1. Revision: Transformation of Surgery c1845-1918
NAME:

2. Checklist: Factual Details
Dealing with pain
Dealing with infections
Dealing with blood loss
Role of factors in the development
Extent of progress in surgery

3. Dealing with Attitudes towards pain relief
Problems before anaesthetics
Problems with anaesthetics
Chloroform
Ether

4. Dealing with Infection
Opposition to Lister
Early attempts to control Infection
Problems of Infection
Dealing with Infection
Antiseptic Conditions
Aseptic Conditions
Carbolic Acid

5. Controlling Blood Loss
Problems of Blood Loss
Dealing with Blood Loss
Controlling Blood Loss
Replacing Blood

6. Factors Affecting Developments
Individuals
Factors Affecting Developments
Science
Technology
Communication
War

7. Advantages and Improvements
Extent of Progress Within Surgery
Hindrances to Progress
Disadvantages and Setbacks

8. Checklist: Evidence Skills
Inference: your ability to work things out from the source, e.g. what can you work out about a situation, the attitude of an author, the message of a cartoon, the purpose of a speech
Analysis of the source: which parts of the sources create a certain impressions, which parts of a source support or challenge an idea of another source
Cross-referencing: checking how far sources agree with each other and considering the overall weight of evidence
Evaluation of Reliability or Usefulness: the use of various checks to see how reliable or useful a source is
Making a judgement: weighing up all the evidence of an issue in order to come to a thoughtful and supported conclusion

9. A valid inference is made, but not support from the source
Question 1 Mark Scheme
Level
Mark
Description 1
Selects relevant details from the source e.g. the patient was held down 2
2-3
A valid inference is made, but not support from the source 3
4-6
Valid inferences are made and supported from the source. If there is only 1 developed point, the maximum mark is 5
Things I have to include or remember for this type of question:

10. Question 2 Mark Scheme
Level
Mark
Description 1
1-2
A valid comment is offered but there is not support from the source OR answer identifies detail or information from the source, but the relevance is not explained 2
3-5
A valid comment is offered and linked to the content or the nature of the source 3
6-8
An analysis of the treatment or selection of the source content is used to explain the message
Things I have to include or remember for this type of question:

11. Question 3 Mark Scheme
Level
Mark
Description 1
1-2
Offers an undeveloped comment without support from the sources OR selects details from the sources but without linking it to the sources 2
3-6
Identifies elements of support and/or challenge based on matching details of the sources content OR the concept of support/challenge is approached as a reliability issues and comments are based on the nature of the source 3
7-10
Cross referencing of the sources focuses on content (considers elements of both areas of support and challenge to reach a judgement on the extent of support) OR Cross referencing focuses on the source (considers the nature of the source in order to judge the strength/quality of support/challenge provided by the content
Things I have to include or remember for this type of question:

12. Question 4 Mark Scheme
Level
Mark
Description 1
1-3
Comments are based on subject/amount of detailed or assumptions about the reliability of a source e.g. because it is a primary source or from an eye witness 2
4-7
Judgement is based on the usefulness of the sources information and focuses on what the source can or cant tell us OR judgement is based on evaluation of nature or authorship of the sources and the answer focuses on how reliable/how representative/authoritative the source is 3
8-10
Judgement combines both elements of L2 to assess the contribution the sources can make to a specific enquiry. Answer considers the value of the information, taking into account an aspect of its nature (i.e how representative/authoritative/comprehensive it is)
Things I have to include or remember for this type of question:

13. Question 5 Mark Scheme – MARKED ON COMMUNICATION AGAIN
Level
Mark
Description 1
1-4
A general answer. Answer offers an undeveloped comment with no support from sources or own knowledge OR selects details from the source but does not relate it to the question. Everyday language used and SPAG used with little accuracy 2
5-8
Answer offers a judgement on the question and links relevant details from sources and/or own knowledge. SPAG used with general accuracy and writing organised inaccurately 3
9-12
Answer focuses on the issue and reaches a judgement based on the evidence. Answer written well and SPAG considerably accurate 4
13-16
Answer considers both sides of the argument and places this within the context of the question. Own knowledge and evidence from the sources is used to support the points made. Communication is effective and SPAG is accurate
Things I have to include or remember for this type of question:

14. QUESTION 1 EXAMPLE QUESTIONS

15. From The Age of Miracles by Guy Williams, 1981
From The Age of Miracles by Guy Williams, Here he is writing about surgery in the mid-nineteenth century.
“Very few people who were operated on in the overcrowded hospitals actually survived the dreaded period after surgery. This was because the flesh that had been cut would start, almost inevitably, to develop gangrene. With such a big problem, the surgeons of those days were forced to limit their activities to the performance of emergency operations such as the amputation of limbs and minor repairs to the outer surfaces of the body. Major
surgical work on the chest or internal organs was made virtually impossible by the great risk of sepsis.”
Study Source A. What can you learn from Source A about problems in surgery in the mid-nineteenth century? (6 marks) ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

16. Study Source A. What can you infer about the way operations were carried out in the early 19th century? (6 marks) ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
A painting from 1817 showing an operation in a patients home in Dublin to remove a tumour from a mans arm pit

17. From the diary of Gideon Mantell, a surgeon
1 May 1847
Went to Bartholomew’s Hospital and witnessed two operations under the influence of Ether: the first I have seen. The loss of feeling on both occasions was complete: the patient had no consciousness of the operation. But the effect on the patient afterwards was appalling, although brief.
Study Source A. What can you infer from Source A about Mantell’s attitude towards the use of ether?(6 marks) ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

18. Study Source A. What can you learn from Source A about people’s attitudes towards Simpson and the discovery of anaesthetics. (6 marks)
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A statue of James Simpson that were erected in Edinburgh after his death; the money for the statue came from collections from the public

19. QUESTION 2 EXAMPLE QUESTIONS

20. Sources for 2a
Source A - A painting from 1817 showing an operation in a patients home in Dublin to remove a tumour from a mans arm pit
Source C: A photograph of an operation in It was one of the first to use an
anaesthetic.
Source B: From a book published by John Leeson in 1927 about his early days as a
medical student in Leeson later worked with Joseph Lister.
“I remember the surgeon with his threaded needles hanging from the front of his coat, the
silken threads touching the well worn cloth which was blood-stained and dirty. One of our
surgeons lectured on anatomy in an old coat. I see it now, faded with age, stained with
blood and covered with pus.”

21. Question 2a Study Sources A, B and C
Question 2a Study Sources A, B and C. How far do Sources B and C support the view of problems in surgical operations given in Source A? Explain your answer, using all three sources (8 marks)
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22. Sources for 2b
A painting by Henry Tonks, a surgeon and artists, showing a military dressing station in France in A dressing station was the place were the injured would receive basic treatment before they were sent to hospital for more complicated treatment

23. Question 2b Study Source B
Question 2b Study Source B. What impression has the artist tried to give of the treatment of wounded soldiers in the First World War? Explain your answer, using Source B. (8 marks)
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24. Sources for 2c
From a speech by James Simpson to a meeting of doctors in Edinburgh in 1847
In years to come people will look back with sorrow at our reaction to anaesthetics. They will be amazed at the idea of humane men saying they prefer operating on patients who are conscious instead of anaesthetised, and that fearful agonies of an operation should be endured quietly

25. Question 2c Study Source A
Question 2c Study Source A. How can you tell from Source A that Simpson thought that anaesthetics were an advance in surgery? (8 marks)
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26. Sources for 2d
Source B: A painting about the first use of ether as an anaesthetic. It shows an operation carried out in the USA by Dr Warren and Dr Morton in 1846.

27. Question 2d Study Source B
Question 2d Study Source B. How has the artist shown the importance of this first use of ether? Explain your answer, using Source B. (8 marks)
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28. QUESTION 3 EXAMPLE QUESTIONS

29. Sources for 3a
Source D: From an article by Joseph Lister in Here he is writing about the impact of the ideas of Louis Pasteur on his own work as a surgeon.
It had been shown by the researches of Pasteur that the septic* nature of the atmosphere was not a result of miasma but was the result of tiny organisms suspended in the air. It occurred to me that gangrene in the injured limb might be avoided by applying as a dressing some material capable of destroying the life of these tiny organisms.
*septic = infected
Source E: From The Greatest Benefit to Mankind by Roy Porter, 1999.
Lister saw the effectiveness of using carbolic acid to reduce infection among cattle and on sewage farms. He became convinced that it was necessary to cleanse the wound and keep out further infection, and tried various ways to do so. His first trial was on a boy with a broken leg who had been run over by a cart; Lister used a dressing soaked in carbolic acid. The dressing remained in place for four days and the wound stayed infection-free; the boy walked out of the hospital after six weeks.

30. Question 3a Study Sources D and E
Question 3a Study Sources D and E. Is Source D more useful than Source E to the historian studying the methods of Joseph Lister? Explain your answer, using Sources D and E. (10 marks)
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31. Sources for 3b
Source D: A report in a medical newspaper about the use of chloroform, December 1849
A Welsh girl had to undergo a very painful operation, the removal of an eyeball. The surgeon administered about one-third of the quantity of chloroform he ha given to other patients. It had, however, such an effect on her that she had a fit and died.
Source E: From For Fear of Pain: British Surgery by Peter Stanley, 2003
It is possible that surgeons only used chloroform in the 1850s because patients demanded it. It kept patients from pain

32. Question 3b Study Sources D and E
Question 3b Study Sources D and E. Which source is most valuable for telling you about people’s reactions to the use of chloroform? (10 marks)
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33. Sources for 3c
Source C: From the Boston Daily Evening newspaper, 1st October 1846.
NEW AND VALUABLE DISCOVERY
Dr Morton has discovered something which can reduce the sufferings of those
who need painful operations in dentistry and surgery and make the operation
easier for the surgeon to carry out. He can make the patient unconscious and
any operation can then be performed without causing pain. We are told by a
gentleman of the highest respectability that he witnessed an experiment carried out by Dr Morton last week. A bad tooth was taken out without giving the patient the slightest pain. He was put into a kind of sleep by inhaling this preparation. The sleep lasted less than a minute, just long enough to extract the tooth. This discovery is destined to make a great revolution in surgery and dentistry.
Source D: From A Brief History of Medicine by Paul Strathern, Here he is writing about the introduction of anaesthetics.
A newspaper headline announced ‘We have conquered pain!’ but people remained unconvinced. There was widespread opposition on religious grounds, especially about the use of anaesthetics during childbirth. According to the bible, God had said childbirth would be accompanied by pain. More serious objections came from medical opposition to ether. It was found that this could damage the lungs, and occasionally cause vomiting which, if it happened during an operation, could lead to the death of the patient.

34. Question 3c Study Sources C and D
Question 3c Study Sources C and D. How far does Source D support the impression given in Source C that the use of anaesthetics was an important breakthrough in surgery and dentistry? (10 marks)
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35. QUESTION 4 EXAMPLE QUESTIONS

36. Sources for 4a
Source F: From the British Medical Journal, reporting on an international meeting of medical experts in Paris in 1878.
Professor Joseph Lister gave a speech in response to the criticisms made of his antiseptic methods. Professor Lister was greeted by the whole assembly with the greatest enthusiasm. When he rose to make his speech the whole assembly rose to their feet. With deafening and repeated cheers, and waving of hats they hailed the distinguished Professor time and time again. This continued for some minutes until Professor Donders shook his hand and
said: ‘Professor Lister, it is not only our admiration which we offer you; it is our gratitude and the gratitude of all our nations’.

37. Question 4a Study Source F
Question 4a Study Source F. How does the author of this article suggest that Lister’s work was important in the development of surgery? Explain your answer, using Source F. (8 marks)
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38. Sources for 4b Source E: From a letter from Lister to Pasteur in 1874
…give thanks for having, by your brilliant researches, proved o me the truth of the germ theory. You furnished me with the principle upon which alone the antiseptic system can be carried out
Source F: A table based on Lister’s own records, showing the death rate among amputation cases before and after the use of carbolic acid
Years
Total Cases
Survived
Died
Death Rates 35 19 16
46% 40 34 6
15%

39. Question 4b Study Sources E and F
Question 4b Study Sources E and F. Which is more useful to the historian who is investigating the ideas behind Lister’s use of carbolic acid?
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40. Sources for 4c
Source E: An operation in the late eighteenth century This cartoon shows an amputation. It was drawn in 1793.
Source F: A painting of the great German surgeon, Theodor Billroth performing an operation. It was painted in 1890.
Theodor Billroth ( ) was Professor of Surgery in Vienna from He was described at
the time as one of Europe’s best and most trusted surgeons.. He developed many new surgical procedures. This painting recognises the importance Billroth gave to the training of surgeons.

41. Question 4c Study Sources E and F
Question 4c Study Sources E and F. How useful are these sources in explaining how surgery has changed over time?
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42. QUESTION 5 EXAMPLE QUESTIONS

43. Sources for 5a
Source A: From The Age of Miracles by Guy Williams, Here he is writing about
surgery in the mid-nineteenth century.
Very few people who were operated on in the overcrowded hospitals actually survived the
dreaded period after surgery. This was because the flesh that had been cut would start,
almost inevitably, to develop gangrene. With such a big problem, the surgeons of those
days were forced to limit their activities to the performance of emergency operations such
as the amputation of limbs and minor repairs to the outer surfaces of the body. Major
surgical work on the chest or internal organs was made virtually impossible by the great
risk of sepsis.
Source C: A photograph of an operation in It was one of the first to use an
anaesthetic.
Source D: From an article by Joseph Lister in Here he is writing about the impact of the ideas of Louis Pasteur on his own work as a surgeon.
It had been shown by the researches of Pasteur that the septic* nature of the atmosphere was not a result of miasma but was the result of tiny organisms suspended in the air. It occurred to me that gangrene in the injured limb might be avoided by applying as a dressing some material capable of destroying the life of these tiny organisms.
*septic = infected
Source G: From The Lancet, a medical magazine. This article is reporting ideas held by
some surgeons in 1875.
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.

44. Question 5a Study Sources A, C, D and G and use your own knowledge
Question 5a Study Sources A, C, D and G and use your own knowledge. ‘The work of Lister was the main factor in solving the problem of infection after surgery.’ How far do you agree with this statement? Use your own knowledge, Sources A, C, D and G and any other sources you find helpful to explain your answer.
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46. Sources for 5b
Source D: From A Brief History of Medicine by Paul Strathern, Here he is writing
about the introduction of anaesthetics.
A newspaper headline announced ‘We have conquered pain!’ but people remained unconvinced. There was widespread opposition on religious grounds, especially about the use of anaesthetics during childbirth. According to the bible, God had
said childbirth would be accompanied by pain. More serious objections came from medical opposition to ether. It was found that this could damage the lungs, and occasionally cause vomiting which, if it happened during an operation, could lead to the death of the patient.
Source A: An eighteenth century painting of an operation before anaesthetics
were used.
Source G: An account of the death of Hannah Greener, aged 15, in 1848, published in a medical journal. She was the first person to die under chloroform. Her operation was for the removal of a toenail.
‘She inhaled a teaspoonful of chloroform from a handkerchief. In about half a
minute, when she was unconscious, I requested Mr Lloyd to begin the operation.
She gave a kick, which made me think the chloroform had not had sufficient
effect. I was giving her more chloroform when her lips suddenly became pale and
she spluttered. I threw down the handkerchief, threw cold water in her face and
gave her some water to drink, without any effect. The whole process of inhaling,
operation and death, could not have taken more than two minutes.´

47. Question 5b Study Sources A, D and G and use your own knowledge
Question 5b Study Sources A, D and G and use your own knowledge. ‘Surgery in the 19th century improved significantly with the use of anaesthetics.’ How far do you agree with this statement? Use your own knowledge, Sources A, D and G, and any other sources you find helpful.
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49. Sources for 5c
Source E: A photograph of Walter Yeo, showing his face after (left) and during the tube pedicle reconstruction of his face (right). Walter Ernest O'Neil Yeo was a sailor during WWI, and is thought to be the first person to benefit from advanced plastic surgery, namely a skin graft
Source F: A painting by Henry Tonks, a surgeon and artists, showing a military dressing station in France in A dressing station was the place were the injured would receive basic treatment before they were sent to hospital for more complicated treatment
Source G: Cathy Warren and Nigel Bushnell, Medicine and Surgery, 2010
In 1915, the American doctor Richard Lewisohn found that adding sodium citrate stopped blood from clotting. This meant that that the donor did not have ot b present and therefore more transfusions could be carried out. Although it was found that the blood was not used soon afterwards, this discovery still saved the lives of thousands of wounded soldiers

50. Question 5c Study Sources E, F and G and use your own knowledge
Question 5c Study Sources E, F and G and use your own knowledge. ‘The First World War led to major improvements in surgical methods and techniques’. How far do you agree with this statement? Use your own knowledge, Sources E, F and G and any other sources you find helpful to explain your answer.
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52. Sources for 5d
Source A: Lister’s own description of the treatment from a letter to his father in 1866
Though I hardly expected any success I tried carbolic acid on the wound to prevent the formation of pus in the leg. Well it is now eight days since the accident and the patient had reacted just as if there had been no open wound.
Source F: From the memoirs of a doctor who worked with Lister
Everything was soaked in carbolic – hands, instruments and the patient’s skins. The whole scene of the operation was covered in it’s spray, which dispersed its globules into every nook and cranny of the wound. Our faces and coat sleeves often dripped with it. It was a relief to us all when the spray was [not used anymore]. It was costly and cumbersome and often broke down.
Source G: An operation in antiseptic conditions in 1900

53. Question 5d Study Sources A, F and G and use your own knowledge
Question 5d Study Sources A, F and G and use your own knowledge. ‘Lister’s antiseptic methods changed surgical practice in a short period of time.’ How far do you agree with this statement? Use your own knowledge, Sources A, F and G and any other sources you find helpful to explain your answer.
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