Edexcel IGCSE History: Changes in Medicine, c1848–c1948 (4HI1)

Breadth Study B2, “Changes in medicine, c1848–c1948”, is one of eight breadth studies in change in Section B of Pearson Edexcel International GCSE History (4HI1) Paper 2. It follows a century of change, mainly in Britain, from a time when doctors did not know what caused disease and surgery was a race against pain and infection, to the discovery of germs and antibiotics and the founding of the National Health Service in 1948. Questions ask you to compare, explain causes of change and judge significance over long periods.

Related: Revision notes | Practice questions | Paper 2 overview

Syllabus coverage

The specification (Issue 5, February 2026) names five themes: changes in treatment and in understanding the cause of illness; public health; surgery; the role of women in medicine; and the impact of war and of science and technology. The (c) essay normally draws on two or more key topics. The five key topics are:

1. Progress in the mid-19th century: Nightingale, Chadwick, Snow and Simpson — barriers to progress, Nightingale at Scutari, the dangers of surgery and Simpson’s chloroform, Chadwick and the Public Health Act (1848), cholera and Snow.
2. Discovery and development, 1860–75: Lister and Pasteur — germ theory, Lister and antiseptics, the Public Health Act (1875), Nightingale and nursing, Elizabeth Garrett and women in medicine.
3. Accelerating change, 1875–1905: Ehrlich, Koch and chemistry — Koch and bacteriology, aseptic surgery, the 1875 Act’s effects, blood transfusion, magic bullets and Ehrlich, radioactivity and Marie Curie.
4. Government action and war, 1905–20 — the Liberal reforms (1906–11), and the First World War’s impact on women in medicine, treatment, surgery, X-rays, blood transfusion and fighting infection.
5. Advances in medicine, surgery and public health, 1920–48: the NHS — penicillin (Fleming, Florey and Chain), the Second World War and skin grafts, blood transfusion and women; Beveridge and the NHS.

What was medicine like in the mid-19th century?

The main barrier to progress was that no one knew what caused disease. Many believed in miasma — bad air from rotting matter. Industrial towns were overcrowded, with polluted water and no proper sewers, so diseases such as cholera and typhoid spread rapidly.

Public health. Edwin Chadwick’s report (1842) linked poor living conditions to disease and poverty. The Public Health Act 1848 set up a General Board of Health, but local boards were voluntary, so many towns did nothing. In the cholera epidemic of 1854 John Snow mapped deaths around the Broad Street pump in London; when the pump handle was removed, cases fell. He showed cholera was spread by water, but without knowing about germs he could not explain why.

Nursing. In the Crimean War Florence Nightingale took nurses to the army hospital at Scutari (1854). Cleanliness, better food and ventilation, together with improvements to the sanitation made by a government commission, reduced the death rate dramatically. On her return she set up a training school for nurses at St Thomas’ Hospital (1860).

Surgery faced three problems: pain, infection and bleeding. James Simpson discovered the anaesthetic properties of chloroform in 1847. Some patients died from overdoses, and some surgeons opposed it, but it gained acceptance after Queen Victoria used it in childbirth (1853). Anaesthetics allowed longer operations — which, without antiseptics, could increase deaths from infection.

How did germ theory change medicine, 1860–75?

Louis Pasteur proved in 1861 that microbes caused decay, publishing his germ theory. Joseph Lister applied it to surgery, using carbolic acid to clean wounds, instruments and dressings from 1865; death rates in his wards fell sharply, though many surgeons resisted the unpleasant spray. The Public Health Act 1875 made improvements compulsory: councils had to provide clean water, sewers and drainage and appoint medical officers of health. Nightingale’s influence raised the standard of nursing and hospital design. Elizabeth Garrett qualified through the Society of Apothecaries in 1865 and opened a dispensary for women; an Act of 1876 allowed women to qualify as doctors.

Why did change accelerate, 1875–1905?

Robert Koch founded bacteriology, identifying the germs causing anthrax (1876), tuberculosis (1882) and cholera (1883) using new staining techniques and better microscopes. Pasteur’s team developed vaccines for chicken cholera, anthrax and rabies. Surgery moved from antiseptic to aseptic methods — keeping germs out altogether with steam-sterilised instruments, gowns, masks and rubber gloves. Karl Landsteiner discovered blood groups in 1901, making safe transfusion possible. Paul Ehrlich searched for “magic bullets” — chemicals that would kill a specific germ; in 1909 his team found Salvarsan, a cure for syphilis. Wilhelm Röntgen discovered X-rays (1895), and Marie Curie’s work on radioactivity led to radium being used to treat cancer.

How did government and war change medicine, 1905–20?

The Liberal governments introduced free school meals (1906), school medical inspections (1907), old-age pensions (1908) and the National Insurance Act (1911), which gave workers free treatment from a doctor and sick pay. These measures were partly prompted by the poor health of Boer War recruits.

The First World War sped up change. Mobile X-ray units located bullets and shrapnel — Marie Curie organised such units in France. Methods of storing blood using sodium citrate and refrigeration made transfusion near the front possible. Harold Gillies pioneered plastic surgery for facial injuries, and infection was fought with wound cleaning and the removal of dead tissue. Women served as nurses, ambulance drivers and doctors — for example in Elsie Inglis’s Scottish Women’s Hospitals — changing attitudes to their role.

What were the advances of 1920–48?

Alexander Fleming noticed in 1928 that penicillin mould killed bacteria but could not produce it in quantity. Howard Florey and Ernst Chain in Oxford purified it and tested it on patients (1940–41). American government funding and industry mass-produced it during the Second World War, in time for D-Day (1944). The war also brought advances in skin grafts (Archibald McIndoe’s work with burned airmen), a national blood transfusion service and wider roles for women.

The Beveridge Report (1942) called for a welfare state to defeat the “five giants”, including disease. The Labour government’s Health Minister Aneurin Bevan launched the National Health Service on 5 July 1948, providing free treatment for all, paid for from taxation — the biggest change in public health of the period.

Frequently asked questions

Which factor mattered most: science or war? A classic (c) question. Science provided discoveries (Pasteur, Koch, Fleming); war provided urgency, funding and practice (X-rays, transfusion, penicillin).

Why was Snow’s discovery not accepted at once? Miasma theory was dominant, and he could not explain the mechanism until germ theory.

Why did the NHS matter? It made healthcare free at the point of use for everyone.

Official syllabus

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