1. Practice Paper 21: Surgery c.1850-c.1950
Read the accompanying sources carefully and then answer the questions below.
1. Study Sources A and B
What can you learn from Sources A and B about the problems facing surgeons in the early 19th
century?
4 marks
2. Study Source C.
How can you tell that Davy’s use of laughing gas as an anaesthetic wasn’t taken seriously by
the cartoonist?
6 marks
3. Study Source D.
How far can we rely on this source to tell us about public attitudes towards Simpson?
8 marks
4. Study Sources E and F.
How far do these sources agree about how chloroform was received by the medical profession
in the 1840s?
9 marks
5. Study Source G.
Use Source G and your own knowledge. Explain why people were opposed to Lister’s idea of
using carbolic in operations.
8 marks
6. Study Source H.
How valuable is Source H for a historian trying to find out about the achievements of Joseph
Lister?
7 marks
7. Study Sources H and I.
In what ways do Source H and I differ in their portrayal of Lister’s achievements?
6 marks
8. Study all the sources and use your own knowledge.
Did Lister or Simpson contribute more to the advancement of surgery in the 19th century? Use
the sources and your own knowledge in your answer.
12 marks
Total: 60 marks

2. Practice Paper 21: Surgery c.1850-c.1950
Source A
Dr Syme describes the amputation of a leg in the 1830s.
I brought down the edge of the knife and cut with a sawing motion. My assistant pressed on the
numerous cut arteries with his hand. I now cut down close along the bone and then made a single cut
along the head of the bone, which with a loud noise popped from its socket. It seemed at first as if the
bleeding vessels which supplied so many jets of blood could never all be closed. But in the course of a
few minutes the bleeding was restrained by the application of ten or twelve ligatures.
Source B
Fanny Burney wrote about the mastectomy (removal of the breast) that she had done in 1810.
M. Dubois placed me upon the mattress and spread a handkerchief upon my face. It was transparent
however and I saw the glitter of polished steel… When the dreadful steel was plunged into the breast,
cutting through veins, arteries, flesh, nerves, I began a scream that lasted during the whole time of the
incision and I almost marvel that it does not still ring in my ears so excruciating was the agony!
Source C
A cartoon by James Gillray, showing Humphry Davy experimenting with laughing gas c.1796. The
title of the cartoon reads: Scientific Researches! New discoveries in pneumatics or an experimental
lecture on the power of air.

3. Source D
A plaque on the wall of Westminster Abbey to commemorate James Simpson.
"To whose genius and benevolence [kindness]
The world owes the blessings derived
From the use of chloroform for
The relief of suffering
Laus Deo"
Source E
A letter to James Simpson from Dr Cockburn in January 1849 about doctors who opposed the use of
chloroform.
My Dear Simpson,
Many thanks for your letter.
There is a very strong prejudice in England against chloroform in midwifery – but I find that all those
medical men who are most opposed to its use have not the slightest practical, or personal, experience
of it.
One great reason for their prejudice is money. Though perhaps convinced in their own minds of the
benefit of chloroform they would never recommend it if they thought it would startle the notions of
their patients and stop them buying the old treatments. They care nothing for science – all they care
for is the number of pink draughts that they can sell.
Chloroform will make its own way – but it will be through the patients, not through the apothecaries.
Yours faithfully
Archibald W. M. Cockburn
Source F
A letter from Dr Alex Tyler of Dublin to James Simpson in 1848. He explains why obstetricians at his
hospital are reluctant to use chloroform.
Dear Dr Simpson
I received your letter inquiring as to the use of chloroform in obstetric practice. Here, I regret to state
that it has not yet been fairly put to the test by our Dublin midwives, owing to a dread of bad
consequences resulting. I suspect Dr Churchill has an imperfect method of administering chloroform,
as I heard he failed completely in a Lady Drysdale’s case, who was very anxious to be put under its
effects during labour.
In my first case I must have given too full a dose of it, as labour was slowed. In subsequent cases I
have been too cautious, so that labour went on with interruptions and with pain. Dr Kingland of the
Coombe used it in several cases at first but tells me that he is afraid of it.
As to the Surgeons, I hear them all speak in the highest terms of chloroform. The Resident Surgeon of
Stevens, Wilmot, told me yesterday that he administers it in every operation there, now in some
hundred cases, without meeting with any untoward result.
Alex Tyler

4. Source G
From the memoirs of a doctor who worked with Lister.
In the operating theatre, everything was soaked in carbolic, hands, instruments and the patients’ skin.
Huge quarts of the precious fluid were everywhere around. The whole scene of an operation was
covered in its spray. Our faces and coat sleeves often dripped with it.
It was a relief to us all when the spray was abandoned. It was costly and cumbersome and often broke
down. Carbolic acid made sad work with our hands which were always rough and cracked.
Source H
From an obituary published by Glasgow University on Joseph Lister in 1912, when he died.
Unlike Ignaz Semmelweiss and Oliver Wendell Holmes, who preceded Lister in recognizing the
importance of cleanliness in preventing infection during childbirth, Lister offered a method that did not
imply that doctors were dirty, and so his message was heeded rather than rejected. Therefore he, more
than Semmelweiss or Holmes, deserves much credit for making childbirth safe, as well as for the
concept of antiseptic surgical operations. Lister was showered with honours, including elevation to the
peerage, the first medical doctor to achieve this distinction. He was buried in Westminster Abbey with
the pomp and ceremony reserved for the greatest national heroes.
Source I
From a school textbook about Joseph Lister, published in 2003.
Antiseptics had long been discussed and were widely used. Sanitarians like Florence Nightingale
insisted on spotless conditions in hospitals. But such disinfective moves were not based on an
understanding of bacteria. They were merely attempts to fight contagious diseases. Lister did not
invent antiseptic surgery but his understanding helped to make it effective, routine, famous and safe.