Answer ALL questions. Write in full sentences for Questions 13 and 14. You are advised to spend about 65 minutes on this pack.
1
Give one piece of equipment, other than a soaked dressing, that Lister used to reduce germs reaching a wound during an operation.
(Total for Question 1 is 1 mark)
2
Name the earlier scientist whose work on microbes Lister used to justify antiseptic surgery.
(Total for Question 2 is 1 mark)
3
State one reason why some doctors at first resisted Lister's antiseptic methods.
(Total for Question 3 is 2 marks)
4
State one way the introduction of anaesthetics changed surgery in the nineteenth century.
(Total for Question 4 is 2 marks)
5
State two elements of Lister's antiseptic practice in the 1860s.
(Total for Question 5 is 2 marks)
6
Explain one way in which the development of anaesthetics in the mid nineteenth century was similar to the development of antiseptic surgery later in the century.
(Total for Question 6 is 4 marks)
7
Explain why surgical practice changed so much in Britain between about 1840 and 1880.
You may use the following in your answer: - James Simpson and the introduction of chloroform as an anaesthetic in the 1840s - Joseph Lister and the introduction of carbolic antisepsis in the 1860s
You must also use information of your own.
(Total for Question 7 is 12 marks)
8
Explain why some surgeons were slow to accept Lister's antiseptic methods in the late nineteenth century.
You may use the following in your answer: - carbolic acid procedures - attitudes towards germ theory
You must also use information of your own.
(Total for Question 8 is 12 marks)
9
'Without anaesthetics and antiseptics surgery could not have developed into modern safe practice.' How far do you agree? Explain your answer.
(Total for Question 9 is 16 marks)
Mark scheme · 1.14 Anaesthetics and Antiseptics: Simpson, Lister and Safer Surgery
Question 1
B1 a carbolic acid spray, a device that produced a fine mist of carbolic acid over the wound and instruments, oe
Answer: A carbolic acid spray, which produced a fine mist of carbolic acid over the wound and instruments during an operation.
Question 2
B1 Louis Pasteur
Answer: Louis Pasteur
Question 3
B1 some surgeons were sceptical of the new germ ideas and thought infection was due to bad air or patient weakness
B1 supporting detail, e.g. using carbolic was seen as messy and time-consuming and some feared it would damage living tissue
Answer: Doctors resisted because they rejected germ-based explanations of infection and because carbolic procedures were seen as messy, time-consuming and possibly harmful to tissue.
Question 4
B1 allowed surgeons to perform longer and more complex operations without the patient feeling pain
B1 supporting detail, e.g. operations that had been impossible because of patient pain became practicable
Answer: Anaesthetics allowed longer, more complex operations without pain, so surgeons could attempt procedures previously impossible because patients could not bear them.
Question 5
B1 rinsing wounds and instruments with carbolic acid
B1 using carbolic-soaked dressings to protect wounds after surgery
Answer: Rinsing wounds and instruments with carbolic acid, and using carbolic-soaked dressings to cover wounds.
Question 6
B2 identifies one clear similarity, for example that both depended on scientific discoveries which changed practice, and explains it with supporting detail
B2 supporting detail showing the similarity, e.g. both used a new scientific idea to transform surgery: chloroform applied chemistry/physiology to relieve pain, and Lister applied Pasteur's microbial ideas to prevent infection
Answer: Both developments transformed surgery by applying a new scientific idea to solve a specific problem: chloroform anaesthesia applied chemistry and physiology to remove the pain of operations, while Lister's carbolic antisepsis applied Pasteur's germ theory to prevent wound infection, so each used scientific discovery to make operations safer and more widely acceptable.
Question 7
Level 1 (1-3): Identifies one or two simple reasons for change in surgical practice with little or no supporting detail or explanation.
Level 2 (4-6): Offers some explanation of reasons for change, with relevant detail, but the answer is limited in development or balance.
Level 3 (7-9): Explains a range of reasons for the changes in surgical practice with accurate detail and begins to show how the reasons connect or the consequences they produced.
Level 4 (10-12): Provides a well-developed explanation of why surgical practice changed, supported throughout by precise, accurate detail and showing clear links between causes and consequences.
Indicative content:
The arrival of anaesthetics, such as chloroform from 1847, removed the barrier of patient pain and allowed longer and more daring operations, which encouraged surgeons to develop new techniques and reshaped the scope of surgery.
Lister's antiseptic methods from the 1860s, building on Pasteur's germ theory, reduced deadly wound infections and therefore lowered mortality, making operations less risky and so more acceptable to both surgeons and patients.
Technological and scientific advances, including improved surgical instruments and better understanding of anatomy, supported more precise operations once pain and infection were addressed.
The professionalisation of surgery, with better training, hospital organisation and a growing medical press, helped spread new practices such as anaesthesia and antisepsis more quickly among practitioners.
Public and institutional pressure, including demand from patients and support from some hospital administrators, encouraged adoption of safer techniques; high-profile failures and debates also pushed reform.
The interplay of factors mattered: anaesthesia created the opportunity for more complex surgery, while antisepsis made those operations survivable, so both developments together led to the sharp change in surgical practice between c1840 and c1880.
Question 8
Level 1 (1-3): Identifies one or two simple reasons with little supporting detail or explanation.
Level 2 (4-6): Offers some explanation of reasons, supported by relevant detail, but links may be limited or uneven.
Level 3 (7-9): Explains several reasons clearly, supported by accurate detail, and begins to show how the reasons worked together.
Level 4 (10-12): Provides a well-developed explanation, supported by precise and accurate detail, analysing how the reasons combined to produce the outcome named in the question.
Indicative content:
Some surgeons resisted because carbolic acid procedures were awkward, unpleasant and time-consuming. Sprays, soaked dressings and cleaning instruments could slow down operations and irritate skin or tissue.
Some doctors doubted germ theory or did not accept that invisible microbes caused infection, so they saw Lister's explanation as unproven or unnecessary.
Many surgeons were influenced by habit and professional pride. Experienced practitioners could be reluctant to change methods that had given them status and authority.
Hospitals varied in resources and organisation, so consistent antiseptic practice required equipment, training and discipline that were not always easy to provide.
Results could appear inconsistent if Lister's methods were used carelessly or only partly, which made some surgeons question whether antisepsis itself worked.
A strong answer explains that resistance came from both practical barriers and intellectual attitudes, while also recognising that evidence of reduced infection gradually encouraged wider acceptance.
Question 9
Level 1 (1-4): Shows limited knowledge and offers a simple, unbalanced judgement on the statement with little supporting evidence.
Level 2 (5-8): Shows some relevant knowledge and begins to weigh factors for and against the statement, but the argument lacks depth or balance.
Level 3 (9-12): Shows good knowledge and offers a balanced evaluation of the importance of anaesthetics and antiseptics, supported by accurate evidence and some analysis.
Level 4 (13-16): Shows precise, well-selected knowledge and offers a sustained, balanced judgement on how far the statement is accurate, explaining the roles of anaesthetics and antiseptics and considering other contributing factors.
Indicative content:
Support for the statement: anaesthetics such as chloroform removed the barrier of pain, allowing longer, more complex operations and the development of new surgical techniques; without anaesthesia surgery would remain limited.
Support for the statement: antiseptics introduced by Lister reduced post-operative infection and death, transforming operations from often fatal procedures into survivable ones and so enabling the growth of modern surgery.
Qualification or challenge: other factors were also essential, such as improvements in surgical instruments, better training and professionalisation of surgeons, and changes in hospital organisation and nursing, which together with anaesthetics and antiseptics enabled safer practice.
Qualification or challenge: advances in diagnostics, anaesthetic technique refinement, and later developments in aseptic technique and sterilisation also contributed; early anaesthetics and antiseptics were important but not the only necessary elements.
Balanced judgement: while anaesthetics and antiseptics were crucial and foundational, they worked in combination with other scientific, institutional and technological changes; the development of modern safe surgery was a multi-causal process in which anaesthesia and antisepsis were leading but not solitary factors.