AQA GCSE HISTORY: HEALTH AND THE PEOPLE: C1000 TO THE PRESENT DAY | ANSWERS

Part one: Medicine stands still

1 Medieval medicine and medical progress

1 How useful is Source A to a historian studying medieval medicine?
Explain your answer using Source A and your contextual knowledge. (8)

Mark scheme

An example of a Level 1 answer

The source is useful because it shows what medieval hospitals were like. There are nuns caring for people and giving them drink and food.

An example of a Level 2 answer

The source is useful because it gives an idea of what medieval hospitals were like. The source shows nuns caring for people, as well as religious features such as a crucifix on the wall. In the medieval period, many hospitals were based in religious buildings and funded by the Church. The source also shows nuns giving patients food and drink rather than doctors treating them, which reflects the medieval idea that hospitals were places to care for people but not treat them.

An example of a Level 3 answer

The source is useful because it gives an idea of what larger medieval hospitals towards the end of the medieval period were like. The source shows nuns caring for people, someone praying, and religious features such as a crucifix on the wall. In the medieval period, many hospitals were based in religious buildings and funded by the Church. The Church was very powerful and influenced the practice of medicine, teaching that it was important to care for the sick, but it was down to God whether they got better or not. The source reflects this idea by showing nuns giving patients food and drink rather than doctors treating them.

The source is unusual in that it shows a large hospital, when many hospitals at the time were small and only had room for 12 patients. But it is useful in showing what a hospital run by the Church was like: a quiet and clean place where patients could rest and recover.

An example of a Level 4 answer

The source is useful because it gives an idea of what larger medieval hospitals towards the end of the medieval period were like. The source shows nuns caring for people, someone praying, and religious features such as a crucifix on the wall. This reflects the fact that many medieval hospitals were based in religious buildings and funded by the Church. The Church was very powerful and influenced the practice of medicine, teaching that it was important to care for the sick, but it was down to God whether they got better or not. The source reflects this idea in that it shows nuns giving patients food and drink and what looks like a priest giving spiritual support, but there are no doctors present, and no one is receiving ‘treatments’ such as bloodletting or purging.

The source is unusual in that it shows a large hospital, when many hospitals at the time were small and only had room for 12 patients. But it is useful in showing what a hospital run by the Church was like by the end of the medieval period: a quiet and clean place where patients could rest and receive shelter, food, and spiritual support. The source is an illustration, quite possibly produced by the Church, so it is likely to show an idealised rather than wholly accurate picture. There is little evidence of the illnesses the patients are suffering from. Also, as a French source, it may not fully reflect English practices, so there are limits to the source’s usefulness.

2 Public health in the Middle Ages

1 How useful is Source A to a historian studying the Black Death?
Explain your answer using Source A and your contextual knowledge.(8)

Mark scheme

Relevant points that could be included

• The source shows an engraving of a plague sufferer covered in what looks like pustules. People and their animals appear to be fleeing a town that has been destroyed by the plague.
• The source is useful in showing symptoms of the plague (pustules all over the body) as well as the devastation caused by the plague, represented by people fleeing the town on fire. Lightning from the sky reflects the belief that the plague came from God. A lady appears to be blessing the victim, showing the importance of religious belief in combatting disease.
• The English engraving was made in 1348, which was the same year the plague first hit England. This makes the source useful in capturing some of the upheaval and devastation that England experienced at the time.

Part two: The beginnings of change

3 The impact of the Renaissance on Britain

1 How useful is Source A to a historian studying Renaissance medicine?
Explain your answer using Source A and your contextual knowledge. (8)

Mark scheme

Relevant points that could be included

• The source shows a detailed drawing of a human skeleton from Vesalius’ famous textbook On the Fabric of the Human Body.
• The detailed and precise drawing of a human skeleton is useful in showing the progress made in our understanding of human anatomy during the Renaissance. It reflects the fact that Vesalius was able to dissect humans, when this was frowned upon in the medieval period and anatomical knowledge had to rely on animal dissections.
• The illustration comes from Vesalius’ influential medical textbook, which challenged Galen’s ideas of human anatomy. The source reflects the forefront of Renaissance medicine and the experimentation and discovery of the time, coupled with the technological breakthrough of the printing press to help spread ideas.

2 Explain the significance of the work of Ambroise Paré. (8)

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An example of a Level 1 answer

Ambroise Paré helped to improve amputations for soldiers by making them less painful.

An example of a Level 2 answer

Ambroise Paré made advances in amputations for soldiers. He helped to make amputations less painful by using ligatures to stop the bleeding rather than cauterisation. He also made false limbs for soldiers, which were basic but helped to improve soldiers’ quality of life.

An example of a Level 3 answer

Ambroise Paré made advances in amputations for soldiers. He helped to make amputations less painful by using ligatures to stop the bleeding rather than cauterisation. Reducing pain was important at a time when anaesthetics were not usually used in surgery. Paré also made false limbs for soldiers, which were basic but helped to improve soldiers’ quality of life.

When Paré ran out of hot oil during a battle, he just used a cream instead, which helped his patients heal quickly while in less pain. This encouraged him to question accepted wisdom. He inspired English surgeons to question old ideas at a time when it was difficult to challenge the traditional teachings of Galen and Hippocrates. This was significant because it encouraged surgeons to experiment and improve their knowledge of anatomy and medicine.

An example of a Level 4 answer

Ambroise Paré made advances in amputations for soldiers. He helped to make amputations less painful by using ligatures to tie the blood vessels and stop the bleeding rather than cauterisation. Reducing pain was important at a time when anaesthetics were not usually used in surgery and the patient felt everything that was happening to them. It was also significant because it was unusual to prioritise the patient’s comfort. Another way that Paré accidentally helped patients feel less pain was when he ran out of hot oil during a battle in 1537. Instead, he used a cream of rose oil, egg white, and turpentine. This helped his patients heal quickly while in less pain and encouraged him to question accepted wisdom.

Paré wrote books such as his influential Works on Surgery in 1575. His books and teachings inspired English surgeons, such as the famous surgeon William Clowes, to question old ideas at a time when it was difficult to challenge the traditional teachings of Galen and Hippocrates. This was significant because it encouraged surgeons and doctors to experiment, question accepted but wrong ideas, such as the theory of opposites, and improve their knowledge of anatomy and medicine. Paré’s work on treating battlefield wounds also helped others improve medicine and surgery to help wounded soldiers. For example, William Clowes was inspired by Paré to write his own book, Proved Practice.

3 Explain two ways in which medieval surgery and Renaissance surgery were similar. (8)

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An example of a Level 1 answer

Medieval and Renaissance surgery were similar because they were both very painful for patients.

An example of a Level 2 answer

Surgery was a painful last resort in both the medieval and Renaissance periods. It used painful techniques such as cauterisation and amputation without any proper anaesthetics. Patients often died from blood loss or infection.

An example of a Level 3 answer

Surgery was a painful last resort in both the medieval and Renaissance periods. It used painful techniques such as cauterisation and amputation, but these often led to infection. For example, it was common in both periods to use cauterisation to stop blood loss from battlefield wounds, and because anaesthetics were risky to use, it was more common to simply hold patients down. Patients often died from shock, blood loss, or infection, and so people tried to avoid surgery if they could.

Another similarity is that surgeons in both periods experimented with new methods and shared their ideas through writing. For example, in the medieval period, John of Ardene developed a safer treatment for anal abscesses and shared his knowledge in the book Practica. In the Renaissance, Ambroise Paré developed a less painful way to stop blood loss from amputations and shared his ideas in the book Works on Surgery. In both periods, there were surgeons who tried to improve surgical techniques.

An example of a Level 4 answer

Surgery was a painful last resort in both the medieval and Renaissance periods. It used techniques such as cauterisation and amputation, but these often led to infection. For example, it was common in both periods to use cauterisation to stop blood loss from battlefield wounds, which was very painful but safe anaesthetics were not developed until the nineteenth century, so it was common just to hold patients down. In both periods, patients often died from shock, blood loss, or infection and so people tried to avoid surgery if they could. It was mainly reserved for the battlefield.

Another similarity is that there were surgeons in both periods who experimented with new methods and shared their ideas through writing, helping to gradually make surgery safer and more effective. For example, in the medieval period, John of Ardene developed a safer treatment for anal abscesses and shared his knowledge in the book Practica. In the Renaissance, Ambroise Paré developed a less painful way to stop blood loss from amputations and shared his ideas in the book Works on Surgery. Surgeons such as these and others (including Hugh of Lucca and Andreas Vesalius) were criticised and mocked by some for their new ideas, and it took time for their advances to filter through to everyday medicine. But they helped to improve surgical techniques and paved the way for surgery to be seen as more useful and less risky in the seventeenth and eighteenth centuries.

4 Has the role of the individual been the main factor in the development of surgery and anatomy?
Explain your answer with reference to the role of the individual and other factors.
Use a range of examples from across your study of Health and the people: c1000 to the present day. (16)

Mark scheme

Please note that Question 4 also has four marks available for spelling, punctuation, and grammar (SPaG). As a result, it is important that specialist terms and key names are used correctly in your answers. Always allow time to review your answers to check your writing.

You may have focused on only the medieval and Renaissance periods in your answer if you have not yet revised later periods. However, we’ve provided a full answer here – covering a wider period of history – so you can familiarise yourself with what’s expected in the exam.

An example of a Level 1 answer

Individuals such as Abulcasis and Vesalius helped to develop surgery and our understanding of human anatomy. They experimented with new ideas, and they also shared their ideas with others by writing books. Vesalius wrote the book On the Fabric of the Human Body and lots of other surgeons read this.

An example of a Level 2 answer

Key individuals such as Abulcasis and Vesalius helped to develop surgery and our understanding of human anatomy. They had the courage to experiment with new ideas. For example, Abulcasis experimented with using ligatures to tie off blood vessels, and Vesalius experimented with dissecting human bodies. Vesalius wrote up his findings in the book On the Fabric of the Human Body. This book was read by doctors across Europe, and so even though Vesalius was only one individual, he had a lot of influence.

Another factor that has made a difference is war. This is because innovations often take place during wartime to help soldiers, such as the portable X-ray machine that was invented during the First World War. This made it possible for X-ray images to be taken near the battlefield. Another wartime development was plastic surgery, which Harold Gillies pioneered to help soldiers with serious facial wounds.

An example of a Level 3 answer

Individuals have been important because key individuals such as Abulcasis, Andreas Vesalius, and John Hunter helped to develop surgery and our understanding of human anatomy. They had the courage to experiment with new ideas and challenge accepted wisdom. For example, Abulcasis experimented with using ligatures to tie off blood vessels, and Vesalius experimented with dissecting human bodies. From this Vesalius gained a more accurate understanding of human anatomy and he wrote up his findings in the book On the Fabric of the Human Body. This book was read by doctors and surgeons across Europe, and so even though Vesalius was only one individual, he had a lot of influence and played a key role in improving our knowledge of human anatomy.

Another factor that has made a difference is war. This is because innovations often take place during wartime to help wounded soldiers, such as the portable X-ray machine that Marie Curie invented during the First World War. This made it possible for X-ray images to be taken near the battlefield. Another wartime development was plastic surgery, which Harold Gillies pioneered during the First World War to help soldiers with serious facial wounds by using skin graft techniques.

A third important factor is science and technology. Careful scientific experimentation has led to the discovery of theories such as William Harvey’s theory of circulation and Louis Pasteur’s germ theory. These have helped to develop our understanding of human anatomy (such as how the heart works) and improve surgery (such as germ theory leading to antiseptic and then aseptic surgery). Using technology such as lasers in surgery has made surgery safer and easier to recover from.

Individuals have been the most important factor because surgery would not have developed without their courage and dedication pushing things forwards.

An example of a Level 4 answer

Individuals have been important throughout the history of surgery because key individuals such as Abulcasis, Andreas Vesalius, and John Hunter helped to develop surgery and our understanding of human anatomy. They had the courage to experiment with new ideas and challenge accepted wisdom, and the dedication to work hard for years on their craft. For example, Abulcasis experimented with using ligatures to tie off blood vessels, and Vesalius experimented with dissecting human bodies. From this Vesalius gained a more accurate understanding of human anatomy, and he wrote up his findings in the book On the Fabric of the Human Body. This book was read by doctors and surgeons across Europe, and so even though Vesalius was only one individual, he had a lot of influence. Communication was an important factor here, too, because it helped to spread new ideas, but individuals are more important because, without their hard work, there would be no new ideas to spread.

Another factor that has made a difference is war. This is because innovations often take place during wartime to help wounded soldiers, such as the portable X-ray machine that Marie Curie invented during the First World War. This made it possible for X-ray images to be taken near the battlefield. Another wartime development was plastic surgery, which Harold Gillies pioneered during the First World War to help soldiers with serious facial wounds by using skin graft techniques. The urgent need to help wounded soldiers during wartime led to important developments, but this still required pioneering individuals like Harold Gillies to introduce these new ideas and techniques.

A third factor that has become increasingly important over time is science and technology. Careful scientific experimentation has led to the discovery of theories such as William Harvey’s theory of circulation and Louis Pasteur’s germ theory. These have helped to develop our understanding of human anatomy (such as how the heart works) and improve surgery (such as germ theory leading to antiseptic and then aseptic surgery). Using technology such as lasers and tiny cameras in surgery has made surgery safer and easier to recover from. These developments have definitely helped to improve surgery, but they have still relied on key individuals coming up with new ideas and theories to test and build on. Pasteur’s work was only taken further through the vision of individuals such as Joseph Lister and his discovery of carbolic acid as an antiseptic, and William Halsted’s development of protective clothing leading to aseptic surgery. These individuals exploited technological developments and Pasteur’s work to combat the problem of infection in surgery.

In conclusion, war and science and technology have been important factors, but individuals have been even more important throughout because surgery would not have developed without their courage, dedication, and creativity pushing things forwards. Without their new ideas, surgery could not have developed during wartime and new technology would not have been developed.

4 Dealing with, and preventing, disease

1 How useful is Source A to a historian studying eighteenth-century medicine?
Explain your answer using Source A and your contextual knowledge. (8)

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Relevant points that could be included

• The cartoon shows four doctors who cannot agree on what is ‘wrong’ with a pregnant woman; all four misdiagnose her.
• The cartoon shows that there were two types of doctors in the eighteenth century: physicians and surgeons. The fact they are in discussion with each other and dressed similarly suggests they had a similar status by the end of the eighteenth century. The inability to diagnose pregnancy and the caption ‘Time [is] the best doctor’ reflects the fact that many eighteenth-century diagnoses and treatments were still ineffective.
• The cartoon likely reflects public attitudes towards physicians and surgeons around the end of the eighteenth century, but their ineptitude is also probably exaggerated for comedic effect.

2 Explain the significance of hospitals in the development of medicine. (8)

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Relevant points that could be included

• Specialist hospitals and specialist wards were established in general hospitals in the eighteenth century. These helped doctors develop their skills and expertise in one area and improved specialist treatments.
• Medical schools were often attached to the new hospitals built in the eighteenth century. These helped to give student doctors and surgeons more hands-on experience; this practical knowledge would have helped them to develop better treatments.
• As more hospitals were built, they could care for more patients – by 1800, London’s hospitals could care for over 20,000 patients a year. This provided ample opportunities to test new treatments and determine whether they were effective.
• Hospitals have been significant in helping medical practitioners improve and test their skills and knowledge, which has helped them to discover more effective treatments.

3 Explain two ways in which medieval treatments and treatments in the eighteenth century were similar. (8)

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Relevant points that could be included

• Treatments in both periods were largely based on inaccurate beliefs, such as the belief that unbalanced humours caused illness. This meant that bloodletting and purging remained popular across both periods.
• In both periods, treatments from trained doctors were largely reserved for the wealthy. Most people obtained treatments from barber-surgeons, apothecaries, and wise people, often relying on herbal remedies that had been passed down through generations.

4 Has science and technology been the main factor in improving the treatment of disease in Britain?
Explain your answer with reference to the role of science and technology and other factors.
Use a range of examples from across your study of Health and the people: c1000 to the present day. (16)

Mark scheme

Please note that Question 4 also has four marks available for spelling, punctuation, and grammar (SPaG). As a result, it is important that specialist terms and key names are used correctly in your answers. Always allow time to review your answers to check your writing.

You may have focused only on developments up to the eighteenth century in your answer if you have not yet revised later periods. However, we’ve covered a wider period of history here so you can familiarise yourself with what’s expected in the exam.

Relevant points that could be included

• Scientific experimentation has led to theories and discoveries that have improved the treatment of diseases. Technology has aided this. For example, Pasteur and Koch’s work (which relied on the microscope) led Ehrlich to discover magic bullets.
• Communication has been another influential factor. New treatments have been shared through doctors and scientists publishing their work, or by teaching others. Effective communication has been important in persuading people to accept challenging ideas, such as Tyndall and Cheyne defending Germ Theory, and the invention of the printing press challenging the Church monopoly on learning.
• The dedication of key individuals has been important in developing treatments for diseases. For example, Florey and Chain’s dedication (despite a lack of funding from the British government) led to the production of penicillin. Ehrlich’s dedication to testing hundreds of chemical compounds led to the discovery of Salvarsan 606. Jenner’s perceptive investigation led eventually to the eradication of smallpox.
• It could be argued that without key developments in science and technology (such as the technology needed to create and then mass-produce penicillin and the scientific knowledge of how to do this), the treatment of disease in Britain could not have progressed very far.

Part three: A revolution in medicine

5 Advances in medical science

1 How useful is Source A to a historian studying surgery in the nineteenth century?
Explain your answer using Source A and your contextual knowledge. (8)

Mark scheme

Relevant points that could be included

• The engraving shows surgeons performing an operation in the nineteenth century using carbolic spray as an antiseptic.
• The engraving shows carbolic acid being sprayed on surgical instruments and in the air of the operating room. It shows the use of antiseptics in surgery (pioneered by Joseph Lister in the 1860s), but not the use of aseptic techniques (such as wearing gloves or sterilising surgical instruments with steam) as the doctors are all in normal clothing.
• The engraving was likely accurate as it was published in a ‘serious’ medical textbook by Joseph Lister’s deputy surgeon. Published in 1882, it reflects recent developments in surgery aimed to reduce infections and make operations safer.

2 Explain the significance of Germ Theory. (8)

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Relevant points that could be included

• Germ Theory gave Robert Koch the idea that specific germs could cause specific illnesses. This led him to identify the germs that caused anthrax, cholera, and tuberculosis, and his work helped other scientists to identify the germs responsible for other diseases.
• Germ Theory and Koch’s work led Louis Pasteur to develop vaccines for anthrax and rabies – and other scientists to develop vaccines for other diseases. This made the prevention of disease much more effective.
• Germ Theory led Joseph Lister to try using carbolic acid to kill any bacteria that could cause infections during surgery. This led to the development of antiseptic and then aseptic surgery.
• Although Germ Theory itself was not about medicine, doctors and surgeons applied it to their own work to make both the prevention and treatment of diseases and infections much more effective.

3 Explain two ways in which the discovery of new medical ideas in the Renaissance and in the nineteenth century were similar. (8)

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Relevant points that could be included

• Careful scientific experimentation contributed to discoveries in both periods. For example, in the Renaissance, William Harvey spent years dissecting hearts to build up his theory of circulation. In the nineteenth century, Paul Ehrlich tested hundreds of chemical compounds before discovering the first magic bullet.
• In both periods, new discoveries were treated with scepticism. For example, in the Renaissance, Vesalius faced criticism for challenging Galen and was mocked by his former teacher and pupils. In the nineteenth century, doctors and surgeons were sceptical of Germ Theory and defended spontaneous generation.

4 Has chance been the main factor in the development of medicine?
Explain your answer with reference to the role of chance and other factors.
Use a range of examples from across your study of Health and the people: c1000 to the present day. (16)

Mark scheme

Please note that Question 4 also has four marks available for spelling, punctuation, and grammar (SPaG). As a result, it is important that specialist terms and key names are used correctly in your answers. Always allow time to review your answers to check your writing.

You may have focused only on developments up to the nineteenth century in your answer if you have not yet revised later periods. However, we’ve covered a wider period of history here so you can familiarise yourself with what’s expected in the exam.

Relevant points that could be included

• Chance has played a key role in a number of important discoveries. For example, Jenner, by chance, heard stories about cowpox, which led him to develop the first vaccination. Vaccinations have since become hugely important in preventing disease. Fleming, by chance, left a Petri dish out when he went on holiday and discovered penicillin, which has since saved hundreds of millions of lives. Paré only abandoned cauterisation because he ran out of hot oil during a battle.
• Government funding has played an important role. For example, Pasteur and Koch were well-funded by their respective governments, helping to make it possible for them to develop and find practical uses for Germ Theory. Penicillin could only be mass-produced with help from the US government. In Britain, the government funds the NHS, which helps doctors to improve and test their knowledge and skills.
• Communication has been another influential factor. New discoveries have been shared through doctors and scientists publishing their work, or by teaching others. The invention of the printing press was a key development that helped break the Church’s hold on medical learning. Effective communication has been important in persuading people to accept challenging ideas, such as Tyndall and Cheyne defending Germ Theory.
• It could be argued that while chance has played a key role in some important discoveries, these discoveries may well have happened anyway at some point. Communication could be more important because scientists and doctors have only been able to develop medicine through listening to and developing other people’s ideas.

6 Improvements in public health

1 How useful is Source A to a historian studying public health in the nineteenth century?
Explain your answer using Source A and your contextual knowledge. (8)

Mark scheme

Relevant points that could be included

• The cartoon shows three serious contagious diseases (portrayed as unhealthy children) being introduced to London via the River Thames.
• The cartoon shows there was some understanding at the time that pollution (the factory) and waste (the foul river) contributed to poor public health and the spread of contagious diseases. It shows that contagious diseases were a serious concern for public health in the nineteenth century.
• The cartoon was published in 1858 during the Great Stink, when a heatwave exposed a lot of sewage and waste in the River Thames. Four years earlier, John Snow had shown the link between dirty water and a cholera outbreak in the city.

2 Explain the significance of the British government’s public health reforms in the nineteenth century. (8)

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Relevant points that could be included

• A major public health reform in the nineteenth century was building a network of underground sewers across London. This helped to improve public health by making the streets and River Thames much cleaner, and afterwards cholera never returned to London.
• The Second Public Health Act ordered local councils to improve public health in their areas by supplying fresh water, collecting rubbish, and so on. Partly due to these reforms, the average age of death in Britain rose from around 40 to 46 over the course of the nineteenth century.
• At the start of the early nineteenth century, the government took a laissez-faire approach to public health. The success of public health reforms during the nineteenth century prompted the government to become more interventionist. This encouraged later public health reforms, leading to the introduction of the NHS in 1948.
• Public health reforms in the nineteenth century showed a change in attitudes and approaches in Britain that led to further improvements in health and longevity.

3 Explain two ways in which public health in the Middle Ages and public health in the nineteenth century were similar. (8)

Mark scheme

Relevant points that could be included

• In both periods, sewage and waste were usually washed into nearby rivers, causing poor public health. For example, in the Middle Ages, gong farmers and businesses would often dump waste in the local river. In the nineteenth century, the sewage and waste in the River Thames was so bad that it caused the Great Stink.
• In both periods, there was a limited understanding of what caused poor public health. For example, in the Middle Ages, the Black Death was thought to be caused by God, the position of the planets, or bad air. In the nineteenth century, many people also believed that the cholera outbreaks were caused by bad air.

4 Has science and technology been the main factor in improving public health in Britain?
Explain your answer with reference to the role of science and technology and other factors.
Use a range of examples from across your study of Health and the people: c1000 to the present day. (16)

Mark scheme

Please note that Question 4 also has four marks available for spelling, punctuation, and grammar (SPaG). As a result, it is important that specialist terms and key names are used correctly in your answers. Always allow time to review your answers to check your writing.

You may have focused only on developments up to the nineteenth century in your answer if you have not yet revised later periods. However, we’ve covered a wider period of history here so you can familiarise yourself with what’s expected in the exam.

Relevant points that could be included

• Scientific discoveries and technological advances have helped to improve public health. For example, Snow proved that cholera is often spread through contaminated water. Partly as a result of this, the government introduced reforms to make streets and water supplies cleaner, improving public health. At the time it was built, Bazalgette’s sewer system would have been technologically advanced, and it helped ensure cholera never returned to London.
• Governments have played an important role in improving public health by introducing and funding reforms. Examples include the First and Second Public Health Acts, the Liberal social reforms, and the creation of the NHS. However, they played a more limited role in the outbreaks of plague in the medieval and Renaissance periods.
• Individuals have been instrumental in researching and writing reports that have pressured governments to act to improve public health. Examples include Chadwick’s report, Booth and Rowntree’s reports, and the Beveridge Report. Individuals have occasionally been key in enacting measures to help public health, for example King Charles II reacted to the Great Plague by banning public gatherings.
• It could be argued that while individuals and science and technology have pressured governments into acting and shown them how to act, it is government reforms that have had the biggest impact on improving public health in Britain. These large-scale reforms have been important in increasing life expectancy in Britain (for example by an average of 13 years between 1948 and 2019).

Part four: Modern medicine

7 Modern treatment of disease

1 How useful is Source A to a historian studying modern medicine?
Explain your answer using Source A and your contextual knowledge. (8)

Mark scheme

Relevant points that could be included

• The cartoon shows a giant superbug throttling an American, surrounded by antibiotics. It is saying ‘That which does not kill me, makes me stronger.’
• The cartoon shows that superbugs such as MRSA are a real threat to public health because they are antibiotic-resistant. It also shows that antibiotics have become overused in modern medicine, and superbugs are one outcome of this.
• The cartoon was published in 2007, 46 years after MRSA was first reported in a British study. This shows that the overuse of antibiotics and superbugs have been a problem that modern medicine has found tough to solve. However, historians should remember that the cartoonist may be exaggerating the dangers of superbugs for comedic effect.

2 Explain the significance of the work of Howard Florey and Ernest Chain. (8)

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Relevant points that could be included

• Based on Fleming’s research, Florey and Chain found a way to grow and purify a small amount of penicillin. Without their efforts, it could have taken much longer before Fleming’s research was put to practical use.
• Florey persuaded the US government to mass-produce penicillin. This helped to save the lives of 12 to 15% of wounded British and American soldiers during the Second World War.
• The huge demand for penicillin during the Second World War led to the rapid growth of the pharmaceutical industry. Today, it is one of the biggest industries in the world, providing medicines to millions of people each year.
• Florey and Chain developed penicillin and played an important role in its mass production. Penicillin is still commonly used today to treat bacterial infections and is estimated to have saved hundreds of millions of lives.

3 Explain two ways in which the treatment of illness and disease in the seventeenth century and the treatment of illness and disease in the twenty-first century are similar. (8)

Mark scheme

Relevant points that could be included

• In both periods, some treatments had little scientific evidence to support them. For example, in the seventeenth century, quacks sold ‘miracle cures’ that were rarely effective. In the twenty-first century, alternative treatments such as homoeopathy are not backed by mainstream science.
• In both periods, doctors and scientists sought to experiment with new ideas and ways of treating people. For example, in the seventeenth century, Thomas Sydenham experimented with new treatments, such as laudanum for pain relief. In the twenty-first century, the human genome project completed its map of human DNA, opening up the study and treatment of genetic diseases.

4 Has the role of government been the main factor in improving the treatment of disease?
Explain your answer with reference to the role of the government and other factors.
Use a range of examples from across your study of Health and the people: c1000 to the present day. (16)

Mark scheme

Please note that Question 4 also has four marks available for spelling, punctuation, and grammar (SPaG). As a result, it is important that specialist terms and key names are used correctly in your answers. Always allow time to review your answers to check your writing.

Relevant points that could be included

• Government funding has played an important role. For example, Pasteur and Koch were well-funded by their respective governments, helping to make it possible for them to develop and find practical uses for Germ Theory. Penicillin could only be mass-produced with help from the US government. In Britain, the government funds the NHS, which helps doctors to improve and test their knowledge and skills.
• Scientific experimentation has led to theories and discoveries that have improved the treatment of diseases. Technology has aided this. For example, Pasteur and Koch’s work (which relied on the microscope) led Ehrlich to discover magic bullets. Jenner’s experiments with smallpox led to the first vaccine.
• Chance has helped to improve the treatment of disease. For example, Fleming, by chance, left a Petri dish out when he went on holiday and discovered penicillin, which has since saved hundreds of millions of lives. Paré only abandoned cauterisation because he ran out of hot oil during a battle, and his new approach to treatment (just using cream) caused patients to heal more quickly with less pain.
• It could be argued that, although government funding has eased the development of treatments, science and technology have been more important: without key advances in science and technology (such as the technology needed to create and then mass-produce penicillin and the scientific knowledge of how to do this), the treatment of disease could not have progressed very far.

8 The impact of war and technology on surgery

1 How useful is Source A to a historian studying modern developments in the treatment of disease?
Explain your answer using Source A and your contextual knowledge. (8)

Mark scheme

Relevant points that could be included

• The poster shows a soldier looking cheery in a hospital bed, with text celebrating penicillin and motivating the people who produce it.
• The poster shows that penicillin was a new ‘wonder drug’ in the early 1940s, implying that before then there was nothing like penicillin available, and that penicillin saved a lot of soldiers’ lives during the Second World War. The image also suggests that, by the 1940s, hospitals were clean, comfortable places to treat diseases – though the fact the patient is smoking implies there was still a limited understanding of disease (in this case, that smoking causes disease).
• The poster was created by the US government during the Second World War to motivate people working in the pharmaceutical industry. This shows that the US government was heavily invested in mass-producing penicillin to treat its soldiers, and that by the 1940s the pharmaceutical industry was growing substantially.

2 Explain the significance of modern surgical methods in the development of medicine.(8)

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Relevant points that could be included

• Organ transplants have become safer since the 1950s thanks to immunosuppressants. They allow damaged human organs to be replaced with healthy ones, for example if an organ is too damaged to be repaired by surgery or supported by medicines.
• Laser surgery allows surgeons to operate using lasers rather than surgical instruments. It can make surgery more precise and reliable, making fiddly surgery (such as eye surgery) safer.
• Keyhole surgery allows surgeons to access the inside of the body without making large cuts in the skin. This helps patients to recover faster after operations and leaves less scarring.
• Developments such as organ transplants, laser surgery, and keyhole surgery have extended people’s lives and made surgery safer and easier to recover from.

3 Explain two ways in which surgery during the twentieth century and surgery during the nineteenth century were similar. (8)

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Relevant points that could be included

• The development of anaesthetics in the nineteenth century made it easier to perform complex operations on the inside of the body because patients were no longer conscious and in pain during surgery. Developments in the twentieth century also made it easier to carry out complex internal operations, such as laser surgery and keyhole surgery.
• In the nineteenth century, antiseptic surgery was developed to prevent germs from causing infections during operations. By the twentieth century, this had evolved into aseptic surgery, but the focus on excluding germs to combat infection remained the same now that Germ Theory was largely accepted.

4 Has war been the main factor in improving the treatment of disease in Britain?
Explain your answer with reference to the role of war and other factors.
Use a range of examples from across your study of Health and the people: c1000 to the present day. (16)

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Please note that Question 4 also has four marks available for spelling, punctuation, and grammar (SPaG). As a result, it is important that specialist terms and key names are used correctly in your answers. Always allow time to review your answers to check your writing.

Relevant points that could be included

• War has pressured governments and individuals to find new ways to reduce soldiers’ suffering. For example, war led the US government to fund the mass production of penicillin, which supercharged the growth of the pharmaceutical industry and helped to make penicillin widely available in Britain.
• Communication has been another influential factor. New treatments have been shared through doctors and scientists publishing their work, or by teaching others. The invention of the printing press was a key development that helped break the Church’s hold on medical learning. Effective communication has been important in persuading people to accept challenging ideas, such as Tyndall and Cheyne defending Germ Theory.
• The dedication of key individuals has been important in developing treatments for diseases. For example, Florey and Chain’s dedication (despite a lack of funding from the British government) led to the production of penicillin. Ehrlich’s dedication to testing hundreds of chemical compounds led to the discovery of Salvarsan 606. The work of individuals such as Harvey and Sydenham paved the way for a more scientific approach.
• Although the pressures of war have contributed to improving the treatment of disease (and making new treatments more accessible), it could be argued that communication has been more important, because scientists and doctors have only been able to develop treatments through listening to and developing other people’s ideas.

9 Modern public health

1 How useful is Source A to a historian studying the National Health Service?
Explain your answer using Source A and your contextual knowledge. (8)

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Relevant points that could be included

• The poster shows a person exercising, accompanied by some brief text on why and how to start exercising. The header, ‘Small step to lift your mood’ highlights the benefits.
• The poster shows that the NHS does not just aim to treat disease also to prevent it. One of its functions is to run public health campaigns to encourage people to make healthy lifestyle choices. Using an older person on the poster could reflect the fact that an ageing population is costing the NHS more money, so keeping people healthier for longer could reduce the burden on the NHS.

2 Explain the significance of the work of social reformers to public health. (8)

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Relevant points that could be included

• The research of social reformers such as Booth and Rowntree showed the link between poor living conditions and poor public health. This helped governments figure out that they can improve public health by reducing poverty and improving living conditions.
• Social reformers have raised the public’s awareness of what causes poor public health, pressured governments to make changes to improve it. For example, the Beveridge Report contributed to Labour winning the 1945 election and setting up the NHS.
• Social reformers have made concrete recommendations that governments have been able to act on. For example, Edwin Chadwick’s 1842 report recommended installing new sewers. Although it took time (and more cholera outbreaks) for the government to act on this recommendation, they eventually did so in the 1860s.
• Social reformers have greatly helped to improve public health by researching how to improve public health and then pressuring governments to act on it.

3 Explain two ways in which public health reforms in the nineteenth century and public health reforms in the twentieth century were similar. (8)

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Relevant points that could be included

• In both periods, public health reforms were inspired by reports produced by social reformers. In the nineteenth century, Edwin Chadwick’s report influenced the First and Second Public Health Acts. In the twentieth century, the Beveridge Report influenced the creation of the NHS.
• In both periods, there was an understanding that poverty caused poor public health and that public health reforms needed to take this into account. In the nineteenth century, public health reforms ordered local councils to make improvements that would benefit those living in poverty (such as supplying them with fresh water). In the twentieth century, the NHS provided free treatment to everyone.

4 Has communication been the main factor in the development of public health in Britain?
Explain your answer with reference to the role of communication and other factors.
Use a range of examples from across your study of Health and the people: c1000 to the present day. (16)

Mark scheme

Please note that Question 4 also has four marks available for spelling, punctuation, and grammar (SPaG). As a result, it is important that specialist terms and key names are used correctly in your answers. Always allow time to review your answers to check your writing.

Relevant points that could be included

• Communication has played an important role in showing the government how to improve public health and pressuring the government to act. For example, the Beveridge Report sold over 100,000 copies in its first month. It was very popular and partly why Labour won the next general election, as they promised to act on it.
• Scientific discoveries and technological advances have helped to improve public health. For example, Snow proved that cholera is often spread through contaminated water. Partly as a result of this, the government introduced reforms clean streets and water supplies, improving public health. At the time it was built, Bazalgette’s sewer system would have been technologically advanced, and it helped ensure cholera never returned to London.
• Governments have played an important role in improving public health by introducing and funding public health reforms. Examples include the First and Second Public Health Acts, the Liberal social reforms, and the creation of the NHS. These large-scale reforms have been important in increasing life expectancy in Britain (for example, by an average of 13 years between 1948 and 2019). Governments also played a more limited role in the outbreaks of plague in the medieval and Renaissance periods.
• While advances in communication, science, and technology have pressured governments into action and shown them how to act, government reforms have had the biggest impact on improving public health in Britain.