The impact of war and technology on surgery

Model answer

Box X is the casualty clearing station. These were the first places near the front where major operations could be done, and surgeons there used X-ray machines and blood transfusions, including the stored blood first used at Cambrai in 1917.

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Source A is useful because it shows the kind of terrible facial injuries that the First World War produced. Trench warfare meant that soldiers' heads were exposed when they looked over the parapet, and shell fragments and bullets caused huge numbers of face wounds. It was injuries like the one in the drawing that led Gillies to set up a specialist unit at Aldershot in 1916; after the Battle of the Somme about 2,000 men arrived.

The provenance makes the drawing reliable. Tonks had trained as a surgeon, so he understood anatomy and could draw wounds accurately. The drawings were made as medical records for Gillies, not for the public or for propaganda, so there was no reason to hide or exaggerate the injuries. Pastel colours also showed the wounds more clearly than the black-and-white photographs of the time. The fact that an artist was part of the team is itself useful evidence, because it shows Gillies' methodical approach: surgeons, dentists, anaesthetists, photographers and artists worked together, and before-and-after records were used to plan and judge each operation.

However, the source has limits. It shows only one soldier, so it cannot show the scale of Gillies' work, which treated over 5,000 servicemen at the Queen's Hospital, Sidcup. It does not show the techniques that were developed, such as the tubed pedicle of 1917, or how many operations were needed. Nor does it show the result, or the stigma that some disfigured men faced afterwards.

Overall, Source A is useful for showing the injuries caused by the war and the careful, team-based methods of Gillies' unit, but less useful for showing the surgical techniques and their success, so it would need to be used with other evidence such as Gillies' own records.

Model answer

Source A is useful because it gives the basic facts of the first human heart transplant and shows the excitement it caused. Its details are accurate: Barnard's team in Cape Town replaced the diseased heart of Louis Washkansky, a 53-year-old grocer, with the heart of a young woman killed in a road accident, on 3 December 1967. Phrases such as 'the greatest operation of the century' show how the operation was seen as a breakthrough, because the heart had always been regarded as the centre of life. This helps explain why surgeons around the world rushed to copy it, with about 100 heart transplants attempted in 1968, including the first British one in May 1968.

However, the provenance limits its usefulness. It was written the day after the operation, relying on early reports from the hospital, so the journalist could not know what would happen. Washkansky died after only 18 days, of pneumonia, because the drugs used to stop rejection had weakened his immune system. As a newspaper aiming to sell copies, it is also sensational and over-optimistic: the claim that hearts could soon be replaced 'as easily as a worn-out part in a machine' was proved badly wrong. Most early transplant patients died within weeks or months, and in Britain heart transplants were stopped until Papworth resumed them in 1979.

The source also leaves out the wider development of transplant surgery. It does not mention earlier kidney transplants, the first successful one in 1954, or the problem of rejection, which was only overcome when ciclosporin came into use in the early 1980s.

Overall, Source A is useful for showing the moment of breakthrough and the public's optimistic reaction, but its date and purpose make it unreliable as a guide to how successful transplant surgery really was.

Model answer

The history of surgery is full of famous individuals, from Paré to Lister and Gillies, and their determination and skill have been very important. However, I will argue that individuals were not the main factor, because their achievements depended on science and technology and were often made possible by war or government.

In the medieval and early modern periods individuals made important but limited contributions. John of Arderne developed a successful operation for anal fistula and wrote it down in 1376, and in 1403 John Bradmore saved Prince Henry by removing an arrowhead from his face. In the sixteenth century Vesalius corrected Galen's anatomy and Paré used ligatures instead of cauterising and designed artificial limbs. These individuals showed skill and courage in challenging tradition, but the authority of another individual, Galen, together with the problems of pain and infection, meant that surgery changed slowly.

In the eighteenth and nineteenth centuries individuals made breakthroughs that transformed surgery. John Hunter brought an experimental, scientific approach to surgery and taught many surgeons. James Simpson discovered chloroform in 1847 and argued against religious objections to it, and Joseph Lister introduced antiseptic surgery from 1865, persisting despite opposition from other surgeons. Without their determination these advances might have been delayed.

In the twentieth century individuals were again important. Harold Gillies developed plastic surgery in the First World War, Archibald McIndoe transformed the treatment of burns in the Second, John Charnley developed the hip replacement in 1962 and Christiaan Barnard carried out the first heart transplant in 1967.

However, almost every one of these individuals depended on other factors. Lister's work was only possible because of Pasteur's germ theory and the chemical carbolic acid; Simpson built on the chemistry that had produced ether. Gillies and McIndoe developed their methods because war produced thousands of patients with terrible injuries, and Paré too was an army surgeon. Barnard's operation only became truly successful when the anti-rejection drug ciclosporin was developed in the 1980s. Government also mattered: the Anatomy Act of 1832 allowed surgeons to study anatomy legally, and the NHS from 1948 paid for transplants and new technology. Chance played a part, as when Roentgen discovered X-rays in 1895, and communication spread individuals' ideas, through printed books and journals such as The Lancet. In modern surgery, developments such as keyhole surgery, which depended on Harold Hopkins' fibre optics and video cameras, are the work of teams, engineers and companies as much as individual surgeons.

In conclusion, individuals have played a vital role in surgery, because someone had to have the vision to try a new method and the determination to persuade others. But they were not the main factor. Their success depended on science and technology, which provided the knowledge and tools, and on war and government, which provided patients, urgency and money. The greatest advances came when a determined individual was able to use new science in the right circumstances.