hi there welcome to this revision video for Ed EXL GCSE history medicine in Britain 1250 present day this video is going to talk about the British sector of the Western Front 1914 to 1918 injuries treatment and the trenches this is the historic environment part of the exam so really really important you know this one really really well in terms of preparing for your exam okay so that just outlines um what the specification says in terms of what you need to know so the key things are the context of the British sector of the western FR theater of the war in Flanders and northern France the Eep Salient the S Aras and Cai the trench system its organization including Frontline support trenches and the significance for medical treatment of the nature of the terrain and problems of the transport and Communications infrastructure you need to know what conditions required medical treatment on the Western Front including the problems of ill health arising from the trench environment the nature of wounds from rifles and explosives the problem of shrap wound infection increased number of head injuries and the effects of gas attacks you need to know about medical treatment on the Western Front the work of the uh nurses the transport in the chain of evacuation stretch of eras horse and motor ambulances stages of treatment areas include in the chain of evacuation um first aid posts and field ambulances dressing stations casual clearing stations and base hospitals and also to know about the underground hospital at Aras the significance of the Western Front for experiments in surgery and Medicine new techniques in the treatment of wounds and infection including the Thomas splint the use of Mobile X-Ray units the creation of a blood bank for the Battle of Cambry and you need to know about historical context of medicine in the early 20th century the understanding of infection and moves towards a septic surgery and developments in the storage of blood so there's quite a lot to know about in this topic and but we're going to break that down for you and we're going to go through this in this revision video for you as part of this content you also need to know about historical sources that can be used for historical inquiries so knowledge of sources relevant to the period in issu such as Army records National newspapers government reports and medical articles knowledge of any local sources relevant to the period and issues such as personal accounts photographs hospital records Army statistics recognize the strength and weaknesses of different types of sources for specific inquiries and framing of questions relevant to the pursuit of an inquiry and selection of appropriate sources for specific investigations and we'll have a look at some of that as well within this video so we're going to Begin by looking at the context of the British sector of the Western Front um and so let's find out a little bit more about this part of the course okay so here's just a timeline of the first world war and I think this is incredibly helpful just to have a timeline here just to know some of the key dates so you can kind of connect all the different stories and learning together so the first World War began in August 1914 the first trenches for August to September 1914 both Sid Doug trenches defended with bwire and machine guns and we get this essentially stalemate um situation on the Western Front October to November 1914 the first battle of EP British troops stopped the germs from capturing ports like C in April May 1915 is the Second Battle of EP uh German attack using chlorine gas 60,000 Allied casualties the Battle of Verdan is February to December 1916 German forces attacked French forces 160,000 French soldiers killed the battle of the Som takes place July to November 1916 there's 60,000 British casualties on the very first day of fighting including 20,000 killed the Battle of Aras is April to May 1917 large scale attack on German positions very high casualties the third battle of E the Battle of passendale the aim is to capture the passendale Ridge near the town of Eep it was captured but at the cost of 245,000 British casualties November to December 1917 the Battle of Cambry the British army used a large number of Tanks to attack German trenches 40,000 British casualties spring 1918 the German spring offensive the German Army launched a major attack along a 50m front was initially successful but it led to 200,000 British casualties but the jman Army did not achieve the decisive breakthrough the end of the first world war was the 11th of November 1918 after the Allied armies with US forces broke through German lines so you can see here first world war you know very brutal uh conflict lots of casualties and obviously we're going to look at the kind of medical history of that um as part of this um this video okay so in Flanders and Northern France we had the EP Salan or wipers as the British soldiers called it now many battles took place here because it was on the way to the channel ports of c and Dunkirk Germany wanted to capture these ports in order to cut off British supplies the Eep s was really vulnerable because the Germans had the higher ground and could see Allied movements tunneling and Mining were used by the British at Hill 60 to try to recapture it in April 1915 now Hill 60 was a man-made Hill captured by the Germans the first battle of e that took place in 1914 the British held off a German attack um Germans were trying to you know basically get a route through to C to stop um you know the the British being able to supply their forces the Second Battle of e in April May 1915 so the first use of chlorine gas by Germany and the third battle of e sometimes known as the Battle of passendale took place from July to November 1917 so lots of fighting took place um during the um the E Salient and you can see there in that map at the bottom which shows the first battle of e there's this very distinctive kind of Bulge um in the front line here which gives it the name the Salient so further south of EP is the S um and it's very famous of course for the battle of the S which took place between July and November 1916 along the river Som in northern France on the first day the 1st of July 1916 the British suffered 60,000 casualties including 20,000 dead it's the worst day in the history of the British Army in total there were around 400,000 casualties putting enormous pressure on the medical services Across the Western Front during this time period another key place where fighting took place was um at a place called Aras okay the Battle of Aras took place in April 1917 north of where the battle of the S took place now this is distinctive and remembered for Allied soldiers digging a network of tunnels below Aras uh the the tunneling was easier due to the chalky ground um so new tunnels joined with existing tunnels caves and quaries there were even rooms that were created with running water and electricity there was also an underground Hospital located there that we're going to talk about a little bit more in the presentation the tunnels were used for the safety uh used for safety enabled soldiers to walk to the front or get to the front line in secret so that was the uh the the um the Battle of Aras okay and then another place that's important in the Western Front is cry um so the Battle of cry took place in o October 1917 during the battle over 450 large scale tanks were used by their allies to launch a surprise assault on the German Front Line the tanks did not have enough infantry support the British lost the ground they had taken okay so as the first World War developed into a defensive War a line of trenches was dug all along the western front now the trenches were around 2.5 M deep and they were dug in a zigzag pattern for defense um and contained dugouts for soldiers to take cover now some key words and and ideas to be aware of the front line was the trench nearest the enemy where soldiers would fire from this was by far the most dangerous part of the trenches to be in and where most of the fighting um obviously took place the command trench would be about 10 to 20 M behind that firing line from the front trench uh behind that would be a support trench which about 200 to 500 M behind the front line um and that's where soldiers would be who could then support the front line uh trenches if need be and the reserve trench was then 100 m behind the support trench and they would be there ready to mount a Counterattack if necessary if the enemy entered the front line the communication trenches link the front line with the command support and Reserve trenches and no man's land is the land between Allied and German trenches and that's pretty much how the sort of trench system worked in the first world war and soldiers would spend various amounts of time in different parts of the trenches but would sometimes have some time uh behind the the lines to of rest and recuperate so for example at the E salent you know British soldiers would go back to the town of eat for example um to sort of like rest and relax and uh you know rebuild their strength um then to go back onto the front line so the trench system was really complex and it made it really hard the terrain of the trenches with all the mud for example made it really hard to move the wounded from trenches to hospitals moving through the trench system was really hard because it was so cramped and there were lots of men and equipment so it could be very slow uh to get through the trenches and communication was really difficult during major battles particularly hard to move around at night time and collected wound the wounded from no man's land was very difficult because it was mostly had to be done under Fire so people called stretcher bearers would have to go onto the battlefield with stretches to try and rescue wounded men from the battlefield no man land on the trenches themselves were often deep in mud making it practically impossible to move around really stretch of bears found it difficult to move around corners and obviously the zigzag uh trench system made that really difficult as well so all in all the actual terrain but also the the way that the trenches were constructed made it really really difficult um to move um soldiers um it wounded soldiers around okay so we're now going to look at what conditions required medical treatment on the Western Front and the ill health from the trench environment and also within this we're going to look at the effects of gas attacks as well okay so in terms of conditions requiring uh treatment on the Western Front um one of the uh conditions requiring treatment on the Western Front was called trench fever or sometimes known as pyrexia this was transmitted by Body LI or graybacks as the soldiers called them you had flu like symptoms high temperature and severe headaches drug treatments that were tried such as quinine and salverson but they did not work passing an electric current through the affected area was also um used by 1918 the cause had been identified as lice so this meant that the the main way of tackling this disease was by tackling the lice so it meant the clothes were disinfected and delousing stations were set up bath houses were used um trench fever affected nearly half a million men on the Western Front another really nasty disease or condition was trench foot this was caused by standing in mud and water loged trenches and that led to painful foot swellings tight boots added to issues as they restrict blood flow Gang Green would set in for example uh treatments included keeping the feet clean and dry in the worst cases the foot might have to be amputated so the prevention for this was through changing socks and keeping feet dry officers ordered that all men should have three pairs of socks some soldiers rubbed whale oil into their feet men were put into pairs they could look after each other's feet moner each other's feet and just take care of each other during the winter of 1914 1915 20,000 Allied men were affected train foot was definitely worse at the start of the war before um the soldiers really got the kind of idea and approach of how to actually treat um the condition of trench foot another condition was shell shock which is um a mental kind of condition um suffering the Mental effects of the first world war pretty much akin to post-traumatic stress disorder to be honest PTSD um it's caused by the unbelievably stressful conditions on the Western Front um symptoms would include things like tiredness headaches uncontrolled shaking and a mental breakdown the condition was not well understood during the war treatments involved rest and some soldiers were sent to recover back in Britain now historians believe that 880,000 British soldiers experienced some kind of shell shock some were accused of being cowed with some soldiers even being shot at door when they had shell shock serious cases were labeled as nydn which stands for not yet diagnosed nervous and of course we would recognize this as combat stress disorder or PTSD postraumatic stress disorder um in the 21st century so what kind of weapons of war and what kind of wounds did that create well obviously rifles the you know the Lee Enfield standard issue rifle for example um loaded from one cartridge case which created automatic rapid fire rather than uh one bullet the bullets had points on them which caused them to do even more damage um so you're looking at lots of wounds and um horrible kind of like injuries and obviously those injuries if they didn't kill um the men could obviously lead to horrible infections as well machine guns could fire 500 rounds a minute that led to devastating attacks to soldiers attacking across No Man's Land bullets would damage organs fractur bones um horrible head injuries for example many soldiers would uh tragically be killed outright and many left with the most devastating wounds sometimes they would succumb to those wounds in the sort of days and weeks afterwards um sometimes of course they would um we would be able to survive them artillery and the Cannons just grew bigger and bigger and became more powerful like the British Howitzer which could send 900 kgam shells a shell means explosives there's continuous bombardment which could last for weeks and sometimes months um and obviously they could do a lot of damage and kill soldiers outright shrapnel was what exploded midair above the enemy so it was a hollow shell Hollow explosive filled with steel balls or lead with gunpowder and a time of fuse it was used against troops advancing across no man's land and shells targeted soldiers in the trenches as well now these weapons also led to an increase in head injuries so in 1915 as a standard issue a steel helmet steel helmet replac the soft caps of soldiers and helmets reduced head injuries by around 80% so many soldiers had their lives saved by steel helmets gas attacks um so we've already found out the first um gas attack using chlorine gas was at the Second Battle of epril 1915 gas was a new type of warfare in the first world war which spread much fear in most cases its effects though were short lived and disappeared after a couple of weeks in the hospital there were three main types of gas used in the first world war firstly chlorine this was used by the Germans in 1915 and led to death by Suffocation so in July 1915 gas masks were given to all British troops before this soldiers would urinate on the handkerchiefs and hold these on their faces so as not to breathe in the gas the ammonia and urine would offer a degree of protection against the gas although he was nowhere near as effective as having a gas mask fos Gene was first used by the Germans in in 1915 it worked more quickly than chlorine but had similar effects it could kill someone exposed to it within 2 days and then mustard gas this was first used by the Germans in 1917 an odorless gas that worked in 12 hours caused blisters and could burn the skin through clothing we're now going to look at medical treatment on the Western Front and we are going to think about um all the different things including the underground hosital Aras which we've already mentioned okay so in terms of treating the wounded on the western we had what was called the evacuation route so how are we going to get these soldiers out um of the trenches if they've been injured maybe injured on the battlefield so let's imagine a situation where a soldier is injured in no man's land and maybe they've gone over the top uh in an attack like at the Battle of the PM on the 1st of July 1916 so they've been injured they're lying injured on the battlefield so their treatment would kind of go through these different stages so firstly stretcher bearers um so these are um soldiers um off these could be sort of like non-competent roles um these um stretcher barers will go onto no man's land at night or maybe during a lullin fighting to collect both the dead and the wounded every Battalion had a stretcher Bearer and it took four men to carry a stretcher as you can see in that artistic interpretation we then have the regimental Aid post or the wp now the wrap was close to the front line each Battalion was um each Balian um had a regimental medical officer and their job was to identify those who were lightly wounded and those soldiers who needed more medical attention it was moved forward when casualties were expected in an attack okay so from there there would be the field ambulance and dressing station now field ambulance was a Mobile Medical unit with medical officers support staff and nurses from 1915 emergency treatment happened here and they're about a mile from the front line and this was where triage was set up to provide a little bit of treatment and the more and a less seriously injured separated out from there we have the casualty clearing station CCS this was a large and well equipped medical unit it contained x-ray machines and water with beds they were located in tents or Huts about 10 mil from the front line usually had seven doctors with nurses and other staff and then finally we have the base Hospital which is usually a civilian hospital or a converted building near Railways soldiers could arrive by train ambulance or even Canal they had operating theaters x-ray departments and specialist areas to deal with gas poisoning from the base Hospital most casualties were sent back to Britain in converted Hospital trains okay so how did the treatment of the Wounded change during the first world war well soldiers generally receiv received better care as the war went on and that's not a surprise you know people got more experience and how to deal with the wounds and the systems got a lot more sophisticated in 1914 there were no motor ambulances and H drawn ambulances could not cope with lots of casualties but by November 1915 there were 250 motor ambulances in France ambulance trains were also introduced and they could carry lots of casualties up to about 800 and ambulance barges were used to carry casualties along the river Som which you can see a picture of there okay let's talk about the underground hospital at Aras so we've already found out that the chalky G of atmosphere at Aras was really really good for tunneling so 160,000 British and Australian soldiers were were actually killed at the Battle of our ass and in just the first three days 7,000 were wounded and the evacuation route worked well in 1916 existing tunnels and quaries were extended to create almost like an underground town for soldiers that even had running water and electricity and included a hospital with 700 beds and operating theaters it was so large a hor drawn Railway was used to move supplies okay in terms of nurses and doctors all medical officers and men in 1914 belonged to something called the ramc the Royal Army Medical corpse membership increased greatly during the war from 9,000 in 19 14 to 113,000 in 1918 this was because there were so many more wounded doctors had to learn quickly about new conditions at the start of the war nurses were from the Queen Alexandra's nurses volunteer nurses were turned away and women of the first aid nursing yry the F also helped out as ambulance drivers and nurses they also carried supplies to the front line and drove motorized kitchens to supply food okay we're now going to look at the significance of the Western Front for experiments in surgery and Medicine new techniques including the Thomas splint Mobile X-Ray units and the creation of a blood bank for the Battle of C Bri so why did the Western Front improve medicine it's a really good question there's quite a lot of evidence for this firstly everyone in the medical service worked hard on the did in peace time so there's very much a sense of people pulling together and working together for a common goal also the Western Front created new problems such as deep infections which needed urgent Solutions there was pressure on doctors to get men fit for service to return them to the front line and Industry and government gave resources to developing improving medical and surgical equipment doctors had to innovate quickly to find new Solutions created by powerful new weapons surgeons did many more operations and that increased their experience and expertise okay so in terms of treating wounds and infection in 1900 most operations were carried out using what was called aseptic methods so that was the idea of keeping the whole operating theater clean with this could not be done on the Western Front because all equipment had to be carried this made it hard to treat infections such as those caused by gas ganger other treatments were used such as debridment which means cutting away infected tissue around the wound this had to be done quickly and the wound then closed to prevent infection there's also the caralin method which is when a sterilized salt solution used in a was used in a wound through a tube or put into the wound through a tube the solution though only lasted 6 hours so had to be made when needed so it could be quite a slow process the car baking method and then of course there's amputation which is a more extreme kind of form of treatment this was used if the above did not work by 1918 240,000 men had actually lost limbs okay the Thomas splint those with the gunshot or shrapnel injury had around 20% um survival chance and this is because compound fractures were common this is when the bone broke through the skin and that massively increased the risk of infection now doctors only had simple splints which did not really stop the broken ends um of bone causing huge blood loss which actually caused many soldiers to die however a Liverpool surgeon called Hugh Owen Thomas um which gives us the name the Thomas splint invented a new splint and you can see a picture of it there it was used from 1916 onwards the Thomas splint was used which kept the leg rigid and stopped the joints moving and that um lessened the concern about blood loss and that increased the survival rate from this wound up to 82% now X-rays were first discovered in 1895 by Will ronen a German physicist from 1896 Radiology departments were opening a number of hospitals x-rays enabled a surgeon to carry out a diagnosis before an operation took place X-rays were used from 1914 to locate bullets and trapnel but it had to be removed from wounds X-rays were a great success but did have some limitations first the x-rays could not detect all objects in the body such as fragments of clothing could not be detected wounded soldiers had to remain really still which is really really difficult if they're in a lot of pain and tubes and x-ray machines often overheated meaning they could only be used for an hour before needing to be left to cool down the solution was using three machines in rotation Mobile X-Ray units so there were six Mobile X-Ray units in the British sector of the Western Front they were transported around the Western Front in a truck enabling more soldiers to quickly have their x-rays the mobile x-ray machine could go to the location of the battle rather than waiting for soldiers to be transported the quality of X-rays were not quite as good but they were good enough locate bullet and trapnel okay so blood transfusions and storage of blood now blood loss was a major problem in surgery and the first experiments on blood transfusion took place in the 19th century blood could not be stored so it had to be used as soon as possible transfusions were carried out with the donor being directly connected by a tube to the recipient now some problems with early blood transfusion were that blood clots as it leaves the body so tubes often became blocked donor blood was some times rejected for not being compatible blood groups were only discovered in 1901 by Carl liner there was a danger of infection from unsterilized equipment now blood transfusions were used at base hospitals from 1915 this was extended to casualty clearing stations in 1917 a doctor called Jeffrey ke designed a portable blood transfusion kit which could be used close to the front line now in 1915 it was discovered that sodium citrate could be added to the blood which removed the the need for donor recipient transfusion in 1916 it was discovered that adding a citrate glucose to blood enabled it to be stored for up to 4 weeks so what we've got invented here is the idea of a blood bank and the fact that blood transfusions don't need the donor patient there at the same time stored blood was used at the Battle of Cambra in 1917 there was a blood bank with blood stored in glass bottles so that's all about blood bank at cry in 1917 now there were lots of head injuries in the first world war so developments like blood transfusions and saline Solutions had helped more people survive and progress was made in brain surgery too so a local anesthetic was used rather than a general anesthetic to to decrease risks and stop the brain from swelling now Henry Cushing developed a surgical magnet to extract bullets from head wounds and x-rays also helped locate where the bullets were and also locate where injuries were within the brain there's also huge developments in plastic surgery so obviously lots of soldiers got um facial wounds during the first world war now Harold Gillies was a doctor from New Zealand and he was sent to Western Front in 1915 now Gillies became interested in facial reconstruction replacing restoring parts of the face that had been destroyed by weapons of war skin graphs were developed where skin was taken from another part of the patient's body and used to repair the wound so in terms of historical sources there are many different types of sources that can help us to find find out about the British sector of the Western Front there are National Army records for individual soldiers National newspaper reports contained reports about different battles so for example the times reporting on the battle of the Sor in 1916 there's hospital records that been kept government reports on battles or aspects of the war personal accounts of Medical Treatments by soldiers doctors and nurses there's even things like War Perry for example the Army kept detailed statistics about people that were killed and injured and what injuries people had medical articles were written by doctors or nurses who took part in the war and they were produced in things like the British medical journal there's lots of photographs that exist from the Western Front and also people wrote down their life stories in the forms of autobiographies so when you're get into the question about thinking about what sources could be used to help answer a question these are good sources just to have at the back of your mind that you could make specific reference to okay so thanks for listening to that revision video uh for Med in Britain 1250 to present day looking at the British sector of the Western Front 1914 to 1918 injuries treatment and the trenches thank you very much and good luck with your exams