Goes Back in Time Operation Ouch!

Today's Operation Ouch! is different.

-We're going back in time.

-Chris, we may be doctors...

TARDIS THRUMS ..but we're not THAT doctor.

Xand, don't be ridiculous.

We're ditching the lab and heading into the trenches.

As it's the centenary of World War I,

we're heading back 100 years

to show you what medicine was like during that time

and that's what these guys are here for.

We're about to show you a moment in history where

they really put the ouch into every operation.

Get ready cos this is going to be great.

Coming up on this special Operation Ouch!...

creepy-crawlies are on the loose.

Nearly all soldiers would have had lice all over their bodies.

We look at the fight against disease.

-BOTH:

-Let battle commence.

And find out what big bangs...

EXPLOSION

..did to soldiers' hearing.

This is a replica of a World War I trench.

We're here today to show you what the conditions were like

and what medical problems soldiers faced in the trenches.

Soldiers used to dig these to protect themselves

from attacking armies.

The trenches were the front line and this is real footage filmed

during the war.

The trenches were where most of the battles were fought from.

They were often wet and miserable, a bit like our rainy trench today.

Soldiers would live, sleep and hide away in here.

They would dig and dig making them longer and longer

so they could get closer and closer to the enemy.

But which countries were involved

-and where did they keep their armies?

-Up their sleevies.

'Er, thanks, Xand.'

World War I was a four-year battle that started in 1914

and involved some of the most powerful countries in the world,

the Allied forces in blue versus the Central Powers in red.

Nearly a million soldiers who fought for the British Empire died

and nearly two million men returned home injured.

It was a terrible war but it also led to doctors and scientists

making some incredible medical breakthroughs.

They even invented gadgets to help protect the human body.

And what's utterly brilliant is we still have these around today.

So we're going to look at some of these ingenious inventions

and show you how World War I affected the human body.

Now if you were a soldier on the front lines,

you were lucky to make it back to the safety of a trench like this alive.

Even a small cut could put you at risk of dying of infection

and if you got seriously wounded out there,

you relied on your mates to take you all the way back to here.

This is a Regimental Aid Post.

Now in this tiny space there would have been a medical officer

and an orderly to help.

They could be dealing with up to 300 casualties in any one day.

It looks pretty basic, Chris. Where are the machines that go beep?

Well, there aren't any machines that go beep.

A Regimental Aid Post was really only intended for the

immediate treatment of wounds and first aid.

There were more sophisticated hospitals, but they could be up

to 20 miles away and a lot of people died before they even got there.

Ow, ow, ow!

'Looks like we've got some work to do, Xand.

'Let's give this casualty some World War I-style treatment.

-'Ready?

-Er, I'll give it a go.'

Argh!

Right, Xand, it looks like this guy has a very badly broken leg.

What are you going to do?

Right, OK, first of all I need to wash my hands.

-Where's the sink?

-Well, you might have a field basin,

but basically it is very hard to wash your hands in a trench.

There's no running water.

OK, never mind. What he really needs is a general anaesthetic.

I'm going to need to knock him out.

-HE GROANS

-Xand! What are you going to do?

I was just going to knock him out with this piece of wood.

I guess I didn't think they'd have anything better.

Well, actually you're wrong.

In fact they do have a good painkiller in this medical kit

called morphine. We still use it today and it's very effective.

OK, so let's suppose I give him some morphine,

he's feeling more comfortable.

There's not a lot else I can do for him.

-I wonder if he'd like a cup of tea.

-Probably.

In fact, during the First World War,

people did use tea as treatment for shock.

It was sweet, it was liquid and it was familiar.

It was very reassuring.

-Xand!

-Oh!

OK. Sorry, Chris.

Right, so the most important thing now is to get him to hospital,

so what I'm going to give him is a casualty card.

What this says is who he is, what's wrong with him

and what we've done for him.

There you go, soldier. That's your ticket out of here.

And that's where we get that expression from.

Now our patient's off to hospital on this light railway.

Just like the ones specially built during the war.

At the start of World War I,

eight out of ten soldiers who broke their leg died of their injury,

but by the end of the war it had dropped to just one in ten,

thanks to this guy.

His name was Hugh Owen Thomas

and in 1916 he invented the Thomas splint,

which stopped soldiers dying of broken legs.

To show us how it works is Richard Townsley.

He's an expert in World War I medicine.

And his great-grandad Major William Stewart Dickie,

was a surgeon who served in the war for real.

So, Richard, how would you have treated someone

during the First World War with a very badly broken leg?

Basically you'd use a Thomas splint.

The way this works is by reknitting the bones together

and using something called traction.

If you break your leg very badly,

the muscles around it pull the leg shorter and the bones overlap.

Traction works by pulling the muscles back to allow the

bones to be realigned.

Stabilising broken bones like this saved lives during the war

because it meant blood loss could be controlled

and there was a better chance of keeping infection out.

It looks very uncomfortable to use. Is that right?

-Yes, it's incredibly uncomfortable.

-Maybe Xand should have a go.

-Yeah, I think so.

-Brilliant. Brilliant.

All right, then.

-If you hold it straight.

-OK.

-OK.

-We need to...

Up through there.

It's very difficult doing this kind of thing if we imagine him in the

trenches covered in mud like this and presumably you'd be working with

people shooting at us and shells landing around at the same time?

Yep.

You're starting to see how difficult medicine would be in the trenches.

You can see why you don't even bother to wash your hands

beforehand. The mud gets into everything.

So basically, as Richard's tightening there, this frame

is now pushing in your groin and the bones that are broken here will be

being separated and then they can grow back together normally.

What's amazing is to see this being used

in a replica of a World War I trench

and to think I've used one of these in a modern emergency department.

It's exactly the same thing.

So how do you feel, Xand? It is comfortable?

It's not very comfortable for me and it would be very painful

if I really had a broken leg, but my leg is very well supported.

It would also mean I'm much more likely to survive.

All right, Richard, I think he's done,

-time to get him to the surgical hospital.

-Let's do it.

This brilliant First World War invention is still used today

and has been saving lives for over 100 years.

And the best thing is it's stabilising Xand's leg

while he gets to the surgical hospital.

Chris? My leg's not actually broken.

Chris!

It's incredible to think that not only did ten million

World War I soldiers die in combat

but two million also died from disease.

And one of those diseases that soldiers were desperate to avoid

was trench foot.

Trench foot was caused by soldiers' feet being continually soaked

in cold, wet, muddy trenches for days

with no way of drying them properly.

Now get ready for a gross picture, because when trench foot took hold

it looked like this.

Urgh.

To show you how this disease starts,

I've had my foot sitting in cold water for two hours.

Disgusting. There you go, Xand, take that.

That's all white and cold and wet and wrinkly. Urgh.

This is because when you get cold your brain makes a judgment call

on which parts of your body need heat the most,

so the warm blood rushes inwards

to help the organs that your body can't really do without

keep the right temperature.

But that can be bad news for hands and feet,

especially for long periods of time.

The soldiers' feet would start to die because of low blood flow

and dead flesh is perfect food for bugs.

And take a look at what happens once the bugs take hold.

Gross. Trench foot smelt absolutely terrible

and it was extremely painful and eventually,

if left untreated, the gruesome foot would need to be amputated.

To understand how an infection like this could take hold so easily,

we're going to show you a war that was taking place

at a microscopic level, on the soldiers' skin.

This was the battle of soldier...

..versus bug.

-Dr Xand.

-Dr Chris.

-BOTH:

-Let battle commence.

Our war map represents the soldiers' skin in super close-up.

Every day their skin had to battle against invading armies of germs

and bacteria.

These layers of skin represent the trenches

where all your skin cells lie waiting for battle.

And these are macrophages.

They're big, hungry cells that live at the top layer of your skin and

their job is to march forward and eat anything that tries to get past,

like a skilled army of soldiers going into battle.

So with my skin cells lying in wait and my hungry macrophages

ready for battle, I have a strong army here, Xand.

Well, Chris, we'll see about that.

Your macrophages might be doing everything they can

to stop these guys, my bacteria, trying to get into your body

and cause harm, but soldiers were constantly wet.

They ate bad food and they were tired and stressed

meaning that your immune system wouldn't be working properly.

And because of that, Chris, I'm going to take away some of your soldiers.

-Take that.

-No!

-And that.

No!

Ha.

Because of my poor immune system and damaged skin,

I am unable to repel Xand's bacterial forces.

So my bacteria are advancing into the skin, swarming across the lines

and Dr Chris succumbs to an overwhelming infection.

I win.

And this is what happened to many soldiers in the war.

Living in terrible conditions meant their immune systems weren't

strong enough and so their skin cells and macrophages couldn't cope

when invading bacteria tried to get in

and that's why they succumbed to nasty diseases.

But bacteria weren't the only kind of bugs World War I soldiers

had to worry about.

Everyone's itching and so are we.

This must be a case for Investigation Ouch!.

If you were a soldier in the First World War,

the chances are you'd be spending months on end in the trenches

and your skin would be itchy and sore.

This medical problem was caused by a nasty critter infesting

the trenches.

Body lice.

Now body lice are very uncommon now but they actually look just like

these head lice because they're from the same family.

But much deadlier.

The head lice people get today are completely harmless,

they just itch a bit,

but body lice in the trenches carried serious disease

and they were a real problem.

The cramped trenches were hot, sweaty and damp.

The perfect breeding conditions for lice.

Nearly all soldiers in the trenches would have had lice

all over their bodies.

This is Vince Smith,

an entomologist who knows all about lice.

So, Vince, what diseases did the body lice spread?

During World War I the main disease was trench fever

and this was a really virulent disease.

Something like one in five of the soldiers

during World War I were infected by trench fever.

Trench fever caused flu-like symptoms

and eventually it led to heart failure.

And there's a simple reason why the disease infected so many soldiers.

They were all huddled up close

and so the lice would literally just creep between the soldiers.

So, Vince, the head lice that you've got here

feed in exactly the same way as body lice, is that right?

Absolutely. In fact if we put one on you now we can see it feed.

-Well, brilliant.

-Do you want to try it?

Here we go.

OK, there he is there. What's he doing now?

He's trying to dig into the skin

to try and find a little blood vessel

and when he hits one, he'll start sucking up the blood.

Here are some lice in super close-up.

You can see the blood this one's drunk moving inside its body.

That's what's going on with my arm right now.

Now if I was a soldier in World War I,

I'd be at high risk of getting trench fever.

Soldiers knew lice were bad news and they did what they could to stay

lice free, including picking them off their clothes like this guy.

They called lice "chats" and removing them was called "chatting".

Whilst these critters were spreading disease,

some other creepy-crawlies were helping to fight it.

They were maggots.

A surgeon called William Baer

discovered the power of maggots one day

when he examined a soldier with a wound.

Thousands of maggots had filled the area,

but when Baer picked them off,

instead of finding infected dead tissue

he was surprised to see the wound had healed.

It's a maggoty miracle.

And we still use sterilised maggots to treat wounds today,

as we're going to show you with this 21st-century foot.

But prepare to look away if you're squeamish.

You may have seen this foot before on Ouch!, and underneath the bandage

500 maggots have been on the wound for two days doing their magic.

OK, squeamish people, look away now.

It might look horrible but the wound is healing thanks to the maggots.

They're eating all the infected dead flesh

but they don't touch the nice new flesh that's growing.

So it's a win-win,

maggots love eating dead flesh that would otherwise be food for bacteria

which would cause infections.

They're perfect wound-cleaning machines.

And although we now have antibiotics to treat wound infections,

maggots are still a really important alternative to surgery

for removing dead flesh.

Well done, you squirmy yet beautiful little beasts.

HE KISSES

Still to come,

Paralympian Sophie Kamlish tries out a World War I innovation.

And find out how explosions damaged soldiers' ears.

But first...

..how many doctors and nurses left the UK

to help soldiers on the front line during World War I?

Was it A. 1,800,

enough to fill one modern hospital?

B. 18,000,

enough to fill 12 hospitals?

Or C. 118,000,

enough to fill 78 hospitals?

In fact the answer is C.

By 1918 around 118,000 medical staff

had joined the Royal Army Medical Corps

and they helped save thousands of wounded soldiers.

But that meant that there weren't many doctors or nurses left

to treat sick people back home.

During the First World War, with most of the doctors sent to battle,

there were very few medical people at home to treat civilians like you.

And doctors then could have as many as 3,000 patients.

It would be really difficult to get to see one.

You might remember Charley from Liverpool.

He came in to accident and emergency with a broken elbow.

Now we're going to show you just how different his treatment

would have been 100 years ago compared to today.

In hospital Charley's being examined by Doctor Sarah.

-Has he had all his immunisations?

-Ooh.

-Sore there?

Now a child suffering from Charley's break at home

would have been treated by his mum.

Right, his dad's been sent away to war so he's not around

and his mum probably would have had to use things

like rolled-up newspapers as splints. I mean, it would have been very bad.

Yeah. And because there was no National Health Service

most people couldn't afford to

or didn't want to pay for their own treatment.

Luckily Charley, like everyone else in the UK,

is able to get free treatment on the NHS.

I was a bit worried you might have broken

the bottom of the humerus which is this long bone here.

And it starts with an X-ray to find out exactly what's broken.

But 100 years ago you'd have had to pay for an X-ray

and you probably wouldn't have been able to afford it.

Even if you could, it was done on film

and so it would take much longer to get results.

Luckily it's taken no time at all for Charley to get his X-ray results

back and they show he's got a bad break that needs surgery.

So, it's off to theatre for a hi-tech operation

to get his broken bones realigned with wires.

Now operating theatres back then would have

been in the roof to get in enough light through a skylight,

because the artificial lights were so dim.

They ran on gas so they weren't any good at all.

And, of course, the surgeon wouldn't have had a live X-ray to refer to.

Of course there wouldn't have actually been a surgeon at all.

There wouldn't have been an operation for a break like Charley's,

in fact there wouldn't have been an operation for any broken bone.

So Charley would have been destined to have a painful,

badly functioning elbow for the rest of his life.

They look fine.

Thankfully after having an operation and a cast on for a few weeks,

our modern-day patient has ended up as good as new.

-BOTH:

-Phew.

Of the soldiers that were lucky enough to survive World War I,

41,000 of them lost an arm or a leg from the fighting.

This had never happened on such a large scale before,

but World War I was the first time such powerful weapons

and heavy machinery had been used in battle.

The consequence was a huge number of amputees.

They were evacuated from battle and sent home,

but these were young guys. They wanted to get on with their lives.

They wanted to work and look after their families

so something had to be done.

UK military technicians came up with the solution.

They started making vast quantities of artificial limbs

known as prosthetics.

In fact, they had so many to make

that a whole hospital was built in London to produce them

and it was up to doctors to make sure they were made right.

From the start to the end of the war, they went from 624 patients

to over 26,000 and the limbs they made looked like this.

It's made out of hollowed wood and modelled on a real human leg.

Not bad considering it's 100 years old.

Now soldiers were given legs like these free of charge and

in those days when you had to pay for medical care, this was a big deal.

They were even given help learning how to use them.

Since then prosthesis design has gone from this...

to this.

GUNSHOT

Meet Paralympian Sophie Kamlish.

She competed at London 2012 in the 100 and 200 metre sprints.

She runs on a modern hi-tech blade

and for everything else she wears this carbon fibre leg.

So, Sophie, it evidently looks very different to your leg.

Yeah, it's a lot heavier than mine,

probably about five times the weight.

How does it look in terms of comfort and fit?

I wouldn't have to wear a strap around my waist to wear a leg

which is...obviously it would be

very annoying with clothes and stuff.

Because I do a lot of athletics it would feel heavy to drag around,

so I probably wouldn't enjoy it at all.

-It's not really built for speed, is it?

-Definitely not.

It might not have been built for speed, but artificial legs like this

transformed the lives of thousands of soldiers after the war.

And to find out what it's like to wear one,

Sophie is going to test-drive this -

a 1914-style leg specially made to fit her.

And so it's the 1914 hundred metre challenge and taking it on with

full gusto is Sophie Kamlish, one of Great Britain's Olympic heroes.

Good luck and tally-ho.

GUNSHOT

And she's off to a...

a slow start.

She's clearly unable to build up much speed

but then this leg wasn't made for running,

as those chaps found out after the war.

Walking with a new leg was tricky enough,

so all things considered, Sophie's done spiffingly.

Your time was 56.5 seconds. What's your personal best?

13.69 seconds.

Ah, so you were 42.81 seconds slower than normal?

May I ask, how did that feel?

It's not very cushiony so it was pretty tricky.

Definitely not a sprinting leg, but a pretty good walking leg.

Ah, that's the spirit.

So in 100 years prosthetics have come a long way.

Sophie's blade's a bit different to this, but this is where it all began.

For a soldier returning home from World War I missing a leg

this was a passport to freedom

and it offered them a much better life because of it.

When the First World War ended in 1918,

thousands of soldiers returned home with significant hearing loss,

if not completely deaf.

Now we're going to show you why so many men

suffered damage to their ears.

Just don't try anything you see here at home.

We've come out of the trenches and we're now in a massive field.

Look, massive.

And we need to be.

It's also why these chaps are here.

Aside from the men who were killed or lost limbs in World War I,

many soldiers would return home with another serious ailment,

hearing loss.

This was caused by the deafening noise of guns and explosions

because the soldiers didn't wear any kind of ear protection.

Sometimes they'd just put their fingers in their ears. Look!

The loudness of noise is measured in decibels and experts agree

that continued exposure to noises of 85 decibels or more

will harm your hearing.

Now explosions in the First World War measured over 140 decibels

and the gunshots could measure as much as 150.

So you see the soldiers in battle

really didn't stand much chance of their hearing being unaffected.

That's because when an explosion occurs it releases a shock wave

of pressure which is so powerful it bursts your delicate eardrum.

We're going to set off three World War I explosions to show you

how much damage they would've done to soldiers' hearing.

We're placing our wooden men at increasing distances

from the blast site.

And because shock waves destroy eardrums,

we fitted them with shock wave stickers.

The paint inside them bursts if a strong enough shock wave hits them.

Purple means a small shock wave has struck

but green means a massive one.

So with a very loud bang and a huge amount of pressure,

we're going to have to be very careful of our ears.

Which is why we've come right over here where it's completely safe

and we're wearing these.

Couldn't you have got some blue ones for me?

What?

Never mind.

So now we can get to the bit that I've been really looking forward to,

pressing the button to let off the explosions.

-Can I press it now?

-No, not yet, Xand.

Now in our first explosion we have black powder,

also known as gunpowder.

-Can I press it now?

-No.

This is what was used in hand grenades.

So let's see what kind of pressures it exerts on our soldiers.

-Can I press it now?

-Xand, press the button.

-Yes!

Oh, wow!

Wow.

Let's have a look at our first soldier.

One of his shock meters has gone off.

So the amount of force that's applied to him isn't that great,

although it's enough to knock him down

and this guy probably would have damaged his hearing very seriously.

The shock meters on our next two soldiers are unbroken,

so they wouldn't have been deafened.

But they would have had some serious ringing in their ears.

Let's go do our next test.

Now this second explosion is louder and more powerful than black powder

like many of the explosions the soldiers would have heard.

-OK, you ready?

-Yep.

-Let's do it.

Oh, wow. That is a much bigger bang.

The first soldier wouldn't have survived this blast.

Let's have a look at the next one.

So on this soldier all the meters have been activated.

And the same goes for the soldier furthest away.

Both these men would have definitely lost their hearing.

OK, let's try our next test.

Now this final test is ammonium nitrate.

It was a material often used in World War I mines

and in high explosives.

Because it releases a supersonic shock wave.

So we've doubled the amount of soldiers to show you

just how far the effects of this explosion will travel.

So two of those soldiers have completely gone.

And all the others have had their shock meters activated,

even the very last man.

The noise level here would have been absolutely deafening.

And that's because, unlike today,

World War I soldiers had no ear protection,

so when an explosion like this created a supersonic shock wave,

it burst their eardrums.

In fact, some of the real mines used in World War I made bangs so loud

they could be heard all the way from France to Britain.

So as amazing as the human body is,

in times of war it's also very vulnerable.

And it's not surprising that with much less medical know-how

than we have today,

there were over 37 million casualties in the First World War.

Thankfully we've learned a lot

and although explosions are still on the news,

soldiers since have been kitted out

with lots of ways to protect their bodies, like ear defenders.

So we've shown you just how much the soldiers of World War I

were up against.

It was a terrible war which devastated the lives

of both the men fighting and their families back at home.

100 years on, we salute all those soldiers who fought for their

country and we thank those scientists and doctors

who made incredible advances in medicine

that we still use to treat people in our modern hospitals today.

So it's goodbye to the trenches

as we head back to the 21st century, where we're very lucky to be.

-So that's it till next time. BOTH:

-Bye!