Revision: Transformation of Surgery c1845-1918 - PowerPoint Presentation

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Revision: Transformation of Surgery c1845-1918 - PPT Presentation

NAME Checklist Factual Details Dealing with pain Dealing with infections Dealing with blood loss Role of factors in the development Extent of progress in surgery Dealing with Problems before anaesthetics ID: 409305

sources source operation question source sources question operation surgery answer support marks lister knowledge anaesthetics surgeon chloroform explain pain blood painting patient

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Slide1

Revision: Transformation of Surgery c1845-1918

NAME:Slide2

Checklist: Factual Details

Dealing with painDealing with infections

Dealing with blood loss

Role of factors in the development

Extent of progress in surgerySlide3

Dealing with

Problems before anaesthetics

Ether

Problems with anaesthetics

Attitudes towards pain relief

Chloroform Slide4

Dealing with Infection

Problems of Infection

Early attempts to control Infection

Carbolic Acid

Opposition to Lister

Antiseptic Conditions

Aseptic ConditionsSlide5

Dealing with Blood Loss

Problems of Blood Loss

Controlling Blood Loss

Replacing BloodSlide6

Factors Affecting Developments

Individuals

Science

Technology

Communication

WarSlide7

Extent of Progress Within Surgery

Advantages and Improvements

Disadvantages and Setbacks

Hindrances to ProgressSlide8

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 conclusionSlide9

Question 1 Mark Scheme

Level

Mark

Description

Selects relevant

details from the source e.g. the patient was held down

2-3

valid inference is made, but not support from the source

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:Slide10

Question 2 Mark Scheme

Level

Mark

Description

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

3-5

A valid comment is offered and linked to the content

or the nature of the source

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:Slide11

Question 3 Mark Scheme

Level

Mark

Description

1-2

Offers

an undeveloped comment without support from the sources OR selects details from the sources but without linking it to the sources

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

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:Slide12

Question 4 Mark Scheme

Level

Mark

Description

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

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

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:Slide13

Question 5 Mark Scheme – MARKED ON COMMUNICATION AGAIN

Level

Mark

Description

1-4

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

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

9-12

Answer focuses on the issue and reaches a judgement based on the evidence.

Answer written well and SPAG considerably accurate

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:Slide14

QUESTION 1 EXAMPLE QUESTIONSSlide15

Study 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.”Slide16

Study Source A.

What can you infer about the way operations were carried out in the early 19

century? (6 marks)

A painting from 1817 showing an operation in a patients home in Dublin to remove a tumour from a mans arm pitSlide17

Study Source A.

What can you infer from Source A about Mantell’s attitude towards the use of ether?(6 marks)

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.Slide18

Study Source A.

What can you learn from Source A about people’s 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 publicSlide19

QUESTION 2 EXAMPLE QUESTIONSSlide20

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 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, thesilken 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 withblood and covered with pus.”

Source C:

A photograph of an operation in 1847. It was one of the first to use an

anaesthetic.Slide21

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)

…………………………………………………………………………………………………………………………….........................Slide22

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 treatmentSlide23

Question 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)

…………………………………………………………………………………………………………………………….........................Slide24

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 quietlySlide25

Question 2cStudy Source A.

How can you tell from Source A that Simpson thought that anaesthetics were an advance in surgery? (8 marks)

…………………………………………………………………………………………………………………………….........................Slide26

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.Slide27

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)

…………………………………………………………………………………………………………………………….........................Slide28

QUESTION 3 EXAMPLE QUESTIONSSlide29

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.Slide30

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)

…………………………………………………………………………………………………………………………….........................Slide31

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 painSlide32

Question 3bStudy Sources D and E

. Which source is most valuable for telling you about people’s reactions to the use of chloroform? (10 marks)

…………………………………………………………………………………………………………………………….........................Slide33

Sources for 3c

Source C: From the Boston Daily Evening newspaper, 1st October 1846.NEW AND VALUABLE DISCOVERYDr 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.Slide34

Question 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)

…………………………………………………………………………………………………………………………….........................Slide35

QUESTION 4 EXAMPLE QUESTIONSSlide36

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 andsaid: ‘Professor Lister, it is not only our admiration which we offer you; it

is our gratitude and the gratitude of all our nations’.Slide37

Question 4aStudy 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)

…………………………………………………………………………………………………………………………….........................Slide38

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

46%

1867-1870

15%Slide39

Question 4bStudy Sources E and

F. Which is more useful to the historian who is investigating the ideas behind Lister’s use of carbolic acid?

…………………………………………………………………………………………………………………………….........................Slide40

Sources for 4c

Source E:

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 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.Slide41

Question 4cStudy Sources E and F.

How useful are these sources in explaining how surgery has changed over time?

…………………………………………………………………………………………………………………………….........................Slide42

QUESTION 5 EXAMPLE QUESTIONSSlide43

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 greatrisk of sepsis.

Source C:

A photograph of an operation in 1847. It was one of the first to use an

anaesthetic.

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 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 less

successful.

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 = infectedSlide44

Question 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, D

and G and any other sources you find helpful to explain your answer.

…………………………………………………………………………………………………………………………….........................Slide45

…………………………………………………………………………………………………………………………….........................

……………………………………………………………………………………………………………………………………………………..Slide46

Sources for 5b

Source A:

An eighteenth century painting of an operation before anaesthetics

were used.

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 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 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.´Slide47

Question 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, D

and G, and any other sources you find helpful.

…………………………………………………………………………………………………………………………….........................Slide48

…………………………………………………………………………………………………………………………….........................

……………………………………………………………………………………………………………………………………………………..Slide49

Sources for 5c

Source E:

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, 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

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 soldiersSlide50

Question 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, F

and G and any other sources you find helpful to explain your answer.

…………………………………………………………………………………………………………………………….........................Slide51

…………………………………………………………………………………………………………………………….........................

……………………………………………………………………………………………………………………………………………………..Slide52

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 1900Slide53

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.

…………………………………………………………………………………………………………………………….........................Slide54

…………………………………………………………………………………………………………………………….........................

……………………………………………………………………………………………………………………………………………………..