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The Trenches, illness and Injuries on The Western Front 1914-1918

This pack contains two booklets combined:

The knowledge workpack- pages 2-20. A)The Context of the Western Front: Should already be completed via INSIGHT, can catch up it not

B)Helping the Wounded on the Western Front:Should already be completed via INSIGHT, can catch up if not

C)Illnesses & wounds requiring Treatment on the Western Front: Easter work

D)Developments in medical treatment and surgery during WWI: week beginning 20/4/20

and

a Source skills booklet- pages 21-34 E) Revising Key Concepts and Features: week beginning 27/4

F) Source Skills-Utility: week beginning: week beginning 4/5

G)Source Skills- Following up a Source: week beginning 11/5

H) Revision and Assessment Task: week beginning 18/5

Name:

Teacher:

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Section A: The Context of the Western Front

What was the Western Front?When Britain declared war on Germany, they sent troops over to Northern _____________ ,to stop the German Army taking over all of France. The Western Front was the line of _________________ between the British and the Germans. The Western Front extended through the corner of ________________ and France: From the English ____________ (Sea) to border with Switzerland.Words: fighting, Belgium, Channel, France

What were the key features of the four main battles and their locations?

1.The Battles of Ypres This location was very_____________. It was between the ports and the rest of the Western Front: If the Germans controlled it, Britain would _________. The Germans held the __________ ground so the British were down on the low-lying waterlogged ground.

1st Battle 1914:There were 50,000 casualties.2nd Battle April-May 1915: 1st effective use of poison __________by Germans. Mass casualties 59,000.At the Battle of Hill 60 they dug _____________into the Hill that the Germans were on, to try to blow them up. Some soldiers died inside the tunnels.3rd Battle June Nov 1917: (Also called Passchendaele): Ground turned to deep mud, due to constant_________. Casualties 160,000 British and Canadian casualtiesWords: lose, tunnels, gas, high, important, rain

2.The Battle of the Somme July-Nov 1916It was very cold, wet and ___________ in this area. It was ________________ ground down by the river.__________ were first used at the Somme.During this battle there were lots of _____________ (injured) and killed. On the first day Britain had 60,000 casualties and 20,000 dead.The numbers of casualties made it very __________ for Medical staff to cope.Words: casualties, muddy, hard, Tanks, low-lying

3.The Battle of Arras April 1917The ground was very dry and __________in this area. There were lots of old ______________ in the chalk ground. There was almost no mud.The tunnels were expanded to provide a place for soldiers to rest and get _______________, they even installed lighting During this battle there were lots of casualties (injured) and many killed. Medical Staff cared for injured soldiers (casualties) inside an ___________ hospital set in the tunnels Words: tunnels, protection, underground, chalky

4. The Battle of Cambrai July-Nov 1916It was ________________ground down by the river. It rained constantly and was very cold wet and __________. This was the battle with the first large-scale use of __________(450)

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It was also the first place that a blood bank was prepared ready to give _________ to soldiers wounded in battle. This meant, whilst there were mass casualties far more soldiers were __________ from death, than in earlier battles.

Words: tanks, blood, saved, muddy, low lyingWith the information above covered up, can you remember which of the features are correct for which battles? (They often apply to more than one). Write pencil, then check your answers by reading the text, and correct if necessary:

Features BattlesYpres Somme Arras Cambrai

Mud, very deepLow-lying water-logged groundMass CasualtiesTunnelsChalky GroundTanks UsedGas UsedFound new ways to care for injured(give example)

Now answer the following question: Describe two key features of the battle of the Cambrai:

This answer needs four sentences: Feature detail (bit of evidence or explanation) Feature stated, detail (bit of evidence or explanation)

One key feature of the Battle of Cambrai was that…For example..

Another feature of the Battle of Cambrai was……For example…

The trench systemWhilst not all fighting and battles took place within a trench system, much of the conflict on the Western Front was within this context. The Trench system formed a highly effective defence system. It resulted in a far more static war than previous conflicts, as it was difficult to gain land from the enemy. To try to overcome the stalemate, new tactics and equipment (methods of warfare) were developed: gas, tanks and creeping barrage artillery bombardment.

Inside a trench. Look at the diagram above and give examples for the following:

Features of the trench that were there to keep the soldiers safe:

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Features of the trench that helped soldiers shoot at the enemy:

The trench system:Parts of the system that provided protection for soldiers:

Part of the system that meant that resources could get to the front line trench:

How did the terrain of the Western Front impact on helping the wounded?

It was very difficult to help all those in need. As well as the very high numbers of wounded, the terrain had it harder to provide the help.Read through the four features of the terrain that had an impact on helping the wounded. Then read through the details. Match them up

Key features of the terrain

Letter of matching detail

Details

1:The destroyed land surface was very difficult to move on:

A)This method of warfare meant that the wounded had to be collected from No Man’s Land. This was dangerous & had to happen under fire and at night.

2: The earth itself could cause ill-health:

B)Lot of the region was low-lying land, which easily waterlogged and very muddy. Constant shelling created large craters, which filled with water and mud, and destroyed roads.

3:The Trench system method of warfare made it hard to reach the wounded:

C)The trench were often very overcrowded, with men moving one way or another, and equipment pile around: Carrying stretchers in the crowds and around the corners of the trenches was hard.

4:Lack of space in the Trenches

D)The region used to be farmland, which meant that there was lots of bacteria in the

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made transporting the wounded difficult

soil. This caused lots of infections that had to be treated.

Which two features do you think would be most important to include in an answer the question: Describe two key features of the terrain, which impacted on helping the wounded?

Challenge: IF you wanted to include all the information in the table, but could only write about two key features, which pairs of features could you combine together, and what would your wording of the two wider key features be?

Quick Quiz A : What was the Western Front?Without looking at the previous information, try to answer this quiz. Then mark yourself, using the answer sheet on the next page.

1. At which battle were the British not fighting on low lying, wet, muddy ground? (1)

a)Ypres b)Somme c)Arras d)Cambrai

2. Which of the battle locations was very important strategically, and why? (1) a)Ypres b)Somme c)Arras d)CambraiWhy? (1)

3. Which two battle location saw the use of tunnels? (2)a)Ypres b)Somme c)Arras d)Cambrai

4. At which battle were tanks first used, and at which was there the first mass use of tanks? (2) First use: First Mass use:

5. At which battle was a blood bank first used? (2)

6. Which battle had the highest casualties in a single day? (1)

7. Write in the relevant key word for each question: (5)low-lying crowded explosions no man’s land farmland

Where did the wounded have to be collected from?Why did the earth in this area contain so much bacteriaWhy was it hard to move the wounded around the trenchesWhy was the land covered in holes

Why was the area so muddy?

8. Identify 3 parts of the front line trench designed for protection: (3)parapet, fire step, 2.5 metres deep, ammunition shelf, barbed wire, duckboards

9. Identify 3 parts of the front line trench designed to help fight the enemy: (3)5

parapet, fire step, 2.5 metres deep, ammunition shelf, barbed wire, duckboards

10. Identify 2 parts of the trench system designed for protection (2)Zig-zag shape, support trench, reserve trench, communication trench, dug-outs

11. Identify 2 parts of the trench system designed to help get resources to the front line (2)

Zig-zag shape, support trench, reserve trench, communication trench, dug-outs

12. Did soldiers spend all their time in the front line trench? (1) YES / NO

Marks out of 26=

ANSWERS Quick Quiz A

1. At which battle were the British not fighting on low lying, wet, muddy ground?

a)Ypres b)Somme c)Arras d)Cambrai

2. Which of the battle locations was very important strategically, and why? a)Ypres b)Somme c)Arras d)CambraiWhy? Positioned in between Calais Port and rest of the Front- If Germans gained control of the region, Britain would be defeated.

3. Which two battle location saw the use of tunnels?a)Ypres b)Somme c)Arras d)Cambrai

4. At which battle were tanks first used, and at which was there the first mass use of tanks?

5. First use: Somme First Mass use: Cambrai

6. At which battle was a blood bank first used? Cambrai

7. Which battle had the highest casualties in a single day? Somme

8. Write in the relevant key word for each question:low-lying crowded explosions no man’s land farmland

Where did the wounded have to be collected from?

No Man’s Land

Why did the earth in this area contain so much bacteria

Farmland

Why was it hard to move the wounded around the trenches

Crowded

Why was the land covered in holes explosions

Why was the area so muddy? Low-lying

9. Identify 3 parts of the front line trench designed for protection:6

parapet, fire step, 2.5 metres deep, ammunition shelf, barbed wire, duckboards

10. Identify 3 parts of the front line trench designed to help fight the enemy:parapet, fire step, 2.5 metres deep, ammunition shelf, barbed wire, duckboards

11. Identify 2 parts of the trench system designed for protectionZig-zag shape, support trench, reserve trench, communication trench, dug-outs

12. Identify 2 parts of the trench system designed to help get resources to the front line

Zig-zag shape, support trench , reserve trench , communication trench , dug-outs

13. Did soldiers spend all their time in the front line trench? YES / NO

Section B Helping the wounded on the Western Front: The Evacuation Route: Soldiers were collected from No Mans’ Land, brought back to the trenches and evaluated. If their injuries were serious, they would be sent along the Evacuation Route, until they reach a point at which the medical teams were able to treat them. The most serious or long term cases would be sent. from the Base hospitals. back to Britain.

Colour-code or underline the following:location, medical staff, treatment offered, transportation

Regimental Aid Posts: They were located within 200m of the front line trench, often within in the support trench or very nearby deserted buildings. A Medical Officer, stretcher-bearer team of 16 and orderlies were based there. Wounded soldiers either arrived there on foot or carried by other soldiers or on stretchers, mostly coming back from No-Man’s Land. They only gave first aid, and identified more serious cases to be sent on to the Dressing Stations.

Dressing Stations: There were Advanced Dressing Stations (400 m from front) or main Dressing Stations (1000 m from front). These either used abandoned buildings or tens. The Field Ambulance team (not a vehicle) were based there-10 medical officers, orderlies and a few stretcher bearers.

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a Dressing Station (Field Ambulance base)

Some has a few nurses. Soldiers mostly walked or were carried here. Many soldiers were treated here for issues like wounds, for up to several days and were then sent back. If they had serious injuries they were sent on by horse-drawn or motorized ambulance

Casualty Clearing Stations: These were based several miles from the front. They were very large, with many medical staff, operating theatres, x-ray units, wards, kitchens, laundries, staff accommodation. These were mostly housed in a series of huts or large tents. They dealt with the most critical injuries. Cases were triaged- into 3 groups: 1)Walking wounded -to be treated and sent back to the front2)Life-threatening injuries- were mostly sent on to base hospitals, but increasingly through the war, they did complex surgery or treatment at the Casualty Clearing Stations, realising that more could be saved if they treated them quicker. 3)No chance of recovery-made comfortable but not treated.

Base Hospitals: Usually pre-existing hospitals in large French/Belgium towns, and some specialist units eg for gas poisoning. Patients were brought by ambulance train or barge. Some were treated recovered for weeks/months, then were sent back to the front. Other, who were long-term cases were sent on to England by hospital trains then ship.

Describe two features of the Casualty Clearing Station. One key feature of….For example …..

Another key feature of….For example…..

Challenges with helping the wounded or sick: Read through and underline key words

There was a lack of capacity to cope with the problem but this is improve across the time of the war: For example during the Battle of Arras, April 1917 lasted 39 days. 160,000 were killed in first 3 days alone. 7000 wounded. Increasingly treatment was provided in France not Britain, and as close and soon as possible to the Front. Overall 67% of the wounded returned to fight, due to increased medical capabilities and training. Sick or injured had a greater chance of survival in 1918 than 1914 due to speed, efficiency and quality of treatment.

Different forms of transportation were used to move the wounded and ill, they were different at different stages of the evacuation route and also evolved through the war:Methods improved greatly through the War. There were few horse-drawn ambulance-wagons at the very start of War. But by Nov 1914 a public appeal raise funds for 512 ambulance wagons and the first 250 motor ambulances were sent to the Front. Horse ambulances remained useful for muddy conditions. Wounded men could also be transported by train or canal, especially between Casualty Clearing Stations and Base Hospitals. The first ambulance train, designed to transport patients on stretchers, arrived in Nov 1914. Later on some even contained operating theatres, so procedures could be carried out sooner. Numbers increased from 4 in 1914 to 28 in 1916. However, these trains could block the network and negatively effect other rail needs for the war effort, eg supplies. They began to use the canal network, with hospital barges, to relieve the rail network and as it provided smooth comfortable transportation, despite being slow.

Describe two features of transporting the wounded on the Western Front. One key feature of….For example …..

Another key feature of….For example….

Medical Staffing on the Western Front: Read & underline key words

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THE RAMC (ROYAL ARMY MEDICAL CORPS): They organised and provided medical care and treatment. Also responsible for keeping men healthy through good sanitation. Included all male medical staff: Doctors (including Regimental Medical Officers and surgeons), medical orderlies, ambulance drivers and stretcher-bearers. Numbers rose from 9000 in 1914, to 113,000 in 1918. More doctors were recruited by raising max age to 45.

Nursing and women’s contribution: The main military nurses were the well-trained and experienced Queen Alexandra unit. They carried out most of the medical nursing work throughout most of the war. There were 300 at the start of War and at this point the army was rejecting any volunteer. But the level of need caused a shift in attitudes: Volunteers included members of the VAD (Voluntary Aid Detachment) Some of them were Middle and Upper Class women with little or no experience of work. However, many others also volunteered. The work of volunteers varied from cooking, cleaning and washing clothes to tending to patients in terms of basic needs and supporting them emotionally. By 1917 volunteers were doing some basic nursing tasks such as changing dressings, giving painkillers etc. The FANY (First Aid Nursing Yeomanry) was founded 1907. In WWI 450+ worked as ambulance or supply drivers and as nurses. Some drove motorised kitchens to cook food and they had a mobile bath unit. By 1918 10,000 women, mostly volunteers, were working to deal with the sick and wounded.

Quick Quiz B: Helping the Wounded on the Western FrontWithout looking at the previous information, try to answer this quiz. Then mark yourself, using the answer sheet on the next page.

1. Number the stages of the evacuation route in order (4)Dressing Stations Base Hospitals

Casualty Clearing Stations Regimental Aid Posts

2. Where were the RAPs based? (1)

3. How did the role of the Casualty Clearing Stations and Base Hospitals change through the war? (2)

4. How were soldiers transported between difference stages? Select correct letter A) By ambulance wagon or motorized ambulance B) BY ambulance train then boatC) By ambulance barge or trainD) On foot or by stretcher (5)

Letter?From No Man’s Land to RAPFrom RAP to Dressing StationFrom Dressing Station to CCSFrom CCS to Base HospitalFrom Base Hospital to England

5. What was the unit of medical staff based at the Dressing Stations known as? (1)a)The Medical Team b)The Field Ambulance c)The Emergency Brigade

6. What does RAMC stand for? And name 4 types of medical staff who were part of the RAMC (5)

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7. How many RAMC were there at the start and ends of the War? (2)Start: a)1,000 b)5,000 c)9,000

End: a)13,000 b)113,000 c)130,000

8. Who were the professional military nurses? (1)a)The Queen Victoria Nurses b)The Queen Elizabeth Nurses c)The Queen Alexandra Nurses

9. Name 3 roles carried out by the FANY (First Aid Yeomanry? (3)

10. What were the initials of the volunteer women who joined to assist the professional nurses, and how many women were there at the front by 1918 (2)

Marks out of 26=

ANSWERS Quick Quiz B

1. Number the stages of the evacuation route in order (4)2.Dressing Stations 4.Base Hospitals

3.Casualty Clearing Stations 1. Regimental Aid Posts

2. Where were the RAPs based? (1) In or very close to the trenches

3. How did the role of the Casualty Clearing Stations and Base Hospitals change through the war? (2) Casualty Clearing stations started doing more surgery and treatment. Base Hospitals were gradually used more for rest and some recovery before travel back to England.

4. How were soldiers transported between difference stages? Select correct letter A) By ambulance wagon or motorized ambulance B) BY ambulance train then boatC) By ambulance barge or trainD) On foot or by stretcher (5)

Letter?From No Man’s Land to RAP DFrom RAP to Dressing Station DFrom Dressing Station to CCS AFrom CCS to Base Hospital CFrom Base Hospital to England B

5. What was the unit of medical staff based at the Dressing Stations known as? (1)a)The Medical Team b)The Field Ambulance c)The Emergency Brigade

6. What does RAMC stand for? And name 4 types of medical staff who were part of the RAMC (5)

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Royal Army Medical Corps - surgeons, doctors, ambulance drivers, stretcher bearers, support staff

7. How many RAMC were there at the start and ends of the War? (2)Start: a)1,000 b)5,000 c)9,000

End: a)13,000 b)113,000 c)130,000

8. Who were the professional military nurses? (1)a)The Queen Victoria Nurses b)The Queen Elizabeth Nurses c)The Queen Alexandra Nurses

9. Name 3 roles carried out by the FANY (First Aid Yeomanry? (3)Driving Ambulances, motorized kitchens, mobile bathing units, and delivering goods and resources.

10. What were the initials of the volunteer women who joined to assist the professional nurses, and how many women were there at the front by 1918 (2)

VAD10,000 in total including Queen Alexandra, FANY and VAD

Section C: Medical Conditions at the Western FrontRead through the following information about the Medical conditions which affected soldiers on the Western Front. For each condition use the following key to colour code the text (if you don’t have 4 colours you can label with the initials)Cause(s) Symptoms Treatment & Prevention Impact

Trench Fever and Body LiceTrench Fever was otherwise known as PUO- Pyrexia of Unknown Origin or Relapsing Fever. Symptoms were fever, severe headache, pain in bones and joints, which lasted 5 days and kept returning. A month in hospital was normal and some men were declared unfit to fight. It was spread by lice, ‘greybacks’. They lived in the seams of clothing and in blankets. Nearly everyone had lice. A medical officer inspected 560 men at the Somme and found 422 infested. Rats also carried lice. The link between lice and the fever not found until 1918, but there was concern about lice infestations, which they tried to tackle.

Early diagnosis and effective nursing were crucial to recovery. They tried to reduce lice numbers infected by disinfecting clothing, when men came to the Front their clothes were fumigated, washed and ironed. Bathhouses were built and men issue lice repellent gel and other chemicals to place on their clothes. Some washed under clothes in paraffin. Machines that steamed the clothes and bedding were sent to the Front. Some men picked lice off by hand. All these efforts improved morale, but due to close sleeping quarters in the trenches trench fever continued throughout the war. The key problem was trench fever greatly reduced the number of men who could fight. Between July 1917-July 1918 15% of men were unfit for duty.

Describe two key features of Trench Fever on the Western Front:One key feature of….For example …..

Another key feature of….11

For example…..

Trench FootTrench Foot is the painful swelling and blistering of feet, numbness and turning blue, due to deterioration of blood capillaries and circulation causing flesh to die. Worryingly once the condition developed it deteriorated quickly and could lead to gangrene, the term for the infection and rotting of dead flesh and body tissue. Gangrene spreads around the body, so this often led to amputations. By Jan 1915 the 27th Division had lost 1/6th of its 12 000 men to trench foot. It was caused by standing in waterlogged trenches, for many hours, worsened by tight and unhygienic boots and socks. They could not predict or pre-prepare for trench foot, as no one anticipated what warfare would be like. There was a huge increase in cases in the cold, wet winter of 1914-15.

They tried to ensure all men had 3 pairs of socks, change them 2 a day and rub whale oil into their feet for protection. Men were split into pairs to look after each other’s feet and high rubber waders were issued in the worst conditions. Mechanical pumps were sent, to drain the trenches, and braziers for heating. These did reduce the number of cases. However, the terrain meant waterlogged conditions continued to be common and drainage systems were destroyed by shell fire.

Describe two key features of Trench Foot on the Western Front:One key feature of….For example …..


Shell ShockShellshock was the term used to describe the psychological reaction to experiencing extreme danger or trauma. Symptoms included headaches, nightmares, loss of speech, uncontrollable shaking to complete mental breakdown. They were given food, rest and talks to calm them down, but the condition was not well understood, and some were accused of cowardice. The number of cases grew through the war.

In 1916 army generals were concerned at the 16 000 cases in 6 months. They changed their policy on treatment, rather than evacuate the men to England they treated them in France, as close to the Front as possible. In 1917 orders were given not to use the term shell on Army records, but to use NYD.N (Not Yet Diagnosed) instead. Term. Medical officers made assessments of those with the condition; if it was a result of an explosion the individual was sent to hospital, some developed specialist units. Most returned to duty. Many cases went unrecorded, but overall there were about 80 000 British cases of shell shock.

Describe two key features of shell shock on the Western Front:One key feature of….For example …..


Challenge: What impact do you think that these medical conditions had on…

a)The army’s ability to fight?

b)The RAMC and nurses ability to deal with wounded soldiers?

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Weapons development, wounds and injuries

Read through the following information and then answer the question:

Rifles: load from a cartridge case, which created automatic rapid fire, instead of one bullet at a time. Could fire accurately at up to 500 m. Bullets were pointed so that they drove deeper into the body. Bullets would pierce organs and fracture bones.

Machine guns: had more speed than rifles and could fire 500 rounds a minute.Bullets (from rifles and machine guns together) responsible for 39% of wounds. Bullets would pierce organs and fracture bones.

Artillery: Throughout the war cannons grew bigger and became more powerful. The British Howitzer could send 900 kilo shells. Bombardments could last weeks. Artillery fire caused half of all casualties. High explosive shells and shrapnel (metal balls or shards from the exploded shells) were responsibly for 58% of wounds. Shrapnel wounds were often to the arms and legs of soldiers.

Out of the three main types of weapons, which do you think was the most deadly? Ranks them from most to least, then explain why.

Injuries: Read through the information and underline or highlight key wordsNew powerful weapons led to new types of injuries. Artillery shells could destroy limbs and inflicted major internal damage to the body and head. Machine guns could shatter bones and piece organs. These severe or deep concealed wounds could cause rapid blood loss, particularly resulting from tiny shards of shrapnel, which were too small to see. Those who suffered a broken leg only had a 20% survival rate. 41 000 limbs were amputated. The secondary effect ‘the blast impact’ meant tissue was destroyed. Bayonet wounds, hand grenades and pistols total 5 % of all wounds in WW1. There were an increased number of head injuries due to the developments in weapons 60,000 soldiers received head/eye injuries, due to vulnerability of the head within the trenches. Steel Helmets were first issued to replace soft caps in late 1915, but were only widely issued in the summer of 1916. In a trial it was estimated that helmets reduced fatal head injuries by 80%.

Describe two key features of the injuries caused by weapons in WWI:One key feature of….For example …..


Infection: Read through the information and underline key wordsMany who could have recovered from the actual injury died from infection. Bullets and shrapnel went deep into the body bringing problems of deep infection. Fragments of muddy clothes went into the wounds, which heightened the risk of infection. The problem was the Western Front grounds were farmland, which had been manured, so was very heavy with bacteria. The wait time for wounded in No Man’s Land enhanced the likelihood of infection and reduced the time for treatment.

Gas gangrene a particularly bad type of infection, but unusually common on the Western Front. First signs were a sweet smell, which nurses would check for, the wound then would swell with gas, turn white, then green and made a bubbling sound when pressed. It resulted in many deaths, especially early on in the War, before they developed strategies to tackle it. It was carried by bacteria in soil and

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was a fast developing infection. Very few surgeons had dealt with it in previous wars, as it was usually very rare.

Describe two key features for the problem of infection on the Western FrontOne key feature of….For example …..


The impact of Gas: Read through the information and underline key words The first example was tear gas used by France and Germany in 1914, but had very limited effectiveness. In April 1915 (2nd battle of Ypres) Chlorine Gas was used. It affects breathing and could lead to gradual death through suffocation. Temporary blindness, loss of taste and smell and coughing were the milder short lived symptoms, which could pass after hours, days or weeks of treatment, depending of the severity. At Ypres, soldiers’ only protection was urinating on their handkerchiefs and holding over nose. Phosgene was first used near Ypres later in 1915. Its effects were similar to Chlorine, although stronger and faster acting, killing an exposed person in two days.However, gas masks were developed and given to all troops in later 1915. They used Oxygen to reduce breathing problems and wash to remove traces of gas, large numbers affected in attacks would clogged up treatment areas. Mustard Gas was first used in 1917. It was an odourless gas, which caused internal and external burns and blisters, which also damaged the eyes and lungs. However, Gas was hard to target and fewer than 5% of British soldiers died in gas attacks.

Quick Quiz C: Illnesses and wounds requiring Treatment on the Western Front

Without looking at the previous information, try to answer this quiz. Then mark yourself, using the answer sheet on the next page.

1. What did not contribute to soldiers developing trench foot? (1)a)Cold weather b)Wet/muddy environment c)Standing up for too long

2. What worse condition could develop from having Trench Foot? (1) a)Trench Fever b)Shell Shock c)Gangrene

3. What was the cause of Trench Fever, and when was this link proved? (2)What? When? A)1914 b)1916 c)1918

4. Name two things done to deal with body lice? (2)

5. What was the most common response to Shell Shock sufferers, and how did the army record cases from 1917? (2)

a)anger b)sympathy c)a lack of sympathy How recorded?

6. Which weapon caused over half of all casualties? (1)Gas, Rifles, Artillery, Machine Guns

7. What were introduced from 1915, to protect soldiers from head injuries? (1)

8. Match the key features of gasses (tick correct answers) (9)Gases Year

Introduced?Symptoms How deadly?

191 191 191 Stung Temp loss Burns Not Possible Very 14

4 5 7 eyes, nose throat

of sight coughing suffocate-ion

& blisters to body memb-ranes

several days

but slow

Tear Gas

Chlorine& PhosgeneMustard

9. What was the name of the uncommon and very unpleasant type of infection, which many men developed on the Western Front? (1)

10. Match methods of dealing with infection with definitions (3)Amputation

a) System of tubes-constant flow of antiseptic through wound

Excision b) Cutting away large area of tissue around dead or infected area.

Carrel-Dakin

c) Removal of infected limb to prevent further spread

Marks out of 23=

ANSWERS Quick Quiz C:Illnesses and wounds requiring Treatment on the

Western Front

1. What did not contribute to soldiers developing trench foot? (1)a)Cold weather b)Wet/muddy environment c)Standing up for too long

2. What worse condition could develop from having Trench Foot? (1) a)Trench Fever b)Shell Shock c)Gangrene

3. What was the cause of Trench Fever, and when was this link proved? (2)What? Body Lice When? A)1914 b)1916 c)1918

4. Name two things done to deal with body lice? (2) The army tried to get rid of the lice by spraying, washing and ironing the soldiers’ clothes. Bathhouses were built and soldiers were given lice repellent gel to place on their clothes. The soldiers tried to sort the problem themselves too: they picked lice off by hand and some washed their underwear in paraffin.

5. What was the most common response to Shell Shock sufferers, and how did the army record cases from 1917? (2)

a)anger b)sympathy c)a lack of sympathy How recorded? NYD-N

6. Which weapon caused over half of all casualties? (1)Gas, Rifles, Artillery, Machine Guns

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7. What were introduced from 1915, to protect soldiers from head injuries? (1) Steel helmets

8. Match the key features of gasses (tick correct answers) (9)Gases Year

Introduced?Symptoms How deadly?

1914

1915

1917

Stung eyes, nose throat

Temp loss of sight coughing suffocate-ion

Burns & blisters to body memb-ranes

Not Possible, several days

Very, but slowly

Tear Gas x x xChlorine& Phosgene

x x xMustard x x x

9.What was the name of the uncommon and very unpleasant type of infection, which many men developed on the Western Front? (1) Gas Gangrene

10.Match methods of dealing with infection with definitions (3)Amputation

c a) System of tubes-constant flow of antiseptic through wound

Excision b b) Cutting away large area of tissue around dead or infected area.

Carrel-Dakin

a c) Removal of infected limb to prevent further spread

SECTION D: Medical and surgical Developments during WWI For each area of development: Fill in the blanks and then Colour Code the information for the following (or label with a,b,c or d)(a) Developments before WWI (b) Unique challenges of WWI for this area of medicine(c) New methods of prevention or treatment (d) Evaluation of effectiveness of the method

A. Dealing with Infection There were improvements in dealing with infection from the mid 1860s: Soon after Pasteur developed of Germ Theory, Antiseptics (which killed germs/bacteria at point of entry to wound) were developed: In 1867 Joseph Lister first trialed the use of ______________ Acid, deaths from post-operative infections after amputations dropped from 46 – 15%. By the 1890's there had been the development of Aseptic Surgery: (ensuring ______ _____________ at all were in the area): Operating theatres and hospitals were thoroughly cleaned; by 1887 they had steam-sterilisation of equipment; they used surgical gowns and face masks; and in 1894 sterilised rubber _______________ were developed by surgeon William Halstead.

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The environment of the Western Front created greater problems of infection, due to the bacteria laden ________ and worse injuries, as a result of more destructive weapons. They could not create ___________________conditions for surgery, and most wounds were already infected when they were started trying to treat them. Infections which soldiers developed included tetanus and, the previously rare, gas gangrene. Therefore, at the start of the War, the only way to save soldiers with bad infections to limbs was_______________________. Surgeons started using the methods of Excision. This was the ___________________away of more tissue and any dead muscle around the wound, to ensure that all remove bacteria. Although this created larger wounds, it reduced infections. Another development was the Carrel-Dakin method. It was developed by Alex Carrel and Henry Dakin in 1915. This used a system of _______________, which keep a chemical solution (flowing through the wound, therefore fighting infection or stopping it from developing. It was first used, successfully, by Antoine Depage, at a Base Hospital in La Panne, Belgium, in 1916, along side delayed primary closure, where they checked for infection for a period, before closing up a wound. These methods reduced the number of amputations needed, due to infection. However, neither method resolved the problem of infection entirely, because of the difficult context of the war, and amputations were still necessary. By 1918 _____________ men had had an amputation. WORDS: gloves, tubes, Aseptic, cutting, no germs, soil, 240,000, amputation, carbolic

Describe two key features of dealing with infection at the Western Front:One key feature of….For example …..


B Dealing with injuriesX-Rays: In 1895 Wilhelm Roentgen realised that cathode rays could pass through wood, rubber, human flesh but not bone or metal. He named them ‘X-rays’. X-ray machines were being used within 6 months & radiology departments were opened at most large hospitalsThe developments in weapons during WWI, particularly _________________ and the shattered bones from machine guns, made X-Rays hugely important. By Jan 1915 two ______________x-ray machines had been built. By 1916 most CCS as well as base hospitals had x-rays, mobile x-rays and x-ray lorries had been developed. They aided rapid action by surgeons, by _________________objects needing removal and broken bones, and reduced death rates by infection and blood loss. However, x-rays could not detect all objects like clothing fragments, which could carry bacteria and cause infection infection. Mobile x-ray units took a long time to set up, and the __________________________was not very good. These X-rays took several ___________ to be taken, this was a risk for with some wounds, as soldiers could bleed-out. The tubes in these x-ray machines were very ________________, so could smash, and could ___________ with overuse. They could only be used for one hour before they had to be left to cool down. The solution was to use three machines on ________________ Improved tubes from the USA were available from 1917. Words: mobile, image, detecting, fragile, rotation, minutes, overheat , shrapnel

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Describe two Key features of the use of x-rays at the Western Front:One key feature of….For example …..


The Thomas Splint: In 1914, injuries to the limbs from more powerful weapons were common at the Western Front. Men with gunshot or shrapnel wounds to leg had only a 18-20% chance of survival. Thigh bone breaks were particularly dangerous, as they could cause _________ ________________, resulting in blood loss. Traditional splints for broken legs did not keep the leg ___________so broken ends of bones moved and worsened the damage. By the time that a soldier with a leg fracture had reached the Casualty Clearing Station, to be operated on, he could be in shock from___________ __________, and could well have developed infection, especially with a compound fracture. At the start of the War, Liverpool surgeon, Hugo Owen Thomas, was working with disabled soldiers from the Front, in London, he started to use the ‘____________Splint’, which ____________ the leg length ways, stopping bones ____________ on each other, and the nearby flesh, and reduced blood loss. (The design had been developed by his uncle-but had never been more widely used). In December 1915 he was ____________ to France to introduce its use there. He spread its use later in 1916 when he became Director of Military Orthopedics. All regimental medical officers taught how to use it. Its design meant that soldiers who reached the CCS were fit enough to be operated on, more likely to live and less likely to need an amputation. The Thomas Splint increased the survival rate from leg fractures dramatically from 20% to __________.

Words: rigid, sent, blood loss, pulled, muscle damage, 82%, Thomas, grinding

C Addressing the problem of blood loss:If someone loses too much blood, from an injury or from surgery they can go into shock and die. This was common in the late 19th and early 20th centuries. Transfusions had been tried, but people often died. However, in 1900 Karl Landsteiner identified blood _______ and compatibility. This enabled safe transfusions (first trialed in 1908), but only directly between patient and donor, as blood would _________ outside the body. There had been attempts to find a chemical to stop blood clotting, but the acids used caused fits in patients. Due to the nature of weapons and wounds, there was a significant problem with _________ ________ in the War. During the war there was experimentation in transfusion techniques. In 1915 Lawrence Bruce Robertson used a syringe and tube to transfer blood before surgery to minimize the risk of shock at the Base Hospital in Boulogne, and Geoffrey Keynes designed a ____________ blood transfusion kit, to enable transfusions close to the frontline, and added a flow device . However, both these techniques were based on direct transfusion, and so required the donor to be present, and the huge number of casualties and lack of ____________ at the Front, meant transfusion could only be used in a small number of cases. However, during the war there was also improvement in the of blood: 1915 Richard Lewisohn, discovered that adding sodium citrate to blood to stops clotting. This meant it could be stored but deteriorated quickly within hours. In 1915 Richard Weil also discovered that refrigeration made it last longer. By 1916 Rous and Turner developed the use of ___________ ___________with which blood could last for 4 weeks. This allowed for the creation of the first ___________ ___________, or blood depot at Cambrai in Nov-Dec 1917, Oswald Hope Robertson

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gathered 22 units & saved over half the men who would have otherwise died. In 1918 indirect transfusion, using stored blood=more commonly used. Words: clot, Citrate Glucose, storage, blood bank, donors, portable, blood loss, groups

Describe two key features of blood transfusions at the Western FrontOne key feature of….For example …..


D Improvements in surgeryBrain Surgery: Little known about the brain pre-1914, as such injuries were quite ______, and so the was little focus on how to deal with them. During the War Head wounds were very ____________, as heads were most vulnerable when standing in trenches. . Because of the very high number of casualties and head operations were very time consuming and usually unsuccessful, in early war, they did not operate on brain, but simply patched and bandaged the head injury: They prioritised treating/operating on larger numbers of less serious wounded instead, who had a higher chance of survival. Metal ________________were introduced in late 1915, and were commonly available from 1916. In a trial it was estimated that helmets reduced fatal head injuries by 80%. From 1917, they did start to experiment with techniques to actually treat head injuries, for example putting ____________ _________around the head to apply pressure and reduce bleeding. It started to seem worth trying to treat brain injuries because: 1) More soldiers were being kept alive and fit because they were given blood transfusions and saline solutions to reduce shock. 2) the Developments in X-rays allowed them to locate, identify, and remove shell and bullet fragments. A key development was made by Harvey Cushing. He invented a single ____________, which enabled bullet extraction from head wounds. He also used a local, rather than general, anaesthetic, to prevent swelling of the brain, which had caused problems during operations. However, Brain surgery was still very new and access to this treatment, even by the end of the War, _____________on which CCS or Base Hospital you arrived at, and if leading surgeons were based there. _________________ rates for brain surgery increased with Cushing were 71 % compared to the usual 50% for brain surgery.Words: helmets, elastic bands, common, depended, magnet, Survival, rare

Plastic Surgery: This had previously been trialed in India in earlier centuries, but achievements were limited due to infection and lack of anesthetics. Whilst there were improved by the late 19th century, so there was the possibility to re-try, these types of injuries were so ________ that there was no motivation to really develop techniques. However, during the war, there were terrible wounds from bullet and shell damage, particularly to the face. They developed ________ ______________, taking skin from one part of the body to cover a wound. They also developed jaw splints wiring & ________ plates as replacement cheeks. The work was pioneered by Harold Gillies, a New Zealand Ear Nose & Throat (ENT) surgeon. He was sent to the Western Front in Jan 1915, as a surgeon in the RAMC, where he became interested in facial _________________. By Nov 1915: There were 7 ________________ hospitals in France, working on faces. In 1917: Gilles got Queens Hospital Kent opened, to specialise in _________ injuries. Overall nearly _______________ plastic surgery operations were carried out. Words: metal, rare, skin grafting, 11,000, specialist, facial, reconstruction

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Describe two key features of new surgical techniques in WWIOne key feature of….For example …..Another key feature of….For example….

Quick Quiz D: Developments in medical and surgical treatment

1. What method of dealing with infection could not be effectively used on the Western Front? (1)

a) Excision b) Carrel-Dakin Method c) Aseptic surgery

2. When were X-ray machines first developed? (1)a) 1867 b) 1896 c) 1915

3. Name one problem with the x-ray machines used during WWI? (1)

4. What was the name of the splint used for leg fractures? (1)

5. Dealing with Blood Loss Decide if the statement is True or False? Then amend the False statements, so they read correctly.(6)

Statement T or F?

Direct Blood Transfusions were easy on the Western Front because there were lots of donors

In 1915, Richard Lewisohn discovered that Sodium Citrate stops blood clotting

Refrigeration was introduced which meant blood could be stored for longer

The first blood bank was created at the Battle of the Somme in 1917

6. Which area of medical problem were each of the following help?: Select correct letter (8)I= Infection W=General wounds or injuries (eg Broken bones or shrapnel)B= blood loss H=Head/Facial injury

Development Letter?RefrigerationMetal Helmets Carrel-Dakin methodX-raysSkin Grafting ExcisionThomas SplintCitrate Glucose solution

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Marks out of 18=

Answers: Quick Quiz D Developments in medical and surgical treatment

1. What method of dealing with infection could not be effectively used on the Western Front? (1)

a) Excision b) Carrel-Dakin Method c) Aseptic surgery

2. When were X-ray machines first developed? (1) a) 1867 b) 1896 c) 1915

3. Name one problem with the x-ray machines used during WWI? (1)Fragile bulbs could overheat, took very long time, so needed patient to stay still, needed three on rotation, unclear images

4. What was the name of the splint used for leg fractures? (1) The Thomas Splint

5. Dealing with Blood Loss Decide if the statement is True or False? Then amend the False statements, so they read correctly.(6)

Statement T or F?

Direct Blood Transfusions were easy (difficult) on the Western Front because there were lots of ((few)donors

F

In 1915, Richard Lewisohn discovered that Sodium Citrate stops blood clotting

T

Refrigeration was introduced which meant blood could be stored for longer

T

The first blood bank was created at the Battle of the Somme(Cambrai) in 1917 (1918)

F

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6. Which area of medical problem were each of the following help?: Select correct letter (8)I= Infection W=General wounds or injuries (eg Broken bones or shrapnel)B= blood loss H=Head/Facial injury

Development Letter?Refrigeration BMetal Helmets HCarrel-Dakin method IX-rays WSkin Grafting HExcision IThomas Splint WCitrate Glucose solution B

Section E: Revising Concepts and Features

Activity 1: Recapping Key Words and ConceptsMatch up words to definitions (research if you don’t know!). Write letter next to numbered word

Word Match-up! Definition1. injury C A. Heavy guns that fire shells (similar to cannon)2. artillery B. Fragments of a bomb 3. amputation C. The result of getting hurt – e.g. a cut or wound4. treatment D. Someone killed or injured in war5. prevention E. An army unit 6. shrapnel F. Making better or managing an illness or injury7. casualty G. Escape or rescue from an area of danger8. triage H. The way of avoiding getting ill or injured9. regiment I. Categorise people’s into groups based on seriousness10. evacuation J. The surgical removal of a limb

Word Match-up! Definition11. Western Front K. A piece of land that juts out to form an angle12. Salient L. They collected injured & carried them on a stretcher13. terrain M. The land closest to the enemy14. stretcher bearer N. A deep ditch dug into the ground for defence/shelter15. front line O. The ground (including height and type of soil)16. No Man’s Land P. Region of N France&Belgium lots of WWI fighting17. trench Q. Ground between the two different side’s trenches18. infection R. A type of exploding bomb, shaped like a large bullet19. aseptic S. Completely free from contamination or bacteria20. shell T. When bacteria damages something (e.g. a wound)

Learn these spellings. The first 5 are locations. Practise writing them out 3 times or more.

1.Arras 2.Cambrai

3.the Somme 4.Ypres

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5.Flanders 6.medical

7.transfusion 8.soldier

9.chlorine 10.suffocation

Now get someone to test you – how many did you get right? /10

Activity 2: Recapping Key Features What is a key feature? A key feature is one of the main things about something. For example, a key feature of a table is that it has legs. How do you explain more details about key features? Add more detail that will tell the reader more about the feature. For example, a table usually has 4 legs, one at each corner.

Have a go at filling in the missing features and details of these everyday items below:Feature and detail: Challenge: Add a second feature & detail

Table Feature: LegsDetail: 4 legs, one at each corner

Flat surfaceThey can be used for writing or eating on.

Clock Feature: HandsDetail:

Now try filling in the missing features & details for WWI. You can look back through the content to help you:Feature and Detail: Add a second feature & detail

Weapons in WWI

Feature: Quick-firingDetail: Machine guns could fire…

They were very dangerousRifle and machine gun bullets could damage internal organs.

The RAMC

Feature: Male doctorsDetail: Such as…

Female…Such as…

The RAP Feature: LocationDetail:

They had basic equipment

Arras Feature:Detail:

Dealing with

infection

Feature:Detail:

Activity 3: Practising Key Features QuestionsYou can look back through the earlier part of this booklet to help you answer these practise questions.

1. Describe 2 key features of the Battle of the Somme.One key feature of the Battle of the Somme was the terrain.For example…

Another key feature of the Battle of the Somme was the high casualty rate.For example…

2. Describe 2 key features of Field Ambulance and Dressing Station.One key feature of the Field Ambulance and Dressing Station was its location.

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For example…

Another key feature of the Field Ambulance and Dressing Station was its equipment.For example…

3. Describe 2 key features of nursing units on the Western Front.One key feature of nursing units on the Western front was that they provided skilled…For example the Queen Alexandra nurses…

Another key feature of nursing units on the Western front was that they provided…For example the VAD nurses did tasks such as…

4. Describe 2 key features of the impacts of new technology on treating the injured.One key feature of the impacts of new technology on treating the injured was that it helped diagnose the issue.For example the __-_____ machine helped to…

Another key feature of the impacts of new technology on treating the injured was that it helped to fix injuries.For example the T______________ S___________...

Section F: Source Skills – Utility

Activity 1: Understanding Source UtilitySource utility means how useful a source of information is. Sources are always useful for something, but

depending on what you are being asked their utility varies. Complete the activity below to think about how sources are useful or useless depending on the enquiry (investigation).

Tick the source type that would be most useful for each enquiry, and then explain why:Enquiry Diary Medical

reportPhoto Explanation

How did the soldier feel when he was shot?

How many people were treated at the hospital for head injuries?What was the impact of the type of injuries on the surgeons and nurses?What conditions did soldiers live in?

Challenge: Explain 2 answers.

What was the terrain like in Ypres?


What types of medical staff would treated head wounds?


How did the nurses feel when they saw the patients with horrible injuries?


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When analysing sources you need to consider their content and background (or ‘provenance’), as well as your own knowledge on the topic. Match up the meanings of the following terms:

Word Match-up! Definition1. content A. Why it was made

2. own knowledge B. What you know about the topic3. nature C. Who made it, when and where

4. origin D. What kind of source it is (e.g. photo / letter, etc.)

5. purpose E. What it actually shows / tells us

You don’t have to include all three of Nature, Origin, and Purpose (NOP), but try to include at least one of them in your answer.

Activity 2: Understanding ProvenanceTop Tips:When considering the background or provenance of the source, you need to decide if each aspect of NOP makes the source more or less useful. The usefulness of a source’s provenance (NOP) will depend on your enquiry focus.

Match up the sources with their potential uses:Diary It can reveal what was supposed to have happenedStatistics It can give a national, or regional, view of somethingArmy Order It can give an idea of how common something wasNewspaper It can give a view of one person’s experience of a situation.Personal account

It can help reconstruct the supplies, equipment, and people who worked in a particular place.

Challenge: Complete the table below to consider how each source could be useful (or limited):Utility Super Challenge – limitation

A source written during the Battle of the Somme, by a nurse.

She was there, so…

She won’t have forgotten…

She might have been upset by the trauma.

She can only tell us about her experience, not about how it was elsewhere.

The Battle of the Somme was extremely deadly, so this is not the same experience that someone might have at another time.

A map of the terrain at Ypres made in 1914.

Factual, not based on…

Shows exactly what…

It might become outdated if things change – e.g. when Hill 60 was blown up.

An account of a soldier written years after the war, in a published book.

They would have had time to get over… If they are selling the book to make money, they might have altered…

They might have…

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A newspaper report about the Battle of Cambrai.

This would report on some of the events that happened.

It might have been….

A private government report about the Battle of Cambrai.

This would report is not for the public so would be…

A researched History book on the RAMC.

This would…

A photo of a dressing station.

This would show…

This would be accurate as…

This only shows one moment in one…

This could have been…

A report by the RAMC of ambulance provision in 1914.

This would tell us…

This would be accurate as…

It would not tell us…

Activity 3: Analysing Source UtilityTry breaking down this question to plan an answer by following Steps 1-5:

‘How useful is Source A for an enquiry into the problems involved with performing operations on the Western Front, 1914-1918?’

Source A From an account given after the war by Reverend Leonard Pearson, who was the army chaplain (priest) at Casualty Clearing Station 44 during the Battle of the Somme (1916)

I spent most of my time giving anaesthetics. I had no right to be doing this because I had no medical qualifications, but we were simply so rushed. We couldn’t get the wounded into the hospital quickly enough and the journey from the battlefield was simply terrible for these poor lads. It was a question of operating as quickly as possible. If they had to wait their turn in the normal way, until the surgeon was able to perform the operation with a doctor giving the anaesthetic, it would have been too late for many of them. As it was, many died. We all simply had to help and do anything that was needed.

Step 1: Read the source.

Step 2: Highlight content in the source that talks about the focus of the question: problems involved with performing operations. This has been started for you!

Step 3: Read the caption above the source.

Step 4: Highlight anything about the background, or provenance (NOP) of source that you think might be important in deciding how useful this source is – e.g. WHEN, WHERE and BY WHOM the source was made, and the TYPE OF SOURCE it is. This has been started for you!

Step 5: Add any own knowledge you have that agrees with or helps us understand the information in the source. You can look back through your previous booklet to help you!

Summarise your findings here:Content: The source tells me… It was hard to get the wounded soldiers to the

hospital quickly enough to operate on them. There weren’t enough… Not everyone got a_________________.

Own knowledge to support content: Transport to the CCS from the battlefield might

have taken a long time because there were not enough stretcher bearers – only…

… Different methods of treatment did sometimes

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have to be used because conditions were so…

Provenance: The background of the source. It was written during the Battle of the Somme.

It is a first-hand account from someone who was there.

It is written by a Reverend (a priest).

Own knowledge to support provenance (NOP): The Battle of the Somme had a very high

number of casualties – on the first day alone…

This was written by someone who…

This was written after the war, when the Reverend would have been feeling less…

Challenge: Knowledge that challenges or makes the source less useful:

This source is focusing on the Battle of the Somme, which was worse than…

Activity 4: Practising Source Utility‘How useful is Source A for an enquiry into the problems involved with performing operations on the Western Front, 1914-1918?’

Source A From an account given after the war by Reverend Leonard Pearson, who was the army chaplain (priest) at Casualty Clearing Station 44 during the Battle of the Somme (1916)


There are two structures for answering this kind of question. Everyone should try option 1 to start with. If you feel very confident, then try option 2!

Option 1: Simple structureThe source tells us about… because it says/shows that… (CONTENT) which is accurate because… (OWN KNOWLEDGE)

The source also tells us about… because it says/shows … (CONTENT) which is accurate because… (OWN KNOWLEDGE)

The source is… (PROVENANCE) which makes it useful because… (EXPLANATION maybe with OWN KNOWLEDGE)

Furthermore, the source is… (PROVENANCE) which makes it useful because… (EXPLANATION maybe with OWN KNOWLEDGE)

Have a go at finishing this answer:The source tells us about the problem of not having enough doctors for operations, because it says that ‘If they had to wait their turn… until the surgeon was able to perform the operation… it would have been too late for many of them’, which is accurate because at the Battle of the Somme there were _____________ casualties on the first…

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The source also tells us about the problem of not having enough staff for operations because it says that ‘We all…’, which is accurate because in order increase medical recruitment the government raised the maximum age of doctors to…

The source is by a… which makes it accurate because it tells us just how short-staffed they were as it is not usual for religious people to…

Furthermore, the author of the source was at a CCS, which makes it useful because he was there at the time, and we know that many CCSs would have been very busy when he was writing (during… ) which had the highest casualties of all the…

Option 2: Challenge structure–difficult! ONLY READ THIS PAGE IF YOU ARE WORKING ON EXCELLING THRESHOLDWhen analysing sources to decide if they are useful or not, consider the following criteria:Is the source COMPREHENSIVE? Does it actually tell you much information?Is the source ACCURATE? Is it correct? Does it have details (e.g. statistics / dates / names)?Is the source TYPICAL? Does it tell us something that would have been common or unusual?

Structure your answer using 2-3 PEE paragraphs, using CAT! Top tip:o Sections in italics are super-challenge, and not necessary as long as you write really good C and A

paragraphs.oHave a go at finishing this answer:

Source A is useful as it is comprehensive. For example, it tells us about the problem of not having enough doctors for operations, because it says that ‘If they had to wait their turn… until the surgeon was able to perform the operation… it would have been too late for many of them’. It also says that ‘We all… We know this is true, because at the Battle of the Somme there were _____________ casualties on the first… Furthermore, in order increase medical recruitment by raising the maximum age of doctors to…

However, the source doesn’t mention the role of nurses such as the VAD. It also only focuses on the lack of staff and the quantity and severity of injuries, and doesn’t mention issues such as blood loss or infection, which were major problems in operations on the Western Front.

Source A is quite useful as it is quite accurate. For example, it includes details about the severity of the soldiers’ wounds (‘many ________’) and type of treatment required, such as that many required ‘anaesthetics’ and operations ‘as quickly ____ ________________.’ Furthermore, the source is by someone who was there at the time, which… He also gave the account later, which means he had time to...

However, as this account was given after the event, he might have…

Furthermore, as the author was present and unused to seeing such awful injuries, he might…

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Source A is quite useful as it is somewhat typical. For example, Reverend Pearson describes a scene of chaos at his CCS, which would often have been the case as he was writing during the… which had the highest casualties of all the… Furthermore, it is likely that some operations took place without ‘______________’ as they would not have had enough to give so many soldiers, or enough time to administer it.

However, it would not have been typical for a Reverend to…

Furthermore, the scene is not typical of the whole war, as this battle was significantly…

Section G: Source Skills – Following Up a Source

Activity 1: How to Follow Up a SourceFollowing up a source means investigating it further. When you follow up a source, you pick a detail that you are interested in finding out more about, and create an investigation of your own to learn more about it.

Consider the source you used on the previous pages: You could be asked the question: ‘ How could you follow up Source A to find out more about the problems involved in performing operations on the Western Front ?’

Source A From an account by Reverend Leonard Pearson, who was the army chaplain at Casualty Clearing Station 44 during the Battle of the Somme (1916)


Top tip for following up a source! Try to think of something quantitative (a number) rather than experiential (emotional) to focus on and question. These questions are often easier to answer.o E.g. DO ask: ‘how many…’ DON’T ask: ‘how did it feel when…’.

1) Firstly, pick a detail you want to follow up. This should be a quotation if it is a written source, or a detail from a picture. E.g. I would like to follow up the detail ‘As it was, many died.’

2) Secondly, ask a question about the detail you selected. E.g. I would ask ‘How many died?’

3) Thirdly, select a source that could help you to answer the question you asked.Circle the source you think would be most helpful for the question I have asked:The Reverend’s diary / A hospital record / a soldier’s letter / a surgeon’s diary / a photo of the ward

4) Finally, explain why this source would help you to answer the question you asked. Consider the reliability of your chosen source (why would you trust it?).

Explain your choice:

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Activity 2: How to Select a SourceRemember: Historical sources can take many forms. Here are some examples:

Photograph RAMC medical record Government report SpeechDiary entry Newspaper article Government statistics Employment recordLetter Hospital record Autobiography MapPainting Military War Record Film recording Poem

Complete the example column, and then select two more source types to analyse in this table:Question Source: Diary entry Source: ?? Source: ??

Is this source meant to be kept private or shown to others?

Private – just for yourself.

Is this source likely to tell the truth or exaggerate?

Truth – you don’t expect for anyone else to read it.

Does this source give one person’s viewpoint, or many?Is this source likely to give you a lot of different facts, or just focus on one thing?

Top tip for selecting a source! Use the following formula to select a very specific source type:

o Person/organisation + source type + location (+ date)o E.g. RAMC medical records from the Battle of the Somme, 1916

Which source would you choose to investigate each of the following? Explain your answer:a) You want to find out how someone felt about their injuries.I would choose a… because…

b) You want to find out how many people died in a particular location.I would choose a… because…

c) You want to find out exactly what the terrain and road access was like in a certain area. I would choose a… because…

Activity 3: Practising Following Up a SourceTry this question again, but with a different detail.‘How could you follow up Source A to find out more about the problems involved in performing operations on the Western Front?’

Source A From an account by Reverend Leonard Pearson, who was the army chaplain at Casualty Clearing Station 44 during the Battle of the Somme (1916)


Remember for point 3: Top tip for selecting a source! Use the following formula:30

o Person/organisation + source type + location (+ date)o E.g. RAMC medical records from the Battle of the Somme, 1916

1) Firstly, pick a detail you want to follow up. This should be a quotation if it is a written source, or a detail from a picture.

I would like to follow up the detail ‘I had no medical qualifications.’

2) Secondly, ask a question about the detail you selected.I would ask ‘Why…

3) Thirdly, select a source that could help you to answer the question you asked.I would use a…

4) Finally, explain why this source would help you to answer the question you asked. Consider the reliability of your chosen source (why would you trust it?).

This would be useful because…

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Section H: Revision and Assessment

The British Sector of the

Western Front,

1914 – 1918.

Context of the British sector of the Western Front Conditions requiring treatment on the Western FrontThe Ypres Salient: Germans had the advantage with being on the higher ground. Tunnelling and mines were used by the British at Hill 60. First Battle of Ypres - 1914.Second Battle of Ypres -1915.Third Battle of Ypres - 1917.

The Somme: Battle of the Somme - July-November 1917.1st day of battle, 60,000 casualties and 20,000 died. In total, 400,000 Allied casualties and this put pressure on medical services on the Western Front.

Ill health: Trench fever: caused by body lice and included flu-like symptoms including high temperature. Treatment: Passing electric current through infected area was effective. Prevention: Clothes disinfected and delousing stations were set up. Affected 0.5 million.Trench foot: caused by soldiers standing in mud/waterlogged trenches. Treatment: soldiers advised to keep clean but worst cases, amputation. Prevention: Changing socks + keeping feet dry and rubbing whale oil into feet. Affected 20,000 in winter of 1914-1915. Shell-shock: caused by stressful conditions of war and symptoms included tiredness, nightmares, headaches and uncontrollable shacking. Treatment: Not well understood. Prevention: rest and some received treatment in UK. Affected 80,000 and some were shot!Weapons of war: Rifles: fired one at a time/loaded from cartridge case creating rapid fire.Machine guns: Fired 500 rounds a minutes. Pierced organs and fracture bones. Artillery: Bombardments were continuous, Artillery fire caused half of all causalities.Shrapnel: Caused maximum damage exploded mid-air above enemy. Killed/injured.Chlorine Gas: Led to death by suffocation. 1915, gas masks given to all British soldiers. Phosgene Gas: Faster acting than Chlorine but with similar effects. Could kill within 2 days.Mustard Gas: Odourless gas, worked in 12 hours. Caused blisters, burn the skin easily.

Arras: Battle of Arras - 1917. Before the battle, Allied soldiers dug tunnels below Arras. Tunnels led to rooms and included an underground hospital.

Cambrai: Battle of Cambrai -1917. 450 tanks used to advance on the German position, however, plan did not work because there was not enough infantry to support.

Impact of terrain on helping the wounded: Difficult to move around, + night, communication was difficult, collecting wounded from No Man’s Land was dangerous. Stretcher bearers found it difficult to move around corners and transport of the wounded was difficult because of this.

Key words Key wordsNo Man’s Land: Land between Allied and German trenches in WW1.Trenches: Long, narrow ditches dug during the First World War.Ypres Salient: Area around Ypres where many battles took place in WW1.

Gangrene: When a body decomposes due to a loss of bloody supply.Shrapnel: A hollow shell filled with steel balls or lead, with gunpowder and a time fuse.

Helping the wounded on the Western Front The impact of the Western Front on MedicineEvacuation route: Survival depended on speed of treatment. Care improved as war progressed. 1914 – 0 motor ambulances but by 1915, it was 250. Ambulance trains were introduced, as well as, ambulance barges used along River Somme. Stretcher bearers: Collect wounded, 16 in each battalion + 4 for each stretcher.Regimental Aid Post: Always close to the front line and staffed by a Medical officer selected those who were lightly wounded/needed more attention. Field Ambulance and Dressing Station: Emergency treatment for wounded.Casualty Clearing Station: Large, well equipped station, 10 miles from trenches.Base Hospitals: X-ray, operating theatre and areas to deal with gas poisoning. Underground hospital at Arras: Running water, 700 beds and operating theatre.RAMC: Involved medical officers and learnt about wounds never seen before.FANY: Volunteer nurses, who helped the wounded and also drove ambulances.

The Thomas Splint: Stopped joints moving and increased survival rates from 20 to 82%. Reduced infection from compound fractures. X-rays: Developed in 1895, X-rays used to diagnose issues before operations. But there were some problems: X-ray could not detect all problems, were fragile and overheat. Mobile X-rays: 6 operated on the front line, used to locate shrapnel and bullet wounds. Transported around in a truck and enabled soldiers to be treated more quickly.Blood Transfusions: Blood loss = major problem. Blood transfusions used at Base Hospitals by a syringe and tube to transfer blood from patient to donor. Extended to CCS from 1917.Blood bank at Cambrai: Adding Sodium Citrate allowed blood to be stored for longer. Blood was stored in glass bottles at a blood bank and used to treat wounded soldiers.Brain surgery: Magnets used to remove metal fragments from the brain. Local anaesthetic.Plastic surgery: Harold Gillies developed new techniques, skin drafts developed for grafts.

Key words Key wordsFANY: First Aid Nursing Yeomanry. Founded in 1907 by a soldier who hoped they would be a nursing cavalry to help the wounded in battle. RAMC: Royal Army Medical Corps. This organisation provided medical care. It consisted of all ranks of male medical staff from doctors to ambulance drivers and stretcher bearers.Triage: A system of splitting the wounded into groups according to who needed the most urgent attention.

Compound Fracture: Broken bones pierces the skin + increases risk of infection in wound.Debridement: Cutting away of dead and infected tissue from around the wound.Gas Gangrene: Infection that produced gas in gangrenous wounds. Mobile X-ray unit: Portable X-ray unit that could be moved around the Western Front.Blood transfusions: Blood taken from a healthy person and given to another person.General anaesthetic: Putting a patient to sleep during an operation.Local anaesthetic: Area being operated on is numbed to prevent pain + patient awake.

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Revision of Content: 1) Read through the summary on page 30, 2)Complete the grid below, 3)Draw the evacuation route &trench system and label it Challenge tasks: 4)Make flashcards: question one side, answers on the other, 5)Make a mind map for each section, different branch for each subheading.Which battle had the most casualties on the first day of fighting?

Give two problems with X-Ray machines during WWI

Name three types of male medical staff on the Western From

Put in order: Regimental Aid Post Hospital, Clearing Station and Dressing Station.

How many stretcher bearers did each battalion have?

In which battle area was there an underground hospital, and why?

What is shrapnel? What caused Trench Fever?

Name two types of gas used as weapons. What was developed to stop fractured legs from moving?

In which battle, and year, was there first Blood Bank

What was the name of the Medical branch of the Army called?

What was introduced by 1916, which dramatically reduced head injuries?

Name two different kinds of female staff on the Western Front

Who developed plastic surgery techniques during WWI?

How did the army respond to sufferers of Shell-Shock?

Name four forms of transportation used to move wounded or sick soldiers along the evacuation route

What did many soldiers develop, due to having their feet in soaking wet and muddy conditions for long periods of time?

Why were there so many infected wounds on the Western Front?

Which type of weapon caused the highest proportion of injuries?

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Revision of SkillsRead back through pages 23-29, and make yourself flashcards on techniques, for each source question type:

Key features: A key feature is a main things about something. Details tell the reader more about the feature.

Source utility:o Source utility: How a source is useful, depends on your enquiry focus. o Provenance means the background of the source, e.g.NOP: its Nature (what kind of source is it?), Origin

(who made it, where, and when?), and Purpose (why was it made?). Try to comment on at least one.o Be careful! Just because someone was not there, doesn’t make the source useless.

Following up a source:o Try to think of something quantitative (a number) rather than experiential (emotional) to follow up

and ask a question about. E.g. DO ask: ‘how many…’ DON’T ask: ‘how did it feel when…’.o When selecting a source, use the following formula: Person/organisation + source type + location (+

date) E.g. RAMC medical records from the Battle of the Somme, 1916

Activity 2: AssessmentComplete the questions below: You can either type your answers or handwrite it. Please email a copy or photo of your work, to your teacher.

1) Describe two key features of the trench system.Writing Frame:One key feature of the trench system was… For example… Another key feature of the trench system was… For example….

2 a)How useful are Sources A and B for an enquiry into the treatment of battle injuries by medical staff on the Western Front?

Use the planning grid to help you talk about content & provenance, and use own knowledge.Content: The source tells me…

Own knowledge to support content:

Provenance: The background of the source. Nature (source type): Origin: Taken in… Purpose (challenge):

Own knowledge to support provenance (NOP):

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Writing Frame:Source A tells us about… because it says/shows that…(CONTENT) which is accurate because…(OWN KNOWLEDGE)Source A also tells us about… because it says/shows …(CONTENT) which is useful because… (OWN KNOWLEDGE)Source A is… (PROVENANCE) which makes it useful because… (EXPLANATION maybe with OWN KNOWLEDGE)Furthermore, Source A is… (PROVENANCE) which makes it useful because… (link to CONTENT)

Challenge: If you feel confident use the CAT structure you practised in Section B Activity 4.Is the source COMPREHENSIVE? Does it actually tell you much information?Is the source ACCURATE? Is it correct? Does it have details (e.g. statistics / dates / names)?Is the source TYPICAL? Does it tell us something that would have been common or unusual

Now repeat for Source BContent: The source tells me…

Own knowledge to support content:

Provenance: The background of the source. Nature (source type): Origin: Written by…Written during…

Published in… Purpose (challenge):

Own knowledge to support provenance (NOP):

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Writing frameSource B tells us about… because it says/shows that… (CONTENT) which is accurate because… (OWN KNOWLEDGE)

Source B also tells us about… because it says/shows … (CONTENT) which is accurate because… (OWN KNOWLEDGE)

Source B is… (PROVENANCE) which makes it useful because… (EXPLANATION maybe with OWN KNOWLEDGE)

Furthermore, Source B is… (PROVENANCE) which makes it useful because… (EXPLANATION maybe with OWN KNOWLEDGE)

Challenge: If you feel very confident use the CAT structure from Section B Activity 4, instead of the above..Is the source COMPREHENSIVE? Does it actually tell you much information?Is the source ACCURATE? Is it correct? Does it have details (e.g. statistics / dates / names)?Is the source TYPICAL? Does it tell us something that would have been common or unusual?

2b) How would you follow up Source B to find out more about the treatment of battle injuries by medical staff on the Western Front?

Remember:o Try to think of something quantitative (a number) rather than experiential (emotional) to focus on and

question. These questions are often easier to answer.E.g. DO ask: ‘how many…’ E.g. DON’T ask: ‘how did it feel when…’.

o When selecting a source use the following formula to select a very specific source type:Person/org. + source type + location (+ date) E.g.RAMC medical records from the Battle of the Somme, 1916

Writing Frame: Detail in Source B that I would follow up:I would follow up the detail :

Question I would ask:I would ask the question ‘

What type of source I could use:I would use a

How this might help answer my question:This would help me answer the question because…

It would also be helpful because....

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