Medicine and Public Health Through Time: KS3 History Study Pack

1. Introduction

Medicine is the study and practice of preventing, understanding and treating illness. Public health is about protecting the health of whole communities. It includes clean water, sewers, vaccination programmes, food safety, housing, hospitals, health education and government action.

This study pack looks at medicine and public health through time. It does not tell a simple story of everything getting better in a straight line. Some ideas improved quickly, while others stayed the same for centuries. Some treatments helped, some did little, and some could be harmful. Change was often uneven because it depended on science, technology, religion, communication, war, government, money, education and access to care.

British medicine was never separate from the wider world. Ancient Greek and Roman ideas influenced medieval Europe. Islamic scholars preserved, tested and developed medical knowledge. Trade, books, printing, translation and travel helped ideas move between societies. In the modern period, scientists and doctors from many countries contributed to germ theory, vaccines, surgery, antibiotics and public health.

When studying this topic, keep asking:

• What changed?
• What stayed the same?
• Why did change happen at different speeds?
• Who had access to care, and who did not?
• How useful is the evidence?
• Why might historians disagree about what mattered most?

2. Key Definitions

• Medicine: Knowledge and practice used to prevent, diagnose and treat illness or injury.
• Public health: Actions taken to improve the health of a whole population, such as clean water, sewers and vaccination.
• Four humours: An ancient Greek theory that the body contained four fluids: blood, phlegm, yellow bile and black bile. Illness was believed to come from imbalance.
• Miasma: The belief that disease was caused by bad air, often linked to smells from rotting waste.
• Germ theory: The scientific idea that many diseases are caused by microorganisms, such as bacteria and viruses.
• Vaccination: Giving a weakened, dead or harmless part of a disease-causing organism to help the body build immunity.
• Antiseptic: A substance or method used to prevent infection by killing or reducing germs, especially during surgery.
• Antibiotic: A medicine that kills or slows the growth of bacteria. Antibiotics do not work against viruses.
• Anatomy: The study of the structure of the body.
• Surgery: Medical treatment involving operations on the body.
• NHS: The National Health Service, created in Britain in 1948 to provide healthcare funded mainly through taxation and free at the point of use.
• Continuity: Something that stays the same over time.
• Change: Something that becomes different over time.
• Cause: A reason why something happened.
• Consequence: A result or effect of an event or development.
• Significance: The importance of a person, event or development, judged using criteria such as impact, scale and long-term effects.
• Quarantine: Separating people, ships or goods to reduce the spread of disease.
• Epidemic: A sudden outbreak of disease affecting many people in one area.
• Pandemic: A disease outbreak spreading across many countries or continents.
• Physician: A medically trained doctor, often focused on diagnosis and advice.
• Apothecary: A person who prepared and sold medicines.
• Barber-surgeon: A person who performed basic surgery, tooth pulling, bloodletting and similar procedures.
• Dissection: Cutting open a body to study its internal structure.
• Inoculation: An older method of deliberately introducing a disease, often in a mild form, to protect against a worse infection. It was used before modern vaccination.
• Immunity: The body's ability to resist a disease.

3. Timeline / Chronology

Date / Period	Development	Why It Matters
c. 460-370 BCE	Hippocrates works in ancient Greece	Linked illness to natural causes rather than only supernatural explanations.
c. 129-216 CE	Galen works in the Roman Empire	Developed influential ideas about anatomy and the four humours.
700s-1200s	Islamic medicine develops in centres such as Baghdad, Damascus and Cordoba	Scholars translated, preserved and added to Greek, Roman, Persian, Indian and other knowledge.
900s-1000s	Hospitals in the Islamic world provide treatment, teaching and care	Shows organised medical care existed outside medieval Europe and influenced later learning.
1300s	The Black Death spreads across Europe	Exposed limits of medieval medicine and encouraged some public health measures.
1348-1349	Major Black Death outbreak in England	Killed a large proportion of the population and shaped attitudes to disease.
1400s-1500s	Renaissance interest in observation and anatomy grows	More scholars questioned old authorities and studied the body directly.
1543	Andreas Vesalius publishes work on human anatomy	Corrected some of Galen's errors using dissection and observation.
1628	William Harvey explains the circulation of blood	Improved understanding of how the heart and blood vessels work.
1665	Great Plague of London	Government and local authorities used quarantine, pesthouses and bills of mortality.
1796	Edward Jenner tests vaccination against smallpox	Helped make smallpox prevention safer than older inoculation methods.
1848	First Public Health Act in Britain	Gave towns powers to improve water, drainage and sanitation, though early action was limited.
1854	John Snow investigates cholera in Soho, London	Used mapping and evidence to link cholera to contaminated water.
1858	The Great Stink in London	Smell from the Thames helped push Parliament to support major sewer improvements.
1860s	Louis Pasteur develops germ theory evidence	Helped show that microbes caused decay and disease.
1860s-1870s	Joseph Lister promotes antiseptic surgery	Reduced infection by using carbolic acid and cleanliness.
1870s-1880s	Robert Koch identifies specific bacteria causing diseases	Strengthened germ theory and laboratory medicine.
1875	Second Public Health Act in Britain	Made local councils responsible for sanitation, clean water and waste removal.
1928	Alexander Fleming notices penicillin's antibacterial effect	Important step towards antibiotics, though mass use came later.
1940s	Penicillin is mass-produced during and after the Second World War	Transformed treatment of many bacterial infections.
1948	NHS begins in Britain	Improved access to healthcare regardless of ability to pay.
1950s-1960s	Wider vaccination programmes expand	Reduced diseases such as polio, diphtheria and measles.
1980	Smallpox declared eradicated worldwide	A major global public health achievement using vaccination.
Late 1900s-present	New challenges include antibiotic resistance and health inequalities	Shows medicine continues to face limits and uneven access.

Simple Timeline

Ancient ideas -> Islamic knowledge transmission -> Medieval care and plague -> Renaissance anatomy -> Vaccination -> Public health reform -> Germ theory -> Antiseptic surgery -> Antibiotics -> NHS and vaccination programmes -> Modern challenges

4. Core Knowledge Sections

A. Ancient Ideas: Hippocrates, Galen and the Four Humours

Ancient Greek medicine was important because some thinkers argued that illness had natural causes. This did not mean everyone stopped believing in religion or supernatural explanations, but it did encourage observation and reasoning.

Hippocrates is often linked to the idea that doctors should observe patients carefully, record symptoms and look for natural explanations. The Hippocratic tradition encouraged doctors to think about diet, exercise, environment and lifestyle. This was significant because it moved some medical thinking away from blaming illness only on gods, curses or spirits.

The four humours theory became very influential. It claimed the body contained four fluids:

• blood
• phlegm
• yellow bile
• black bile

Health was believed to depend on keeping these humours balanced. If someone was ill, a doctor might recommend changing diet, resting, exercising, taking herbal remedies, vomiting, purging or bloodletting. These treatments were based on the idea of restoring balance.

Galen, a Greek doctor working in the Roman Empire, built on earlier ideas. He carried out animal dissections and used observation, but he also made mistakes because he could not always dissect human bodies. His writings became extremely respected in medieval Europe. For many centuries, doctors followed Galen because his work seemed logical, fitted with the four humours, and was supported by universities and religious authorities.

There was both change and continuity here. Ancient medicine encouraged natural explanations and careful observation, which was a change from purely supernatural explanations. However, the four humours continued to influence medicine for a very long time, even when some treatments were ineffective or harmful.

B. Medieval Islamic Medicine and Knowledge Transmission

Medieval Islamic medicine was a major part of world medical history. From the 700s onwards, scholars in the Islamic world translated medical texts from Greek, Roman, Persian, Indian and other traditions. Translation centres, libraries and hospitals helped preserve and spread knowledge.

Important centres of learning included Baghdad, Damascus, Cairo and Cordoba. Scholars did not simply copy older knowledge. Many discussed, organised, questioned and developed it. Medical writers such as Ibn Sina, known in Europe as Avicenna, wrote works that were later used in European universities. Al-Razi, known in Europe as Rhazes, wrote about diseases including smallpox and measles.

Hospitals in parts of the Islamic world could provide care, teaching and sometimes separate wards for different illnesses. They were often supported by charitable funding. Doctors could learn from patients and from written medical texts. Pharmacy and the preparation of medicines also developed.

Knowledge travelled through trade, conquest, translation, pilgrimage and contact between cultures. In medieval Spain and Sicily, Arabic medical texts were translated into Latin. These translations helped European scholars access ancient and Islamic medical knowledge.

This matters because it challenges a simple Europe-only story of medical progress. British and European medicine were shaped by wider-world knowledge. Medical progress often depended on communication across cultures, not just on one country or one individual.

C. Medieval European Medicine: Care, Religion and Everyday Treatment

In medieval Europe, medicine included a mixture of natural, religious and practical ideas. Many people believed illness could be caused by an imbalance of the humours, bad air, punishment from God, astrology, poor diet or contact with infection. These explanations could exist together. A person might pray, visit a healer and take a herbal remedy.

Care was provided by different people:

• physicians, who diagnosed illness and advised wealthier patients
• apothecaries, who prepared and sold medicines
• barber-surgeons, who carried out basic operations and bloodletting
• midwives, who supported childbirth
• monks and nuns, who cared for the sick in religious houses
• family members and local healers, who provided most everyday care

Medieval hospitals were often more about care than cure. Many were linked to monasteries or religious charities. They might provide food, shelter, prayer and nursing for the poor, elderly, travellers or sick people. Some hospitals avoided patients with contagious disease, while others focused on specific conditions, such as leprosy.

Religion could both help and limit medical change. Religious ideas encouraged charity and care for the sick. Monasteries preserved books and provided hospitals. At the same time, respect for old authorities and religious explanations could sometimes discourage questioning. However, it is too simple to say religion always blocked medicine. The relationship was mixed.

Everyday treatment often used herbs, diet, rest and prayer. Some herbal remedies may have had useful effects, while others did not. Surgery was risky because there was no modern anaesthetic, limited understanding of infection and no antibiotics. Pain, blood loss and infection made operations dangerous.

D. Plague, Miasma and Quarantine

The Black Death reached England in 1348 and caused huge death rates. It was part of a wider pandemic across Eurasia and North Africa. Many historians believe bubonic plague, caused by the bacterium Yersinia pestis, was a major cause, though historians and scientists continue to study the details of how it spread.

Medieval people tried to explain plague using the knowledge available to them. Explanations included:

• miasma, or bad air
• punishment from God
• movements of the planets
• imbalance of the humours
• contact with infected people or goods

Some responses were religious, such as prayer and processions. Others were practical, such as cleaning streets, shutting infected houses, avoiding strangers, burning strong-smelling herbs, and using quarantine. Quarantine developed especially in port cities, where ships, goods and travellers could be held before entering.

Miasma theory was wrong about the exact cause of many diseases, but it was not completely useless in practice. If people cleaned up rotting waste because they feared bad smells, this could sometimes reduce disease risks by improving sanitation. This is a good example of why we should not mock past people. They worked with the evidence and ideas available to them.

The plague also shows limits in public health. Authorities could issue rules, but they lacked microscopes, germ theory, antibiotics and modern laboratories. They did not fully understand bacteria, fleas, rats or transmission. Their actions could reduce contact, but they could not cure plague effectively.

E. Renaissance Anatomy: Vesalius and Harvey

The Renaissance was a period of renewed interest in learning, observation and the human body. Printing helped spread books more quickly. Artists and anatomists studied bodies in greater detail. Some scholars began to question ancient authorities such as Galen.

Andreas Vesalius was important because he studied human anatomy through dissection and published detailed illustrations in 1543. He showed that some of Galen's ideas were wrong because Galen had relied partly on animals. Vesalius did not create modern medicine by himself, but he showed the importance of direct observation.

William Harvey, an English physician, published his explanation of the circulation of blood in 1628. He argued that the heart acted as a pump and that blood circulated around the body. This challenged older ideas and improved understanding of physiology, which is how the body works.

These developments did not immediately cure disease. Better anatomy did not automatically mean better treatments for ordinary people. Surgery still remained dangerous because pain and infection were major problems. However, Renaissance anatomy mattered because it changed methods. Observation, experiment, dissection, diagrams and printed books became more important.

F. Jenner and Vaccination

Smallpox was a feared disease that killed many people and left others with scars or blindness. Before vaccination, some people used inoculation, which involved deliberately giving someone a small amount of smallpox material. This could protect them, but it was risky because the person might develop serious smallpox and spread it to others.

Edward Jenner, an English doctor, investigated the idea that people who had caught cowpox, a milder disease, seemed protected from smallpox. In 1796 he tested this idea. His work helped develop vaccination against smallpox. The word vaccination comes from vacca, the Latin word for cow.

Jenner was significant, but he was not the only person involved in prevention. Ideas about inoculation had travelled from other parts of the world, including Asia and the Ottoman Empire, before becoming known in Britain. Lady Mary Wortley Montagu helped introduce smallpox inoculation to Britain after seeing it in the Ottoman Empire. African knowledge also played a role in the history of inoculation in the Atlantic world. This shows that medical change often depended on global knowledge transmission.

Vaccination faced opposition. Some people feared it was unsafe, unnatural or against religion. Others distrusted doctors or government. Over time, evidence showed vaccination reduced smallpox deaths. Governments became more involved in vaccination, especially in the nineteenth and twentieth centuries.

Vaccination prevents disease by training the immune system. It is different from antibiotics, which treat bacterial infections after someone is already infected. This difference is a common KS3 mistake.

G. Nineteenth-Century Public Health: Cholera, Cities and Government

The nineteenth century brought rapid industrialisation and urbanisation in Britain. Towns and cities grew quickly as people moved for factory work. Many working-class areas had overcrowded housing, polluted water, poor drainage and overflowing waste. These conditions helped diseases spread.

Cholera was one of the most feared diseases. It caused severe diarrhoea and dehydration and could kill quickly. Many people believed cholera was spread by miasma. This seemed believable because dirty areas smelled bad and often had more disease. However, cholera is actually spread mainly through water or food contaminated with human waste containing the cholera bacterium.

John Snow investigated a cholera outbreak in Soho, London, in 1854. He mapped deaths and noticed that many victims used water from the Broad Street pump. When the pump handle was removed, the outbreak declined, though historians point out the outbreak may already have been slowing. Snow's work was important because it used evidence, mapping and careful reasoning to link disease to water.

Edwin Chadwick also influenced public health. His 1842 report argued that poor sanitation caused disease and that improving drainage and water supplies would save money and lives. Chadwick believed strongly in miasma, so his theory of disease was not fully correct. However, his solutions often improved public health because clean water and sewers reduced waterborne disease.

The 1848 Public Health Act allowed local boards of health to improve sanitation, but it was not strong enough everywhere. The 1875 Public Health Act was more effective because it made local authorities responsible for clean water, sewers, rubbish collection and public health officers. Government action became more important as people accepted that health was not only a private matter.

The Great Stink of 1858 helped push change in London. Hot weather made the polluted River Thames smell terrible near Parliament. This encouraged politicians to support Joseph Bazalgette's major sewer system. It shows how political pressure, technology, engineering and public discomfort could combine to create reform.

H. Germ Theory: Pasteur and Koch

Germ theory transformed medicine because it explained that microorganisms could cause disease. Before germ theory, many people believed in miasma or spontaneous generation, the idea that living things could arise from decay. Germ theory developed gradually through experiments, microscopes and laboratory work.

Louis Pasteur, a French scientist, showed that microbes caused fermentation and could spoil liquids. His work helped challenge spontaneous generation and supported the idea that microbes had specific effects. Pasteur also contributed to vaccines, including work on rabies and anthrax.

Robert Koch, a German doctor and scientist, helped identify specific bacteria that caused specific diseases, including anthrax, tuberculosis and cholera. His laboratory methods helped make germ theory more precise. Germ theory became more convincing when scientists could identify, grow and study microbes.

Germ theory changed medicine in several ways:

• It improved understanding of how disease spread.
• It supported cleaner surgery and hospital practice.
• It encouraged vaccination research.
• It helped public health campaigns focus on water, hygiene and infection control.
• It supported laboratory diagnosis.

However, germ theory did not solve everything immediately. Many people still lacked clean water, decent housing or access to doctors. Some diseases were viral and harder to treat. Scientific discoveries needed government action, money, trained staff and public trust to become widely useful.

I. Lister and Antiseptic Surgery

Before modern antiseptic and aseptic methods, surgery was extremely dangerous. Even if a patient survived the operation, infection could kill them afterwards. Surgeons often operated in ordinary clothes and did not always wash hands, instruments or bandages carefully. They did not understand germs.

Joseph Lister used Pasteur's ideas about microbes and applied them to surgery. In the 1860s he began using carbolic acid to clean wounds, instruments and dressings. His antiseptic methods reduced infection rates.

Lister's work was significant because it connected scientific theory with practical hospital change. It also shows how one development can depend on another. Lister's antiseptic surgery relied on germ theory, chemical technology and communication through medical journals.

Not all surgeons accepted Lister's ideas at once. Carbolic spray could irritate skin and was unpleasant. Some doctors doubted the theory or found the methods difficult. Over time, antiseptic methods were improved, and aseptic surgery developed. Aseptic surgery aims to prevent germs entering the wound in the first place, using sterilised instruments, gloves, masks and clean operating theatres.

Surgery also improved because of anaesthetics. Ether and chloroform began to be used in the nineteenth century to reduce pain, although they carried risks. Better anaesthetics, antiseptics, blood transfusion and later antibiotics made more complex surgery possible.

J. Twentieth-Century Medicine: Antibiotics, the NHS and Vaccination Programmes

The twentieth century saw major medical changes, but access remained uneven. Scientific discoveries mattered, but so did government, war, industry and public funding.

Alexander Fleming noticed in 1928 that a mould called Penicillium killed bacteria in a laboratory dish. This discovery was important, but penicillin did not become widely available immediately. In the 1930s and 1940s, scientists including Howard Florey and Ernst Chain helped develop penicillin as a usable medicine. During the Second World War, governments and pharmaceutical companies supported mass production. Penicillin then saved many lives from bacterial infections.

Antibiotics changed treatment of diseases such as pneumonia, infected wounds and some sexually transmitted infections. However, antibiotics do not work against viruses, such as the common cold or influenza. Overuse and misuse of antibiotics can lead to antibiotic resistance, where bacteria evolve so medicines become less effective.

The NHS began in Britain in 1948. Before this, access to healthcare often depended on money, charity, insurance, local services or workplace schemes. The NHS aimed to provide healthcare free at the point of use. This was a major change in access and public health. It did not remove all inequalities, but it reduced the barrier of direct payment for many patients.

Vaccination programmes expanded in the twentieth century. Diseases such as diphtheria, polio, measles, mumps and rubella were reduced through organised vaccination. Public health campaigns, school medicine, health visitors and record keeping helped reach more children.

War also influenced medicine. The First and Second World Wars created urgent need for better surgery, blood transfusion, infection control, rehabilitation and emergency care. War caused terrible harm, but it also increased government spending and medical organisation. This is an example of a factor that could speed up medical change while also causing suffering.

K. Factors Causing Change

Medical change rarely has one cause. It usually happens when several factors work together.

Factor	How It Helped Change	Example
Science	Improved understanding of the body and disease	Germ theory, anatomy, laboratory medicine
Technology	Provided tools for investigation and treatment	Microscopes, printing, X-rays, sterilisation equipment
Government	Passed laws, funded services and organised public health	Public Health Acts, NHS, vaccination programmes
War	Created urgent need and funding for medical improvements	Penicillin mass production, blood transfusion
Religion	Supported care and charity, but could sometimes encourage traditional explanations	Monastic hospitals, religious charity
Communication	Spread ideas through books, journals, translation and education	Printing of Vesalius's anatomy book, medical journals
Individuals	Made discoveries, campaigned or connected ideas	Jenner, Snow, Pasteur, Koch, Lister
Economy	Wealth and industry affected what could be built or supplied	Sewers, hospitals, pharmaceutical production
Public pressure	Forced governments to act	Great Stink, fear of cholera

The most important factor depends on the period and question. For example, government was crucial for public health reform, but science was crucial for germ theory. Individuals mattered, but they usually depended on wider conditions.

L. Limits and Inequalities in Access to Healthcare

Medicine did not improve equally for everyone. Access often depended on wealth, gender, class, race, empire, location and education.

In medieval and early modern Britain, wealthy people could pay physicians, while poorer people relied more on family care, charity, local healers or hospitals. Women provided much everyday healthcare as mothers, midwives and carers, but they were often excluded from universities and formal medical professions.

In the nineteenth century, working-class urban communities often suffered from overcrowding and poor sanitation. Public health reforms improved conditions, but slowly and unevenly. Rural areas had different problems, including distance from hospitals and doctors.

Empire also shaped medicine. European empires collected knowledge, resources and data from colonised regions, often in unequal and exploitative ways. Some medical campaigns helped reduce disease, but colonial healthcare frequently prioritised soldiers, officials, trade and control rather than equal care for local populations.

Even after the NHS, inequalities continued. Poverty, housing, diet, pollution, disability, racism, region and education could still affect health. Public health is therefore not only about doctors and hospitals. It is also about living conditions, work, environment and fairness.

5. People, Places and Events

Key People

Person	Period	Significance
Hippocrates	Ancient Greece	Linked illness to natural causes and careful observation.
Galen	Roman Empire	Developed influential anatomy and humoural theories used for centuries.
Ibn Sina / Avicenna	Medieval Islamic world	Wrote major medical texts used across Islamic and European learning.
Al-Razi / Rhazes	Medieval Islamic world	Wrote important medical works and descriptions of diseases.
Andreas Vesalius	Renaissance Europe	Used human dissection to improve anatomy and challenge Galen.
William Harvey	Early modern England	Explained circulation of blood.
Lady Mary Wortley Montagu	Eighteenth-century Britain and Ottoman Empire	Helped introduce smallpox inoculation to Britain.
Edward Jenner	Eighteenth-century England	Developed vaccination against smallpox.
Edwin Chadwick	Nineteenth-century Britain	Campaigned for sanitary reform using public health reports.
John Snow	Nineteenth-century London	Used mapping and evidence to link cholera to contaminated water.
Joseph Bazalgette	Nineteenth-century London	Engineered London's modern sewer system.
Louis Pasteur	Nineteenth-century France	Developed evidence for germ theory and contributed to vaccines.
Robert Koch	Nineteenth-century Germany	Identified bacteria causing specific diseases.
Joseph Lister	Nineteenth-century Britain	Developed antiseptic surgery.
Alexander Fleming	Twentieth-century Britain	Discovered penicillin's antibacterial effect.
Howard Florey and Ernst Chain	Twentieth century	Helped develop penicillin into a usable medicine.
Aneurin Bevan	Twentieth-century Britain	Health minister linked to the creation of the NHS.

Key Places

• Ancient Greece: Important for natural explanations and the Hippocratic tradition.
• Roman Empire: Galen worked in this wider imperial setting.
• Baghdad: Major centre of translation and learning in the medieval Islamic world.
• Cordoba: Centre of learning in Islamic Spain, important for knowledge transmission.
• Monasteries: Important places of care, charity and book preservation in medieval Europe.
• London: Site of plague outbreaks, cholera investigations, the Great Stink and sewer reform.
• Soho, London: John Snow's Broad Street pump investigation took place here.
• Hospitals and laboratories: Became increasingly important in modern medicine.

Key Events

• Development of four humours theory.
• Growth of Islamic hospitals and medical scholarship.
• Black Death in Europe.
• Renaissance anatomical studies.
• Jenner's smallpox vaccination.
• Cholera outbreaks in nineteenth-century Britain.
• Public Health Acts of 1848 and 1875.
• Development of germ theory.
• Lister's antiseptic surgery.
• Mass production of penicillin.
• Creation of the NHS.
• Expansion of vaccination programmes.

6. Sources and Evidence

Historians use different types of evidence to study medicine:

• medical books and university texts
• hospital records
• government reports
• laws and public health acts
• maps and disease data
• diaries and letters
• images of hospitals, streets or operations
• archaeological evidence, such as skeletons and medical tools
• newspapers and posters
• statistics about death rates and vaccination

When using a source, ask:

• Who made it?
• When was it made?
• What does it say or show?
• What was its purpose?
• Who was its audience?
• What was happening at the time?
• What are its limits?
• How does it compare with other evidence?

Source A: Medieval Medical Advice

An invented extract based on common medieval medical ideas:

"If a patient is feverish and restless, the physician should consider whether the blood is too hot and too plentiful. Let the patient avoid heavy foods, rest in a clean room, and take a cooling drink made from herbs. If the signs continue, bleeding may restore balance."

Questions:

1. What does the source suggest medieval doctors believed caused illness?
2. Which phrase shows the idea of balancing the humours?
3. How useful is this source for understanding medieval treatment?
4. What are its limitations?

Guidance:

• The source suggests illness could be explained through the four humours.
• "Bleeding may restore balance" is useful evidence.
• It is useful for ideas and treatments, but it does not prove all medieval people used the same treatment.

Source B: Vaccination Source Extract

An invented extract based on late eighteenth-century debates:

"Some parents in the town now bring their children to receive the cowpox vaccination, believing it may protect them from smallpox. Others refuse, saying the practice is new and they cannot yet trust it. The doctor keeps records of those who later fall ill."

Questions:

1. What does the source say people hoped vaccination would do?
2. What does it suggest about opposition to vaccination?
3. Why is the doctor's record keeping important?
4. How could a historian check whether vaccination worked?

Source C: Cholera Map Description

Visual source description:

A map of a London neighbourhood in 1854 shows black marks for cholera deaths. The marks are clustered around one public water pump. Streets further away from the pump have fewer marks. A workhouse and brewery nearby have fewer deaths than expected because they used different water supplies.

Questions:

1. What pattern does the map show?
2. What inference could John Snow make from this pattern?
3. Why is map evidence useful for studying public health?
4. What other evidence would make the conclusion stronger?

Source D: Public Health Data Table

Invented but historically plausible data for a growing industrial town:

Year	Estimated Population	Houses With Piped Clean Water	Recorded Cholera Deaths
1849	80,000	18%	420
1854	95,000	25%	360
1866	130,000	52%	140
1880	160,000	78%	35

Questions:

1. What happened to the population between 1849 and 1880?
2. What happened to access to clean water?
3. What happened to recorded cholera deaths?
4. Does the table prove clean water caused cholera deaths to fall? Explain carefully.

Good answer point:

The table shows a strong link between more clean water and fewer cholera deaths, but it does not prove clean water was the only cause. Other changes, such as sewers, public health laws and better reporting, may also have mattered.

Source E: Surgery Image Description

Visual source description:

An illustration from the 1870s shows a surgeon operating in a hospital theatre. Assistants stand close by. A spray device releases carbolic acid mist near the patient. Some people wear ordinary clothing rather than modern sterile gowns.

Questions:

1. What does the image show about antiseptic surgery?
2. What does it show had not yet changed fully?
3. How useful is this image for studying Lister's methods?
4. What questions should a historian ask about the image's creator and purpose?

7. Interpretations

An interpretation is someone's explanation of the past. Historians may agree about facts but disagree about which causes were most important.

Interpretation 1: Individuals Drove Medical Progress

This interpretation argues that key people were the main reason medicine changed. It points to Jenner, Snow, Pasteur, Koch, Lister and Fleming. These individuals made discoveries, challenged old ideas or introduced new methods.

Strengths:

• Individuals made real contributions.
• Their work can be linked to specific changes.
• They often showed courage, persistence or careful thinking.

Limits:

• Individuals depended on earlier knowledge.
• They needed technology, funding, institutions and communication.
• Some discoveries were ignored until society was ready to use them.

Interpretation 2: Government and Public Health Were Most Important

This interpretation argues that medicine improved most when governments took responsibility for health. It points to public health laws, sewers, vaccination programmes and the NHS.

Strengths:

• Government action affected millions of people.
• Public health could prevent disease before treatment was needed.
• Laws and funding could reduce inequality.

Limits:

• Governments often acted slowly.
• Scientific knowledge was needed to guide action.
• Local resistance and cost could limit change.

Interpretation 3: Science and Technology Were the Main Drivers

This interpretation focuses on microscopes, laboratories, anatomy, germ theory, antiseptics, antibiotics and vaccines.

Strengths:

• Scientific understanding changed diagnosis and treatment.
• Technology allowed new discoveries and safer procedures.
• Germ theory transformed public health and surgery.

Limits:

• Science alone did not guarantee access.
• Poor communities could still suffer from bad housing and pollution.
• Public trust and government organisation were needed.

Balanced Judgement

The strongest answer usually combines factors. For example, Lister's antiseptic surgery depended on Pasteur's science, hospital practice, chemical technology, medical journals and surgeons willing to change. The NHS depended on government, public demand, wartime experience, taxation and political decisions. Medical progress was caused by connected factors, not by one hero or one invention.

8. Tables

Disease Explanation Comparison Table

Explanation	Periods Used	Main Idea	Strengths in Context	Problems
Supernatural	Ancient, medieval and later	Illness caused by gods, spirits, sin or punishment	Matched religious worldviews and gave meaning	Did not identify physical causes or reliable cures
Four humours	Ancient to early modern	Illness caused by imbalance of body fluids	Encouraged natural explanations, diet and observation	Led to harmful treatments such as excessive bloodletting
Miasma	Medieval to nineteenth century	Disease caused by bad air and smells	Encouraged cleaning streets and removing waste	Could not explain waterborne or person-to-person infection accurately
Contagion	Used in different periods	Disease spread by contact with infected people or goods	Supported quarantine and isolation	Often lacked detail about how disease spread
Germ theory	Nineteenth century onwards	Microorganisms cause many diseases	Supported modern public health, surgery and vaccines	Not all diseases are bacterial; access to treatment remains unequal

Public Health Data Table

Public Health Problem	Common Cause	Public Health Response	Example
Cholera	Contaminated water	Clean water, sewers, waste removal	Broad Street pump investigation, Public Health Acts
Smallpox	Viral infection	Vaccination	Jenner's vaccine and later vaccination programmes
Industrial disease	Pollution and poor working conditions	Factory laws, inspection, housing reform	Nineteenth-century urban reforms
Tuberculosis	Bacteria, overcrowding and poor living conditions	Better housing, diagnosis, antibiotics, vaccination in some contexts	Nineteenth and twentieth-century campaigns
Antibiotic resistance	Overuse or misuse of antibiotics	Careful prescribing, research, infection control	Modern public health challenge

Factor Ranking Grid

Use this grid to rank factors in different periods. Give each factor a score from 1 to 5, where 5 means very important.

Period / Development	Science	Technology	Government	War	Religion	Communication	Individuals
Medieval hospitals	2	1	2	1	5	3	2
Renaissance anatomy	4	4	1	1	2	5	4
Smallpox vaccination	4	2	3	1	2	4	5
Public Health Acts	3	4	5	1	1	4	3
Germ theory	5	5	2	1	1	4	5
Penicillin	5	5	4	5	1	4	4
NHS	3	3	5	3	1	4	3

These scores are arguable. A strong historian explains the ranking with evidence rather than just giving numbers.

Individual Significance Cards

Individual	Most Significant Contribution	Limits of Their Contribution
Hippocrates	Encouraged natural explanations and observation	Later followers could still use ineffective treatments
Galen	Organised medical ideas that lasted centuries	Some anatomy was wrong and his authority slowed change
Ibn Sina	Organised medical knowledge in influential texts	Textbook knowledge did not always produce cures
Vesalius	Improved anatomy through dissection	Did not solve infection, pain or disease treatment
Jenner	Developed smallpox vaccination	Built on earlier inoculation knowledge and faced opposition
Snow	Used evidence to link cholera to water	Germ theory was not yet fully accepted
Pasteur	Provided evidence supporting germ theory	Others developed disease-specific laboratory proof
Koch	Identified specific bacteria	Laboratory discoveries needed public health action
Lister	Reduced surgical infection	Methods took time to spread and improve
Fleming	Noticed penicillin's effect	Others developed and mass-produced it
Bevan	Helped create the NHS	Health inequalities continued after 1948

9. Text / ASCII Diagrams and Timelines

Cause and Consequence Chain: Public Health Reform

Industrialisation -> rapid city growth -> overcrowded housing and polluted water -> cholera outbreaks and high death rates -> reports by reformers such as Chadwick -> public fear and political pressure -> Public Health Acts -> sewers, clean water and waste removal -> fewer waterborne disease outbreaks

Medical Progress Is Not a Straight Line

Ancient observation | v Four humours accepted for centuries -----> continuity | v Renaissance anatomy questions Galen -----> change in knowledge | v Germ theory explains infection ----------> major change | v Access still unequal --------------------> continuity and limitation

Source Evaluation Grid

Question	What To Think About
Content	What does the source say or show?
Provenance	Who made it, when and where?
Purpose	Why was it made?
Audience	Who was meant to read or see it?
Context	What was happening at the time?
Usefulness	What can it help us understand?
Limitations	What does it leave out or possibly distort?

Comparing Vaccination and Antibiotics

Vaccination: prevents disease before infection -> trains immune system -> often used for viruses and bacteria -> public health programme

Antibiotics: treat bacterial infection after infection -> kill or slow bacteria -> do not work on viruses -> resistance can develop

10. Common Mistakes

• Thinking medicine only improved steadily: Medicine changed unevenly. Some ancient ideas lasted for centuries, and some modern problems remain unsolved.
• Mocking past ideas without context: Miasma and humours were wrong in important ways, but they seemed logical using the knowledge available at the time.
• Assuming one individual caused all change alone: Jenner, Pasteur, Lister and Fleming mattered, but they depended on earlier knowledge, technology, funding and communication.
• Confusing vaccination and antibiotics: Vaccination prevents disease by preparing the immune system. Antibiotics treat bacterial infections.
• Thinking public health is only about doctors: Public health also involves engineers, councils, laws, clean water, housing, education and government.
• Ignoring Islamic and global knowledge contributions: European medicine was influenced by knowledge from the Islamic world and other global traditions.
• Confusing Galen and Hippocrates: Hippocrates is linked to natural explanations and observation; Galen developed influential anatomy and humoural ideas.
• Thinking Renaissance anatomy immediately cured disease: It improved knowledge of the body but did not solve infection or pain.
• Forgetting inequality: Medical progress did not reach everyone equally.
• Using sources at face value: Always consider provenance, purpose, audience and limitations.
• Writing only description: KS3 history answers should explain why changes happened and why they mattered.
• Overstating the Great Stink: It did not create public health by itself, but it helped push sewer reform in London.

11. Exam Tips

• For describe questions, give clear features or details.
• For explain questions, use because, therefore and this meant that.
• For compare questions, include both similarity and difference.
• For how far questions, give both sides and a judgement.
• For how useful questions, discuss content and provenance.
• For significance questions, judge importance using impact, scale, duration and consequences.
• For change and continuity, write about what changed and what stayed the same.
• For factor questions, avoid choosing a factor without evidence. Explain why one factor mattered more than another.
• Use precise examples: Jenner and smallpox, Snow and cholera, Lister and antiseptic surgery, the NHS in 1948.
• Do not just say "medicine got better". Explain what improved, for whom, and why.
• A strong paragraph often follows this pattern: Point, Evidence, Explanation, Link.

Example paragraph:

Government was very important in nineteenth-century public health because individual doctors could not build sewers or force towns to provide clean water. For example, the 1875 Public Health Act made local authorities responsible for sanitation, water and waste removal. This mattered because diseases such as cholera spread more easily where water was contaminated. Therefore, government action helped turn medical knowledge into practical improvements for whole communities.

12. Practice Questions

A. Quick Recall Questions

1. What is public health?
2. Name the four humours.
3. Who was Galen?
4. What was miasma theory?
5. What was the Black Death?
6. Why were medieval monasteries important for care?
7. Name one centre of medieval Islamic medical learning.
8. What did Vesalius study?
9. What did William Harvey explain?
10. What disease did Jenner's vaccination help prevent?
11. What is the difference between inoculation and vaccination?
12. What disease did John Snow investigate in 1854?
13. What was the Broad Street pump?
14. What did the 1875 Public Health Act do?
15. What is germ theory?
16. Name one scientist linked to germ theory.
17. What did Joseph Lister use carbolic acid for?
18. What are antibiotics used against?
19. When did the NHS begin?
20. Give one reason access to healthcare was unequal.

B. Multiple Choice Questions

Choose one answer for each question.

1. Public health mainly means: A. Treating only wealthy patients
   B. Improving health across whole communities
   C. Studying only bones
   D. Performing surgery only

2. The four humours were: A. Four hospitals
   B. Four body fluids believed to affect health
   C. Four types of plague
   D. Four public health laws

3. Hippocrates is mainly linked to: A. Natural explanations and observation
   B. Antibiotics
   C. The NHS
   D. X-rays

4. Galen's ideas lasted a long time partly because: A. Nobody could read them
   B. They were respected by universities and fitted existing beliefs
   C. He invented penicillin
   D. They were based on germ theory

5. Medieval Islamic medicine was important because: A. It stopped all disease
   B. It preserved and developed knowledge from many cultures
   C. It rejected all hospitals
   D. It had no contact with Europe

6. A medieval apothecary: A. Built sewers
   B. Prepared and sold medicines
   C. Invented vaccination
   D. Ran Parliament

7. Miasma theory blamed disease on: A. Bad air
   B. Bacteria seen under microscopes
   C. Antibiotics
   D. Vaccination

8. Quarantine means: A. Mixing infected and healthy people
   B. Separating people or goods to prevent disease spread
   C. Studying anatomy
   D. Removing a pump handle

9. Vesalius was significant because he: A. Improved anatomy through human dissection
   B. Created the NHS
   C. Discovered penicillin
   D. Built London sewers

10. William Harvey explained: A. The circulation of blood
    B. The cause of cholera
    C. Smallpox vaccination
    D. Antibiotic resistance

11. Jenner's vaccination was used against: A. Cholera
    B. Smallpox
    C. Tuberculosis
    D. Influenza

12. Lady Mary Wortley Montagu is linked to: A. Introducing knowledge of smallpox inoculation to Britain
    B. Building the NHS
    C. Discovering bacteria
    D. Writing the Public Health Act

13. Cholera is mainly spread through: A. Contaminated water or food
    B. Broken bones
    C. Lack of exercise only
    D. Cowpox vaccination

14. John Snow used which method in his cholera investigation? A. Mapping deaths near a water pump
    B. Dissecting animals
    C. Bloodletting
    D. Creating antibiotics

15. Edwin Chadwick argued for: A. Better sanitation
    B. More bloodletting
    C. Ending all hospitals
    D. Less clean water

16. The Great Stink happened in: A. 1543
    B. 1628
    C. 1858
    D. 1948

17. Germ theory states that: A. All disease comes from bad smells
    B. Many diseases are caused by microorganisms
    C. Illness is always caused by the stars
    D. Surgery is impossible

18. Pasteur was a scientist from: A. France
    B. England
    C. Germany
    D. Greece

19. Robert Koch helped identify: A. Specific bacteria causing specific diseases
    B. The four humours
    C. The NHS budget
    D. The first monastery

20. Lister used carbolic acid to: A. Prevent infection in surgery
    B. Build sewers
    C. Vaccinate against smallpox
    D. Treat viral colds with antibiotics

21. Antiseptic means: A. Designed to reduce or kill germs
    B. Against government
    C. A type of humour
    D. A medieval tax

22. Penicillin is: A. An antibiotic
    B. A vaccine against smallpox
    C. A sewer system
    D. A theory of bad air

23. Fleming noticed penicillin's effect in: A. 1348
    B. 1543
    C. 1796
    D. 1928

24. The NHS began in: A. 1848
    B. 1875
    C. 1948
    D. 1980

25. Antibiotics work against: A. Bacterial infections
    B. All viruses
    C. Broken bones only
    D. Poverty directly

26. A major modern problem with antibiotics is: A. Antibiotic resistance
    B. Miasma balance
    C. Too much quarantine in 1348
    D. Printing errors in Vesalius

27. Which factor was especially important for building sewers? A. Government and engineering
    B. Astrology only
    C. Bloodletting
    D. Dissection only

28. Which statement is most accurate? A. Medicine improved in a simple straight line
    B. One person caused all medical progress
    C. Medical change was uneven and caused by many factors
    D. Public health had nothing to do with government

29. The NHS changed healthcare access because: A. It made care free at the point of use
    B. It ended all disease
    C. It abolished vaccination
    D. It stopped doctors using evidence

30. A historian should evaluate a source by considering: A. Content, provenance, purpose and context
    B. Only whether it is old
    C. Only whether it is colourful
    D. Only whether it agrees with them

C. Source Questions

Use Source B in Section 6.

1. Identify one reason some parents accepted vaccination.
2. Identify one reason some parents refused vaccination.
3. What does the source suggest about trust in new medicine?
4. How useful is the source for studying attitudes to vaccination?

Use Source D in Section 6.

5. Describe the trend in clean water access.
6. Describe the trend in cholera deaths.
7. Explain one possible link between these trends.
8. Why must historians be careful when using this table?

Use Source E in Section 6.

9. What does the image description show about surgery in the 1870s?
10. What does it suggest about continuity in surgical practice?
11. How could the source be useful to a historian?
12. What limitation might it have?

D. Short Answer Questions

1. Describe two features of four humours theory.
2. Explain one way Islamic medicine influenced later European medicine.
3. Describe one role of medieval hospitals.
4. Explain why plague was difficult to control in the fourteenth century.
5. Describe one way Renaissance medicine challenged Galen.
6. Explain why printing helped medical change.
7. Describe one difference between inoculation and vaccination.
8. Explain why cholera encouraged public health reform.
9. Describe one way germ theory changed medicine.
10. Explain why Lister's work was significant.
11. Describe one way war helped medical development.
12. Explain one reason healthcare access remained unequal.

E. Longer Written Questions

1. Explain why medicine changed slowly in the medieval period.
2. How significant was Islamic medicine in the development of medical knowledge?
3. Explain why public health improved in nineteenth-century Britain.
4. How far was germ theory the most important turning point in medicine?
5. Compare medieval and nineteenth-century explanations of disease.
6. Which factor was most important in medical progress: science, government, individuals, technology or war? Explain your judgement.
7. How useful is John Snow's cholera map evidence for understanding public health?
8. Explain change and continuity in surgery from the medieval period to the twentieth century.

13. Answer Key

Quick Recall Answers

1. Public health means actions to improve the health of whole communities.
2. Blood, phlegm, yellow bile and black bile.
3. A Greek doctor in the Roman Empire whose ideas influenced medicine for centuries.
4. The belief that disease was caused by bad air.
5. A major plague pandemic that reached England in 1348.
6. They provided care, charity, prayer, shelter and preserved learning.
7. Baghdad, Damascus, Cairo or Cordoba.
8. Human anatomy.
9. The circulation of blood.
10. Smallpox.
11. Inoculation used smallpox material and was riskier; vaccination used cowpox to protect against smallpox.
12. Cholera.
13. A public water pump linked to cholera deaths in Soho.
14. It made local authorities responsible for sanitation, water and waste removal.
15. The idea that microorganisms cause many diseases.
16. Pasteur or Koch.
17. To reduce infection in surgery.
18. Bacterial infections.
20. Wealth, class, gender, race, location, empire, poverty, housing or education.

Multiple Choice Answers

1. B
2. B
3. A
4. B
5. B
6. B
7. A
8. B
9. A
10. A
11. B
12. A
13. A
14. A
15. A
16. C
17. B
18. A
19. A
20. A
21. A
22. A
23. D
24. C
25. A
26. A
27. A
28. C
29. A
30. A

Short Answer Guidance

1. Four humours theory said the body contained four fluids and illness came from imbalance.
2. Islamic scholars translated and developed medical texts that later reached European universities.
3. Medieval hospitals provided care, food, shelter, prayer and nursing, often rather than cures.
4. Plague was hard to control because people lacked germ theory, antibiotics and full understanding of transmission.
5. Vesalius used human dissection to correct some of Galen's errors.
6. Printing spread diagrams and medical arguments more quickly and accurately.
7. Inoculation involved smallpox material; vaccination used cowpox and was safer.
8. Cholera exposed the dangers of polluted water and overcrowded cities.
9. Germ theory helped doctors understand infection and encouraged hygiene, vaccines and laboratory medicine.
10. Lister reduced surgical infection by using antiseptic methods.
11. War increased urgency, funding and organisation for surgery, blood transfusion and antibiotics.
12. Access remained unequal because poverty, location, discrimination and housing affected health.

14. Model Answers

Model Answer 1: Explain why medicine changed slowly in the medieval period.

Medicine changed slowly in medieval Europe for several reasons. One reason was the strong influence of old authorities such as Galen. His ideas about the four humours were taught in universities and seemed to fit with existing beliefs about balance in the body. This meant many physicians repeated older ideas rather than testing them.

Another reason was limited technology. Without microscopes, doctors could not see bacteria or understand germs. Surgery was also dangerous because there were no modern anaesthetics, antiseptics or antibiotics. Even when surgeons had practical skill, infection and pain limited what they could do.

Religion also shaped medicine. Religious care could help the sick through hospitals, charity and nursing, but some people also explained disease as punishment from God. This did not always stop practical treatment, but it could make supernatural explanations important.

However, medicine did not completely stand still. Islamic scholars preserved and developed medical knowledge, and hospitals provided organised care in different parts of the world. Medieval people used herbs, observation and quarantine. Overall, change was slow because old ideas, limited technology and lack of scientific understanding made it difficult to challenge traditional medicine.

Model Answer 2: How significant was Islamic medicine in the development of medical knowledge?

Islamic medicine was highly significant because it helped preserve, organise and develop medical knowledge from many cultures. Scholars translated Greek, Roman, Persian and Indian texts into Arabic. This meant ancient knowledge was not lost and could be studied by later generations.

Islamic medicine was also significant because scholars added to earlier ideas. Writers such as Ibn Sina and Al-Razi produced important medical works. Hospitals in cities such as Baghdad and Damascus provided care and teaching. This shows that medicine was not only theoretical but also connected to institutions.

Its long-term significance can be seen in knowledge transmission. Arabic medical texts were later translated into Latin and used in European universities. This influenced medieval and Renaissance learning.

The significance should not be exaggerated as if Islamic medicine solved all medical problems. Many treatments were still limited by the lack of germ theory and modern technology. Even so, Islamic medicine was very important because it connected world knowledge, supported hospitals and shaped later European medicine.

Model Answer 3: Explain why public health improved in nineteenth-century Britain.

Public health improved in nineteenth-century Britain because industrial cities created serious health problems that became impossible to ignore. Overcrowded housing, dirty water and poor drainage helped diseases such as cholera spread. High death rates put pressure on reformers and politicians to act.

Individuals helped by gathering evidence. Edwin Chadwick's 1842 report argued that poor sanitation caused disease and that cleaner towns would save money. John Snow's 1854 cholera investigation used mapping to link deaths to the Broad Street pump, supporting the idea that contaminated water spread cholera.

Government action was also important. The 1848 Public Health Act allowed towns to create boards of health, though it was limited. The 1875 Public Health Act was stronger because it made local councils responsible for clean water, sewers and waste removal. This meant public health became a government responsibility, not just a private issue.

Technology and engineering mattered too. Joseph Bazalgette's sewer system in London helped remove waste from the city. Overall, public health improved because evidence, fear of disease, government laws, engineering and public pressure worked together.

Model Answer 4: How far was germ theory the most important turning point in medicine?

Germ theory was a very important turning point because it changed understanding of disease. Before germ theory, many people believed in miasma or humoural imbalance. Pasteur and Koch helped show that microorganisms caused many diseases. This supported cleaner surgery, laboratory diagnosis, vaccination research and better public health.

Germ theory was especially important for surgery. Joseph Lister applied Pasteur's ideas by using carbolic acid to reduce infection. This made operations safer and helped surgery develop. Germ theory also helped public health officials understand why clean water and hygiene mattered.

However, germ theory was not important on its own. Scientific knowledge needed technology such as microscopes and laboratories. It also needed government action to improve water supplies and sanitation. Poor people could still suffer if they lacked clean housing or access to doctors. Earlier developments, such as vaccination and anatomy, were also significant.

Overall, germ theory was one of the most important turning points because it changed the explanation of disease. But its impact depended on other factors, especially technology, government, communication and practical application.

Model Answer 5: Which factor was most important in medical progress?

The most important factor in medical progress depends on the period, but government was especially important for public health because it could improve conditions for whole populations. For example, the 1875 Public Health Act made local authorities responsible for clean water, sewers and waste removal. Individual doctors could not achieve this alone.

Science was also crucial. Germ theory explained why hygiene and clean water mattered, while antibiotics changed treatment of bacterial infection. Without scientific understanding, many reforms would have been based on incomplete explanations.

Individuals mattered because people such as Jenner, Snow, Pasteur, Koch and Lister made discoveries or applied ideas in new ways. However, they usually depended on wider factors. Jenner built on earlier inoculation knowledge. Lister depended on Pasteur's germ theory. Fleming's discovery needed other scientists, war funding and industry before penicillin became widely useful.

Overall, the strongest judgement is that no single factor always mattered most. Government was most important for public health and access, science was most important for understanding disease, and individuals helped connect ideas to action. Medical progress happened when factors worked together.

15. Final Revision Checklist

• key dates
• key people
• key events
• causes
• consequences
• change and continuity
• source skills
• interpretations
• exam questions

Before finishing revision, check that you can:

• explain the four humours and why the theory lasted
• describe the importance of medieval Islamic medicine
• explain the role of monasteries and hospitals in medieval care
• compare miasma, humours and germ theory
• explain why plague was difficult to control
• describe the significance of Vesalius and Harvey
• explain Jenner's contribution to vaccination
• describe why cholera led to public health reform
• explain the importance of Snow, Chadwick and Bazalgette
• explain germ theory using Pasteur and Koch
• describe Lister's antiseptic surgery
• explain why antibiotics changed medicine
• describe why the NHS was significant
• explain why access to healthcare remained unequal
• rank factors for medical progress with evidence
• evaluate a source using content, provenance, purpose and context
• write a balanced judgement about the most important factor in medical progress