Lesson video

Hello, I'm Mr. Marchant, and thank you for joining me for today's history lesson.

I'll be guiding you through all of our resources today.

And my top priority is to make sure that by the end of our lesson, you are able to successfully meet our learning objective.

By the end of today's lesson, you'll be able to explain the impact of surgical developments to manage blood loss, pain, and infection during the 19th century.

There are four key words which will help us navigate our way through today's lesson.

Those are invasive, transfusion, anaesthetic, and sterilise.

Invasive in this context refers to medical treatments which involve cutting into the body.

A transfusion is the process of adding an amount of blood to a person's body.

Anaesthetic is a substance that makes you unable to feel pain.

And sterilising something means to make it free from microbes.

Today's lesson will be split into three parts.

And we'll begin by focusing on attempts to manage pain and blood loss.

At the start of the 19th century, surgery still faced three major problems, pain, blood loss, and infection.

New developments during the first half of the century helped make some progress in the management of both pain and blood loss.

As surgeries are invasive procedures, they often involve blood loss.

This was a major challenge as it risked sending patients into shock, a potentially fatal condition.

In the early 19th century, the physician James Blundell worked to overcome this problem by experimenting with blood transfusions.

Between 1818 and 1829, Blundell conducted the first successful transfusions of human blood and reported successes in 50% of his cases.

Some surgeons did follow Blundell's lead and conducted their own blood transfusions.

However, while some experiments had been successful, Blundell and other doctors in the 19th century had no knowledge of blood groups.

This was important because it meant that when transfusions were attempted, patients were not always provided with blood which their body could accept.

Subsequently, many patients who received blood transfusions, including half of Blundell's still died.

For this reason, most surgeons considered transfusions quite risky and avoided conducting them during the 19th century.

So let's reflect on what we've just had.

What was James Blundell the first person to perform? Was it a successful blood transfusion, a successful organ transplant, or a successful leg amputation? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said the correct answer was A.

James Blundell was the first person to perform a successful blood transfusion, which he did between 1818 and 1829.

And this time we have a statement on the screen which reads, blood transfusions became widespread in surgery by the end of the 19th century.

But is that statement true or false? Pause video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said that that statement was false.

But we need to be able to justify our response.

So why is it that that original statement was incorrect? Pause video here and press play when you're ready to check your answer.

Okay.

And well done to everybody who said a lack of knowledge of blood groups meant many blood transfusions failed so most surgeons preferred to avoid the procedure.

Prior to the 19th century, many efforts had been made to manage pain during surgeries.

But this had often involved the use of unreliable anaesthetics such as opium.

In the 19th century, increasing attention was given to the use of chemicals as anaesthetics.

During the 1840s, successful experiments with ether led to it becoming a popular anaesthetic.

However, whilst ether did manage pain, it came with other problems. For one, ether often caused discomfort for patients after their surgeries causing both sore throats and vomiting.

Furthermore, ether is highly flammable, which makes it difficult to store safely.

This situation improved in 1847 when the physician James Simpson discovered that chloroform could be used as an anaesthetic.

Unlike ether, chloroform was safe to store and did not create discomfort for patients.

Initially, there was opposition to the use of chloroform, especially after one patient Hannah Greener died after being given too much during a small surgery.

Nevertheless, this opposition was overcome during the 1850s.

For one, John Snow developed a chloroform inhaler, which allowed surgeons to safely control the amount of chloroform a patient was given.

Furthermore, in 1853, Queen Victoria agreed to use chloroform whilst giving birth.

The birth was conducted without complication, and as Victoria praised the benefits of chloroform, many more members of the public felt reassured that the anaesthetic was both safe and effective.

So thinking about what we've just heard, I want you to identify two problems for using ether as an anaesthetic.

The possible problems you can choose from are, that ether is highly flammable, that many patients died from overdoses, that patients still felt pain, or that some patients felt discomfort afterwards.

Remember, you need to identify two problems from those options.

So pause the video here and press play when you're ready to see the right answers.

Okay, and well done to everybody who said that the correct answers were A and D.

One problem of the use of ether as an anaesthetic was that it was highly flammable, so it was difficult for doctors and surgeons to store.

Additionally, some patients felt discomfort afterwards when they'd received ether during an operation.

And let's check our knowledge in a slightly different way.

I want you to change one word to correct the following sentence.

In 1847, James Simpson discovered that opium could be used as a safe and effective anaesthetic.

So consider which word appears to be incorrect and what should it be changed to? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said that the incorrect word was opium and that that should have been changed to chloroform.

In 1847, James Simpson discovered that chloroform could be used as a safe and effective anaesthetic.

Let's try one more question.

Which two individuals helped to overcome opposition to chloroform in the 1850s? Was it James Blundell, James Simpson, John Snow, or Queen Victoria? Remember, you need to select two of those options as part of your answer.

So pause the video here and press play when you're ready to see the right answers.

Okay, well done to everybody who said that the correct answers were C and D.

John Snow helped to overcome opposition to chloroform by developing an inhaler, which meant that doctors and surgeons could safely control the amount of chloroform given to patients.

Queen Victoria accepted the use of chloroform whilst giving birth and praised chloroform after the delivery.

This helped encourage many other people to feel safe and comfortable with the use of ether.

So we are now in a good position to put all of our knowledge about managing pain and blood loss into practise.

I want you to complete the table by filling in the missing information for each surgical development.

So in each row, you might need to identify what surgical development is being referred to, what problem of surgery it was supposed to be a solution for, what its benefits were, or what problems might have been associated with it.

So pause the video here and press play when you're ready to check your answers.

Okay, well done for all of your effort on that task.

So I asked you to complete the table by filling in the missing information for each surgical development.

And your answers may have included for the use of ether that that was intended to be a solution to the problem of pain.

And that a benefit of it was that ether was an effective anaesthetic.

In our second row, the surgical development, which was being referred to was the use of chloroform.

But a problem with the use of chloroform was that it faced initial opposition due to worries about its safety and effectiveness.

And then on our final row, the surgical development being referred to was the use of blood transfusions.

A problem in the 19th century associated with blood transfusions was that there was no knowledge of blood groups so many transfusions failed.

So really well done if your own responses look something like those answers which we've just seen.

And now we're ready to move on to the second part of our lesson for today where we are going to focus on infections and 19th century surgery.

Developments in managing pain and blood loss during the first half of the 19th century were important.

However, infection remained a major problem in surgery at this time.

In fact, improvements in managing pain actually helped to make the threat posed by infection even greater.

Infection posed a severe danger to patients in the early 19th century.

In no small part, this was because surgeons and physicians had no knowledge of the role microbes played in causing disease.

As a result, little effort was put into avoiding unsanitary conditions and practises.

For instance, many surgeons used unwashed equipment and wore ordinary clothes which they had not changed before operating.

Surgeries also tended to involve many people, including observers and dressers who held down patients that were in pain.

All of these practises increased the risk that microbes would infect a patient's wounds.

The problem of infection actually began to worsen in the middle of the 19th century, whereas a patient's pain had encouraged surgeons to restrict operations to quick and limited procedures.

The use of anaesthetics like chloroform encouraged surgeons to perform lengthier and more invasive surgeries.

However, these more invasive surgeries meant that patients were left even more exposed to harmful microbes when they were operated on.

So the risk of infection became even greater than it had been.

So let's reflect on everything we've just heard and make sure our knowledge is secure.

I want you to write the missing word from the following sentence.

In part, surgical conditions were often unsanitary because the role of blank in causing infections was not understood.

So what's the missing word? Pause the video here and press play when you're ready to check your answer.

Okay, well done to everybody who said that the missing word was microbes.

In part, surgical conditions were often unsanitary because the role of microbes in causing infections was not understood.

And now I want you to study the image shown on the screen.

It's a painting of a surgery in 1800.

I want you to identify one way in which the painting shows unsanitary conditions during surgery.

So pause the video here and press play when you're ready to check your answer.

Okay, well done to anybody who identified that we can see people wearing ordinary clothes in the image.

This would increase the risk that microbes might be brought into an operating theatre and infect a patient's wounds.

Similarly, we can see many people present in the image.

That also increase the risk that microbes be brought into an operating theatre and allow to infect a patient's wounds.

And let's write a slightly different approach to checking our knowledge.

This time we have a statement on the screen which reads, improvements in anaesthetics made infection a greater problem in surgery.

But is that statement true or false? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said that that statement was true.

But we to be able to justify our response.

So why is it that that original statement was correct? Pause the video here and press play when you're ready to check your answer.

Okay, well done to everybody who said with more effective anaesthetics, surgeons began to attempt lengthier and more invasive surgeries.

These left patients more exposed to disease-causing microbes.

So we're now in a good position to put all of our knowledge of infections and 19th century surgery into practise.

So I want you to answer the following question.

Why was infections such a serious issue in surgeries by the mid-19th century? You may consider medical knowledge at the time and surgical practises at the time.

So pause the video here and press play when you're ready to reflect on your response.

Okay, well done for all of your hard work on that task.

So I asked you, why was infection such a serious issue in surgeries by the mid-19th century? And your answer may have included.

One reason why infection was such a major problem in surgery was because there was no knowledge that microbes could cause disease.

As a result, unsanitary conditions, which made it easier for microbes to infect patient's wounds were usually accepted.

For instance, surgeries often involved many different people including observers and dressers.

Furthermore, the use of effective anaesthetics after the 1840s encouraged surgeons to attempt lengthier and more invasive surgeries.

However, these more complex procedures left patients more exposed to harmful microbes so many patients developed infections.

So really well done if your own response looks something like that model which we've just seen.

And so now we're ready to move on to the third and final part of our lesson for today, where we are going to think about antiseptic and aseptic surgery.

In the second half of the 19th century, new approaches to surgery led to significant improvements in the management of infections.

These new approaches consisted of antiseptic surgery and aseptic surgery.

Antiseptic surgery was pioneered by the surgeon Joseph Lister in the 1860s.

This method focused on sterilising a patient's wounds during and after a surgery.

Lister was inspired by Louis Pasteur's germ theory, which suggested that microbes could be responsible for disease.

Lister began his antiseptic experiments by soaking bandages in a carbolic acid before applying these to any wounds.

He hoped that this would kill any microbes which were present.

These initial experiments proved successful as Lister found that his patients wounds healed cleanly without infection.

Building on this success, Lister began to apply his methods to the operating room.

He developed a carbolic acid spray, which would be sprayed from a pump at the side of the operating table.

This sterilised the air and equipment in the room, killing any microbes which were present.

The records Lister kept demonstrated how successful his new antiseptic methods were.

Death rates during his surgeries fell from 40% before he began using carbolic acid to just 15% afterwards.

So let's make sure we've understood everything we just had.

Who pioneered the use of antiseptic surgery? Was it James Simpson, John Snow, or Joseph Lister? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said that the correct answer was C.

Joseph Lister pioneered the use of antiseptic surgery.

And now I want you to write the missing keyword from the following sentence.

Antiseptic surgery aimed to blank patient's wounds, during and after surgeries.

So what's the missing key word? Pause the video here and press play when you're ready to check your answer.

Okay, well done to everybody who said that the missing word was sterilise.

Antiseptic surgery aimed to sterilise patient's wounds, during and after surgeries.

And let's try one more question.

How did the use of carbolic acid affect death rates in Joseph Lister's surgeries? Was it that they almost halved, that they decreased by more than half, or that they almost doubled? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said the correct answer was B.

Joseph Lister's use of carbolic acid more than halved the death rates he saw in his surgeries, which fell from 40% before he began using carbolic acid to 15% afterwards.

Although Lister's use of carbolic acid as an antiseptic was effective, his methods faced considerable opposition.

For one, when Lister first began to share his findings, many scientists and medics had not yet accepted germ theory.

Because the science which informed Lister's work was not fully accepted, his methods were also avoided by many other surgeons.

Furthermore, some were reluctant to use carbolic acid as they complained it was unpleasant, irritating their eyes, and drying out the skin on their hands.

Nevertheless, as evidence proving the effectiveness of antiseptic methods grew, and as germ theory became more widely accepted in Britain, the importance of Lister's work began to earn more recognition.

By 1895, Lister had even become president of the Royal Society.

In fact, Lister's work encouraged surgeons to invest increasing amounts of effort into preventing infection.

By the end of the 1890s, this had led surgeons to begin adopting aseptic methods for operations.

Aseptic surgery attempted to prevent infections by ensuring that all people and things in a surgical environment were sterilised before an operation.

For instance, surgeons began washing their hands carefully, wearing rubber gloves, surgical gowns, and face masks, and steam cleaned their equipment before performing operations.

These were all examples of aseptic surgery in use.

So let's check our understanding.

We have a statement on the screen which reads, Lister's use of carbolic acid was accepted almost immediately by most of the surgeons.

But is that statement true or false? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said that that statement was false.

But we need to be able to justify our response.

So why is it that that original statement was incorrect? Pause the video here and press play when you're ready to check your answer.

Okay, well done to everybody who said many surgeons were reluctant to follow Lister's antiseptic methods, both because the science behind it was still debated and also because carbolic acid could be unpleasant to use.

Okay, and now I want you to study the image that you can see on the screen.

Identify one way in which the image demonstrates aseptic surgery being practised.

So think about the details which you can see.

Pause video here and press play when you're ready to check your answer.

Okay, well done yo everybody who identified one of the following details in the image.

That rubber gloves are being worn, that face coverings are being worn, and that surgical gowns are being worn by the people present.

All of this was intended to try and ensure that the surgical environment was sterilised before an operation took place.

So we are now in a good position to put all of our knowledge about antiseptic and aseptic surgery into practise.

I want you to explain two reasons why Joseph Lister's work was important for improvements in 19th century surgery.

You may consider the direct impact of Lister's work and the longer term benefits of Lister's work.

So pause the video here and press play when you're ready to reflect on your response.

Okay, well done for all of your effort on that task.

So I asked you to explain two reasons why Joseph Lister's work was important for improvements in 19th century surgery.

And your answer may have included.

One reason why Joseph Lister's work was important was because he demonstrated that antiseptic methods could help prevent infections, a major problem of 19th century surgery.

In the 1860s, Lister began using carbolic acid to soak bandages and as a spray during operations.

Lister's aim was to sterilise the wounds of his patients in order to prevent infections.

The result of these experiments demonstrated their effectiveness.

Death rates in Lister's surgeries dropped from 40% before he began using carbolic acid as an antiseptic to just 15% afterwards.

Another reason why Lister's work was important was because it encouraged surgeons to put more effort into preventing infection.

In the long term, this helped lead to the development of aseptic surgery.

Aseptic surgery focused on preventing infection by ensuring that surgical environments were sterilised before operations took place.

For instance, by the end of the 1890s, many surgeons wore face masks and rubber gloves during operations and used equipment which had been steam cleaned beforehand to kill any microbes.

This reduced the chance of microbes being introduced to wounds in the first place and enhanced the work started by Lister to prevent infections.

So really well done if the reasons you identified were similar to those which we've just seen in our model answers.

And so now we've reached the end of today's lesson, which puts us in a good position to summarise our learning about the revolution in 19th century surgery.

We've seen that chemicals like chloroform were used as effective anaesthetics during surgeries from the 1840s onwards.

Improved anaesthetics led to more invasive surgeries, which made infection a greater danger during the mid-19th century.

Joseph Lister used carbolic acid as an antiseptic to sterilise wounds.

Lister's methods face medical opposition due to debates over germ theory and practical issues with the use of carbolic acid.

And aseptic surgery was practised by the end of the 19th century, including the use of face masks and steam cleaning of equipment.

So really well done for all of your hard work during today's lesson.

It's been a pleasure to help guide you through our resources today.

And I look forward to seeing you again in the future as we continue to think about medicine in Britain and health and the people.