Factual details for the exam

Revision: Transformation of Surgery c1845-1918NAME:

Checklist: Factual DetailsDealing with painDealing with infectionsDealing with blood lossRole of factors in the development Extent of progress in surgery

Dealing with

Problems before anaesthetics EtherProblems with anaesthetics Attitudes towards pain reliefChloroform Dealing with Infection

Problems of InfectionEarly attempts to control InfectionCarbolic AcidOpposition to ListerAntiseptic ConditionsAseptic Conditions

Dealing with Blood Loss

Problems of Blood LossControlling Blood LossReplacing BloodFactors Affecting DevelopmentsIndividualsScienceTechnologyCommunicationWar6Extent of Progress Within SurgeryAdvantages and ImprovementsDisadvantages and SetbacksHindrances to ProgressChecklist: Evidence SkillsInference: 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 speechAnalysis of the source: which parts of the sources create a certain impressions, which parts of a source support or challenge an idea of another sourceCross-referencing: checking how far sources agree with each other and considering the overall weight of evidenceEvaluation of Reliability or Usefulness: the use of various checks to see how reliable or useful a source isMaking a judgement: weighing up all the evidence of an issue in order to come to a thoughtful and supported conclusion

Question 1 Mark SchemeLevelMarkDescription11Selects relevant details from the source e.g. the patient was held down22-3A valid inference is made, but not support from the source34-6Valid inferences are made and supported from the source. If there is only 1 developed point, the maximum mark is 5Things I have to include or remember for this type of question:

Question 2 Mark SchemeLevelMarkDescription11-2A 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 explained23-5A valid comment is offered and linked to the content or the nature of the source36-8An analysis of the treatment or selection of the source content is used to explain the messageThings I have to include or remember for this type of question:

Question 3 Mark SchemeLevelMarkDescription11-2Offers an undeveloped comment without support from the sources OR selects details from the sources but without linking it to the sources23-6Identifies 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 source37-10Cross 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 contentThings I have to include or remember for this type of question:

Question 4 Mark SchemeLevelMarkDescription11-3Comments 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 witness24-7Judgement 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 is38-10Judgement 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:

Question 5 Mark Scheme MARKED ON COMMUNICATION AGAINLevelMarkDescription11-4A 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 accuracy25-8Answer 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 39-12Answer focuses on the issue and reaches a judgement based on the evidence. Answer written well and SPAG considerably accurate413-16Answer 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 accurateThings I have to include or remember for this type of question:

QUESTION 1 EXAMPLE QUESTIONSStudy Source A. What can you learn from Source A about problems in surgery in the mid-nineteenth century? (6 marks).........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................From The Age of Miracles by Guy Williams, 1981. 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. Majorsurgical work on the chest or internal organs was made virtually impossible by the great risk of sepsis.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 pitStudy Source A. What can you infer from Source A about Mantells attitude towards the use of ether?(6 marks).........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................From the diary of Gideon Mantell, a surgeon

1 May 1847Went to Bartholomews 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 learn from Source A about peoples attitudes towards Simpson and the discovery of anaesthetics. (6 marks).............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

A statue of James Simpson that were erected in Edinburgh after his death; the money for the statue came from collections from the publicQUESTION 2 EXAMPLE QUESTIONSSources 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 pitSource B: From a book published by John Leeson in 1927 about his early days as amedical student in 1871. Leeson later worked with Joseph Lister.I remember the surgeon with his threaded needles hanging from the front of his coat, thesilken threads touching the well worn cloth which was blood-stained and dirty. One of oursurgeons lectured on anatomy in an old coat. I see it now, faded with age, stained withblood and covered with pus.

Source C: A photograph of an operation in 1847. It was one of the first to use ananaesthetic.Question 2aStudy 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).........................Sources for 2b

A painting by Henry Tonks, a surgeon and artists, showing a military dressing station in France in 1918. A dressing station was the place were the injured would receive basic treatment before they were sent to hospital for more complicated treatmentQuestion 2bStudy 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).........................Sources for 2cFrom 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 quietlyQuestion 2cStudy Source A. How can you tell from Source A that Simpson thought that anaesthetics were an advance in surgery? (8 marks).........................Sources for 2dSource 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.

Question 2d

Study Source B. How has the artist shown the importance of this first use of ether? Explain youranswer, using Source B. (8 marks).........................QUESTION 3 EXAMPLE QUESTIONSSources for 3aSource D: From an article by Joseph Lister in 1867. 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.Question 3aStudy Sources D and E. Is Source D more useful than Source E to the historian studying the methods ofJoseph Lister? Explain your answer, using Sources D and E. (10 marks).........................Sources for 3bSource 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 1790-1850 by Peter Stanley, 2003

It is possible that surgeons only used chloroform in the 1850s because patients demanded it. It kept patients from painQuestion 3bStudy Sources D and E. Which source is most valuable for telling you about peoples reactions to the use of chloroform? (10 marks).........................Sources for 3cSource C: From the Boston Daily Evening newspaper, 1st October 1846.NEW AND VALUABLE DISCOVERYDr Morton has discovered something which can reduce the sufferings of thosewho need painful operations in dentistry and surgery and make the operationeasier for the surgeon to carry out. He can make the patient unconscious andany operation can then be performed without causing pain. We are told by agentleman 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, 2005. 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.33Question 3cStudy Sources C and D. How far does Source D support the impression given in Source C that the use ofanaesthetics was an important breakthrough in surgery and dentistry? (10 marks).........................QUESTION 4 EXAMPLE QUESTIONSSources for 4aSource 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 andsaid: Professor Lister, it is not only our admiration which we offer you; it is our gratitude and the gratitude of all our nations.36Question 4aStudy Source F. How does the author of this article suggest that Listers work was important in thedevelopment of surgery? Explain your answer, using Source F. (8 marks).........................Sources for 4bSource 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 outSource F: A table based on Listers own records, showing the death rate among amputation cases before and after the use of carbolic acid

YearsTotal CasesSurvivedDiedDeath Rates1864-186635191646%1867-18704034615%38Question 4bStudy Sources E and F. Which is more useful to the historian who is investigating the ideas behind Listers use of carbolic acid?.........................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 (1829-1894) was Professor of Surgery in Vienna from 1867. He was described atthe time as one of Europes best and most trusted surgeons.. He developed many new surgical procedures. This painting recognises the importance Billroth gave to the training of surgeons.

40Question 4cStudy Sources E and F. How useful are these sources in explaining how surgery has changed over time?.........................QUESTION 5 EXAMPLE QUESTIONSSources for 5aSource A: From The Age of Miracles by Guy Williams, 1981. Here he is writing aboutsurgery in the mid-nineteenth century.

Very few people who were operated on in the overcrowded hospitals actually survived thedreaded 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 thosedays were forced to limit their activities to the performance of emergency operations suchas the amputation of limbs and minor repairs to the outer surfaces of the body. Majorsurgical work on the chest or internal organs was made virtually impossible by the greatrisk of sepsis.

Source C: A photograph of an operation in 1847. It was one of the first to use ananaesthetic.Source G: From The Lancet, a medical magazine. This article is reporting ideas held bysome surgeons in 1875.

Many of the most successful surgeons have given Mr Listers plan a trial and then givenit up. They have returned to using previous methods. The use of the antiseptic systemis certainly not more successful than the use of ordinary methods. It is said to be lesssuccessful.Source D: From an article by Joseph Lister in 1867. 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 = infected43Question 5aStudy 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 aftersurgery. How far do you agree with this statement? Use your own knowledge, Sources A, C, Dand G and any other sources you find helpful to explain your answer.....................................................Sources for 5b

Source A: An eighteenth century painting of an operation before anaestheticswere used.Source D: From A Brief History of Medicine by Paul Strathern, 2005. Here he is writingabout 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 hadsaid 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 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 aminute, 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 sufficienteffect. I was giving her more chloroform when her lips suddenly became pale andshe spluttered. I threw down the handkerchief, threw cold water in her face andgave her some water to drink, without any effect. The whole process of inhaling,operation and death, could not have taken more than two minutes.46Question 5bStudy 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, Dand G, and any other sources you find helpful.

....................................................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 1918. A dressing station was the place were the injured would receive basic treatment before they were sent to hospital for more complicated treatmentSource G: Cathy Warren and Nigel Bushnell, Medicine and Surgery, 2010In 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 soldiers49Question 5cStudy 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, Fand G and any other sources you find helpful to explain your answer.

....................................................Sources for 5dSource A: Listers 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 patients skins. The whole scene of the operation was covered in its 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 190052Question 5dStudy Sources A, F and G and use your own knowledge.Listers 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 andG and any other sources you find helpful to explain your answer.

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