatically fell – in 1867, he was vale to announce that no one in his wards had died from blood poisoning in 9 months
He went on to introduce catgut , could be sterilised to stitch wounded instead of silk, which could not be sterilised - He developed a type of catgut which dissolved in the body dater a few days and didn’t have to be removed
Sort of a practical application of new ideas

9. How did Lister change surgery?
Other surgeons = critical of JL’s development, didn’t like smelly, corrosive carbolic acid ad they didn’t believe it would help
However, Lister’s methods changed surgery
By 1890’s antiseptic surgery was coming, eventually developing into aseptic surgery, where germs were removed from operating theatre, rather than the wound
Over coming decades, hospitals became spotlessly clean; instruments were sterilised in boiling water r steam, sterile clothing, face masks and rubber gloves introduced

10. Dealing with blood loss
By the end of the 19th century, blood loss was only major barrier left to successfully surgery. Surgeons had to careful that the patient didn’t lose too much blood during an operations, unable to replace it. Blood transfusions had been successful in past, but also failed sometimes for no apparent reason, which meant not be relied upon. Then in 1900, Karl Landsteiner discovered the blood groups, which made person-to-person blood transfusions possible. Once the technology was created to store blood, the issue of blood loss had been solved.
BREAKTHROUGH NUMBER 3

11. Preventing blood loss before 1900
Early surgeons prevented blood loss by using a methods sometimes used today – cauterisation – blood vessels sealed shut by burning – Renaissance doctors used hot iron bars/ pouring hot oil over wound
16th century French surgeon, Paré started to treat his patients by clipping off blood vessels with metal clips / trying to shut with silk thread called ligatures – not successfully, more infection, step in right direction
Lister later developed on Paré’s idea by using catgut, be sterilised more effectively
Still no way of replacing blood that had been lost, surgeons reduced applying a tourniquet / clamp to reduce blood flow to area being operated on - had to work fast to avoid patient losing too much blood

12. Early experiments in blood transfusions
After Harvey proved blood circulated blood around body, other physicians started to attempt transfusions
Earliest between sheep and humans and were in some cases successful – only tiny amount of blood transfusions
Other animals to persons transfusions caused death and practice was made illegal in Britain in 1670
American doctor, Philip Syng Physick performed a successful human to human transfusion in 1795 and British doctor James Blundell, gave blood transfusions to 10 people between and 1830 – although ½ ended in death - know today due to mismatching the blood groups

13. Blood groups and the development of blood transfusions
In 1900, Austrian doctor Karl Landsteiner showed that there are diff. blood types, and they were incompatible with each other – because off diff. antibodies in blood group reacted wit each other - why some transfusions failed
Landsteiner’s work made transfusions possible, in 1907 in New York doctor, Reuben Ottenberg preformed 1st successful transfusion using blood typing
There was a problem – blood clotted when stored outside the body, meaning the patient and person giving blood had to be together for the transfusion to take place

14. Blood banks
Person-to-person transfusions were fine, not really possible in wartime on the battlefield – when WW1 broke out and soldiers were dying of wounds in Europe, scientists stepped up their research for way to blood to be stored for later use
In 1914, a doctor form Belgium found that sodium citrate stopped blood from clotting - other experimented with it until process was perfect and blood could be stored for several days after being removed from donor
Then process developed for separated the blood cells from actual blood - these could be stored, packed with ice and diluted with saline to create usable blood – making transfusions possible for 1000’s of soldiers wounded on the front lines
British set up blood banks for use during the war, 1st blood depot set up in carried only blood type O which can be safely be given to other patients regardless of their own blood type

15. Factoring influencing developments in surgery

16. The impact of WW1 on the development of surgery.
Deep wounds from shrapnel led to surgeons developing the use of saline to fight infection
Surgeons had to improvise – leading to rapid developments
1st attempts at brain surgery happened at this time
New weapons created new types of wounds.
The impact of WW1
Surgeons had to treat lots of casualties in temporary operating theatres on battlefield, with bad conditions.
Surgeons gained lot of experience very quickly
Surgeons had to work with wide variety of wounds, meaning their training was broader
Plastic surgery was developed to tackle disfiguring injuries

17. The impact of communication on the development of surgery
Many surgeons took careful notes and encouraged people to take and publish photographs – Lister recorded the impact of his use of carbolic acid over several years , helping him to prove he was right
More scientists were publishing their ideas sharing good practice and new ideas with doctors and surgeons -medical journals like Lancet started to appear in 19th century where surgeons could write their methods and success rates, encouraging succession of ideas among doctors
Medical conferences started to take place, surgeons attended lectures given by other surgeons, Lister presented his work to Pasteur and 2500 other scientists n Paris in 1892
Newspapers reported notable operations, such a when Queen Victoria used chloroform during childbirth and when King Edward VII and his appendix removed

18. The impact of science and technology on the development of surgery
Developments in anaesthetics, antiseptic and the storage of blood for transfusions was greatly assisted by the study of chemistry
Development of bacteriology, new science, helped doctors to understand what caused disease and infection, in turn helping them to fight it
X rays, developed after 1895, made it possible for surgeons to have a look inside the patient before operating
Mechanism for spraying carbolic acid and the steam steriliser both helped them to keep germs out of surgery, lowering infection rate
Hypodermic needles invented in 1853 were useful in administering a measured dose of a drug, later used in blood transfusions

19. Exam technique

20. Question 1 Question one. - inferences from a source - 6 marks
Go beyond the obvious clues and explain what you can learn, but still back up with reference to the source
Stick to the focus of the question (don't waste time saying the source is reliable etc. - you won't get any marks for it here!)
Try to stick to one paragraph only
Practice by highlighting words or phrases which suggest inferences as you read a source ( if its a visual source, draw lines out from the details which you can use)
Try writing the inference and then support it with a word or phrase from the source.
Remember you need to make two supported inferences to achieve full marks!

21. Question 2 Question two - portrayal (source analysis) - 8 marks
Go beyond the obvious clues and explain how the artist/writer is aiming to create a certain impression - by what they put in and by how they describe it - certain words, colours or expressions.
Revise the two types of this question

22. Question 3 Question 3 - cross-referencing sources - 10 marks
Compare what is being said in the sources and reach a judgement as to how far they are saying the same thing (similarities)
Show support on how far they agree with each other
Challenge how far they differ in what they suggest
Reliabilities!!
Answer plan;
what the first source says.
- 'in some ways source......supports source '
- 'however in some ways source...does not support source...'
- 'in conclusion, source.....completely/mostly/partly/does not really support source......because....'
EXPLAIN USING DIRECT QUOTES!

23. Question 4
Question 4 - evaluating the usefulness of sources - 10 marks
•You need to think about BOTH the information in the source (how relevant it is to the question) and also the type of source it is (how reliable/accurate that information is)
Answer plan;
- In some ways source.....is useful (what's good about the info + the type of source)
- However source......also has limitations (what's left out from the info +
what's bad about this type of source)
- Repeat for second source
- In conclusion......(you must make a decision which is more useful and say why)

24. Question 5
Question 5 - using sources to reach a judgement - 16 marks •Use the sources and your own knowledge to evaluate an interpretation or point of view. Before you start, go through the sources and put a tick or cross in the margin where you find details that support or contradict the information.
Answer plan; - In some ways i agree with this statement. - Use sources AND your own knowledge to explain why you agree. Use PEE*. make sure you explain exactly HOW what you've said means you agree with the statement. - However in some ways i disagree with this statement. - Use sources AND your own knowledge to explain why you disagree. Use PEE*. make sure you explain exactly HOW what you've said means you disagree with the statement. - In conclusion i think... make sure you're clear exactly which source each quote comes from! *PEE = point, evidence, explain