Syllabus Edition
First teaching 2024
First exams 2026
Treatments for Disease in the 18th & 19th Century (Edexcel GCSE History)
Revision Note
Advances in 18th and 19th Century Treatments - Summary
Methods of treatment had significantly changed by 1900. By the end of the 19th century, many medical professionals had accepted Germ Theory. This led to the development of more effective care and treatments. In the 18th century, hospitals were busy and unhygienic. Nurses were not medically trained. By the 19th century, hospitals had clean wards, staffed by professionally trained nurses. The experiences of Florence Nightingale helped to transform British hospitals. They also helped nursing to become a respected profession. Nurses became regarded as healthcare professionals. Surgery underwent many improvements. In c.1250, surgery was often deadly due to blood loss, shock and infection. This was still the case during the Renaissance. During the 19th century, Joseph Lister reduced infection rates by using antiseptics. He discovered the benefits of carbolic acid in cleaning wounds. The ongoing developments of anaesthetics eliminated death by shock. James Simpson found chloroform, an effective anaesthetic with reduced side effects. Queen Victoria used chloroform during the birth of her eighth child in 1853. This increased chloroform's popularity and its use in more complex surgical procedures. Methods of care and treatment were still not fully effective. Diseases like syphilis still evaded treatment and people continued to die from minor injuries. Hospitals were not accessible to the poor who could not afford to pay medical bills. Antiseptics prevented infection from spreading but aseptic surgery took time to implement. It was hard to give patients the correct dose of anaesthetics like chloroform, which meant many people died during procedures. Patients continued to lose too much blood in operations. Surgeons had no methods available to replace blood until the development of effective blood transfusions in the 20th century. |
What were Hospitals Like in the 18th Century?
Positives | Negatives |
|---|---|
Curing patients - The focus had changed to providing medical treatments. Doctors, apothecaries and surgeons were all on-site | Unsafe - The rich received many of their medical treatments, including surgery, at home |
Increased access - The Deserving Poor who could afford medical care could access trained doctors for the first time | Selective - Hospitals turned away the Idle Poor who could not pay their medical bills |
Isolation - Wards separated patients with infectious diseases from other patients | Unhygienic - More infectious patients were being treated in hospitals. Doctors did not understand Germ Theory so did not wash their hands between patients |
More hospitals - When Henry VIII dissolved the monasteries, hospital numbers decreased. By the mid-19th century, hospital numbers had increased | Availability - Wealthy donors established hospitals. Some parts of Britain had too many hospitals, others did not have enough to meet the demand |
Florence Nightingale and Nursing Improvements
Who was Florence Nightingale?
Nightingale became superintendent of nurses at King’s College, London in 1853
In Britain, at this time, nursing was not considered a respectable profession
The public thought nurses were drunk and uncaring
Nightingale worked in the Crimean War. Whilst there, she:
Demanded that areas near patients be clean
Organised the nurses to provide more efficient treatment
Insisted on clean bedding, ventilation and good meals
After Nightingale's intervention, mortality rates dropped from 40% to 2%
Nightingale returned to England as a national hero in 1856, ready to improve British hospitals
The Impact of Florence Nightingale in Britain
Nightingale wrote Notes on Nursing (1859)
The book outlined nurse training, behaviour and the best care for patients
In 1860, Nightingale established the Nightingale School for Nurses at St Thomas’ Hospital in London
This school still exists today as part of King's College London
Nurse education included training on good hygiene and sanitation
Nursing became a respected, skilled profession for women
The number of nurses grew and many were from middle-class families
Nightingale influenced hospital design by:
Insisting on easily cleanable materials to be used in the building of hospitals
Promoting ‘pavilion style’ hospitals. Built on open ground the hospitals had separate wings with wards for infectious diseases
Improvements in Hospitals
Issues with 18th century hospitals | Hospitals by 1900 |
|---|---|
Hospitals were considered unsafe | Hospitals established specialist departments and equipment for different procedures. They strived to attract student doctors by providing modern facilities |
Some hospitals turned away those that could not pay | The issue of paying for medical care remained an issue |
Conditions in hospitals were unhygienic | Staff used antiseptics and constantly cleaned. Hospitals adopted aseptic practices to remove any possibility of germs |
Some areas lacked the number of hospitals required to meet demand | Many areas still did not have the hospitals they needed |
Worked Example
Describe a feature of a hospital by 1900
2 marks
Answers:
Hospitals by 1900 were focused on hygiene (1). They understood Germ Theory and used antiseptics to avoid spreading infections (1).
Exam Tip
This question previously asked students to describe two features of a given event. This question was out of four marks. However, as of 2025, Edexcel will split this question into two subsections, asking you to describe a feature of two different events. Each subsection is worth two marks.
When answering ‘Describe a feature of…’ questions, two marks are given to you for:
Identify - write a relevant point based on the question topic. For example, hospitals were focused on hygiene
Describe - add some specific own knowledge about the point you have made. For example, specific references to Germ Theory and antiseptics
The Development of Anaesthetics
Early Developments in Anaesthetics
Laughing gas (nitrous oxide) had proved successful for smaller operations like tooth extractions
Humphry Davy, a dentist’s assistant, had discovered the pain relief properties of laughing gas in 1795
American surgeon Dr Crawford Long used ether in 1846. He successfully removed a tumour from a patient’s neck
Ether created excitement amongst doctors as an anaesthetic
There were problems with ether including:
It made patients vomit
It irritated the lungs, causing the patient to cough even when they were unconscious
The chemical was flammable
This was dangerous in an operating theatre lit by gas lamps or candles
There was a desire within the medical community to discover an effective anaesthetic which had fewer side effects
James Simpson and Chloroform
Simpson gathered his friends in 1847 and smelt various chemicals
Simpson was attempting to discover a better anaesthetic than laughing gas
After smelling chloroform, Simpson and his friends passed out for some time
This confirmed the potential of chloroform as an anaesthetic
Risks and rewards of chloroform
Risks | Rewards |
|---|---|
It was easy to overdose and kill a patient | It was better than other anaesthetics at the time for reducing pain |
It could affect the heart, causing young, healthy patients to die. Hannah Greener was only 14 years old when she died under chloroform during a toenail removal | Simpson gained attention receiving a knighthood for his services to medicine. Having the Queen’s support made anaesthetics more accepted by the public |
Longer, more complicated surgeries caused more issues with infection and bleeding | Longer, more complex surgeries forced advancements in antiseptics |
Worked Example
Explain one way in which methods of pain relief in the years c1250-c1500 were different to methods of pain relief in the 18th and 19th centuries.
4 marks
Answers:
One way in which methods of pain relief were different from the Medieval period to the 18th and 19th centuries was the use of chemicals (1). In the Medieval period, barber surgeons had no understanding of the properties of certain chemicals (1), they relied on their patients biting down on wood to relieve pain (1) whereas, in 1847, Simpson discovered the chemical chloroform. Smelling the chemical made a patient unconscious. This removed the pain a patient would feel during surgery (1).
Exam Tip
In this style of question, you must either identify a similarity or a difference between the two time periods. To answer this question well, make sure that you:
Identify a clear similarity or difference
Give a clear example from both time periods
Use words like 'similarly' or 'whereas' to compare the two time periods
Lister & Antiseptics
Surgery in the 18th Century
Surgeons in the 18th century did not understand the importance of cleanliness
They did not clean the operating theatre
They did not wash their hands before or after surgery
Their aprons were not washed as a stained coat showed a surgeon’s experience
Surgical equipment was not washed between operations
Operating theatres were busy
Medical students watched the surgeon to gain practical knowledge
‘Dressers’ were tasked to hold the patient still
Many patients died post-surgery
Issues like gangrene and sepsis were to blame for a lot of deaths
Exam Tip
The status and reputations of 18th and 19th-century surgeons were related speed at which they could operate. Robert Liston, known as ‘the fastest knife in the West End,’ became famous for amputating a leg in just under 3 minutes. Some reports stated he managed to reduce this to 28 seconds. Performing to the crowds in the operating theatre was more important than improving a patient’s health.
Joseph Lister and Carbolic Acid
Pasteur’s Germ Theory inspired Lister
Lister noticed that flesh rotted
If microbes caused wine and vinegar to go bad, Lister believed they could also be causing flesh to rot
He wanted to develop an antiseptic which would stop the flesh from rotting
Carbolic acid was a pre-existing product
It eliminated bad smells in the new sewage system which was being built in London
In 1865, Lister soaked a bandage with carbolic acid and applied it to a broken leg after performing an operation on the break
The wound was observed after the operation
It healed without infection
This discovery led to spraying carbolic acid into the air to monitor the impact
He published his findings in the medical journal The Lancet, providing examples of 11 successful operations where carbolic spray was used
Risks and Rewards of Carbolic Acid
Risks | Rewards |
|---|---|
Carbolic spray dried out the skin and had an unpleasant smell. It made surgeon's hands sore | Lister encouraged surgeons to use carbolic acid. He believed practical success would convince more surgeons to use antiseptics than explaining the science |
In the short term, surgeons did not understand the science behind Germ Theory. They were not willing to use carbolic spray. Lister stopped using carbolic acid in 1890 | In the long term, carbolic acid changed attitudes. It encouraged scientists to discover new antiseptic methods. By 1900, it paved the way for aseptic surgery |
Opposition to Antiseptics and Anaesthetics
Aseptic Methods
By 1900, surgeons had developed methods of aseptic surgery
A number of strategies were used by medical staff, they all:
Washed their hands, face and arms before entering an operating theatre
Wore rubber gloves and gowns
Covered their faces with masks
Surgical equipment was sterilised in boiling steam
Charles Chamberland, a French scientist, invented a machine called an autoclave to clean the equipment
They removed bacteria from the air in the operating theatre
The air was heated to kill microbes and then pumped into the room
German surgeons Neuber and von Bergmann developed this method
These methods increased the safety of surgery in the 1900s
Exam Tip
When comparing treatments in the Renaissance to the 19th century, it may be hard to judge progress. Pasteur’s breakthrough discovery of germs allowed medical professionals to better understand the causes of disease but improvements in treatment took longer. Part of this was due to public and professional resistance to accept and apply Germ Theory.
Another factor is that early treatments using Germ Theory had many damaging side effects. You should state that 19th-century treatments were experimental but underpinned by science. It was only a matter of time before treatments became safer and effective.
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