Edexcel IGCSE History: Changes in Medicine, c1848–c1948 — Practice Questions

These are original questions written for Marlbridge, for revision and practice on this content. They are not reproduced past-paper questions, and they do not replicate the exam’s exact structure, question count or mark tariffs — examination boards hold copyright in their own papers. Use these alongside the official past papers available free from your board.

Related: B2 revision notes | B2 study guide

These questions practise the three Breadth Study question types of Pearson Edexcel International GCSE History 4HI1 Paper 2, Section B — two differences (6), two causes (8) and a 16-mark change-over-time essay — across the five key topics and themes of “Changes in medicine, c1848–c1948”.

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Set 1

1(a) Explain two ways in which public health in 1848 was different from public health in 1875. [6]

1(b) Explain two causes of the development of penicillin as a usable drug in the years 1928–44. [8]

1(c) “The work of individuals was the main reason for improvements in surgery in the years c1848–1918.” How far do you agree? [16]

You may use the following in your answer:

• James Simpson and chloroform
• the First World War

You must also use information of your own.

Set 2

2(a) Explain two ways in which the role of women in medicine in 1854 was different from their role in 1918. [6]

2(b) Explain two causes of the Liberal government’s health reforms of 1906–11. [8]

2(c) “Government action was more important than scientific discovery in improving the nation’s health in the years 1848–1948.” How far do you agree? [16]

You may use the following in your answer:

• the Public Health Act (1875)
• the work of Koch

You must also use information of your own.

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Answers and mark guidance

1(a) [6]

• Compulsion: the 1848 Act set up a General Board of Health but local boards were voluntary, so many towns did nothing; the 1875 Act forced councils to provide clean water, sewers and drainage.
• Understanding: in 1848 action was based on miasma theory and Chadwick’s link between dirt and disease; by 1875 germ theory (1861) and Snow’s work gave a stronger case for clean water.

1(b) [8]

• Scientific research: Florey and Chain at Oxford purified penicillin and tested it on mice and then patients (1940–41), proving its value where Fleming had been unable to produce it.
• The Second World War: the need to treat infected wounds led the US government to fund mass production by drug companies, so enough was available by D-Day (1944).

1(c) [16]

Individuals: Simpson (chloroform, 1847) solved pain; Lister applied Pasteur’s germ theory with carbolic acid (1865); Landsteiner’s blood groups (1901); Gillies’s plastic surgery in the First World War. Other factors: science and technology (microscopes, steam sterilisation, X-rays); the First World War, which created urgent need and huge numbers of cases (mobile X-ray units, stored blood); communication of ideas; government and hospital investment; opposition and attitudes slowing change (resistance to chloroform and to Lister’s spray). Judgement: individuals made breakthroughs, but science, technology and war determined how quickly they spread. Answers should cover the whole period, including aseptic surgery after 1875.

2(a) [6]

• Status and training: in 1854 nursing was a low-status job with little training until Nightingale; by 1918 nursing was a trained profession and women could qualify as doctors (since 1876).
• Range of roles: in 1854 women served only as nurses; by 1918 they worked as doctors, surgeons and ambulance drivers in the war, as in the Scottish Women’s Hospitals.

2(b) [8]

• Evidence of poor health: many volunteers for the Boer War (1899–1902) were unfit, and studies by Booth and Rowntree showed widespread poverty and illness.
• Politics: the Liberals’ landslide in 1906, the rise of the Labour Party and the example of German social insurance encouraged action to win working-class support.

2(c) [16]

Government action: 1848 and 1875 Public Health Acts; Bazalgette’s London sewers; Liberal reforms (1906–11), including National Insurance; wartime funding of penicillin; the NHS (1948). Scientific discovery: germ theory (Pasteur), Koch’s identification of specific germs, vaccines, Ehrlich’s Salvarsan, X-rays, blood groups, penicillin. Links: government action often followed scientific understanding (1875 after germ theory) and science often needed government funding to have impact (penicillin). Judgement: science explained disease, but government action delivered health improvements to the whole population, especially through public health and the NHS. Reward sustained comparison across at least two key topics.

Set 3 — extra practice

3(a) Explain two ways in which hospital treatment of wounded soldiers in the Crimean War (1854–56) was different from treatment in the First World War (1914–18). [6]

3(b) Explain two causes of the founding of the NHS in 1948. [8]

3(a) [6]

• Infection: at Scutari, before germ theory, hygiene relied on Nightingale’s cleanliness; by 1914–18 antiseptic and aseptic methods, and the cutting away of infected tissue, were standard.
• Technology and techniques: Crimean surgeons had chloroform but no X-rays or transfusion; First World War doctors used mobile X-ray units to find shrapnel and stored blood for transfusions.

3(b) [8]

• The Second World War: the Emergency Medical Service showed that a national hospital system could work, and the shared sacrifice of war created support for fairer services.
• The Beveridge Report and Labour’s victory: Beveridge (1942) proposed a free national health service to defeat disease, one of the “five giants”; Labour won the 1945 election and Bevan carried the NHS Act (1946), overcoming opposition from many doctors.

Where marks are usually lost

• In (a), describing only one of the two dates.
• In (b), giving one cause twice in different words.
• In (c), writing a list of discoveries without comparing factors.

Source: question patterns modelled on the Pearson Edexcel International GCSE History (4HI1) specification, Issue 5, February 2026, Paper 2, Section B.

Frequently asked questions

How is the Paper 2 breadth study question structured? Part (a) asks you to explain two ways something was different at two dates (6 marks), part (b) to explain two causes (8 marks) and part (c) is a 16-mark essay on change, continuity or significance across the period.

How did public health law change between 1848 and 1875? The 1848 Public Health Act was voluntary, so many towns did nothing; the 1875 Act made councils provide clean water, drainage and medical officers.

What is a common part (c) mistake? Listing discoveries without comparing factors or judging which mattered most.

Are these real Edexcel past-paper questions? No. They are original questions written in the style of Pearson Edexcel International GCSE History 4HI1; use them alongside the official past papers and mark schemes.