1. Friday, 30 November 2018 HOW TO ANSWER SOURCE QUESTIONS ON SURGERY QUESTION 5
Make sure you answer ALL Questions – especially Question 5 – this is worth the most marks.
2) Stick to a strict TIME LIMIT for Each Question as follows;
- Question 1 – 6 Marks = 10 Minutes
- Question 2 – 8 Marks = 10 Minutes
- Question 3 – 10 Marks = 15 Minutes
- Question 4 – 10 Marks = 15 Minutes
- Question 5 – 16 Marks = 20 Minutes
3) ANSWER QUESTION 5 FIRST AND THEN WORK YOUR
WAY BACKWARDS THROUGH THE PAPER.
3) PLAN your answers carefully – if the Question asks you to
Use 4 sources and your own knowledge – you should usually
write FIVE PARAGRAPHS – one paragraph on each of the
sources and one paragraph on your own knowledge.

2. Opposition to Lister’s Methods
Question 5
Source F suggests that the main reason for opposition to Lister’s method was that surgeons could not believe that germs caused infection.
How far do you agree with this interpretation?
Explain your answer, using your own knowledge, Sources D, E and F and any OTHER SOURCES you find helpful.
(16 MARKS)
Examiner’s Tip:
BEST answers include OWN KNOWLEDGE , ALLof the sources D, E and F AND AT LEAST ONE OTHER SOURCE.

3. SOURCE D
From an article written by the editor of The Lancet in The Lancet is a medical journal.
“Many of the most successful surgeons have given Mr Lister’s plan a trial and then given it up. They have returned to using previous methods. The use of the antiseptic system is certainly not more successful than the use of ordinary methods. It is said to be less successful. The germ theory may be correct, but nine out of ten surgeons do not much care whether it is or not. Their concern is only to cure their patients and reduce deaths to the lowest possible number.”

4. SOURCE E
From an article in The Times newspaper, published in It was written shortly after Lister’s death.
“The opponents of Lister were not all stupid. In 1865 on one could have seen how successful Lister’s work would be. Disagreement arose because only a few people believed in the germ theory and accepted the views of Lister and Pasteur. Lister’s early methods did not always work. Statistics showed conflicting results. There was a need for more knowledge. Meanwhile, improvements were made without using carbolic acid. All these things led to resistance and arguments.”

5. SOURCE F
From Joseph Lister by W. Watson Cheyne, published in Cheyne had been one of Lister’s assistants.
“It was difficult to convince surgeons that tiny objects about mm in size could be the cause of infection. The surgeons of that day were interested in keeping up with developments in anatomy and in working faster in operations. Tiny germs seemed to have no relevance to practical work.

6. MAKING NOTES – QUESTION 5
Agree with Statement
Disagree with Statement – suggests there were other reasons for opposition to Lister’s methods.
Source D
Source E
Source F
Shows that surgeons did not care about the germ theory and “returned to using previous methods”.
Source D shows a resistance to change.
They did not believe in new ideas like the germ theory, therefore did not trial Lister’s methods for long enough.
Source D shows that surgeons did not reject the germ theory and they were prepared to try the antiseptic method, BUT they did not trial Lister’s method for long enough to see the benefits.
States that only a few people believed in the germ theory.
Lister’s methods did not always work.
Statistics showed conflicting results.
Shows that there was a lack of understanding of how carbolic acid actually worked (Lister could not explain his ideas clearly).
Source E notes that a few surgeons DID believed in the germ theory. BUT there was greater opposition.
Improvements were being made without using carbolic acid.
Argues that surgeons found it difficult to believe that tiny germs caused infections.
Source F also suggests that surgeons were more interested in learning about the anatomy and “working faster in operations”. Lister’s method slowed down operations. Therefore the opposition was less to do with germs and more to do with practical issues.

7. MAKING NOTES – QUESTION 5
Agree with Statement
Disagree with Statement – suggests there were other reasons for opposition to Lister’s methods.
Other Sources
Own Knowledge
Include more knowledge from page “Brown Book”
Source B shows the importance of the use of carbolic acid in reducing infections.
Lister could not explain his ideas clearly. This links to source E and opposition to his methods because of a lack of knowledge.
Some surgeons joked about shutting the doors to keep ‘Mr Lister’s germs out’. This shows that they had a lack of knowledge of how the germ theory and Lister’s methods worked.
Some surgeons mistakenly thought that Lister’s methods did not work after they tried them but this was because they did not use the methods properly and because their theatres lacked cleanliness.
Lister’s methods slowed down surgery and increased blood loss. This links to source F which states that surgeons were more interested in working faster.
There were practical problems of carbolic acid such as physical irritation.

8. Own knowledge Joseph Lister and antiseptics Page 118-119 “Brown Book”
Opposition to Lister’s methods
Page “Brown Book”
Some doctors didn’t accept the idea that microbes caused infection because microbes could not be seen without a microscope.
Using carbolic solutions slowed down the whole operation, which lead to problems of blood loss.
Doctors who copied Lister’s ideas did not always copy them properly and then, if they did not get an improved survival rate after operations they said that Lister’s ideas were wrong.
Lister himself kept changing his methods in an attempt to further improve his work – many doctors thought this meant he was not sure of his ideas.
The equipment was expensive and heavy.
Some doctors had good results even without using carbolic acid.
The nurses resented the extra work caused by this emphasis on hygiene.
Carbolic acid caused irritation to doctors and nurses hands and lungs.

9. PLANNING MAKES PERFECT
TASKS
1) How many paragraphs are you going to write to answer this Question?
2) Write a PLAN to show how you would answer this Question?

10. REMEMBER: PEEL and LINK back to the question throughout your answer.
HOW DID YOU DO?
Paragraph 1
Write about how far Source D agrees and disagrees with the statement.
Paragraph 2
Write about how far Source E agrees and disagrees with the statement.
Paragraph 3
Write about how far Source F agrees and disagrees with the statement.
Paragraph 4
Write about how far Other Sources agree and disagree with the statement.
Paragraph 5
Using your OWN knowledge say how far YOU agree and disagree with the statement.
Paragraph 6
CONCLUSION – Overall do you agree or disagree with the statement.
REMEMBER: PEEL and LINK back to the question throughout your answer.

11. HOW TO MARK ANSWERS Level ONE = 1 – 4 Marks = Grades
Generalised answer with undeveloped comments. Lacks direct linkage to the question.
Example – people thought Lister’s methods didn’t work; Source E says there was a need for more knowledge.
Level TWO = 5 – 8 Marks = Grades
Offers a judgement and links to relevant details from sources D, E and F and/or OWN KNOWLEDGE.
Example – Selects evidence from Source D to show that surgeons did not care about the germ theory and returned to previous methods; selects evidence from Sources E and F to explain that surgeons did not at first understand the idea o germs, including OWN KNOWLEDGE to explain that they joked about shutting the doors to keep ‘Mr Lister’s germs out’.
NB: MAX LEVEL 2 for answers which do NOT use the sources.
Level THREE = 9 – 12 Marks = Grades
Evaluation is unbalanced and the student ONLY writes about how they either agree or disagree with the statement.
Example – explains that the sources do suggest the main reason was doubts about the germ theory. Sources D, E and F all suggest that they just did not believe it, and this was because it was difficult to understand that infection was caused by something so small which could not be seen. Adds from OWN KNOWLEDGE that Lister was poor at explaining his work and the ideas behind it and that partly explains why they did not understand it. Also suggests that resistance to change contributed to their opposition: Source D implies they preferred the old methods and all three sources suggest surgeons were not prepared to accept new ideas linked to the germ theory.
MAX 10 MARKS for answers which do NOT include OWN KNOWLEDGE.
Level FOUR = 13 – 16 Marks = Grades
Sustained argument, exploring the evidence for and against the statement. Considers the evidence that surgeons’ doubts about the germ theory were the prime reason AND considers evidence which suggests other reasons were MORE IMPORTANT.
Example – Weights the evidence of doubts about the germ theory as the prime cause.
You could argue Source D shows that surgeons did not reject the germ theory and they were prepared to try the antiseptic method, but the prime concern in D appears to be about practical issues, which is confirmed in Source E. On the other hand, you could argue that Source D agrees with the statement because it gives evidence of ready rejection. Resistance to change was a more significant reason for opposition to Lister since it was the underlying reason for unwillingness to accept both the germ theory and the new antiseptic methods.
Includes resistance to change such as; rejection of the germ theory, resistance to the careful operation of the antiseptic methods, need for speed in operations, practical problems of carbolic acid, physical irritant, mistaken ideas that it didn’t work but only because theatres lacked cleanliness.
BEST ANSWERS include BOTH the strengths and weaknesses of the sources.
For this Level – you MUST include your OWN KNOWLEDGE

12. RESOURCES Blank A3 copy of table “Making Notes Question 5”
Page “Brown Book” - Opposition to Lister’s methods.
Page “Brown Book” - Joseph Lister and antiseptics

13. MAKING NOTES – QUESTION 5
Agree with Statement
Disagree with Statement
Source D
Source E
Source F
Other Sources
Own Knowledge
Include more knowledge from page “Brown Book”