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 Edexcel unit on Medicine in Britain.

By the end of today's lesson, you'll be able to assess the impact of medical and surgical experiments conducted on the Western Front.

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

Those are invasive, antiseptic, sterilise, irrigation, and clotting.

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

An antiseptic is a substance used to destroy disease-causing microbes.

To sterilise something is to make it free from microbes.

Irrigation in this context is the process of washing out a wound to prevent infection.

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

Today's lesson will be split into three parts, and we'll begin by focusing on the use of X-rays and the Thomas Splint.

Most wounds on the Western Front were caused by bullets and shrapnel.

These objects could pierce organs, fracture bones, cause bleeding, and risk infections.

Equipment like X-rays and a Thomas Splint helped medics respond to the challenges created by these types of wounds.

During World War I, X-ray images proved particularly helpful for identifying the location of shrapnel and bullets in wounded soldiers' bodies.

This meant that surgeries performed to remove these objects could be less invasive and also reduce the threat which blood loss and infection posed to patients.

For this reason, base hospitals were equipped with their own radiology departments and static X-ray machines.

Although most Casualty Clearing Stations, or CCSs, lacked access to their own static X-ray machines, many did benefit from mobile X-ray units, which moved across the Western Front.

Mobile X-ray units were first designed by the scientist Marie Curie.

She used the engine of a van to power the X-ray machines they carried.

Although the images produced by these mobile X-ray units were of lower quality than static machines, the mobile units did allow more surgeons and CCSs to use X-rays to guide their work.

By 1915, two mobile X-ray units were operating in the British sector of the Western Front, and this increased to six as the war continued.

So thinking about what we've just heard, I want you to write the missing word from the following sentence.

X-ray images reduce the risk of blood loss and infection during operations because they meant surgeries could be less blank.

So what's the missing word? Pause the video here and press Play when you're ready to see the right answer.

Okay, well done to everybody who said that the missing word was invasive.

X-ray images reduced the risk of blood loss and infection during operations because they meant surgeries could be less invasive.

And where were mobile X-ray units most likely to be used? Was it at regimental aid posts, dressing stations, Casualty Clearing Stations, or base hospitals? 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 C.

Mobile.

X-ray units were most likely to be used at Casualty Clearing Stations.

Shrapnel and bullets were responsible for fracturing many femurs, the thigh bone.

This type of wound proved to be particularly deadly in the early years of World War I, with just 20% of soldiers surviving a fractured femur.

Some men died before they even reached a Casualty Clearing Station, and many of us did not survive surgery.

This was because the broken bone could move around as soldiers were evacuated, piercing skin and muscles in the process which could cause severe blood loss and increase the risk of infection.

Many soldiers who did survive only did so because their legs were amputated.

Eventually, a solution was found for this problem, use of the Thomas Splint.

The Thomas Splint kept wounded men's legs rigid, meaning that fractured bones could not move and could be applied over soldiers' uniforms, unlike many other splints, making it quick and easy to use.

Stretcher bearers received training to use Thomas Splints, which were used on the Western Front from 1916 onwards.

This practise proved very successful.

The survival rate for fractured femurs rose to 80% whilst amputation rates decreased significantly.

So thinking about what we've just heard, we have a statement which reads, "The purpose of the Thomas split was to keep legs with fractured bones rigid." 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 original 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 fractured bones can cause severe blood loss and infection if they move when a wounded person is evacuated.

The use of the Thomas Splint in World War I prevented bones from moving by keeping legs rigid.

And identify two impacts of the use of the Thomas Splint on cases with fractured femurs.

You can choose from amputation rates fell, infections became more common, fewer soldiers suffered fractured femurs, and survival rates increased.

So which two of those impacts are correct? Pause the video here and press Play when you're ready to see the right answers.

Okay, well done to everybody who said the correct answers were A and D.

As a result of the use of the Thomas Splint, amputation rates fell for soldiers who had fractured femurs and survival rates increased for soldiers with this type of injury.

So we're now in a good position to put all of our knowledge about the use of X-rays and a Thomas Splint into practise.

Firstly, I want you to describe one benefit of the use of mobile X-ray units on the Western Front, and then I want you to describe two benefits of the use of the Thomas Splint on the Western Front.

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

Okay, well done to everybody for your hard work on that task.

So firstly, I asked you to describe one benefit of the use of mobile X-ray units on the Western Front, and your answer may have included, "One benefit of mobile X-ray units was that they gave more surgeons, especially those in Casualty Clearing Stations, access to X-ray images.

These images could be used to identify the location of shrapnel and bullets in wounded patients' bodies, making surgeries less invasive." And then I asked you to describe two benefits of the use of the Thomas Splint on the Western Front, and your answer may have included.

"The Thomas Splint was beneficial as it helped improve the survival rate from fractured femurs.

By keeping the wounded men's leg rigid, it prevented fractured bones from moving, and so survival rates increased from 20% to 80%.

And another benefit of the Thomas Splint was that less amputations had to be performed.

Before its introduction, due to infections caused by moving bones, many soldiers with fractured femurs had to have their legs amputated." So really well done if your own responses looked something like those models which we've just seen.

And so now we're ready to move on to the second part of our lesson for today where we're going to talk about preventing infections.

Infection was a serious issue on the Western Front.

Some soldiers were already suffering from infections when they arrived for treatment, and it was often not possible to perform surgery in aseptic conditions.

This encouraged the development of new antiseptic methods to prevent infections.

Two related practises, debridement and the Carrel-Dakin method, were developed during World War I to help manage the problem of infection on the Western Front, particularly for soldiers with bullet and shrapnel wounds.

Debridement was used for 1915 onwards and focused first on removing all fragments of bullets or shrapnel as well as any dirt or soil they brought along with them from inside a patient's body.

This was because these fragments and any dirt they might have brought into the body could be the cause of infection if they carried any harmful bacteria.

Once this had been done, surgeons then focused on cutting away any body tissue which was too damaged to heal.

Again, this reduced the risk of infection and helped wounds to heal more successfully after they were treated.

The success of debridement on the Western Front was helped by the development of the Carrel-Dakin method, which focused on the irrigation of wounds.

At the beginning of World War I, many medical officers attempted to use antiseptics, such as carbolic acid, to irrigate and sterilise wounds.

However, it was found that carbolic acid was ineffective in fighting gas gangrene, a particularly deadly infection caused by bacteria found in the local soil in the British sector of the Western Front.

To overcome this problem, Alexis Carrel and Henry Drysdale Dakin worked together to develop the Carrel-Dakin method.

This method involved using a sodium hypochlorite solution, which could kill bacteria, including those which cause gas gangrene, without harming body tissue.

Once wounds had been debrided, they would often be irrigated with Carrel and Dakin solution multiple times, ensuring that the risk of infection was reduced.

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

How did debridement help more patients to survive their wounds? Was it by removing possible causes of bleeding, by removing possible causes of infection, or by removing the cause of pain? Pause the video here and press Play when you're ready to see the right answer.

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

Debridement helped more patients to survive their wounds by removing possible causes of infection.

And now we have a statement on the screen which reads, "Carbolic acid was used successfully to prevent gas gangrene infections on a Western Front." 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 although carbolic acid is an antiseptic, it could not destroy the bacteria responsible for causing gas gangrene infections.

And what was the name of the method which used a sodium hypochlorite solution to irrigate wounds? Pause the video here and press Play when you're ready to check your answer.

Okay, well done to everybody who said that the Carrel-Dakin method used a sodium hypochlorite solution to irrigate wounds and prevent infections.

So we're now in a good position to put all of our knowledge about preventing infections into practise.

I want you to explain how the irrigation of wounds helped prevent gas gangrene infections during World War I.

You should try to include the following terms as part of your answer: Carrel-Dakin, antiseptic and sterilise.

So the 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 explain how the irrigation of wounds helped prevent gas gangrene infections during World War I.

And your answer may have included, "The bacteria which causes gas gangrene was common in the soil on the British sector at the Western Front.

Consequently, many wounded soldiers were at risk at developing gas gangrene infections.

To deal with this, many medical officers focused on irrigating wounds to sterilise them and protect their patients.

The Carrel-Dakin method involved irrigating wounds using a sodium hypochlorite solution.

This was important because the solution used in this method was capable of destroying the bacteria responsible for gas gangrene infections, unlike antiseptics which had been used previously such as carbolic acid.

Therefore, the irrigation of wounds using the Carrel-Dakin method helped to sterilise them and prevent gas gangrene infections." So really well done if your own response looks something like that model we've just seen, especially if you managed to include all three of those terms I mentioned before we started the question.

And 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 managing blood loss.

Blood loss was a serious problem during World War I.

Injured soldiers who lost too much blood could go into shock, a potentially deadly condition.

During World War I, several important advances allowed a greater number of blood transfusions to be conducted, helping to manage the problem of blood loss.

When World War I began, the expertise and technology existed to make blood transfusions possible.

Indeed, transfusions began in the British Base Hospital at Boulogne in 1915 and had been extended to many CCSs by 1917.

Some of these cases involved the use of a portable blood transfusion kit developed by Geoffrey Keynes, a doctor in the Royal Army Medical Corps, otherwise known as the REMC.

Keynes's portable kit made it possible to conduct transfusions closer to the front line.

However, a key issue encountered when conducting transfusions, even when using Keynes's portable kit, was the inability to store blood for a long period of time.

This was because blood begins to clot once it leaves the body and cannot then be used for transfusions.

As a result, at the start of World War I, medical officers required a donor with a compatible blood type to be available and in the same place as their patient in order to perform a transfusion.

Especially during major battles, this was often not possible.

So, thinking about what we've heard, why were most blood transfusions at the start of World War I performed with the donor close to the recipient? Was it because clotting meant donor's blood could not be stored, because keeping donors nearby reduced the risk of infection, or because storing blood was considered unnecessarily expensive? Pause the video here and press Play when you're ready to see the right answer.

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

Most blood transfusions at the start of World War I were performed with the donor close to the recipient because blood clotting meant that donor's blood could not be stored.

Important advances during World War I helped reduce the challenges posed by blood clotting.

Firstly, it was discovered in 1915 that adding sodium citrate to blood could prevent it from clotting.

Critically, this meant that once it was refrigerated, blood could now be stored for up to two days, meaning that an appropriate donor did not always have to be present at the time a transfusion was performed.

This discovery was built upon in 1916 when it was discovered that adding a citrate-glucose solution to blood and then refrigerating it allowed blood to be stored for up to four weeks.

The ability to stop blood clotting enabled some medical officers to begin developing blood banks, which would allow them to perform more transfusions during major battles.

For instance, before the Battle of Cambrai in 1917, Oswald Hope Robertson stocked 22 units of O type blood.

It was known that O type blood was a universal blood group that could be given to any soldier.

And during the battle itself, Robertson performed transfusions for 20 wounded soldiers.

Each of these men was in such a severe state of shock that it was expected they would die.

However, after receiving the transfusions, 11 of the men were able to recover from the shock and survive.

Whilst this was a small-scale experiment, it clearly demonstrated the potential stored blood had for saving lives.

Advances such as this During World War I were built upon once the conflict had ended, enabling blood transfusions to become widespread in the military in World War II and increasingly common for ordinary people by the second half of the 20th century.

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

I want you to write the missing length of time for the following sentence.

After a citrate-glucose solution was added to blood and it was refrigerated, blood could be stored for up to blank.

So what's the missing length of time? Pause video here and press Play when you're ready to check your answer.

Okay, well done to everybody who said the missing length of time was four weeks.

After a citrate-glucose solution was added to blood and it was refrigerated, blood could be stored for up to four weeks.

And Oswald Hope Robertson first developed a blood bank for use during which battle? Was it the First Battle of Ypres, the Battle of the Somme, the Battle of Arras, or the Battle of Cambrai? 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 D.

During the Battle of Cambrai, Oswald Hope Robertson developed a blood bank which he could use to conduct transfusions for wounded and injured soldiers.

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

How significant were the advances in blood transfusions during World War I? You need to explain your answer, and you may consider the immediate and long-term impacts of these advances.

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 how significant were the advances in blood transfusions during World War I? And your answer may have included, "The advances in blood transfusions made during World War I were very significant because whilst it had been possible to perform these before the war began, the wartime advances overcame some key limitations.

In particular, methods were found to stop clotting and enable blood to be stored.

In 1916, it was discovered that if a citrate-glucose solution was added to blood and then refrigerated, the blood could be stored for up to four weeks before use.

This meant more transfusions could be performed because doctors no longer had to be restricted by whether there was a suitable donor in close proximity to their patients who needed a transfusion.

The use of stored blood was also shown to be effective in treating shock during World War I.

After Oswald Hope Robertson created a blood bank, he was able to use this to treat 20 wounded soldiers for severe shock.

Despite the fact that all had been expected to die, 11 were saved by the transfusions Robertson performed.

Although this was on a small scale, it showed how effective the use of stored blood could be for saving lives.

This encouraged more medical professionals to accept blood transfusions and during World War II and by the second half of the 20th century, transfusions would become increasingly common." So, really well done if your own response looked something like that model answer 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 the significance of the Western Front for experiments in surgery and medicine.

We've seen that X-ray machines and mobile X-ray units were used to guide surgical work on the Western Front and helped make operations less invasive.

The Thomas Splint helped increase the survival rate for fractured femurs from 20% to 80%.

Debridement and the Carrel-Dakin method became widely practised to sterilise wounds and fight infections such as gas gangrene.

Blood transfusions were used to help patients suffering from shock.

And advances like the use of citrate-glucose solutions to stop blood clotting allowed blood to be stored and used for transfusions.

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 medicine in Britain and medical history on the Western Front.