Syllabus Edition
First teaching 2024
First exams 2026
Prevention of Disease in the 18th & 19th Century (Edexcel GCSE History)
Revision Note
Written by: Zoe Wade
Reviewed by: Bridgette Barrett
Improvements in Disease Prevention in the 19th Century - Timeline & Summary
The conditions in towns and cities made the prevention of disease impossible. During the Industrial Revolution, many people migrated from the countryside to industrial towns to find work. This population boom was unmanageable. Back-to-back housing for workers was dangerous and unhygienic. The buildings had little ventilation. Multiple households shared one communal toilet that often overflowed. Water came from neighbourhood water pumps, increasing the chance of contamination. Campaigners like Edwin Chadwick petitioned the government to step in. He proved that the life expectancy of the poor population in cities was much lower than people in the countryside. The average life expectancy was 39 years old. The government did not believe it was their responsibility to look after the health of the nation. This attitude began to change in the 19th century. In 1832, the government passed the Great Reform Act which extended the right to vote to more men than ever before. The government felt more pressure to drop their laissez-faire attitude. They wanted to ensure they received votes from the newly enfranchised. The cholera epidemic in 1854 and the Second Reform Act in 1867 forced the government to intervene further. The 1875 Public Health Act meant that local authorities had to provide clean water and sewage disposal. Failure to comply resulted in a fine. This transformed conditions in cities and increased life expectancy to 47 years old. Instances of epidemics were fewer and less severe. Disease prevention significantly progressed through a combination of vaccination and government intervention. |
Jenner & Vaccinations
Smallpox in the 18th Century
Smallpox is an illness which causes a fever and pus-filled rashes across the body
The disease was incredibly dangerous, killing as many as 30% of victims
Most of these were children
The worst epidemic in Britain was in 1796 when 3,548 people died
Before Germ Theory, people did not understand what caused smallpox
Scientists had noticed those who had a mild case of smallpox never caught it again
A method to prevent smallpox was inoculation
An inoculator would rub pus from a smallpox scab into a cut on the patient or crush a scab for the patient to snort up their nose
Inoculation caused many problems:
Inoculation was expensive so many could not pay for their services
Inoculators became extremely wealthy
Some patients died of the inoculation process
Edward Jenner, having experienced the inoculation process as a child, believed there was a better way to prevent smallpox
He had gathered over 1000 cases where inoculation had failed to prevent smallpox
Jenner and Vaccinations
Jenner noticed that dairymaids did not catch smallpox during epidemics
He regularly treated the maids for cowpox
The disease caused similar blistering to the skin as smallpox but was not deadly
Jenner decided to test the link between smallpox and cowpox
In 1796, Jenner gave a young boy called James Phipps cowpox
Six weeks later, he infected James with smallpox
He did not catch smallpox
He published his findings in 1798 in An Enquiry into the Causes and Effects of the Variola Vaccinae
The term ‘vaccination’ comes from the Latin ‘vacca’ for cow
Reactions to the New Vaccination
Government Reaction
The British government preferred vaccination to inoculation
It was much safer
It was cheaper because people did not need to go into quarantine
The government took steps to change public opinion of vaccination
In 1840, it became illegal to inoculate people
The government paid for children's smallpox vaccination from taxes
In 1852, the government made smallpox vaccination compulsory for children up to 3 months old
In 1871, doctors received payment for vaccinating people against smallpox
In 1872, the government fined those who refused to vaccinate their children
The Impact of the Smallpox Vaccine
Short-term | Long-term |
|---|---|
It saved many lives worldwide. By 1800, 100,000 people had been vaccinated. Napoleon ordered his army to be vaccinated in 1805 | The number of smallpox cases dropped from 1872. By 1979, the World Health Organisation declared that smallpox no longer spreads naturally or exists in humans |
The vaccine faced opposition in Britain from inoculators. It was slow to gain popularity and between 1801-1803, 12,000 British people had been vaccinated | There was less opposition. Some people still believed they had lost their freedom to decide whether to be vaccinated or not |
Vaccinators made mistakes. Patients died of infection because they reused needles. Others were accidentally given smallpox due to a mix-up in samples | Jenner's work inspired other scientists like Pasteur and Koch to develop vaccines. However, Jenner’s method would not work for any other diseases except for smallpox |
The Development of Vaccines
Inspired by Jenner’s work, Louis Pasteur began to look into the possibility of vaccination
He discovered that he would need to identify the germs causing a specific disease to be able to vaccinate against it
This went against Jenner’s approach of observation and human experimentation
In 1879, Pasteur worked on a vaccine for chicken cholera
During the work he:
Identified the germ causing the disease
Produced a weaker version of the disease
Treated his patient with the weaker version
Pasteur proved that treating animals with a weaker version of chicken cholera protected the animals from catching it later
Pasteur later used this method to create vaccines for other diseases
He provided vaccines for anthrax and rabies, both of which impact animals more than humans
Pasteur did not understand the science behind why his method of vaccination worked
He was unaware that a weaker version of a disease encourages the immune system to create antibodies
These antibodies then fight off the disease if the patient catches it again
Koch’s work on discovering the microbes that caused disease also influenced vaccine creation
Emil von Behring used Koch’s research to create vaccines for tetanus and diphtheria
Worked Example
Explain one way in which methods of preventing disease in the Renaissance were different to methods of preventing disease in the 18th and 19th centuries
4 marks
Answers:
One way in which methods of preventing disease were different from the Renaissance to the 18th and 19th centuries was the use of vaccinations (1). In the Renaissance, there was no understanding that germs created disease (1), they relied on ideas about transference to avoid catching disease (1) whereas, in 1796, Edward Jenner created the smallpox vaccine. This encouraged scientists like Pasteur to develop methods of isolating bacteria and creating effective vaccines against them (1).
Examiner Tips and Tricks
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
Government Action to Improve Public Health
Edwin Chadwick wrote a report in 1842 called Report on the Sanitary Conditions of the Labouring Classes
Chadwick proved a connection between life expectancy and living standards
People living in cities died much younger than those living in the countryside
Chadwick:
Concluded this was due to the filthy conditions of cities
Campaigned for the government to make local authorities clean up their towns and cities
Advised setting up boards of health, responsible for clearing sewage and providing fresh water
The government did not believe differences in life expectancy were enough evidence to act on
After John Snow and Pasteur’s work on cholera, there was more proof that clean water was vital for health
The government began to act
Examiner Tips and Tricks
Although not in the specification and learning resources, you could discuss the work of Joseph Bazalgette. London experienced The Great Stink in the summer of 1858. The Thames smelt so badly of raw sewage that the government insisted on action. The government employed Bazalgette to redesign London’s sewage system. By 1865, 1,300 miles of sewers were built and most of the sewers connected most of London by 1866. You can use Bazalgette as proof of government intervention in public health by the mid-19th century.
The Public Health Act of 1875
The government introduced a Public Health Act in 1848
It encouraged cities to set up boards of health and provide clean water
It was not compulsory for local authorities to follow the act
This limited the impact the Act had on the health of the nation
The government passed the second Public Health Act in 1875
This act made it compulsory for local authorities to:
Provide clean water
Dispose of waste properly to avoid polluting drinking water
Build public toilets
Hire a public officer of health to monitor where epidemics of disease occurred
Build new houses with better ventilation and check lodging houses were safe
Provide parks for exercise
A local authority who broke the terms of the Act would pay a fine
By the end of the 19th century, the government had abandoned their laissez faire attitude
They acknowledged that it was the government’s responsibility to protect the health of the nation
Worked Example
Describe one feature of the Public Health Act of 1875
2 marks
Answers:
The 1875 Public Health Act focused on creating hygienic conditions for people living in towns and cities (1). The act stated that local authorities had to dispose of sewage properly to avoid polluting drinking water (1).
Examiner Tips and Tricks
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 one feature of…’ questions, the two marks are given to you for:
Identify - write a relevant point based on the question topic (1)
Describe - add some specific own knowledge about the point you have made (1)
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