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WORKBOOK ANSWERS

Edexcel GCSE (9–1) History Workbook

Medicine in Britain, c.1250–present

The British sector of the Western Front, 1914–18

This Answers document provides suggestions for some of the possible answers that students could give for the questions asked in the Workbook. They are not exhaustive and other answers may be acceptable, but they are intended as a guide to give teachers and students feedback.

Medicine in Britain, c.1250–present

Medicine in medieval England: c.1250–c.1500

Ideas about the causes of disease and illness

1 The Theory of the Four Humours was an idea first put forward by an Ancient Greek doctor called Hippocrates. The theory stated that the body was made up of four humours: blood, phlegm and black and yellow bile. It was believed that the humours must be balanced for a person to be healthy. It was also believed that the humours had their own characteristics, for example phlegm was cold and wet. The humours were also linked to the seasons, for example it was believed that the body produces too much phlegm in winter.

2 a Leprosy is a painful contagious skin disease that leads to paralysis.

b People suffering with leprosy were banished from communities and had to wear a bell to announce their presence. Leper houses were set up on the edges of towns and cities.

3 A lazar house was a place, usually a religious house, in which lepers were cared for.

4 Barber surgeons performed small surgeries such as pulling teeth and bloodletting.

5 Galen’s ideas did not challenge the Bible. He believed in the idea of the soul.

6 During a dissection the physician would sit away from the body and read from the works of Galen. Somebody else would dissect the body.

7 Miasma Theory stated that bad air was filled with poisonous fumes, which caused disease and illness.

8 Urine was carefully examined before diagnosis of a patient. The physician would check the urine’s colour, thickness, smell and taste.

9

|Theory |Explanation |

|The impact of the planets |During the Middle Ages it was believed that a movement in the |

| |planets would result in a disease spreading throughout England. |

|God’s punishment |During the Middle Ages it was believed that God sent illness as a |

| |punishment for sins. |

|Theory of the Four Humours |Medieval people continued to believe that illness was caused by an|

| |imbalance of the four humours. |

|Miasma Theory |Medieval people believed that bad air, filled with poisonous |

| |fumes, was the cause of disease and illness. |

10

|The Church |Individuals |Attitudes and beliefs |

|Religion was so influential during the|Galen’s ideas continued to dominate medicine|Religion was highly influential in medieval |

|Middle Ages that it led to most people|during the Middle Ages. The Church supported|England, and this led to religious ideas |

|believing illness was sent by God as a|his ideas and they were taught in all |about the cause, prevention and treatment of|

|punishment for their sins. |medical schools. |illness and disease. For example, most |

| | |people went on pilgrimages and prayed daily.|

11 In this answer, you are looking for a clear focus on the explanation of ‘why’ throughout the answer.

• You may wish to use bullet points to argue that Galen’s ideas dominated medical training. The Theory of the Four Humours was widely believed in medieval England and so Galen’s Theory of Opposites was used to treat illness.

• Stronger candidates will employ knowledge in addition to bullet points, for example the influence of the Church in medical ideas in medieval England and its support of the work of Galen.

• No introduction or judgement is needed when answering this question.

Approaches to prevention and treatment

12

|Key term |Definition |

|Bloodletting |The opening of a vein to draw blood from a patient |

|Fasting |Going without food |

|Stewes |Public baths |

|Regimen Sanitatis |A set of instructions provided by a physician to help keep a patient healthy |

|Pilgrimage |A journey to an important religious monument, shrine or place |

|Monks and nuns |The staff of a medieval hospital |

|Posy |A bunch of flowers |

|Physician |Medieval doctor |

|The king’s touch |When the king’s hands were rubbed with holy oil before he touched those suffering with |

| |scrofula |

|Apothecary |Those who mixed herbal remedies |

13

|Belief about cause |Treatments |Preventions |

|God’s punishment |Prayer |Penance |

| |Fasting |Prayer |

| |Pilgrimage |Fasting |

| |King’s touch |Pilgrimage |

|Theory of the Four Humours |Bloodletting |Bloodletting |

| | |Regimen Sanitatis |

| | |Stewes |

|Miasma Theory |Stewes |Posy |

14

|Statement |True/False? |Corrected statement |

|Most people in medieval England were treated at home |False |Most people in medieval England were treated at |

|by a male family member. | |home by a female family member. |

|Medieval physicians had a medical degree. |True | |

|The main role of a physician was to treat a patient |False |The main role of a physician was to diagnose |

|after diagnosis. | |illness and recommend treatment. |

|A physician’s medical care was provided to everyone |False |A physician was very expensive and only the rich |

|free of charge. | |could afford to see him. |

|Apothecaries’ knowledge was passed down from family |True | |

|member to family member. | | |

|A medieval hospital was a place where the sick were |True | |

|cared for, not cured. | | |

|A nun’s duties included sampling patients’ urine and |False |A nun’s duties included doing the washing and |

|bleeding patients. | |making sure everything was clean. |

15 In this answer, you are looking for:

• a focus on similarity

• support from both time periods, for example, in both the thirteenth and seventeenth centuries people turned to the Church to explain disease and illness. During the Black Death and the Great Plague, it was believed that God had sent the epidemic as a punishment for sin.

16 In this answer, you are looking for:

• a focus on difference

• support from both time periods, for example, in the thirteenth century monks and nuns looked after patients who attended hospital, and they adopted a ‘care not cure’ approach. However, by the seventeenth century patients attended hospitals with wounds and curable skin conditions for treatment.

Dealing with the Black Death, 1348–49

17

|Treatment |Prevention |

|b Bleeding |a Pilgrimage |

|d Prayer |c Authorities stopped cleaning the streets |

|f Strong-smelling herbs |d Prayer |

| |e Leaving the village |

| |f Strong-smelling herbs |

| |g Quarantine |

| |h Self-flagellation (whipping oneself) |

18

|The Church |The government |Attitudes and beliefs |

|Many believed that the Black Death was |In order to prevent the Black Death |Like physicians, people did not know how to|

|sent by God as a punishment for sins. As |spreading, local authorities introduced |treat or prevent the disease. They still |

|a result, they used prayer, pilgrimage |quarantine laws to stop people moving |believed that miasma was the cause, and |

|and self-flagellation to treat/prevent |about too much. People new to an area |they thought that strong-smelling herbs and|

|it. |were isolated for 40 days. |bleeding were potential treatments. |

19 In this answer, you are looking for a balanced answer that both agrees and disagrees with the statement before reaching a sustained judgement.

Arguments that agree with the statement could include the following:

• Religious ideas that disease and illness were sent as a punishment from God dominated medical practice and led to treatments and preventions such as prayer, pilgrimage and penance.

• Religious teachings led to care of the sick taking place in religious institutions and being carried out by monks and nuns.

• The Church supported the ideas of Galen, as they did not challenge the Bible and so were taught in medical schools across Europe.

Arguments that disagree with the statement could include the following:

• There was a strong belief that disease and illness were caused by an imbalance of the four humours. This led to treatments and preventions such as bloodletting that were intended to balance out the humours.

• More rational ideas began to develop, including the belief that bad air caused disease and illness (Miasma Theory). This led to people carrying and burning sweet-smelling herbs and flowers during the Black Death.

A sustained judgement might include the following:

• Many people relied on religious ideas during the period c.1250–c.1500. However, rational ideas were becoming more prominent and people turned to these ideas during dangerous epidemics when they were desperate.

The Medical Renaissance in England: c.1500–c.1700

Ideas about the causes of disease and illness

20

|Change |Continuity |

|b Physicians carried out observations of their patients |a Miasma Theory |

|e Illness was a result of the weather |c God sent the plague as a form of punishment |

| |d An imbalance of the four humours |

21

|Statement |True/False? |Corrected statement |

|Thomas Sydenham was nicknamed ‘the English |True | |

|Hippocrates’. | | |

|Sydenham’s work was important in moving medicine |True | |

|away from the ideas of Galen and Hippocrates. | | |

|Sydenham relied on the works of Galen when |False |Sydenham refused to rely on medical books when |

|diagnosing a patient’s illness. | |diagnosing a patient. |

|One of Sydenham’s ideas was that diseases were |True | |

|like plants and animals, and could be organised | | |

|into different groups. | | |

|Sydenham’s book The Fabric of the Human Body was |False |Sydenham’s book Observationes Medicae was published in |

|published in 1676. | |1676. |

|Sydenham encouraged his students to observe their |True | |

|patients and note down their symptoms. | | |

|Sydenham identified that measles and scarlet fever|True | |

|were separate diseases. | | |

|Sydenham used ‘sweating’ to cure his patients of |False |Sydenham prescribed airy bedrooms, light blankets and |

|smallpox. | |cold drinks to cure his patients of smallpox. |

22 a Animalcules were ‘little animals’ in plaque scraped from between the teeth. They were the first recorded observation of bacteria.

b Microscopes allowed observation of animalcules to take place. Bacteria were observed.

23 The rise of humanism led to more experimentation and questioning. New ideas began to gain more support.

24 The new printing press enabled medical ideas to spread more widely and much more quickly.

25 a The Royal Society’s aim was to promote and carry out experiments to further the understanding of science. It shared scientific knowledge and encouraged debate.

b The Royal Society encouraged the new medical ideas that developed during the Renaissance, for example animalcules. The Society made it possible for physicians and scientists to access and study each other’s work.

26

|The Church |Science and technology |Attitudes and beliefs |

|Declined in power and allowed new ideas|New microscopes |Development of humanism, questioning, |

|to be questioned and developed |Printing press |experimentation, all leading to a more |

|Humanism and experimentation became | |scientific understanding of the cause of|

|more commonplace as the Church lost | |illness, e.g. animalcules |

|power | | |

27 In this answer, you are looking for a clear focus on the explanation of ‘why’ throughout the answer.

• You may wish to use bullet points and argue that people continued to believe in the Theory of the Four Humours and Miasma Theory as the causes of disease and illness.

• Stronger candidates will use knowledge in addition to the bullet points. For example, although new ideas began to be developed during this period, including animalcules, without widespread technology leading to a change in ideas people turned to the old ideas of the Theory of the Four Humours and Miasma during epidemics such as the Great Plague in 1665.

• No introduction or judgement is needed when answering this question.

Approaches to prevention and treatment

28

|Key term |Definition |

|Iatrochemistry |Chemical cures for diseases |

|Sweating |Making the patient sweat in order to cool the body down |

|Transference |Transferring an illness or disease to something else |

29 For example:

• Onion fixed to a wart

• Patients with a fever slept in a room with a sheep

30 a Your answers could include sarsaparilla, ipecacuanha (ipecac) and cinchona bark.

b New herbal remedies started to appear due to the discovery of new lands.

31 Paracelsus inspired the use of iatrochemistry.

32 For example:

• Removal of bad smells

• Regimen Sanitatis

• Prayer

• Cleanliness

33 For example:

• Practising moderation

• Monitoring the weather

• Removal of rubbish from the streets

34

|Apothecary |Surgeon |Physician |

|a Mixed remedies |c Carried out simple operations |b Trained at university |

|d New entrants to this profession |e Had to possess a licence to practise|f Learned from books, rather than |

|carried out an apprenticeship and |their trade |practical experience |

|learned from a master |g Used by those who could not afford a|h Rarely carried out dissection due to |

|e Had to possess a licence to practise|physician |a lack of corpses |

|their trade | | |

|g Used by those who could not afford a| | |

|physician | | |

35 Vesalius had a deep interest in the human body. In 1543, he published On the Fabric of the Human Body, which was a book of anatomical drawings. To do this, he dissected human corpses. He proved that there were errors in the work of Hippocrates. He also proved that the human jawbone was in one part, that men did not have one fewer pair of ribs than women and that the human breastbone was in three parts. Vesalius encouraged other doctors to base their work on dissection.

36 In this answer, you are looking for a balanced answer that both agrees and disagrees with the statement before reaching a sustained judgement.

Arguments that agree with the statement could include the following:

• The printing press led to an improvement in the communication of new medical discoveries during the Renaissance, for example Vesalius’ book On the Fabric of the Human Body. This enabled his discoveries, which proved Galen wrong, to spread and encouraged medical students to dissect and study the human body, rather than rely on old texts.

Arguments that disagree with the statement could include the following:

• A change in attitudes and beliefs during the period encouraged a more scientific approach to learning, for example the Royal Society encouraged doctors and scientists to discuss and debate medicine, while humanism led to doctors and scientists questioning old ideas and making new discoveries.

• Individuals such as Sydenham, Vesalius and Harvey became important as they developed the confidence to challenge old ideas and encourage medical professionals to study the human body in detail rather than rely on the ideas in old medical texts.

A sustained judgement might include the following:

• During the Renaissance an improvement in technology provided individuals with the opportunity to share their ideas more widely and encouraged a more scientific approach to medical learning.

Key individual: William Harvey and the discovery of the circulation of the blood

37 a

|Harvey proved that blood flowed in one |Harvey disproved the ideas of Galen. |Harvey dissected cold-blooded animals.|

|direction. | | |

|Harvey had to steal bodies from graves |Harvey discovered capillaries but was |Harvey was not allowed to go to |

|for dissection. |unable to prove their existence. |medical school. |

b

|Factor |Contribution to medical understanding |Positive/ |

| | |Negative? |

|Individuals |Harvey’s own abilities — reputation as Charles I’s physician, patience and |Positive |

| |determination to dissect and experiment | |

|Government |Support from Charles I |Positive |

|Science |Dissection became more commonplace and encouraged Harvey |Positive |

|Technology |Harvey’s idea was developed from the mechanical firefighter pumps |Positive |

|Attitudes in society|Medical Renaissance — questioning and experimentation |Positive and |

| | |negative |

c Harvey’s theory encouraged other scientists to experiment on actual bodies.

d Harvey’s discovery had little impact on medical treatment. Doctors of the time ignored and openly criticised Harvey. Old ideas about treatment prevailed.

e Renaissance doctors ignored and openly criticised Harvey’s theory.

38 In this answer, you are looking for a balanced answer that both agrees and disagrees with the statement before reaching a sustained judgement.

Arguments that agree with the statement could include:

• Despite Harvey’s discovery, medical ideas about the causes of disease and illness, and therefore methods of prevention and treatment, stayed the same. This can be seen during the Great Plague of 1665, during which people still used prayer because they believed the epidemic was sent by God as a punishment and burned fires in the street because they believed that bad air caused the disease to spread.

• Harvey published his book An Anatomical Account of the Motion of the Heart and Blood in Animals in 1628. However, medical textbooks continued to give Galen’s account until 1651 and Harvey’s ideas only began to appear in universities from 1673.

Arguments that disagree with the statement could include:

• Harvey’s discovery did encourage other scientists to experiment on actual bodies and carry out dissections.

A sustained judgement might include the following:

• Harvey’s discovery made little difference to medical understanding of the causes of disease and illness, and therefore the methods of prevention and treatment. However, it did encourage scientists to question and challenge old ideas, leading to new scientific discoveries in the long term.

Dealing with the Great Plague in London, 1665

39

|Key term |Definition |

|Quarantine |Isolation inside the home for 28 days |

|Pomander |A ball containing perfumed substances |

|Quack doctor |Somebody who did not have any medical qualifications, but who sold their services as a doctor or |

| |apothecary |

|Plague doctor |A doctor employed to treat plague victims, who wore a special costume of a birdlike mask and a |

| |long coat to avoid catching the plague |

|Searchers |People employed to find, and remove, the corpses of plague victims |

40 a

|Ideas about cause |Preventions |Treatments |

|Miasma Theory |Burning barrels of tar |Sweating |

|Alignment of the planets |Fire |Transference — strapping a live |

|Punishment from God |Pomander |chicken to buboes (swellings of |

|Contagion, person to person |Public meetings, fairs banned |the lymph nodes) |

| |Theatres closed |Herbal remedies |

| |Cats and dogs killed | |

| |Prayer and repentance | |

| |Red cross on doors, ‘Lord have mercy upon us’ | |

b This answer relies on your own answers to Question 40a.

41 a There is no right or wrong answer to this question, but you should be able to support your decision.

b A possible answer to this activity could argue the following, but others are also acceptable:

There was very little change in the ideas of the cause of disease between the Black Death and Great Plague. People still believed that the disease was sent by God as a punishment for sin and that it was spread by bad air (miasma). However, people began to use new methods of prevention linked to these ideas during the Great Plague, including plague water and the smoking of tobacco.

42 In this answer, you are looking for:

• a focus on similarity

• support from both time periods, for example during both the Black Death and the Great Plague bad air (miasma) was believed to have caused the epidemic. As a result, people would smell herbs, carry sweet-smelling flowers and burn fires to drive away the bad air.

43 In this answer, you are looking for:

• a focus on difference

• support from both time periods, for example during the Black Death people would flog themselves to avoid catching the disease. However, by the time of the Great Plague in 1665, the government took more action to prevent the spread of the disease by banning public meetings and closing theatres.

Medicine in eighteenth- and nineteenth-century Britain: c.1700–c.1900

Ideas about the causes of disease and illness

44

|Key term/Date |Definition/Event |

|Germ theory |The belief that microbes in the air caused decay |

|Theory of Spontaneous Generation |The belief that microbes were the product of decay, rather than the cause of |

| |it |

|1861 |The year in which Pasteur published his germ theory |

|Microbe |A living organism too small to see without a microscope (also known as germs)|

|Enlightenment |A movement in Europe that promoted the idea that people could think for |

| |themselves |

|1876 |The year in which Koch discovered the bacterium that caused anthrax |

|Robert Koch |German doctor |

|Anthrax |An infectious disease mostly affecting animals but occasionally people |

|Tuberculosis |A threatening disease in the nineteenth century |

|Louis Pasteur |French chemist |

45

[pic]

46 Louis Pasteur discovered germs. He published the ‘germ theory’ and developed vaccines for chicken cholera and rabies.

47 Robert Koch used a petri dish and chemical dye to identify microbes using a microscope. He discovered the microbes for tuberculosis, cholera and anthrax.

48 a Your answer could include any two of the following:

o Microscope

o Swan neck flask

o Petri dish

o Chemical dye

b Your answer could include any two of the following:

o Miasma Theory

o Spontaneous Generation

o Some doctors did not believe that germs existed and so continued to believe the old ideas.

c Germ theory.

49

|Factor |Contribution to medical understanding |Positive/ |

| | |Negative? |

|Individuals |The scientific skill and determination of Pasteur and Koch. |Positive |

|Government |No government funding for medical experiments just yet. |Negative |

|Science |Scientists and doctors were working together to carry out experiments and |Positive |

| |make progress in the understanding of the causes of disease and illness. | |

|Technology |Vital to scientific experiments: microscope, swan neck flask, petri dish and |Positive |

| |chemical dyes. | |

|Attitudes in society|Scientific understanding (a part of the Enlightenment) was starting to |Positive |

| |dominate by 1900. | |

50 In this answer, you are looking for a clear focus on the explanation of ‘why’ throughout the answer.

• You may wish to use bullet points to argue that the technology available, such as the microscope, was important, alongside the new scientific thinking during the Enlightenment, which encouraged questioning and experimentation.

• Stronger candidates will use knowledge in addition to the bullet points, for example the importance of the individual, Louis Pasteur, and his ability to scientifically question and experiment to discover that germs were the cause of disease and illness.

• No introduction or judgement is needed when answering this question.

Approaches to prevention and treatment

51

|Event |Chronological order |Do I know the year? |

| |(1–9) | |

|Florence Nightingale makes changes to hospitals in the Crimean War |3 |1854 |

|Second Public Health Act |7 |1875 |

|Antiseptic surgery with carbolic spray is first used |5 |1865 |

|Anaesthetic in surgery (chloroform) is discovered |1 |1847 |

|The Nightingale School for Nurses opens |4 |1860 |

|The anthrax vaccine is first created |8 |1881 |

|Sewers are completed in London |6 |1865 |

|First Public Health Act |2 |1848 |

|The rabies vaccine is first used on a human |9 |1885 |

52

|Individual |How did their actions lead to developments in the prevention and treatment of |

| |disease and illness? |

|Florence Nightingale |Her books, Notes on Nursing and Notes on Hospitals, and a training school for nurses|

| |led to improved hygiene in hospitals. They helped to prevent the spread of disease |

| |and revolutionise the care of patients during recovery from illness. |

|James Simpson |Simpson discovered that chloroform is an effective anaesthetic for removing pain in |

| |surgery. |

|Joseph Lister |Lister developed the carbolic spray leading to antiseptic surgery and the beginning |

| |of the removal of germs from an operating theatre. |

|Edwin Chadwick |Chadwick conducted a report into the living conditions of the poor. He came to the |

| |conclusion that the government should clean up the slums to improve the health, and |

| |economic output, of the workforce. |

|Joseph Bazalgette |Bazalgette developed the sewer system in London after the Great Stink. |

53

|Statement |True/False? |Corrected statement |

|Robert Koch developed a vaccine for rabies. |False |Louis Pasteur developed a vaccine for rabies. |

|Florence Nightingale’s book Notes on Nursing |True | |

|was published in 1859. | | |

|Nightingale believed in the Miasma Theory of |True | |

|the cause of disease and illness. | | |

|It was dangerous to use ether as an |True | |

|anaesthetic because it was so flammable. | | |

|Queen Elizabeth used chloroform during |False |Queen Victoria used chloroform during childbirth. |

|childbirth. | | |

|Joseph Lister faced no opposition and the |False |Lister faced lots of opposition, mainly because doctors did |

|death rate in operations continued to fall. | |not accept that germs caused infection. |

|The Church supported the use of anaesthetics |False |The Church disagreed with the use of anaesthetics and |

|in surgery. | |believed that pain in childbirth was intended by God. |

|Antiseptic surgery included the use of steam |False |Aseptic surgery included the use of steam sterilisation, |

|sterilisation, rubber gloves and surgical | |rubber gloves and surgical gowns. |

|gowns. | | |

|The First Public Health Act made little |True | |

|difference because it was voluntary. | | |

|The Second Public Health Act showed the |False |The Second Public Health Act showed the importance of the |

|importance of the Church in developing public| |government in developing public health. |

|health. | | |

54 a In this answer, you are looking for:

o a focus on similarity

o support from both time periods, for example, in both the seventeenth and early nineteenth centuries it was believed that disease was spread by bad air (miasma) and so governments took steps during the Great Plague and early cholera epidemics to clean the streets.

b In this answer, you are looking for:

o a focus on difference

o support from both time periods, for example during the Great Plague of 1665 the government banned public meetings and closed theatres. However, by the late nineteenth century the government knew that dirty water spread cholera and so it funded the building of sewers in London.

Key individual: Jenner and the development of vaccination

55 a

|Event |Chronological order |Do I know the year?|

| |(1–6) | |

|Edward Jenner carries out his experiment on James Phipps |3 |1796 |

|The government makes the smallpox vaccination compulsory |6 |1852 |

|Nationwide epidemics of smallpox (note: multiple years) |1 |1722, 1723, |

| | |1740–42, 1796 |

|Jenner publishes his findings |5 |1798 |

|People are inoculated to prevent the spread of smallpox |2 |From early 1700s |

|The Royal Society refuses to publish Jenner’s findings, demanding more proof |4 |1797 |

b

|Statement |Short-term |Long-term |

| |impact |impact |

|Without knowledge of germs, Jenner was unable to explain why his smallpox vaccine worked. |( | |

|Jenner showed the importance of scientific methods and encouraged other scientists to use |( | |

|experiments and enquiry in order to improve medicine. | | |

|Jenner faced lots of opposition from inoculators, who refused to change their methods of |( | |

|preventing smallpox. | | |

|Jenner set up his own vaccination clinic and distributed the smallpox vaccine for free. |( | |

|Smallpox deaths fell even more rapidly after 1872 when the compulsory vaccination was enforced. | |( |

|By 1980, smallpox had been wiped out worldwide. | |( |

c Jenner’s discovery of the smallpox vaccine had little impact in the short term because he was unable to explain why it worked without knowledge of germs. As a result, there was opposition and inoculation was still used. However, once the government made the smallpox vaccine compulsory in 1852 and enforced its use as a prevention from 1872, the death rate fell dramatically.

56 In this answer, you are looking for a clear focus on the explanation of ‘why’ throughout the answer.

• You may wish to use bullet points and argue that opposition came from the Royal Society because Jenner could not explain why the smallpox vaccine worked before Pasteur’s ‘germ theory’. Additionally, many doctors made a lot of money from inoculation and so opposed the new method of vaccination.

• Stronger candidates will use knowledge in addition to bullet points, for example that opposition also came from the Church, as it did not think that it was acceptable to use a disease from a cow to prevent disease in a human.

• No introduction or judgement is needed when answering this question.

Fighting cholera in London, 1854

57 a Cholera first arrived in Britain in 1831. It spread rapidly in the slums, and so mainly affected poor people. Victims of cholera suffered from diarrhoea, sickness and dehydration before dying. Doctors found it impossible to treat because they did not know its cause.

John Snow was a surgeon who lived in Soho. Snow investigated the cholera epidemic of 1854. Snow created a spot map to show where the deaths had occurred around Broad Street. He was able to connect the deaths to the water pump in Broad Street. He removed the handle from the water pump so that people could no longer use it.

There were no more deaths from cholera. It was then noticed that the well providing water to the pump was close to a cesspit with a cracked lining. Waste from the cesspit was leaking into the well and spreading cholera.

b Cholera was fatal. Sufferers would die between two and six days after falling sick. The disease spread quickly and killed thousands.

c Observation, spot map, pattern noticed, removed handle to prove hypothesis.

d There were no deaths.

e Deaths were linked to a water pump on Broad Street. When the handle of the pump was removed and people could not access this water, the deaths stopped. There were no deaths among people who did not use the Broad Street pump, including at the workhouse and brewery. Upon investigation, Snow found that the waste from a cesspit was leaking into the water supply.

f There was no immediate action, but the government did agree to invest in a sewer system from 1860.

g The ‘Great Stink’ was a bad smell from the River Thames in the summer of 1858.

h The government funded the building of London’s sewer system by Bazalgette from 1860.

i

|Individuals |Science and technology |Attitudes and beliefs |

|The commitment and scientific |Scientific enquiry into the deaths on |The development of scientific thinking |

|thinking of Dr John Snow. He |Broad Street from cholera (spot map, |during the nineteenth century led to much|

|observed the high number of |investigation, removal of the water pump|questioning of medical ideas. |

|deaths and then carried out his |handle, location of the cesspit). | |

|famous investigation. | | |

58 In this answer, you are looking for a balanced answer that both agrees and disagrees with the statement before reaching a sustained judgement.

Arguments that agree with the statement could include the following:

• Dr John Snow discovered that dirty water caused cholera and he eventually encouraged the British government to take responsibility for providing its citizens with clean water. Sewers were built in London from 1860.

Arguments that disagree with the statement could include the following:

• John Snow’s discovery was limited because he was unable to explain the spread of cholera without knowledge of germs and so the British government did not take immediate action.

• Louis Pasteur’s discovery of germs was more of a turning point because it explained the spread of disease and illness, leading to an increase in government action, especially with the introduction of the 1875 Public Health Act. The ‘germ theory’ also led to the identification of microbes, such as tuberculosis by Robert Koch. The identification of microbes enabled vaccines to be developed in order to prevent illnesses such as anthrax and rabies.

A sustained judgement might include the following:

• John Snow’s discovery was important in identifying the cause of cholera, but the turning point only came once Louis Pasteur had discovered germs. The ‘germ theory’ led to disease and illness being accurately understood and explained, which forced the government to take responsibility and intervene to prevent its spread.

c.1900–present: medicine in modern Britain

Ideas about the causes of disease and illness

59

|Key term/Date |Definition/Event |

|Hereditary disease |Disease caused by genetic factors |

|ECG |Electrocardiogram, used to track heart activity |

|DNA |Carries genetic information from one living thing to another |

|Endoscope |A camera on the end of a thin, flexible tube, used to see inside the |

| |human body |

|MRI scan |Magnets and radio waves used to create an internal image of the body |

|1953 |The year in which DNA was discovered |

|CT scan |A more advanced form of X-ray, used to diagnose tumours and other growths|

|Ultrasound scan |The use of sound waves to diagnose gall stones and kidney stones |

60

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61

|Technology |Illness/Disease |

|Blood sugar monitor |Diabetes |

|X-ray |Broken bones |

|MRI scan |Ligament damage |

|CT scan |Tumours |

|Ultrasound scan |Kidney stones |

|ECG (electrocardiogram) |Heart defects |

|Endoscope |Digestive concerns |

|Blood pressure monitor |High and low blood pressure |

62

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63 In this answer, you are looking for a balanced answer that both agrees and disagrees with the statement before reaching a sustained judgement.

Arguments that agree with the statement could include:

• The discovery of DNA by Crick and Watson and the Human Genome Project led to greater understanding of genetic illnesses, such as cystic fibrosis.

Arguments that disagree with the statement could include:

• The twentieth century also saw a change in the understanding of disease and illness as related to lifestyle factors, for example stress, smoking and a poor diet.

A sustained judgement might include the following:

• The discovery of DNA was important in understanding genetic illness. However, the most common killer diseases in the late twentieth century, such as lung cancer, are caused by lifestyle choices.

Approaches to prevention and treatment: NHS, science and technology

64

|Event |Chronological order |Do I know the |

| |(1–9) |year? |

|The NHS is introduced |7 |1948 |

|First magic bullet: Salvarsan 606 |1 |1909 |

|Second magic bullet: Prontosil |4 |1932 |

|Clean Air Acts |8 |1956 and 1958 |

|Penicillin is discovered |3 |1928 |

|Penicillin is mass-produced |6 |1942 |

|Smoking is banned in enclosed workspaces |9 |2007 |

|Diphtheria vaccination |5 |1942 |

|National Insurance Act |2 |1911 |

65 A magic bullet is a chemical cure for a disease.

66 The 1911 National Insurance Act provided medical care to workers following government, employer and employee financial contributions.

67 The NHS provided free medical care for all.

68 Not much changed due to a lack of money. Hospitals desperately needed updating.

69 Your answer could include the following:

• Microsurgery

• Laparoscopic (keyhole) surgery

• Robotic surgery

70 Medical treatment has improved greatly since 1900. For example, X-rays are used to target and shrink tumours (radiotherapy), chemotherapy can treat cancer, dialysis is used to ‘wash’ patients’ blood to help combat kidney failure, heart bypasses are widely available, better prosthetic limbs are now produced.

71 a Your answer could include the following:

o Compulsory vaccinations

o Laws to provide a healthy environment

o Communicating health risks

b Examples could include any of the following:

o Diphtheria

o Polio

o Whooping cough

o Tetanus

o Measles

o Rubella

o HPV

c Your answer could include the following:

o Clean Air Acts (1956 and 1968)

o Smoking legislation, such as banning smoking in all workplaces (2007) and banning smoking in cars (2015).

72 In this answer, you are looking for:

• a focus on similarity

• support from both time periods, for example in both the nineteenth and twentieth centuries vaccines were used to prevent disease and illness. In the nineteenth century the government made the smallpox vaccine compulsory and during the twentieth century more vaccines were used, including the HPV vaccine.

73 In this answer, you are looking for:

• a focus on difference

• support from both time periods, for example during the seventeenth century it was believed that disease and illness could be transferred from a person to an object and so people would place an onion next to a wart. However, by the twentieth century bacteria were understood and magic bullets, including Salvarsan 606 and Prontosil, were developed in order to treat disease and illness.

Key individuals: Fleming, Florey and Chain’s development of penicillin

74 a/b

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c An antibiotic is a drug that destroys or slows down the growth of bacteria.

d Amoxicillin, Doxycycline, Cephalexin, Ciprofloxacin, Clindamycin, Metronidazole, Azithromycin, Tetracycline

e Fleming. He found the bacteria mould growing in his laboratory.

f Florey and Chain. They made enough penicillin to carry out experiments on mice and a human.

g Fleming was unable to develop penicillin further due to a lack of funding.

75 A possible answer could conclude:

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For example:

• Individuals: the genius of Fleming in recognising that the penicillin mould had killed the staphylococcus bacteria it had landed on. The determination of Florey and Chain to carry out tests on mice and humans when making enough penicillin to do this was a challenge.

• Government: the funding of the mass-production of penicillin during the Second World War so that there was enough to treat the casualties on D-Day.

• Science and technology: the building of a homemade penicillin factory out of milk bottles and saucepans to enable Florey and Chain to perform the experiments on mice and a human.

• Attitudes in society: the scientific approach to the development of penicillin by Florey and Chain.

76 In this answer, you are looking for a clear focus on the explanation of ‘why’ throughout the answer.

• You may wish to use bullet points and argue that penicillin was mass-produced after Florey and Chain developed its production so that they had enough to test the drug on mice, and then a human, to prove it successfully treated bacterial infections. You may also argue that the mass-production of penicillin was funded during the Second World War because both the US and British governments needed it for mass use. This led to its use on D-Day to treat thousands of injured soldiers.

• Stronger candidates will use knowledge in addition to bullet points, for example the initial discovery of penicillin by Fleming, who recorded his findings for Florey and Chain to develop later.

• No introduction or judgement is needed when answering this question.

The fight against lung cancer in the twenty-first century

77 a

|Statement |True/False? |Corrected statement |

|Lung cancer is the most common cancer in the UK. |False |Lung cancer is the second most common cancer in |

| | |the UK. |

|Approximately 85% of lung cancer cases are people |True | |

|who smoke, or have smoked. | | |

|British people are screened annually for signs of |False |Regular screening does not take place. |

|lung cancer. | | |

|Medical professionals use a CT scan to determine |True | |

|whether or not cancer is present in the lungs. | | |

|If lung cancer is detected and is not advanced, |True | |

|radioactive material is injected into the | | |

|patient’s body. | | |

|Radiotherapy is used as a treatment for lung |True | |

|cancer. | | |

|It is possible to use genetics to treat lung |False |It is not yet possible to use genetics to treat |

|cancer. | |lung cancer. |

|In 2007, the UK government raised the legal age |False |In 2007, the UK government raised the legal age |

|for buying tobacco from 14 to 16. | |for buying tobacco from 16 to 18. |

|The government has increased tobacco taxes in |True | |

|order to encourage people to stop smoking. | | |

|All cigarette products are clearly on display in |False |Cigarette products are no longer on display in |

|shops. | |shops. |

b

| |Advances |

|Diagnosis |CT scan, PET-CT scan, bronchoscopy |

|Prevention |The government has passed laws to change people’s behaviour, including banning smoking in |

| |all workplaces (2007), banning smoking in cars (2015), raising the legal age of buying |

| |tobacco to 18 (2007) and increasing taxation on tobacco products. |

|Medical treatment |Lung transplants, radiotherapy, chemotherapy |

c

|Science and technology |Government |

|The use of technology in the diagnosis and treatment of lung|Government intervention in the form of legislation to |

|cancer, including CT-scans, bronchoscopy, radiotherapy and |change behaviour and prevent lung cancer, including |

|chemotherapy. |banning smoking in all workplaces (2007), banning smoking |

| |in cars (2015), raising the legal age of buying tobacco to|

| |18 (2007) and increasing taxation on tobacco products. |

78 In this answer, you are looking for a balanced answer that both agrees and disagrees with the statement before reaching a sustained judgement.

Arguments that agree with the statement could include:

• The NHS led to a change in the accessibility of medical care and treatment in the UK, as medical care was available to all free of charge. This included hospital treatment, surgery, and GP and dentist visits.

Arguments that disagree with the statement could include:

• Even though medical care and treatment was accessible to all, the government did not have a lot of money to spend on medical care and so hospitals still needed updating after 1948 and more hospitals needed to be built across the country. A study in the 1950s argued that up to a quarter of GPs were not satisfactory.

• The development of magic bullets, such as Salvarsan 606, were more important in the treatment of disease. They enabled a disease to be targeted and cured.

• The development of radiotherapy and chemotherapy led to the treatment of lung cancer, the second most common cancer in the UK, in the latter half of the twentieth century.

A sustained judgement might include the following:

• The NHS was a turning point in medical treatment because it enabled all people — both rich and poor — to have access to hospitals and GPs. Scientific developments, such as magic bullets, radiotherapy and chemotherapy, enabled the treatment, but it was the NHS that made these treatments available to all.

The British sector of the Western Front, 1914–18

The theatre of war in Flanders and northern France

Problems in providing medical treatment

1 a Front-line trench:

• Where attacks were made from

• Soldiers left the front-line trench via the fire step

b Support trench:

• About 80 m behind the front line

• Troops would retreat here if the front-line trench was under attack from the enemy

c Reserve trench

• At least 100 m behind the support trench

• Reserve troops were mobilised here for a counter-attack if the enemy was advancing

d Communications trench:

• Ran between other trenches

• Allowed communication to take place between soldiers in different parts of the trenches

e Dugout

• Holes dug into the side of the trenches, providing protective cover

• Sometimes used as a regimental aid post (RAP)

f No man’s land

• The area between the two opposing lines of trenches

• Barbed wire was placed here

2

|Nature of terrain |Battles |

| |Ypres |Somme |Cambrai |Arras |

|Mud, sometimes knee-deep |( |( |( | |

|Low-lying ground, waterlogged |( | | | |

|Mass casualties | |( | | |

|Tunnels | | | |( |

|Chalky ground | | | |( |

|Existing tunnels and quarries (before the First World War) | | | |( |

3 In this answer, you are looking for two features, with a supporting sentence.

Features could include:

• Enormous casualties. On the first day, British casualties numbered over 57,000, while total deaths were around 20,000 men.

• New strategies. Tanks were used for the first time, but were not very successful.

4 a In this answer, you should focus on how the sources are useful by considering their content and provenance, and support with additional historical knowledge.

• Source A is useful for showing the problems that large amounts of mud caused for stretcher-bearers as they collected casualties from no man’s land during the Third Battle of Ypres. There were approximately 250,000 British casualties during this battle. The source is useful because an official army photographer, who experienced the battle and witnessed these conditions, took the photo. Therefore, this photograph is a snapshot in time. However, we do not know whether or not mud also prevented the stretcher-bearers from working effectively after other battles, for example at the Somme or Arras.

• Source B is useful because it tells of the mass casualties stranded in no man’s land and the trenches who waited for the stretcher-bearers to come to their aid after battles. Sometimes these casualties were waiting ‘a day and half’ to be collected for care and treatment. Stretcher-bearers were often exposed to shellfire and gunfire while collecting the wounded, which would have slowed them down. The source is useful because it is a contemporary account written by a Royal Engineer who experienced these conditions. However, we do not know if these conditions were typical of all trenches along the Western Front throughout the war.

b

i Detail in Source B that I would follow up: ‘Some had been waiting a day and a half to be brought in’.

ii Question I would ask: How long after a battle were injured soldiers being transported from the battlefield?

iii What type of source I could use: Admission records from a dressing station at the Somme, 1916.

iv How this might help answer my question: Admission records would tell me the dates and times that casualties were admitted, and I could then match this information against the dates and times of the battles.

Conditions requiring medical treatment on the Western Front: shrapnel and infection

5

|Medical problem |Symptoms |

|Trench foot |Painful swelling of the feet |

|Trench fever |Similar to flu, with headache and aching muscles |

|Shell shock |Mental breakdown |

|Dysentery |An infection causing diarrhoea |

|Frostbite |Freezing of the skin and underlying tissues |

|Gangrene |Death of body tissue, caused by lack of blood supply to that part of|

| |the body |

|Gas gangrene |An infection that produces gas in wounds |

6

|Medical problem |British Army solution |

|Trench fever |Delousing stations set up to remove contact with lice |

|Trench foot |Rubbing feet with whale oil, keeping feet dry, regularly changing socks, amputation used as a|

| |last resort |

|Shell shock |Not understood at the time — men suffering with shell shock were sent back to Britain for |

| |treatment |

7 Soldiers typically suffered bullet, shell and shrapnel wounds.

8 The British Army reduced the risk of tetanus on the Western Front through anti-tetanus injections.

9 The British Army reduced the number of head wounds by the end of 1915 by introducing the Brodie helmet.

10 a Gases used in gas attacks on the Western Front were chlorine, mustard and phosgene.

b Gas affected the soldiers on the Western Front by causing death by suffocation, internal and external blisters, and burning of the skin.

c The British Army prepared British troops on the Western Front for gas attacks by issuing them with gas masks from July 1915.

11 a In this answer, you should focus on how the sources are useful by considering their content and provenance, and support with additional historical knowledge.

• Source C is useful for telling a historian about the ‘coughing and choking’ that chlorine gas caused. The Germans first used chlorine gas in 1915 and it could lead to death by suffocation. The source tells that the British Army carried out different experiments to find a treatment for this new battlefield weapon, including using different masks and ammonia to enable a soldier to breathe more clearly. Source C also tells us that these experiments were carried out not only to treat injuries from gas, but also to find a way of safely reaching the injured soldiers in order to help them. The source is useful because a Queen Alexandra nurse wrote the account, and she was on hand to witness the effects of the gas and the experiments carried out during the months in which the Germans first deployed gas on the battlefield.

• Source D is useful because it tells us about the mental and emotional effects of the Western Front in the form of shell shock — ‘men shaking with ague, mouthing like madman, figures of dreadful terror, speechless and uncontrollable’. It has been estimated that about 80,000 British troops experienced shell shock. The source is useful because it is a contemporary account written by a journalist who experienced the conditions on the Western Front and saw the effects that the war, and shell shock, had on soldiers.

b

i Detail in Source D that I would follow up: ‘The shell-shock cases were the worst to see and the worst to cure’.

ii Question I would ask: How was shell shock treated during the First World War?

iii What type of source I could use: A medical journal article that focuses on the effects and treatment of shell shock.

iv How this might help answer my question: A medical journal would detail the treatments used for this new mental and emotional illness suffered by soldiers during the First World War.

The work of the RAMC: transport and treatment areas

12

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13

|Statement |True/False? |Corrected statement |

|Wounded men would travel in an ambulance |False |Wounded men were taken by stretcher-bearers to the RAP. |

|wagon to the RAP. | | |

|After 1915, nurses could be found at the |True | |

|dressing stations. | | |

|A unit of the Royal Army Medical Corps (RAMC)|True | |

|was known as the Field Ambulance. | | |

|Dressing stations were able to accommodate |False |Dressing stations only had facilities to accommodate wounded|

|wounded soldiers for over a week. | |soldiers for less than a week. |

|Wounded soldiers were transported to a |True | |

|casualty clearing station (CCS) by ambulance | | |

|wagon. | | |

|A system of triage was used at the CCSs. |True | |

|There were 20 CCSs on the Ypres Salient. |False |There were 24 CCSs on the Ypres Salient. |

|An underground hospital was built at Cambrai.|False |An underground hospital was built at Arras. |

14 a In this answer, you should focus on how the sources are useful by considering their content and provenance, and support with additional historical knowledge.

• Source E is useful for showing the location of a dressing station on the Western Front. It shows an old building being used. Dugouts and bunkers were also used as dressing station locations. The source is useful because it is a photograph taken on the Western Front during the First World War, meaning that you can see exactly what the conditions were like. However, it only shows us the conditions of one dressing station and further research would be needed to see how typical these conditions were of all dressing stations.

• Source F is useful because it tells us about the first aid work carried out at a regimental aid post (RAP), including the dressing of wounds and provision of pain relief. The RAP was often located within 200 m of the front line because its role was to give immediate first aid and get as many men as possible back to the battlefield. The source is useful because it is an account from a member of the RAMC who experienced the conditions in a RAP on the Western Front and saw the effects that the war had on soldiers. However, we do not know if these conditions were typical of all RAPs in all battle locations throughout the war.

b

i Detail in Source F that I would follow up: ‘But it was all first aid work’.

ii Question I would ask: What first aid supplies were available in the dugouts on the front line?

iii What type of source I could use: RAP records from a dugout on the front line at the Somme.

iv How this might help answer my question: Records would provide details of what supplies were used and delivered to a RAP on the front line.

FANY’s voluntary work in Belgium and France

15 a FANY stands for First Aid Nursing Yeomanry.

b The FANY arrived in France on 27 October 1914.

c In 1914, the British Army only allowed the Queen Alexandra nurses to care for the wounded in the British sector of the Western Front. Volunteer nurses were turned away, and instead found work with the French and Belgian armies. As the number of casualties increased, this attitude changed and thousands of volunteer nurses began helping the British Army. In January 1916, FANYs were allowed to drive ambulances, replacing male British Red Cross drivers. There were never more than 450 FANYs in France, but they did encourage other women to join organisations such as the Voluntary Aid Detachments (VADs) and contribute to helping soldiers on the front line.

d

|Type of work |Yes |No |

|Provided baths to the soldiers |( | |

|Set up cinemas for the soldiers |( | |

|Cooked meals | |( |

|Collected the wounded from no man’s land | |( |

|Drove food and supplies to the front line |( | |

|Cleaned the dugouts | |( |

|Washed clothes |( | |

|Supported surgeons in the operating theatres | |( |

e

|Sources |How? |

|National army records for individual soldiers |Would include the individual experiences of a soldier in battle and |

| |the nursing care they received at a variety of places along the |

| |evacuation route. |

|National newspaper reports |Would include details of the work carried out by the FANY and maybe |

| |an advertisement for recruitment. |

|Government reports on the war |A government report on the evacuation route might detail the work of |

| |the FANY. |

|Medical articles from doctors and nurses who took|Medical articles might provide details of the role of FANY nurses and|

|part in the war |the care they administered. |

|Personal accounts from soldiers, doctors, nurses |The diary of a FANY nurse might describe the work she carried out on |

|or others who were involved |the Western Front. A soldier’s diary might describe the care he |

| |received from a FANY nurse. A doctor’s diary might describe the |

| |support he received. |

|Photographs |Images of the FANY could illustrate their work and uniforms. |

|Hospital records |Hospital records would detail personal details of FANY nurses and the|

| |care they gave to specific patients. |

|Army statistics |These could include, for example, statistics of soldiers who returned|

| |to the front line after FANY nurses cared for them in a dressing |

| |station. |

The significance of the Western Front for experiments in surgery and medicine

16

|Medical development |Usage |

|Carrel-Dakin method |A system of tubes that maintained the flow of a chemical solution through a|

| |wound in order to fight infection and stop the spread of gas gangrene |

|Debridement |Cutting away of dead, damaged and infected skin tissue |

|Thomas Splint System |Used to help fractured bones heal and prevent blood loss |

|Sodium citrate |Used to prevent blood from clotting |

|Citrate glucose solution |Used to defrost blood after frozen storage |

|Blood bank |The storage of blood for blood transfusions |

|Skin graft |Taking skin from one part of the body and using it to cover a wound |

17 You could include the following:

• High numbers of casualties

• Urgent need for improvements in medical care

• Government support

18 The problems surgeons faced on the Western Front included infection. There were no sterile conditions (aseptic surgery) present in hospitals before the war.

19 The Thomas Splint reduced the death rate of soldiers dying from a broken thighbone from 80% to 20%.

20 Mobile X-ray units were used to identify and locate shell fragments and bullets embedded within a patient’s body.

21 Soldiers were treated with a mobile x-ray machine in casualty clearing stations.

22 The first blood bank was used during the Battle of Cambrai.

23

|Source |How? |

|National army records for individual |Would include individual accounts of the treatment soldiers experienced on |

|soldiers |the front line. |

|National newspaper reports |Might include newspaper reports on the advances in medical treatment during|

| |the First World War. |

|Government reports on the war |Government reports would include medical advances, for example the use of |

| |the Thomas Splint or the introduction of the mobile X-ray unit. |

|Medical articles from doctors and |Articles were written that describe the medical advances during the First |

|nurses who took part in the war |World War, such as the use of sodium citrate in blood banks. |

|Personal accounts from soldiers, |Personal accounts could include those from soldiers who benefited from the |

|doctors, nurses or others who were |medical advances. |

|involved |Personal accounts from doctors and/or nurses would describe use of new |

| |treatments and methods, for example plastic surgery. |

|Photographs |Photographs of doctors and nurses using new equipment, such as mobile X-ray|

| |units, would provide important visual information. |

|Hospital records |Hospital records would provide information about where new equipment was |

| |located, for example we’d know how many mobile X-ray units were available |

| |and where these were used following key battles. |

|Army statistics |Statistics could tell us the number of soldiers who received certain |

| |treatments, such as the Thomas Splint. |

24 a In this answer, you should focus on how the sources are useful by considering their content and provenance, and support with additional historical knowledge.

• Source G is useful for illustrating the Thomas Splint, which was first used on the Western Front. The Thomas Splint was used to improve the survival rate of men suffering from a gunshot or shrapnel wound to the leg from 1916. It increased the survival rate from injuries of this type from 20% to 80%. The source is useful because it is a diagram that shows exactly how the device was used to fix the injured leg in order to prevent movement and further injury.

• Source H is useful because it tells us about portable blood transfusions used on the Western Front after 1915. It describes the use of sodium citrate to transfuse the blood successfully and reduce the number of soldiers who would have died from ‘shock and loss of blood’. The use of stored blood was successfully demonstrated in 1917 at the Battle of Cambrai. The source is useful because it is an account from Keynes, who carried out experiments that led to a portable blood transfusion kit for use on the Western Front. However, this source tells us of Keynes’ successful experiments and doesn’t tell us how typical the unit’s use was throughout the Western Front after 1915.

b

i Detail in Source H that I would follow up: ‘It saved countless lives of men who would otherwise have died from shock and loss of blood’.

ii Question I would ask: How many men were given a blood transfusion following the Battle of the Somme?

iii What type of source I could use: Casualty clearing station records from the Somme.

iv How this might help answer my question: All blood transfusions would be recorded following the Battle of the Somme.

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