The First World War: surgery, x-rays, blood and women

What the specification asks for

“The importance of the First World War for the role of women in medicine and improvements in medical treatment, surgery, x-rays, blood transfusion and fighting infection” — examined through change and consequence. Incandio is aligned to specification 4HI1; it is not published by, endorsed by or affiliated with Pearson.

1 · Understand it

What war removes

X-rays existed from 1895. Blood groups were known from 1901. Skin grafting had been attempted for decades. Antiseptic and aseptic technique were established. Almost nothing in this strand was invented in the war.

What the war removed was the constraint. It supplied unlimited casualties, so a technique could be tried and refined hundreds of times in months rather than a few times in a career. It supplied urgency, so objections were overruled. It supplied money, because military necessity has no budget argument against it. And it supplied organisation, because armies plan and standardise where civilian medicine improvises.

That is the honest and uncomfortable causal claim the specification asks about directly, and stating it precisely is worth more than any list of advances.

The advances

Infection. Western Front soil was heavily manured and wounds were contaminated with tetanus and gas gangrene organisms. Antiseptics alone failed in deep wounds, and the answer was surgical: wound excision — cutting away all dead and contaminated tissue — combined with the Carrel-Dakin irrigation system using a controlled hypochlorite solution. Tetanus antitoxin was issued routinely from 1914 and cases fell dramatically.

Fractures. The Thomas splint, which held a broken femur under traction, was applied systematically from 1915 and mortality from compound femoral fractures fell from around 80 per cent to about 20 per cent. It is the option's clearest example of a simple, pre-existing device transformed by systematic application.

X-rays. Mobile units brought imaging to casualty clearing stations, so shell fragments could be located before surgery instead of being searched for. Curie's petites Curies and the training of women operators belong here.

Blood. Sodium citrate as an anticoagulant and refrigeration allowed storage; Oswald Robertson established the first blood depot in 1917, using citrated blood kept on ice, so transfusion no longer required a donor at the bedside.

Plastic surgery. Harold Gillies established a unit at Aldershot and then the Queen's Hospital at Sidcup in 1917, developing the tubed pedicle graft and treating around 5,000 men with facial injuries. Reconstructive surgery becomes a specialism here.

Organisation. The chain of evacuation — regimental aid post, dressing station, casualty clearing station, base hospital — with triage at each stage, is a system rather than a treatment, and it saved more lives than any single technique.

Women, and what happened afterwards

The war opened medicine to women because the men had gone. Medical schools that had refused women admitted them from 1915–16; women served as doctors in military hospitals, and units such as the Scottish Women's Hospitals, founded by Elsie Inglis after the War Office told her to go home and sit still, ran hospitals in France, Serbia and Russia staffed entirely by women. Elizabeth Garrett Anderson's daughter Louisa and Flora Murray ran the Endell Street Military Hospital in London with an all-female staff.

Then the war ended. Several medical schools that had opened in 1916 closed to women again in the early 1920s; the marriage bar operated in many employments; and the proportion of women in medicine grew only slowly through the interwar period.

That reversal is the strongest single piece of evidence in the women's theme, and it is the reason a 16-mark question about progress for women needs a criterion. If the measure is opportunity during the war, the change is dramatic; if it is durable institutional position, the change is small and was partly undone. Saying which measure is being applied is what reaches the top band.

2 · Learn it — the notes

The dates that earn marks

1914

Tetanus antitoxin issued routinely. Why this date: An existing product applied systematically because an army can standardise.

1915

The Thomas splint applied systematically; femoral fracture mortality falls from about 80 to about 20 per cent. Why this date: The clearest single case of organisation rather than invention producing an advance.

1915–16 and early 1920s

Medical schools open to women, and several close again. Why this date: The opening and the reversal are the theme's central evidence.

1917

The first blood depot with citrated, refrigerated blood; Gillies opens Sidcup. Why this date: Storage and reconstructive surgery, both driven by casualty numbers.

The figures, and how far to trust them

• About 80 per cent → about 20 per cent — Mortality from compound femoral fractures after systematic use of the Thomas splint. (Commonly cited figures; the exact baseline varies by source and sector.)
• About 5,000 — Men treated for facial injuries under Gillies at Sidcup.
• 1895, 1901, 1917 — X-rays, blood groups and blood storage — two discoveries and the war that made them usable.

The people to place

• Harold Gillies — Founded modern plastic surgery at Sidcup in 1917 with the tubed pedicle graft.
• Marie Curie — Equipped and drove mobile radiography units and trained women radiographers.
• Oswald Robertson — Established the first blood depot on the Western Front in 1917.
• Elsie Inglis — Founded the Scottish Women's Hospitals after being told by the War Office to go home and sit still.
• Hugh Owen Thomas — Designed the splint, decades before the war that made it standard.

How historians disagree

Attributed interpretations, never voiced — the AO4 seam.

• The 'war advances medicine' reading: War concentrates casualties, money and urgency, and therefore accelerates medical development; the First World War produced transfusion, plastic surgery and mass radiography. Contested by The reading that war destroys far more health than it advances, diverts research and personnel from civilian need, and that almost every wartime advance existed beforehand and would have arrived without the killing..

What students say — and what is actually the case

Not this: The war invented blood transfusion and plastic surgery.

This: Blood groups were identified in 1901 and grafting had been attempted for decades. The war supplied casualties, urgency, money and organisation, which turned existing knowledge into routine practice.

Not this: The war permanently opened medicine to women.

This: Schools opened from 1915–16 and several closed again in the early 1920s. The opening was real and it was substantially reversed, which is the evidence a change/continuity answer needs.

Two things students merge

Blurred: Invention and application.

The distinction: The Thomas splint was designed decades earlier and applied systematically from 1915. The advance is in the application, and saying so is the strand's central analytical point.

Blurred: Advances in medicine and improvements in health.

The distinction: Techniques improved and the war killed around ten million people and produced an influenza pandemic in a weakened population. The two claims are compatible and an answer about war's significance should hold both.

What a Grade 9 answer holds here

A Grade 9 answer says what war contributes and refuses to call it invention. Everything in this strand existed in 1914; what the war supplied was unlimited cases, no budget constraint, no time for objection and an organisation that could standardise a splint across an army — which is a claim about conditions rather than about discovery, and it applies equally to 1939–45.

3 · How it is examined

This strand is genuinely set through: Paper 2 Section B (a) (6 marks — “Explain TWO ways in which … was different from ….”); Paper 2 Section B (b) (8 marks — “Explain TWO causes of ….”); Paper 2 Section B (c)(i) or (c)(ii) (16 marks — “How significant was … in …, in the years …? / How far were … responsible for …, in the years …? You may use the following in your answer: • [prompt] • [prompt]. You must also use information of your own.”).

What earns marks: The four things war supplies — casualties, urgency, money, organisation — stated once and applied to two examples. THEME TRACK: theme 5 (impact of war) and theme 4 (women), and the wartime opening and interwar closure is the sharpest evidence in the women's theme.

4 · Prove it — the questions

Answered inside Incandio, where a marker checks what a correct answer must contain and tells you which half was missing. The marking stays in the app; the questions are here.

1. Explain TWO ways in which the treatment of wounds in 1900 was different from treatment in 1918. [6 marks · Paper 2 Section B (a)]
2. Explain TWO causes of the improvement in medical treatment during the First World War. [8 marks · Paper 2 Section B (b)]
3. Explain TWO causes of the increase in opportunities for women in medicine during the First World War. [8 marks · Paper 2 Section B (b)]
4. How significant was war in improving medicine in the years c1848–c1948? You may use the following in your answer: • the First World War • penicillin. You must also use information of your own. [16 marks · Paper 2 Section B (c)(i) or (c)(ii)]
5. Explain TWO ways in which the position of women in medicine in 1914 was different from their position in 1919. [6 marks · Paper 2 Section B (a)]

Decide it

This lesson feeds a Decide History judgement — a position you commit to, an objection you answer, a criterion you name: Across a century, what moved medicine most: individuals, science, war or government?.

Carry on through the option

• Previous lesson: The Liberal reforms, 1906–11
• Next lesson, in key topic 5: Penicillin: Fleming, Florey and Chain
• Key topic 4 · Government action and war, 1905–20 · Changes in medicine, c1848–c1948 · the option's timeline · Incandio History
• The other key topics of Changes in medicine: Progress in the mid-19th century; Nightingale, Chadwick, Snow and Simpson · Discovery and development, 1860–75; Lister and Pasteur · Accelerating change, 1875–1905; Ehrlich, Koch and chemistry · Advances in medicine, surgery and public health 1920–48; the NHS