Changes in medicine, c1848–c1948

On the public-health part, the focus was the 1875 Public Health Act — its compulsion and the duties it placed on local authorities. Some candidates instead wrote about the early 20th-century Liberal reforms, which were not relevant and could not be rewarded. Contrast the permissive 1848 Act with the compulsory 1875 Act; do not reach into 20th-century welfare.

Do not write that anaesthetics were invented in this period. Their introduction pre-dates 1865: ether from the mid-1840s, chloroform (Simpson) from 1847. So they belong at the start of, or before, the study — used and improved, not invented within it. Keep the sequence: anaesthetics (from 1847) for pain, antiseptics (Lister, 1865) for infection.

Do not confuse the two surgical methods. Antiseptic surgery (Lister, carbolic acid, from 1865) kills germs in the wound and on instruments. Aseptic surgery goes further, keeping germs out of the theatre altogether — sterilised instruments, gowns, gloves and clean theatres. Surgery moved from antiseptic to aseptic; treat them as a sequence, not the same thing.

Keep the chronology right. John Snow proved cholera spread through contaminated water in 1854, by mapping deaths around the Broad Street pump — by observation, before germ theory existed. Pasteur published germ theory only in 1861. So Snow's breakthrough came first and did not depend on germ theory; do not claim he used it.

On the 16-mark part, do not stop at the two obvious points. Florence Nightingale was the overwhelming choice, but a top answer covers a third aspect — her influence on hospital design, or rival developments (germ theory, the NHS). Some candidates surprisingly ignored the impact of penicillin. Cover three aspects, then judge.

On the "explain two causes" part, always give TWO distinct causes and explain WHY each brought about the change — do not simply narrate. For the improved understanding of disease, explain how Pasteur's germ theory (1861) and Koch's identification of specific microbes each advanced understanding, rather than just describing them.

The 1848 Public Health Act did not force towns to clean up. It set up a General Board of Health but was permissive: authorities could act but need not, so many did little. The 1875 Public Health Act was compulsory, requiring local authorities to take charge of sewers, water and nuisances. The key change was from "may" (1848) to "must" (1875).

Do not muddle the two figures. Pasteur established germ theory (1861) — the principle that microbes cause disease, not miasma. Koch went further, identifying the specific microbe for a disease (anthrax 1876, TB 1882). And germ theory did not at once give cures: knowing the cause aided prevention long before a cure, which waited for penicillin (1940s).