'Changes in Medicine, c1848-c1948' is one of the eight Paper 2 Section B breadth studies in change. Students study only one of them, so work through this option only if it is one of your chosen options.
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Unlock This CourseAround 1848, medicine had already made some progress. Edward Jenner's smallpox vaccine (1796) worked and was widely used. Yet in most ways doctors were almost helpless against common killer diseases, such as cholera, typhoid and tuberculosis. Surgery was agonising and often fatal. A big reason was simple: nobody knew what caused disease. Without knowing the cause, doctors could not find a cure or a way of preventing it.
Throughout this option you will look at change over time: what changed, what stayed the same, and why. Here we ask why change was so slow at the start of the period.
Key terms:
Most doctors believed that disease spread through foul-smelling air from rotting waste, dirty water and swamps. The word 'malaria' comes from the Italian for 'bad air'. The idea had a little truth in it, because filthy places really were dangerous. But it pointed people at the smell, not at the real cause, so the cure was to remove smells, not germs.
Under the microscope, scientists could see tiny living things in rotting food and in the bodies of sick people. Most thought they were produced by the decay or by the illness itself, appearing from nothing. They did not think they were the cause. So nobody looked for germs as the reason people fell ill.
These beliefs blocked progress because they were believed by respected doctors, and they seemed to fit what people could see. Until someone proved that germs cause disease, treatments and prevention had no firm basis. You will see how this changed in the lesson called Pasteur and the Germ Theory.
Most politicians believed it was not the government's job to force landlords, factory owners or local councils to clean up towns. Better water and sewers cost money, and ratepayers did not want to pay more tax. Improvements were therefore slow and patchy.
Many doctors learned mainly by working alongside an older doctor, with little scientific study. Until the Medical Act of 1858 there was no official register of qualified doctors, so patients could not easily tell trained doctors from quacks. Nurses had no proper training at all.
Microscopes were not good enough to show bacteria clearly. Methods for staining and growing bacteria in the laboratory had not yet been invented. Without them, doctors could not identify which germ caused which disease.
Treatments reflected this lack of knowledge. Some doctors still bled patients or used leeches, and many people relied on herbal remedies and patent medicines that did nothing. Hospitals were mostly paid for by charity and were often dirty. Nobody understood germs, so infections spread easily.
Things were changing in 1848, but slowly. Doctors were beginning to study disease in a more scientific way, and vaccination for smallpox was already in use even though nobody knew why it worked. What stayed the same was the thinking: miasma and spontaneous generation still ruled. The breakthroughs came in the following decades, once the cause of disease was understood.
Explain TWO causes of the slow progress in medicine in the middle of the 19th century. [8 marks]
One cause was the lack of understanding of what caused disease. Most doctors in the 1840s believed in miasma, the idea that disease came from bad air rising from rotting waste. Many also believed in spontaneous generation, so when microscopes showed tiny living things in rotting food or sick patients, they thought the decay produced them. As nobody saw germs as the cause, doctors looked for the wrong cures and efforts to prevent disease were aimed at smells rather than germs. This meant no real treatment or prevention was found.
A second cause was the laissez-faire attitude of the government. Most politicians believed that it was not their job to force people or councils to clean up the towns, and ratepayers resisted the cost of sewers and clean water. Because of this, towns stayed dirty and diseases such as cholera spread easily. With little government money or pressure, medical research and public health reform went ahead only slowly.
What lifts this to the top level: each cause is developed with precise knowledge, and each paragraph explains how the cause led to slow progress, rather than just naming it.
In an 'Explain TWO causes' question, write two separate paragraphs. Name the cause, add precise detail, then use the phrase 'this meant that...' to link it back to the outcome in the question.