This activity, by Andy Harmsworth, helps students to get to grips with the surgery strand of SHP’s development study of medicine. You and your students carry out a short classroom simulation of a surgical operation at the beginning of the 19 th century. The activity is used after studying the development of surgery before 1800. It provides a lively and memorable introduction to a series of lessons on the development of modern surgery. Specifically, the activity and follow-up discussion help pupils to understand:

• the main features of surgical operations in about 1800
• why surgery was so dangerous at the time
• that surgeons were concerned about their patients’ welfare
• why surgeons in 1800 were able to do so little to deal with the problems of pain, infection and blood loss
• how much progress has taken place in surgery in the last 200 years

Simulations can be a highly effective way of engaging interest, developing understanding, generating questions and aiding longer-term recall by presenting information in a lively, entertaining and dramatic way. Have fun!

To download this enquiry as a Word document [ click here ].

Preparation

You will need to bring to the lesson:

• A dirty science lab-coat splattered with red ink or paint
• A selection of old tools (saws, hammers, wrenches, chisels)
• A belt
• An empty bottle labelled ‘Gin’
• Several lengths of cotton, about 15cm long
• A box, shaped like a book, with ‘Pare’s Works on Surgery, 1576’ written on the front

You will need in your classroom:

• A table, large enough for a pupil to lie on
• A waste bin, placed at one end of the table (or, even better, a ‘bloodstained’ bucket!)

How to set up the ‘operation’

When your class is settled, put on your lab-coat and carefully place your ‘surgical equipment’ on the table. Say nothing at this stage and ignore any comments from the pupils. Then introduce yourself to the class (I use the name ‘Professor Blood’n’Guts’). Welcome them to your operating ‘theatre’ and tell them that it is the year 1800.

Now describe your operating room: it is a barn, there is straw on the floor and some animals in the corner. Tell them that ‘surgery is a dirty business’ - you wouldn’t want to carry it out in your front room!

Select your ‘patient’ or ask for a volunteer. Bring the student towards the operating table and explain the nature of his/her injury: (s)he broke her leg two weeks ago in a farming accident, infection has set in and now you need to amputate the leg above the knee.

Now tell the class (and your ‘patient’) a bit more about yourself:

• You are one of the most highly regarded surgeons in the county
• You have read all the books about surgery, like Pare’s work (proudly show them your copy of Pare’s book)
• You are the fastest surgeon in the area and so the safest - you have amputated a limb in 2½ minutes!
• Speed is essential, the only way of reducing pain. You only operate when absolutely necessary.
• Your success rate for amputations is second to none: about 1 in 10 of your patients survive!
• Pointing to your lab-coat and ‘instruments’, remind everyone that surgery is a dirty business.

Now get your ‘patient’ to lie, face up, on your ‘operating table’. Tell him/her and the class that patients go through agony during an amputation and that you have heard:

• that some surgeons use opium to dull the pain and others (wielding a hammer menacingly above your victim) knock out their patients
• that a chemist called Sir Humphrey Davy says that nitrous oxide (laughing gas) can eliminate pain during operations ; but he isn’t a surgeon, so what does he know? Some surgeons say it only helps a little – and sometimes not at all.

Tell them that for now you have to believe in gin and the Almighty!

• ‘administer’ the gin
• get a group of students to be singers from the local church choir and sing a hymn during the operation (I always suggest ‘Onward Christian Soldiers’ even though it wasn’t written until the later 19 th century)
• choose another student to say a short prayer before the operation begins

Ask another four students to act as ‘strong lads from the local farm’ to hold down the patient during the operation – and position themselves around the table.

Finally, boast again about your speed to save the patient pain and ask a student to time the operation on an ‘18 th century’ digital watch or mobile phone (students should appreciate the anachronism!).

Now everything is ready!

How to carry out the ‘operation’

Fix the belt around the patient’s leg above the knee like a tourniquet, (pretend to) spit on your hands, cough, splutter and wipe your nose (you have a bad cold!) before picking up the saw. Quietly remind the patient to scream and writhe about during the operation, get the ‘strong lads’ to start holding the patient down, get the student to say the prayer, make sure the church choir and time-keeper are ready ....

Go!

Spend about 2½ minutes pretending to saw through the patient’s leg. Tell the class when you’re sawing through flesh and when you’re sawing through bone; use the biggest saw for the bone. Include a few coughs and sneezes! Playing a sound recording of a saw cutting through wood would provide some extra grisly realism! Finally try to drop something into the bucket to simulate the amputated limb falling off.

Tell the time-keeper to stop timing, but keep working frantically to tie up the blood vessels with the cotton threads (representing Pare’s silk ligatures) – and tell the class what you are doing.

Now ask the time-keeper how long the operation lasted. Show immense pride when you are told!

Finally, get your ‘strong lads’ to help the patient to get off the table and to help him/her home. Tell the patient that you will need to see him/her again in a few days. If the infection has continued to spread, you will have to amputate again higher up the leg - but you’ve never done that successfully!

Follow-up discussion

Returning to ‘teacher-mode’, remind your students that the operation was set in 1800. Tell them that the details would not have been very different if it had been set in the Roman period or the Middle Ages. Abler students will be able to detect that the biggest difference was the earlier use of the cautery iron to seal blood vessels.

Discuss the following issues with your students:

• What methods were used at the time to deal with patients’ pain?
• What methods were used to reduce blood loss?
• Was anything done to reduce the risk of infection?
• Why were operations 200 years ago so dangerous?
• Why were operations carried out in such unhygienic conditions?
• What was the surgeon’s attitude to operations without anaesthetic?

Now show your students some photographs of a surgical operation in a modern operating theatre (there are plenty available in textbooks and on the internet). Use them, together with students’ own knowledge (from their own experiences, their science lessons and TV series like ‘Casualty’) to discuss the following issues:

• What do surgeons do today to eliminate pain?
• What do they do to minimise blood loss?
• What do they do to reduce the risk of infection?
• What kinds of operation do surgeons carry out today which would have been impossible 200 years ago?
• How much progress in surgery has there been since 1800?

Students could now brainstorm a list of questions they would like to find answers to in their study of Surgery since 1800, for which this simulation has been hopefully whetted their appetite.