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GCSE · History

EDX.MED11 The Role of Government and Legislation in Medical Change, c1250-1900

EDEXCEL 1HI0 · Calculators not allowed · about 65 minutes

Total Marks

Name: _______________________________ Date: ____ / ____ / ______

Answer ALL questions. Write in full sentences for Questions 14 and 15. You are advised to spend about 65 minutes on this pack.

Give the name of the 19th-century Act that established a central Board of Health with powers to inspect sanitation in England and Wales.

(Total for Question 1 is 1 mark)

Name one kind of local official in medieval towns who might be responsible for cleaning streets or regulating waste.

(Total for Question 2 is 1 mark)

State two actions that Tudor and Stuart plague orders could require when an outbreak occurred.

(Total for Question 3 is 2 marks)

Give the year of the Public Health Act that, by 1875, made sanitation duties compulsory for local authorities.

(Total for Question 4 is 1 mark)

Name one public health power that local boards could adopt under the 1848 Act.

(Total for Question 5 is 1 mark)

State one reason why many towns had regulations about waste and water supply in the medieval period.

(Total for Question 6 is 2 marks)

Name the informal 18th and early 19th-century attitude to government intervention in public health that limited central action.

(Total for Question 7 is 1 mark)

Give two duties that the 1875 Public Health Act required of local authorities.

(Total for Question 8 is 2 marks)

State one limitation of the central Board of Health set up by the 1848 Act.

(Total for Question 9 is 2 marks)

Name one practical sanitary measure often required by Victorian local authorities before 1875, such as in port towns or industrial districts.

(Total for Question 10 is 1 mark)

State two ways in which Tudor and Stuart plague orders sought to limit infection in towns.

(Total for Question 11 is 2 marks)

Explain one way in which medieval borough regulations on water and waste were similar to the public health duties imposed on local authorities by the Public Health Act 1875.

(Total for Question 12 is 4 marks)

Explain one way in which the Public Health Act 1848 represented a change from earlier nineteenth-century practice in England.

(Total for Question 13 is 4 marks)

Explain why government action in public health in Britain increased between c1700 and 1875.

You may use the following in your answer:
- changes in urban conditions and industrialisation
- the impact of publicised disease outbreaks and reports

You must also use information of your own.

(Total for Question 14 is 12 marks)

'Government legislation, not individual doctors or inventors, was the most important driver of improvement in public health before 1900.' How far do you agree? Explain your answer.

You may use the following in your answer:
- the role of national legislation such as the Public Health Acts
- the contribution of local officials and voluntary groups

You must also use information of your own. 4 marks are available for spelling, punctuation, grammar and the accurate use of specialist terms.

(Total for Question 15 is 20 marks)

Mark scheme · EDX.MED11 The Role of Government and Legislation in Medical Change, c1250-1900

Question 1

B1 Public Health Act 1848
Answer: Public Health Act 1848

Question 2

B1 a town beadle, a bailiff, or a town warden
Answer: A town beadle (or bailiff or town warden)

Question 3

B1 closing houses where infection was suspected
B1 appointing watchmen or searchers to enforce quarantine
Answer: E.g. closing infected houses and appointing watchmen to enforce quarantine.

Question 4

B1 1875
Answer: 1875

Question 5

B1 power to provide a sewer or drain, or to supply clean water, or to appoint a medical officer
Answer: For example, the power to provide sewers or drains.

Question 6

B1 to prevent contamination of water supplies used for drinking and washing
B1 supporting detail, e.g. dirty water or piles of waste created bad odours and could spread disease in crowded urban areas
Answer: To prevent contamination of water supplies, because dirty waste and foul water created bad smells and could spread disease in crowded towns.

Question 7

B1 laissez-faire
Answer: Laissez-faire

Question 8

B1 to provide clean water
B1 to provide proper sewage disposal
Answer: To provide clean water and proper sewage disposal.

Question 9

B1 it had limited powers over areas that refused to adopt local boards
B1 supporting detail, e.g. the central board could advise and encourage but could not force many localities to act
Answer: The Board had limited powers where towns refused local boards; it could advise but not always force action.

Question 10

B1 street cleaning or removal of night-soil or provision of paved streets
Answer: Street cleaning (or removal of night-soil).

Question 11

B1 isolating infected households by closing houses and marking them
B1 burning or disinfecting contaminated goods and restricting movement into and out of infected areas
Answer: They isolated infected houses and restricted movement, and ordered burning or disinfecting of contaminated goods.

Question 12

B2 identifies similarity, e.g. both required local officials to take responsibility for keeping water sources and streets clean
B2 supporting detail, e.g. medieval beadles or wardens enforced rules about waste near wells, while the 1875 Act obliged local councils to provide clean water and manage sewage, showing continuity in local sanitary responsibility
Answer: Both put responsibility on local officials to protect water and remove waste: medieval beadles enforced cleanliness around wells and streets, and the 1875 Act made local councils responsible for clean water and sewage disposal.

Question 13

B2 identifies change, e.g. the 1848 Act created a central Board of Health and a statutory framework for intervention
B2 supporting detail, e.g. earlier practice was largely laissez-faire and relied on voluntary action or ad hoc local measures, whereas 1848 introduced recognized central oversight and formal powers that localities could adopt
Answer: The 1848 Act introduced central oversight by creating a Board of Health and a statutory framework for local action, replacing the earlier reliance on voluntary, ad hoc local measures under laissez-faire government.

Question 14

Level 1 (1-3): Identifies one or two simple reasons for increased government action with little supporting detail.
Level 2 (4-6): Identifies and begins to explain some reasons, supported by some accurate detail and showing some links between causes.
Level 3 (7-9): Explains a range of reasons, each supported by accurate and relevant detail, and shows how they contributed to greater government involvement.
Level 4 (10-12): Provides a well-developed explanation that analyses several interconnected reasons for increased government action, supported throughout by precise and accurate detail and clear judgement about their relative importance.
Indicative content:
- Urbanisation and industrialisation increased the size and density of towns, producing overcrowded housing, poor drainage and contaminated water supplies that made disease more common and visible, creating pressure for public action.
- High-profile outbreaks, such as cholera epidemics in the 1830s and 1840s, and published reports like Edwin Chadwick's 1842 Report on the Sanitary Condition of the Labouring Population, publicised the links between environment and illness and persuaded politicians and the public that government action could prevent disease.
- The growth of statistical thinking and public health expertise gave authorities evidence to argue for intervention, for example data on mortality rates in towns versus rural areas.
- Economic and social arguments influenced reformers: employers and civic leaders wanted a healthy workforce and stable urban populations, so economic self-interest supported sanitary reform and encouraged government involvement.
- Changes in political culture, including greater willingness to reform social problems and the example of some effective local sanitation projects, made Parliament more ready to pass acts such as the 1848 Act and later the 1875 Act which made duties compulsory.

Question 15

Level 1 (1-4): Shows limited knowledge of the period and offers a simple, unsupported view on the statement.
Level 2 (5-8): Shows some relevant knowledge and begins to weigh the importance of legislation against other factors, but the argument is not well developed.
Level 3 (9-12): Shows good knowledge and gives a balanced evaluation of legislation and other contributors, reaching a supported judgement with some analysis of connections.
Level 4 (13-16): Shows precise, well-selected knowledge and evaluates in a sustained, balanced way the relative importance of legislation, local officials, voluntary bodies and medical advances, reaching a clear and supported judgement.
Indicative content:
- For government legislation as most important: Acts such as 1848 and 1875 created an organisational and legal framework that allowed systematic improvements in sewerage, water supply and street cleansing, and by making duties compulsory the 1875 Act ensured widespread action where voluntary measures had failed.
- For other contributors: local officials, boards of health and voluntary sanitary associations carried out practical work on sewers and water, and municipal engineers and surveyors provided the technical means for improvement, so local initiative and expertise were essential in implementing national laws.
- Medical and scientific developments, including growing acceptance of germ ideas late in the period and better medical statistics, helped justify and shape legislation, while public campaigns and reporting exposed conditions and mobilised public opinion, pressuring politicians to legislate.
- Limitations of legislation: the 1848 Act was permissive and depended on local adoption, showing that law alone did not guarantee improvement without local willingness and resources; conversely, by 1875 legislation made duties compulsory, showing law could be decisive when enforced.
- A balanced judgement might argue that legislation was the crucial turning point because it provided the necessary legal power and framework, but emphasise that without local officials, voluntary bodies and technical experts to carry out the work, legal change would have had limited impact.

The Role of Government and Legislation in Medical Change, c1250-1900 - Worksheets, Questions and Revision