1. DEALING WITH PAIN:
The discovery of Anaesthetics Learning Objectives: 1) To understand why pain was such an issue for patients in the early-mid 19th century 2) To be able to identify the developments in pain relief from the mid 19th century

2. Overview:
Watch the following 7 part documentary about the development of anaesthetics.
You have a worksheet with 15 questions to complete whilst you are watching!

3. Check your answers:
Who was the quickest surgeon in London in the early nineteenth century? Robert Liston
How quickly could Liston remove a limb? 28 seconds
Why did surgeons prefer their patients to be awake during operations? So they could see they were still alive!
What substance was used firstly by Morton in the USA, then Liston in London in 1846? Ether
Which area of the body could now be operated on that had been almost impossible before an anaesthetic? The stomach
What were the problems of Ether? It made patients throw up the entire contents of their stomach, and was mildly explosive!

4. Check your answers:
7. What substance was discovered by Humphry Davy? Nitrous Oxide 8. What nickname was given to this substance? Laughing Gas 9. What type of medical procedure was used to test laughing gas? Dental Surgery 10. What substance did Simpson discover had anaesthetic qualities in 1847? Chloroform 11. Why did some doctors oppose the use of chloroform? What side effects did it cause? Lack of understanding about side effects, erotic dreams, caused women to behave inappropriately (swearing and flirting!)

5. Check your answers:
12. Who were the two ‘celebrity mum’s’ who chose to have a chloroform birth? Kate Dickens and Queen Victoria 13. Whose death in 1848 caused some to worry about the use of chloroform? Hannah Greener 14. What was the world’s first effective local anaesthetic agent? Cocaine 15. What was discovered in 1905? Novocaine

6. Surgery: Before anaesthetic
In the 19th Century the most common kind of surgical procedure was amputation.
This means that either a leg or an arm had to be removed. This might sound odd to be ‘common’ – but Britain was experiencing an ‘Industrial Revolution’; a period of quick change which saw jobs and the workplace change in lots of ways.
New machinery in new factories came with large moving parts, often which spun very fast. As people (including children) adapted to these changes, accidents were common. Unfortunately - unlike today, the only “cure” for a severely damaged limb was to cut it off!

7. An ‘Amputation Set’ from the 19th Century:
Saw: To cut through bone
Knives: To cut through skin, flesh, muscles etc
Screw tourniquet – tied around a part of the body to put pressure on the blood vessel in order to prevent death from blood loss.

8. Limited surgery:
Apart from amputations, there was very little surgery in the 19th Century.
The lack of anaesthetic and ability to deal with blood loss made it impossible – patients were more likely to die of shock or infection.
Sometimes surgeons operated on ‘bladder stones’ – a common complaint which can be linked to poor diet. Small stones formed in the bladder causing severe pain, but because they were not too deep inside the body they could be removed with a surgical procedure: Either with a finger up the anus or forceps through the penis!

9. Exam Skills Practice: INFERENCE 6 mark question
Study Source A: What can you learn from source A about the nature of operations before the use of pain relief?

10. Source A: A painting of an amputation in the operating
theatre of the old St Thomas’ Hospital, London, around 1775.

11. What is inference?
Inference is the word used to describe what you can learn, or work out from a source – even though it is not actually written down or shown.
For example; the picture you have just seen does NOT show or tell you that the patient is in pain, but you can INFER (work out) from what you can see that he would be in pain.
Inference is also about working out what message the author or artist was trying to get across.
Think about 1) What has been shown 2) Whether anything is missing 3) what is the centre of attention within the source?

12. Exam Skills Practice: INFERENCE 6 mark question
Study Source A: What can you learn from source A about the nature of operations before the use of pain relief?
You have a copy of the question, source and mark scheme in front of you.
Stick your mark scheme in your book – it will be used to give you feedback.
You have 20 minutes to complete your answer.