Answer ALL questions. Write in full sentences for Questions 15 and 17. You are advised to spend about 65 minutes on this pack. The final 4 marks on Question 17 are for spelling, punctuation, grammar and use of specialist terminology.
1
Name the street pump that became central to John Snow's investigation in Soho.
(Total for Question 1 is 1 mark)
2
Give the name of the map feature Snow used to show each death or case on his Soho map.
(Total for Question 2 is 1 mark)
3
Give one piece of equipment or technique John Snow used to show the pattern of cholera cases around the pump.
(Total for Question 3 is 1 mark)
4
Name one immediate effect on public behaviour or local policy after the Broad Street pump handle was removed.
(Total for Question 4 is 1 mark)
5
Name one piece of contextual evidence Snow used, apart from the map, to support his case that the Broad Street pump water caused the outbreak.
(Total for Question 5 is 1 mark)
6
Give two reasons why many medical professionals in the 1850s continued to support miasma theory despite Snow's findings in 1854.
(Total for Question 6 is 2 marks)
7
State one reason why John Snow believed the Broad Street pump was the source of the cholera outbreak.
(Total for Question 7 is 2 marks)
8
Give the name of the physician who published work rejecting the miasma idea and arguing a waterborne cause for cholera before germ theory was established.
(Total for Question 8 is 1 mark)
9
State one limitation of John Snow's argument at the time, which slowed wider acceptance of his findings.
(Total for Question 9 is 2 marks)
10
State two reasons why mapping and local enquiry were effective methods for Snow's investigation.
(Total for Question 10 is 2 marks)
11
Explain why John Snow's Broad Street investigation was important in the development of public health practice in Britain.
You may use the following in your answer: - Snow's use of mapping and case enquiries to identify a local source - the immediate effect of removing the Broad Street pump handle
You must also use information of your own.
(Total for Question 11 is 12 marks)
12
'John Snow's Broad Street investigation proved that cholera was spread through contaminated water, and so it changed public health policy immediately.' How far do you agree? Explain your answer. The final 4 marks are for spelling, punctuation, grammar and the use of specialist terminology.
(Total for Question 12 is 20 marks)
Mark scheme · 1.10 The Cholera Epidemic of 1854 and John Snow's Broad Street Investigation
Question 1
B1 the Broad Street pump
Answer: The Broad Street pump
Question 2
B1 dots (dot map)
Answer: Dots, creating a dot map of cases
Question 3
B1 a dot map plotting deaths or cases
Answer: A dot map plotting cholera deaths or cases
Question 4
B1 fewer people used the pump and cases around it declined
Answer: Fewer people used the pump and cholera cases around it declined.
Question 5
B1 detailed enquiries showing some victims drank the pump water even though they lived away from Broad Street
Answer: Enquiries showing victims who lived away had drunk Broad Street pump water.
Question 6
B1 miasma theory was long established and widely taught, so many doctors trusted it
B1 there was a lack of microbiological evidence identifying a specific germ to explain cholera transmission
Answer: Miasma theory was long established and trusted, and there was no microbiological proof of a specific germ at the time.
Question 7
B1 most cholera deaths were clustered close to the Broad Street pump
B1 some victims who lived further away had used water from that pump, linking cases to the pump
Answer: Most cholera deaths were clustered around the pump, and some victims who lived further away had used water from that pump.
Question 8
B1 John Snow
Answer: John Snow
Question 9
B1 the dominant medical view was miasma theory, which many doctors and officials still accepted
B1 lack of a known specific germ or laboratory evidence to prove a waterborne agent
Answer: Many doctors still believed miasma theory, and there was no identified germ or laboratory proof at the time.
Question 10
B1 mapping revealed a clear spatial pattern that pointed to a local source
B1 local enquiries provided individual case details that linked victims to the pump even when they lived further away
Answer: Mapping showed a spatial cluster pointing to a local source, and enquiries provided case details linking victims to the pump.
Question 11
Level 1 (1-3): Identifies one or two simple reasons why Snow's investigation mattered, with little or no supporting detail.
Level 2 (4-6): Identifies and begins to explain one or two reasons, supported by some accurate detail and showing some links between cause and effect.
Level 3 (7-9): Explains several reasons clearly, each supported by accurate and relevant detail, and begins to place Snow's work in a wider context.
Level 4 (10-12): Provides a well-developed explanation of several reasons why Snow's investigation was important, supported throughout by precise and accurate detail and showing clear links between Snow's methods, immediate effects and longer term influence on public health practice.
Indicative content:
Snow introduced systematic data collection and mapping to identify the likely source of an outbreak, an approach that underpins modern epidemiology.
His local enquiries and case histories provided evidence linking individuals to a water source, showing how combining qualitative and spatial evidence strengthens causal claims.
The removal of the Broad Street pump handle provided a practical intervention that coincided with a fall in local cases, demonstrating the value of targeted public health action.
Although Snow's waterborne theory did not immediately overturn miasma thinking, his methods influenced later sanitary investigators and public health officials who began to use evidence-based approaches.
Snow's work helped shift attention to the role of contaminated water supplies, contributing to later improvements in water and sewage provision even before germ theory was fully accepted.
A top answer will link Snow's methods and immediate success with the gradual change in public health practice, explaining both direct and indirect consequences rather than simply asserting importance.
Question 12
Level 1 (1-4): Shows limited relevant knowledge and offers a simple, unbalanced judgement with little supporting evidence.
Level 2 (5-8): Shows some relevant knowledge and offers a partly developed judgement, but the argument lacks depth or balance.
Level 3 (9-12): Shows good relevant knowledge, evaluates both the extent of Snow's proof and the speed of policy change, and reaches a supported judgement with some analysis.
Level 4 (13-16): Shows precise and well-selected knowledge, gives a balanced evaluation of the strength of Snow's evidence and the pace of change in public health policy, and reaches a sustained, well-supported judgement, using specialist terms accurately.
Indicative content:
Arguments agreeing with the statement: Snow's mapping and enquiries provided strong local evidence that the Broad Street pump was linked to the outbreak, and removal of the pump handle coincided with a fall in local cases, showing immediate practical effect.
Snow presented a clear causal explanation based on spatial and case data, which anticipated later epidemiological methods and focused attention on water contamination as a likely route of transmission.
Arguments disagreeing with the statement: Snow did not identify a causal microbe, and many medical professionals continued to believe miasma theory, so his findings did not lead to immediate, nationwide policy change.
Acceptance of Snow's ideas was slow; broader policy shifts in water and sewage infrastructure developed over subsequent decades and were influenced by many factors beyond the Broad Street case.
Balanced points: Snow's work was an important early demonstration that localised, evidence-based interventions could work, but the change to public health policy was gradual, dependent on further evidence and institutional shifts rather than on a single study.
A strong answer will weigh Snow's clear local success against the limited immediate impact on national medical consensus and policy, and will explain why the case influenced later developments without producing an immediate nationwide policy transformation.