Lesson video

Hello, I'm Mr. Marchant, and I'll be your history teacher for today's lesson.

I'm really excited to have you joining me as we explore today's subject, and my number one priority will be to help ensure that you can meet our lesson objective for today.

Welcome to today's lesson, which is part of our AQA unit on Health and the People.

By the end of today's lesson, you'll be able to evaluate the impact of warfare and new technologies on modern surgery.

There are five keywords which will help us navigate our way through today's lesson.

Those are invasive, transfusion, clotting, skin graft, and prosthetic.

Invasive, in this context, refers to medical treatments which involve cutting into the body.

Transfusion is the process of adding an amount of blood to a person's body.

Clotting is a process in which blood changes into a solid state to form a thick mass or lump.

A skin graft is an operation where skin is taken from one part of the body and used to replace damaged skin elsewhere, and a prosthetic is an artificial body part, such as an arm, that replaces a missing part.

Today's lesson will be split into three parts, and we'll begin by focusing on managing blood loss.

Surgeries are invasive procedures, and they usually result in some blood loss for patients.

If this blood loss is too great, then patients can go into shock and die.

During the 20th century, and especially during World War I and World War II, new knowledge and techniques helped surgeons to manage blood loss more successfully.

During the 19th century, the first successful transfusions of blood to human patients were carried out to try and manage the issue of blood loss.

However, many of these transfusions failed and the procedure was not very common.

In 1901, the existence of different blood groups was discovered.

This discovery helped surgeons understand that patients could not just receive any blood.

For a successful transfusion, patients needed to be given blood that matched their own blood type.

If it didn't, the blood would be rejected.

From this point onwards, it became easier to perform blood transfusions safely.

Nevertheless, other issues still made blood transfusions challenging.

In particular, blood begins to clot when it's outside of the body, and if this happens, it can no longer be transfused.

However, during World War I and World War II, it was critical to minimise the number of soldiers who died from conditions like shock, and progress was made in overcoming blood clotting.

Experiments during World War I revealed that if glucose and sodium citrates were added to blood, they could prevent clotting and the blood could be stored for weeks.

This allowed blood banks to be created, meaning that more successful blood transfusions could be carried out.

Blood transfusions became even more common during World War II.

Over 700,000 people donated blood in Britain alone during the conflict.

Furthermore, research on blood plasma allowed blood to be transported more easily and stored for even longer.

As a result, larger blood banks were created, allowing more transfusions and helping to save more lives.

Since 1945, blood transfusions have become common in surgeries and help surgeons to perform complex operations they would've previously avoided if the risk of blood loss was too great.

So thinking about what we've just heard, why were many blood transfusions before 1901 unsuccessful? Was it because patients were given blood which did not match their own, because patients were given blood from animals, or because patients were not given enough blood? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said the correct answer was a.

Before 1901, many blood transfusions failed because patients were given blood which did not match their own so their body rejected it.

And let's try another question.

Which substances prevented clotting when added to blood? Pause the video here and press play when you're ready to see the right answers.

Okay, well done to everybody who said glucose and sodium citrate.

These substances were found to prevent clotting when added to blood.

And now we have a statement on the screen which reads, "Blood transfusions were not common before the World Wars." Is that statement true or false? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said that that statement was true, but we need to be able to justify our response.

So why is it that that statement was correct? Pause the video here and press play when you're ready to check your answer.

Okay, well done to everybody who said blood clotting made it difficult to store blood and conduct transfusions before World War I.

New methods developed during the World Wars overcame these issues and helped transfusions become more common.

So we're now in a good position to put all of our knowledge about managing blood loss into practise.

I want you to describe how blood transfusions were improved during the 20th century.

You should include the following terms as part of your answer: blood groups, plasma, and clotting.

So pause the video here and press play when you're ready to reflect on your response.

Okay, well done for all of your hard work on that task.

So I asked you to describe how blood transfusions were improved during the 20th century, and your answer may have included, "The discovery of blood groups in 1901 helped make transfusions safer as surgeons realised patients needed to receive blood which matched their own blood type for a transfusion to succeed.

During World War I and World War II, improvements were also made for storing blood.

It was discovered during World War I that adding glucose and sodium citrate could prevent blood clotting so that blood could be stored for weeks to use in transfusions.

Furthermore, research on blood plasma during World War II allowed blood to be transported and stored even more easily so that even more transfusions could take place." So really well done if your own response looks something like that model answer we've just seen, especially if you included all three of those key terms I asked you to.

And now we're ready to move on to the second part of our lesson for today where we're going to think about managing injuries during the World Wars.

As well as improvements in blood transfusions, World War I and World War II also led to advances in the management of injuries which were common during those wars.

In particular, new techniques became increasingly common to manage broken bones and facial injuries.

During World War I, fractures of the femur, or thigh bone, were particularly common.

However, these injuries were also very deadly in the early years of the war.

82% of soldiers with fractured femurs died from their wounds as the broken bone often pierced the skin and nearby muscles leading to high amounts of blood loss.

To manage this problem, a piece of equipment known as the Thomas splint came into widespread use from 1916 onwards.

The splint extended the leg to prevent joints from moving, reducing the damage which broken bones could cause.

Despite its simplicity, the Thomas splint was very effective.

Death rates from broken femurs fell to just 20%, and the splint remains in use to this day.

So thinking about what we've just heard, what piece of equipment was used from the end of World War I onwards to manage patients with fractures in their femur? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said the Thomas splint.

The Thomas splint was used from the end of World War I onwards to manage patients with fractures in their femur, and let's try another question.

What did death rates from fractures of the femur fall to after the Thomas splint was introduced? Was it 5%, 20%, or 40%? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said the correct answer was b.

Use of the Thomas splint saw the death rate for soldiers with fractured femurs fall to 20% when it had been 80% before the new equipment was introduced.

Both World War I and World War II also led to an increase in the number of people suffering from head injuries.

In particular, there were many patients who suffered injuries, which whilst they did not kill them, left them severely disfigured.

To help manage these injuries, there was rapid development in plastic surgery, especially through the work of Harold Gillies, who set up a special hospital in 1917 to treat patients with facial injuries.

Gillies developed new techniques for skin grafting, which helped reconstruct the faces of many severely wounded soldiers.

In fact, nearly 12,000 operations had been carried out at Gillies' hospital by the end of the war in 1918.

Many surgeons continued to practise this type of work during World War II, including Archibald McIndoe.

McIndoe further developed some of Gillies' techniques, including the walking-stalk skin graft, allowing him to treat serious burn injuries such as the loss of eyelids.

The work of wartime surgeons like Gillies and McIndoe established many of the key techniques used by plastic surgeons ever since.

So let's make sure we've got a secure understanding of what we've just heard.

What type of procedures did Harold Gillies and Archibald McIndoe help to develop and improve? Was it blood transfusions, skin grafts, or vaccinations? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said the correct answer was b.

Howard Gillies and Archibald McIndoe helped to develop and improve skin grafts as a medical procedure.

So we're now in a good position to put all of our knowledge about managing injuries during the World Wars into practise.

We have a view from Andeep.

Andeep says, "During the two World Wars, there were few opportunities for surgeons to improve how injuries were managed." I want you to explain one reason why Andeep's view is incorrect.

So pause the video here and press play when you're ready to reflect on your response.

Okay, well done for all of your effort on that task.

So I asked you to explain one reason why Andeep's view is incorrect, and your answer may have included, "One reason why Andeep's view is incorrect is because the two World Wars prompted a rapid development in plastic surgery.

The two conflicts led to many soldiers suffering from severe facial disfigurement, and so new methods of plastic surgery were developed to manage these injuries.

For example, during World War II, Archibald McIndoe used walking-stalk skin grafts to treat patients with serious wounds, like those who had lost their eyelids.

The techniques developed in plastic surgery at this time established many of the key practises used in modern plastic surgery." So well done if your own response looks something like that model which we've just seen.

And so now we're ready to move on to the third and final part of our lesson for today where we're going to think about technology and modern surgery.

Since the early 20th century, technology has increasingly been used to support modern surgeries.

The use of technology has affected how surgeries are conducted, as well as leading to changes in what happens before and after certain surgeries.

From the very beginning of the 20th century, some technologies were applied to try and reduce the negative impacts of surgery.

For instance, X-rays, which were discovered in the 1890s, were used on a large scale in World War I.

This was because they could provide images of the inside of a patient's body, allowing surgeons to observe broken bones or the presence of objects such as bullets or shrapnel from bombs.

These images meant that surgeries became less invasive as surgeons did not have to make heavy cuts to the body to discover what issues their patients were suffering from.

X-rays and other technologies like MRI scans continue to be used for similar purposes in the 21st century.

New technologies have also changed how some patients are cared for after they receive surgery.

For instance, patients who receive amputations have often been given prosthetic limbs to replace those they lost.

In the modern period, technologies have been applied to make prosthetics lighter, more durable, and also more functional.

For instance, in the 21st century, some patients who have had arms amputated have received bionic arms. These bionic arms are controlled by electrical brain signals and can replicate real hand movements, giving patients a higher quality of life after their amputations.

So let's make sure we have a secure understanding of everything we just heard.

Which statement is correct? Is it that X-rays made surgeries less invasive, X-rays made surgeries more invasive, or X-rays had no impact on how invasive surgeries were? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said the correct answer was a, X-rays made surgeries less invasive.

The surgeons could figure out what might be wrong with their patients without the need for making heavy cuts to their bodies.

And now we have a statement on the screen which reads, "There's been little change in modern prosthetics," but is that statement true or false? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said that that statement was false, but we need to be able to justify our response.

So why is it that that original statement was incorrect? Pause the video here and press play when you're ready to check your answer.

Okay, well done to everybody who said some patients who have limbs amputated can now receive bionic prosthetics, such as arms, which are controlled by electrical brain signals.

Modern surgical practises have also involved the use of various technologies during operations themselves.

Amongst the most common examples of this is keyhole surgery.

Keyhole surgery is made possible by the use of tiny cameras and narrow surgical instruments.

These can operate inside the body through small cuts, even if those cuts are some distance away from the actual part of the body which surgeons wish to operate on.

Keyhole surgery is a less invasive procedure which only requires small cuts to be made to the body.

As a result, patients' bodies suffer from less trauma and can heal quicker.

In the 21st century, there's also been a rise in the use of robotic surgery.

Surgeons are able to use robotic instruments to perform a wide range of operations, including the removal of cancerous tumours and even lung transplants.

In the UK, the NHS performs thousands of robotic surgeries each year using systems such as the da Vinci XI robot.

Patients operated on in this way have reported less pain afterwards and on average also remain in hospital for less time than other patients.

However, robotic surgery does involve high costs.

For example, the da Vinci XI robot costs two million pounds, which means this type of treatment is not always available.

Nevertheless, plans have been approved to expand the use of robotic surgery systems in the NHS.

So thinking about what we just heard, how much does the da Vinci XI robot used in surgeries cost? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said the correct answer was two million pounds.

That's the cost of the da Vinci XI robot used in some surgeries.

Let's try another question.

Why do patients receiving keyhole surgery normally recover more quickly than others? Is it because the procedure is carried out by robots, because the procedure is not very invasive, or because the procedure involves blood transfusions? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said the correct answer was b.

Patients receiving keyhole surgery normally recover more quickly than others because the procedure is not very invasive.

It's conducted through just a very small cut made to the body.

So we're now in a good position to put all of our knowledge about technology and modern surgery into practise.

Which factor has led to greater improvements in modern surgery: technology or warfare? You may consider the following to support your judgement , the amount of patients who have been saved and the extent of change which has occurred as a result of those factors.

So pause the video here and press play when you're ready to reflect on your response.

Okay, well done for all of your efforts on that task.

So I asked you which factor has led to greater improvements in modern surgery: technology or warfare? And your answer may have included, "It could be argued that warfare has led to greater improvements in modern surgery than technology.

Indeed, it was during the two World Wars that the major problem of blood loss was overcome.

For example, during World War I, it was discovered that substances such as glucose and sodium citrate could prevent blood from clotting.

This allowed blood to be stored over periods of time, making it easier to conduct blood transfusions which could save patients from shock.

As most surgeries involve blood loss, this was a critical discovery which has reduced the risks posed by surgical operations.

Furthermore, the improvement of blood transfusions has allowed modern surgeries to become more complex, meaning more problems can be treated.

Nevertheless, technology has led to greater overall improvements in modern surgery.

For instance, the use of X-rays and MRI scans has helped make some surgeries less invasive, as problems inside the body can already be identified.

The development of keyhole surgery and robotic surgery, such as through the use of the da Vinci XI robot, have had similar benefits for patients as well, ensuring they suffer less pain and recover more quickly.

Finally, even the care received after surgery has been improved by technology, such as by making bionic prosthetic arms available to amputees.

This shows how far-reaching the benefits of technology have been for modern surgery and is why it was more important than warfare for surgical improvements." So really well done if your own answer looks something similar to that model which we've just seen.

And so now we've reached the end of today's lesson, which puts us in a good position to summarise our learning about improvements in modern surgery.

We've seen that knowledge of blood groups and new methods for storing blood improved the effectiveness of blood transfusions.

Blood loss was no longer a major problem for surgeons after World War II.

The use of the Thomas splint and new methods of plastic surgery developed during the World Wars allowed fractured femurs and some head injuries to be treated more effectively.

Technologies like X-rays and bionic prosthetics have been used before and after operations to reduce the impact of surgeries on patients, and technologies like robots have made modern surgery less invasive.

So really well done for all of your hard work during today's lesson.

It's been a pleasure to help guide you through our resources today, and I look forward to seeing you again in future as we continue to think about medical history and health and the people.