Revision: Transformation of
Surgery c1845-1918
NAME:
Checklist: Factual Details
•
•
•
•
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Dealing with pain
Dealing with infections
Dealing with blood loss
Role of factors in the development
Extent of progress in surgery
Attitudes
towards pain
relief
Problems with
anaesthetics
Chloroform
Dealing with
Problems before
anaesthetics
Ether
Opposition to Lister
Early attempts to
control Infection
Problems of Infection
Dealing with Infection
Antiseptic Conditions
Aseptic Conditions
Carbolic Acid
Problems of Blood Loss
Dealing with Blood Loss
Controlling Blood Loss
Replacing Blood
Individuals
Science
Communication
Factors Affecting
Developments
Technology
War
Advantages and
Improvements
Extent of Progress
Within Surgery
Hindrances to
Progress
Disadvantages and
Setbacks
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
Question 1 Mark Scheme
Level
Mark
Description
1
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:
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:
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:
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:
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
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
written well and SPAG considerably accurate
Things I have to include or remember for this type of question:
QUESTION 1
EXAMPLE
QUESTIONS
From The Age of Miracles by Guy
Williams, 1981. Here he is writing
about surgery in the midnineteenth 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)
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Study Source A. What can you infer about the way operations were carried out in the
early 19th century? (6 marks)
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A painting from 1817 showing an
operation in a patients home in Dublin to
remove a tumour from a mans arm pit
From the diary of Gideon Mantell, a
surgeon
Study Source A. What can you infer from
Source A about Mantell’s attitude towards
the use of ether?(6 marks)
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.
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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
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QUESTION 2
EXAMPLE
QUESTIONS
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 1847.
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 1871. 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.”
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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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
treatment
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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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
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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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.
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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QUESTION 3
EXAMPLE
QUESTIONS
Sources for 3a
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 = 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 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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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 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 pain
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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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, 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.
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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QUESTION 4
EXAMPLE
QUESTIONS
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’.
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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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
1864-1866
35
19
16
46%
1867-1870
40
34
6
15%
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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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 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.
Question 4c
Study Sources E and F. How useful are these sources in explaining how surgery has changed
over time?
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QUESTION 5
EXAMPLE
QUESTIONS
Sources for 5a
Source A: 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. Major
surgical work on the chest or internal organs was
made virtually impossible by the great
risk of sepsis.
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.
Source C: A photograph of an operation in 1847.
It was one of the first to use an
anaesthetic.
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 = infected
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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Sources for 5b
Source D: From A Brief History of Medicine by Paul
Strathern, 2005. Here he is writing
about the introduction of anaesthetics.
Source A: An eighteenth century painting of an
operation before anaesthetics
were used.
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 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.´
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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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 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
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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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
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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