Edexcel IGCSE History: Changes in Medicine, c1848–c1948 — Revision Notes

Quick-recall notes for Breadth Study B2 of Pearson Edexcel International GCSE History 4HI1 Paper 2, “Changes in medicine, c1848–c1948”. Full explanations are in the B2 study guide; practise with the B2 practice questions.

Syllabus coverage (4HI1, Breadth Study B2)

Key topic	Core content
1. Mid-19th century	Barriers, Nightingale at Scutari, surgery’s dangers, Simpson, Chadwick, 1848 Act, Snow
2. 1860–75	Pasteur, germ theory, Lister, 1875 Act, nursing, Elizabeth Garrett
3. 1875–1905	Koch, aseptic surgery, 1875 Act’s effects, blood transfusion, Ehrlich, Curie
4. 1905–20	Liberal reforms; First World War: women, X-rays, transfusion, surgery, infection
5. 1920–48	Penicillin, Second World War, skin grafts, transfusion, women, Beveridge, NHS

Timeline

Date	Event
1842	Chadwick’s report on sanitary conditions
1847	Simpson discovers chloroform as an anaesthetic
1848	Public Health Act (voluntary)
1853	Queen Victoria uses chloroform
1854	Snow and the Broad Street pump; Nightingale at Scutari
1860	Nightingale School of Nursing
1861	Pasteur’s germ theory
1865	Lister uses carbolic acid; Elizabeth Garrett qualifies
1875	Public Health Act (compulsory)
1876	Women allowed to qualify as doctors
1882	Koch identifies the tuberculosis germ
1895	Röntgen discovers X-rays
1901	Landsteiner discovers blood groups
1906–11	Liberal reforms; National Insurance Act (1911)
1909	Ehrlich’s team finds Salvarsan
1914–18	First World War: mobile X-rays, stored blood, plastic surgery
1928	Fleming notices penicillin
1940–41	Florey and Chain test purified penicillin
1942	Beveridge Report
1944	Penicillin mass-produced in time for D-Day
5 July 1948	NHS begins

Themes traced across the century

Theme	c1848	c1900	c1948
Cause of illness	Miasma	Germ theory accepted; bacteriology	Antibiotics target germs
Treatment	Few effective cures	Vaccines; first magic bullet (1909)	Penicillin
Public health	Voluntary (1848)	Compulsory (1875)	Liberal reforms, then NHS
Surgery	Pain, infection, bleeding; chloroform	Antiseptic then aseptic; blood groups	Transfusion service; skin grafts
Women	Nightingale’s nursing	Women doctors allowed (1876)	Wartime roles expanded
War, science, technology	Crimea	Microscopes, X-rays	Two world wars accelerate change

Key individuals

Person	Contribution
Nightingale	Hygienic nursing; nurse training
Chadwick	Linked dirt and disease; 1848 Act
Snow	Cholera spread by water (1854)
Simpson	Chloroform anaesthetic
Pasteur	Germ theory; vaccines
Lister	Antiseptic surgery
Garrett	First woman to qualify in Britain via the Apothecaries
Koch	Identified specific germs
Ehrlich	Magic bullets; Salvarsan
Curie	Radioactivity; mobile X-rays in war
Fleming, Florey, Chain	Penicillin
Beveridge, Bevan	Welfare state; NHS

Key terms

Term	Meaning
Miasma	Belief that disease came from bad air
Germ theory	Microbes cause disease and decay
Anaesthetic	Substance that removes pain
Antiseptic	Killing germs in wounds and on instruments
Aseptic	Preventing germs reaching the wound
Bacteriology	Study of bacteria
Magic bullet	Chemical that kills one specific germ
Antibiotic	Drug, such as penicillin, that kills bacteria

Worked example: explain two ways different

Explain two ways in which surgery in 1850 was different from surgery in 1900. (6 marks)

1. Infection: in 1850 surgeons operated in ordinary clothes with unwashed instruments, so infection killed many; by 1900 aseptic methods (sterilised instruments, gowns, gloves) kept germs out.
2. Understanding: in 1850 surgeons did not know germs caused infection; by 1900 germ theory, from Pasteur and Koch, explained it and guided practice.

Essay plan in outline

“War was the main reason for change in medicine in the years c1848–c1948.” How far do you agree?

• For war: Crimea brought Nightingale to prominence; the First World War spread mobile X-rays, blood storage and plastic surgery and widened women’s roles; the Second World War funded mass production of penicillin, advanced skin grafting and led to the NHS.
• Against: the key discoveries came in peacetime — chloroform (1847), germ theory (1861), Lister (1865), Koch, blood groups (1901), Fleming (1928); public health acts and Liberal reforms were peacetime government action.
• Judgement: war accelerated and spread changes; science and government usually began them.

Common mistakes and exam traps

• Confusing antiseptic and aseptic.
• Saying Fleming developed penicillin. He noticed it; Florey and Chain made it usable.
• Mixing up the two Public Health Acts. 1848 voluntary; 1875 compulsory.
• Treating war as only positive. It sped up some changes but also diverted resources.
• Narrating one discovery. (c) answers must cover change across the period.

Frequently asked questions

Why was there little progress before 1860? No knowledge of germs, belief in miasma, and limited government action.

What was the significance of germ theory? It explained disease and led to antiseptics, vaccines and targeted cures.

Why was the NHS created in 1948? Wartime experience, the Beveridge Report and Labour’s election victory.

Source

Pearson Edexcel International GCSE History (4HI1) specification, Issue 5, February 2026, Paper 2, Breadth Study B2.