Surgery Technique

1) What can you learn from Source A about surgery in the early 1840s? (6) 2 supported inferences. Lead with inference, not example. From Source A we can learn that…. as the Source says … We can also infer that… because… LevelMarkDescriptor 11Comprehension.So what? 22-3Unsupported inference.How do you know? 34-6Supported inference. Maximum of 5 for one supported inference. A good supported inference. 2 good supported inferences.

1. What can you learn from Source A about the work of Joseph Lister? (6 marks)

Makes no sense or is wrong. If you ask ‘so what?’ If you ask ‘how do you know?’ A good, supported answer. 2 or more good, supported points.

Example 1 From Source A I can learn that Joseph Lister’s work was incredibly effective at reducing death rates during operations. I can also learn that he was scientific and logical.

Example 2 From Source A I can learn that between 1864 and 1866, only 35 people had operations, but between 1867 and people had operations with Joseph Lister. I can see that more patients recovered in the second set of operations. The reason the people died was probably because of the unhygienic conditions at that time because surgeons wore their own clothes which spread diseases easily. Source A can tell us a lot about the work of Joseph Lister.

Example 3 From Source A I can learn a number of things about Joseph Lister’s work. The first of these is that he was very thorough and logical, as the table shows that he has recorded information regarding the number of deaths and recoveries during each time period: before and after the introduction of carbolic acid to operations. Another thing I can learn about Joseph Lister’s work from Source A is that his use of carbolic spray helped to save many lives. The evidence for this can be found in the table, which shows that before the use of carbolic acid 16 patients died following amputations, as opposed to only 6 deaths after carbolic acid had been introduced to operations. This suggests that it was a successful antiseptic in stopping wounds from becoming infected.

Example 4 From Source A I can learn that the work of Joseph Lister in developing the use of carbolic spray to prevent infections during operations was very successful, as the table shows that the number of deaths dropped significantly from 16 out of 35 (almost 50%) to 6 out of 40 (around 15%). The carbolic spray was very important in the history of surgery as it used saved many lives.

1.What can you learn from Source A about operations in the mid-nineteenth century? (6 marks)

Doesn’t make sense, or is wrong. If you have to ask ‘so what?’ If you have to ask ‘how do you know?’ A good, supported answer. 2 or more good, supported points.

2) What was the purpose of this representation? Explain your answer using Source B and your own knowledge. (8) LevelMarkDescriptor 11-2EITHER valid comment but without support from the source, OR identifies detail or information but not relevance to the intended purpose. 23-5Valid comment about the purpose of the representation and linked to details in the content of the source. Top of level: if purpose is identified using detail from both content and own knowledge of historical context. 36-8Analysis of treatment or selection of the content of the representation is used to explain its purpose. Maximum of 6 for answers without explicit use of own knowledge of historical context. Identify WHY IT WAS MADE, not just what it says.

2) What was the purpose of this representation? Explain your answer using Source B and your own knowledge. (8) Think about: Style – tone of language (informative, emotional?), or artistic technique (does the scene seem calm?) Selection – what content is or is not included? E.g. do they only talk about the negative side of anaesthetic, when you know there were positives? Provenance – the background to the source. E.g. who wrote it (do they have a motive to present it in some way?)? When was it written (do you know of something happening at this time that might explain its purpose?)?

Antiseptic Paper Style – calm, professional image; ‘note the distance… and the position of’, ‘the surgeon should…’ – instructive tone. Educational. Selection – picture and text to show how carbolic spray should be used. Only positives, no limits. Promotional? Background – written by one of Lister’s assistants – has seen first hand the benefits and would want to show how to use it for best effects – 17 years after introduction so not to promote as it was accepted into medical practice by this point. Therefore educational rather than promotional.

Anaesthetic Paper Style – emotive, dramatic, narrative language. Selection – very negative language about the pain of operations before anaesthetics. Remembering how bad operations were before anaesthetics. Background – written in 1896, 50 years after the discovery of ether. Not promotional because ether was accepted by this point, so celebrating the positive impact it has had. Anniversary celebration?

Blood Paper Style – subtle persuasive language: ‘perhaps we should…’. A bit defensive to protect himself – not ‘I’ but ‘we’. Selection – acknowledges problems but tries to brush over them with conditional language: ‘no clear evidence… might be a possibility’. Background – written by Dr Blundell – who performed early blood transfusions. Some were unsuccessful as blood groups hadn’t been discovered. Trying to persuade people it was beneficial / defend his work.

3) Why was there opposition to anaesthetics? Explain your answer using Source C and your own knowledge. (10) LevelMarkDescriptor 11-3EITHER answer simple statements from the source OR simple statements based on additional knowledge without reference to the source. 24-7Statements are supported by information from the source and/or additional knowledge. Maximum 5 marks if not BOTH the source and additional knowledge are used Answer uses the source and precise own knowledge. Explain why using the source and your own knowledge. Aim to have 3-4 paragraphs each showing a different factor. Explain each one in detail.

4) How reliable are Sources D and E as evidence of attitudes to the use of anaesthetics in the late 1840s? Explain your answer using Sources D and E and your own knowledge. (10) LevelMarkDescriptor 11-3Comments based on subject/amount of detail, or assumed reliability because of time/nature/origins of the source. Maximum 2 marks for use of one source only. 24-7EITHER focuses on details which can be corroborated or challenged OR answer focuses on how reliable/representative/authoritative the source is. Maximum 5 marks if Level 2 criteria are only met for one source. Maximum 6 marks if no use own knowledge of the context Answer consolidates the reliability of the information, taking into account an aspect of its nature (ie how reliable/representative… it is). Must include both sources and explicit use of historical context. Analyse both sources, thinking about who, when, why, who it was made for, what kind of source it is, and content. Make sure you address the focus: reliable AS EVIDENCE OF…

4) How reliable are Sources D and E as evidence of attitudes to the use of anaesthetics in the late 1840s? Say something reliable about the: CONTENT – the actual source and what it says (e.g. use of statistics, or knowledge you can back up with own knowledge) BACKGROUND – who wrote it/when/why/what it is, etc. (e.g. the author has used primary sources in their evidence, it is from a medical journal educating people rather than presenting opinion) Say something unreliable about the: BACKGROUND – e.g. the author has a motive to present the information in a certain way, or it was written early on during the time period and might not give a whole picture of developments… CONTENT – e.g. incorrect information that you can challenge with own knowledge, or personal opinion presented as fact. Conclude: assess HOW reliable each source is AS EVIDENCE OF…

Plan EACH source in a grid like this: ContentBackground Reliable Unreliable

Antiseptic Paper ContentBackground Reliable Statistics – ‘nine out of ten’. Reports on trials and results. Acknowledges why people would have doubted Lister and explains why. Medical journal – should be educational and accurate rather than based on opinions. Published in 1913 after Lister’s death – a chance to look back at his whole career and explain benefits and opposition. Unreliable Reports opinions. Only includes negatives about the work and no successes. Incorrect: ‘the antiseptic system is clearly not more successful than the use of ordinary methods’. Focuses mainly on the negatives/opposition than the benefits. 1875, 14 years after germ theory and 10 years after carbolic spray. Early in Lister’s career – perhaps hadn’t seen the benefits yet so doesn’t give the full picture of ‘the success of Lister’s methods’. Newspapers often exaggerate, especially just after a death – might talk up benefits, but actually quite reliable in this case. Source D Source E

Anaesthetic Paper ContentBackground Reliable Shows both attitudes – ‘doctors were against the use of chloroform but I insisted on it.’ Nothing Letter – if private then probably honest. Charles Dickens = novelist – no motive to promote anaesthetic other than because he believes it to be good – only 3 years after discovery so doctors’ reactions reflect concerns/opposition at the time among many groups. Newspaper – reflects public attitudes at the time. Un- reliable Focuses mainly on the positives and not the negatives, including dosage, blood loss, and infection. Maybe a bit exaggerated? ‘reduced to nothing… miraculous and merciful.’ Mocking those who emphasised the miracles of ether. Not possible to remove someone’s head. No positive attitudes. Letter/novelist – if public might be to persuade others but probably not. Cartoon – exaggerated – mocking ether – opposition common because it was new and hadn’t been refined/perfected yet. Source D Source E

Blood Paper ContentBackground Reliable Very factual, not opinionated. Tells the story of Landsteiner’s developments showing difficulties (‘received little attention until 1909’) and achievements without exaggeration. Factual and scientific – the use of sodium citrate to stop clotting. Speech about his work in 1930 – able to look back with hindsight at the whole of his work. Scientific journal – should be factual and accurate. Almost 100 years later – hindsight to look back over developments. Unreliable Doesn’t directly acknowledge that there were successful blood transfusions between 1901 and The ‘use’ didn’t develop with the ‘outbreak of the First World War’ because the first blood bank was at Cambrai in ‘New knowledge’ (1901) Speech for Nobel Prize for Medicine – might be exaggerated to emphasise positives of his work, though actually reliable. Nothing. Source D Source E

5) ‘The use of anaesthetics in surgery in the years to 1870 brought more problems than benefits.’ How far do you agree with this statement? Explain your answer using your own knowledge, Sources D, F and G and any sources you find helpful. (16) LevelMarkDescriptor 11-4 EITHER undeveloped comment to support or counter the interpretation, without direct source support or additional knowledge, OR selects details from sources to support or counter the view, but without direct linkage to the question Answer offers a judgement that agrees with or counters the view and links to relevant source details and or additional knowledge Answer reasons from the evidence to support or challenge the claim. Answer may be unbalanced and only one view will be convincingly explored. Maximum 10 marks for answers without additional knowledge Considers the evidence supporting both views. The evaluation of the interpretation is supported by precisely-selected evidence from the sources and own knowledge marks for answers that consider the strength of evidence from sources. An essay with an introduction and conclusion, considering both viewpoints, starting with the weaker argument. Include evidence from all suggested sources and own knowledge, and for top marks consider the weight of evidence.