Week 20

Paper 2 Breadth Study:

Changes in medicine, c1848–c1948

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 How to use this booklet
This booklet will contain all the notes and tasks for week 22 of the course.

The information and tasks should follow your lessons exactly. The idea here is
that you ‘use the notes; don’t make the notes. This means that we would rather
you engage in the lessons, ask and answer questions, highlight key bits of
information, complete tasks rather than copying down the information from the
ppts.

It also means that we can introduce something called ‘flipped learning’. This is
where we ask you to read some new information that we will be looking at the
following week and we ask you to complete some tasks based on this. This
should make the Lead lessons less overwhelming for you. You will already have
met the information before, you can check your answers (and correct if need
be) and you can also ask if you don’t understand anything or want to know more.
This way of learning should help to make sure that you have a firm
understanding of the content before we move onto the Explore lessons. It is
crucial that this flipped learning is completed.

The textbook that we have asked you to buy will still be a valuable aide. It will
offer further detail in order to extend your understanding of the subject.

Please make sure that you have this booklet with you for each lesson and then
you can follow the lessons seamlessly. You can print it out and write on it or
save it to your computer, whichever works best for you.

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 Changes in medicine, c1848–c1948

Week 20: Learn Lesson: How and why did the

government improve Public Health 1906-11?
Objectives
 To understand why the government introduced news measure to improve
public health between 1906 and 1911.
 To describe how the government tried to improve health of children between
1906 – 1911.

Key words
Self Help: The idea that individuals should look after their own welfare by
working hard and saving money carefully.

Welfare State: A system in which the government takes responsibility for

health care, education, social services, unemployment benefit and many other
services for whoever needs them

Boer War: War fought between British Empire and two Boer (Afrikaner)
republics 1899 – 1902.

Social Reformers: Individuals who argued for improvements to help to improve

the quality of life for people.

Public Health 1848 - 1875

• Remember the improvements that we have seen in public health up to 1900.

• The government had started to move away from a laissez faire attitude and had
begun to take responsibility for enforcing better standards of public health.

• Public health facilities were beginning to improve. Towns had become cleaner.
Most houses had piped water and lavatories that were connected to a sewerage
system.

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 • The key words however are beginning to and becoming. A great deal had not
changed at all.

• As you can see from the graph below, life expectancy was beginning to rise, but
by 1900 it had only reached 50 for women and 46 for men.

• The infant mortality rate was also still shockingly high by 1900s. In 1899 163
babies out of every 1000 still died before 1st birthday - 3 out of every 20 births

• Many still suffered major health problems because of poverty.

• Poverty meant a poor diet, poor housing and a lack of access to medical
treatment. These factors caused poor health.

• The government gave no help to the sick, unemployed and elderly, no matter how
poor they were.

• Those without help from friends, relatives or charities had to give up their
homes and into the workhouse run by the local council.

Attitudes to Poverty in 1900

• During the 19th century most people believed that anyone could climb out of
poverty if they tried hard enough, so it was their own fault if they stayed poor.

• From 1906 – 1918, the Liberal Party was the largest party in the country and
made up the government. During this time, they changed the focus from Self
Help to Welfare State through a series of laws and social reforms.

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 • These Liberal reforms were based on quite different assumptions:

• It was not always the fault of the poor that they were poor.

• It was the role of government to support the poor when they needed it
most.

So why did things change?

Social Reformers

• Charles Booth and Seebohm Rowntree were two very influences reformers of the
1900s.

• In the 1880s, Booth began to study the slum areas lived in by the poor, especially
the areas around the East End of London. He surveyed each of the houses, asking
the people who lived there questions about their lives; what did they do for a living?
Who did they live with? How many people to each room?

• When Booth’s report was finally published in 1889 it showed that instead of
idleness and drink, the main causes of poverty were illness, being elderly (and
therefore frail and unable to work) unemployment and low wages.

• Rowntree’s studies backed up these ideas. He published a book entitled ‘Poverty, a

study of Town Life’ which detailed how charities were struggling to cope supporting
the vast numbers of poor people. The implication from the book was that the
government needed to take action and support the poor rather than punish them.

The Boer War of 1900

• The Boer war of 1899-1902 showed the poor state of health of the nation.

• One out of every three volunteers failed the army medical due to bad diet and
living conditions.

• This could seriously affect Britain’s military strength if nothing was done to
improve the situation.

The Economy

• The effects of poverty were damaging to society. Health problems and infectious
disease could affect rich and poor. The economy suffered if large numbers of
people were too poor to buy goods and social problems such as crime, prostitution,
slums, and drunkenness were a direct result of poverty.

• There was a particular worry about the effects of poverty on children. Studies had
shown many to be underweight, malformed and infested with lice scabies etc. This

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 would lead to problems in the future – weak sickly children would become weak,
sickly adults.

• There were concerns about Britain’s future ability to compete with new industrial
nations such as Germany and the USA. The quality of the workforce needed to be
improved. A healthy, fit and well-educated workforce was required. Ill-health and
poor diet weakened workers and lead to high absences.

The threat from the Labour Party

• At the beginning of the 20th century a new political party was created: the Labour
Party. The Liberal party suddenly became aware that if they didn’t offer policies
that more working-class people liked, they could lose their position in power.

• A group of Liberal MPs started to support the idea of ‘new liberalism’, which lay a
greater emphasis on the government helping the poor. (Lloyd George and Winston
Churchill).

What did the Government do?

In the 1906 election the Liberal Party won by a huge majority which gave them
the power to pass controversial laws. These laws focused on improving the public
health of the following groups:

Children

The Old

Workers

Children

1906: Free school meals.

• The government introduced free school meals for children from poor
families.

• Local authorities received a grant from government to cover half the cost.

• The number of meals increased from 3 million in 1906 to 14 million in 1914.

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• This was a significant step having one proper meal a day would provide
children with the food needed to support their bodies growth and improve
their general health.

Limitations

The Act did not force local authorities to provide school meals. As a result only
half of Britain’s local authorities actually set up a meals service.

1906: Board of Education leaflet on hygiene.

• This explained the importance of washing regularly, brushing teeth, changing

clothes and washing clothes regularly

• Good hygiene helps to prevent the spread of diseases passed on through

personal contact.

1907: School Medical Service set up.

• Children would be inspected at school for signs of infectious disease or

conditions such as ringworm or lice.

• Health Visitors would visit homes to check on very young children

Limitations

• At first this service only provided free checks, parents were expected pay
for any medical treatment which was needed. Many parents simply couldn’t
afford the treatment.

• Treatment was only provided by the clinics after 1912 and even then many
local authorities did not provide it.

The 1908 Children’s Act

• This made it illegal for children to work in dangerous trades or workhouses,

enter pubs or buy cigarettes.
• Children became ‘protected persons’ which meant that their parents could be
prosecuted for cruelty against them.
• It also established juvenile courts, which meant that children did not have to
be tried and imprisoned with adults.

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 • It also introduced the registration of foster parents, meaning the
government could monitor child welfare more closely.

How did it improve children’s health?

• Offered a new level of protection to children.

• Protected them from some of the worse working conditions.

Limitations

• Little success with alcohol and tobacco, even today

• The Children's Charter did little to deal with the causes of juvenile crime.

Government measure Who did it How did it What were the

help? improve people’s limitations of the
health? measure?
1906: Free school meals. Children from Children would
The government paid half the cost poor families warm food and
of providing free school meals and good nutrition,
the number of meals increased making them
from 3 million in 1906 to 14 million healthier and less
in 1914. likely to become ill.
1906: Board of Education leaflet Children from
on hygiene. poor families
This explained the importance of
washing regularly, brushing teeth,
changing clothes and washing
clothes regularly.
1907: School Medical Service set Children from At first this service
up. poor families only provided free
Children would be inspected at checks; parents were
school for signs of infectious expected pay for any
disease or conditions such as medical treatment
ringworm or lice. which was needed.
Health Visitors would visit homes Many parents simply
to check on very young children. couldn’t afford the
treatment.
Not until 1912 that
treatment was also
provided by the
clinics.

1908: Children and Young Persons Children

Act.
This made it illegal for children to
work in dangerous trades or

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workhouses, enter pubs or buy
cigarettes.
Children became ‘protected
persons’ which meant that their
parents could be prosecuted for
cruelty against them.
It also established juvenile courts,
which meant that children did not
have to be tried and imprisoned
with adults.
It also introduced the registration
of foster parents, meaning the
government could monitor child
welfare more closely.

1908: Old age pensions introduced. The elderly Only 650,000 people
People over the age of 70 who qualified for the
earned less than £31.50 per year pension in 1908.
would receive 25p. This was because.
You had to be over
Significant that poverty was 70 to receive it
being tackled by direct funding Many pensioners had
from the government rather than no birth certificates
local rates and could not prove
age.
The pension could be
refused if they were
alcoholics or had
been in prison in the
previous 10 years.
Only British citizens
who had been living
in Britain for the
last 20 years
qualified
You could be refused
if it was shown that
you had ‘failed to
work to the best of
your abilities’ during
your working life.

1909: Labour Exchanges set up. Workers

In 1909, Labour Exchanges were
set up to help the unemployed find

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employment.
This meant that unemployed
workers could go to a labour
exchange to look for a job instead
of having to tramp from workplace
to workplace to find work.

1911: National Insurance Act. Workers

Sick Pay

The first part of the Act dealt

with health insurance.
Workers, employers and the
government all paid into a fund.
Any worker who became ill could
receive free medical care from a
doctor linked to the scheme.
They could also claim sickness
benefit.
A maternity grant was given to
help pay for baby essentials.

1911: National Insurance Act. Workers It was restricted to

Unemployment trades where
seasonal
The second part of the Act dealt unemployment was
with unemployment and common, including
underemployment. building, ship building
Additional payments could be made and engineering. It
which would provide unemployment therefore covered
benefit if they lost their jobs. around 2.25 million
workers - mostly
skilled workers.
Cover was only
provided for a
limited time
depending on
contributions - after
this, the Poor Law
had to be used

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 Changes in medicine, c1848–c1948

Week 20: Explore Lesson One: How and why did the
government improve Public Health 1906-11?
Objectives
 To describe how the government tried to improve public health between
1906 – 1911.
 To explain why the Liberal reforms were significant.

Challenge yourself!

How many of these questions can you answer?

How did John Snow prove Why was the 1875 Public Which government
a link between cholera Health Act significant? brought in new public
and dirty water? health reform in the
early 1900s?

What caused the Great Name one factor involved in What war had shown
Stink? the passing of the 1875 how unhealthy the
Public Health Act? population of Britain
was?

What did Joseph What was the main focus of Which groups of
Bazalgette build? the 1875 Public Health Act? people did the Liberal
Reforms aim to help?

What can you infer from Source A about life for working class people
during the late 1800s-early 1900s?

A family… cannot save, nor can they join a sick club or Trade Union because they
cannot pay the necessary subscriptions. The children must have no pocket

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money for dolls, marbles or sweets… Should a child fall ill, it must be attended
by the parish doctor; should it die, it must be buried by the parish. Finally, the
wage-earner must never be absent from his work for a single day.

Source A: An extract from Benjamin Seebowm Rowntree’s Poverty: A Study of

Town Life, 1901.

What did the Government do?

Workers

• In 1909, Labour Exchanges were set up to help the unemployed find

employment.

• This meant that unemployed workers could go to a labour exchange to look for a
job instead of having to tramp from workplace to workplace to find work.

• If people had a regular wage, they and their families were more likely to eat
properly and live in decent accommodation

Limitations

• It was not compulsory for employers to register vacancies

• It was also criticised for only finding temporary and low paid work, so did not
reduce poverty

Workers - The National Insurance Act, 1911: Sickness

Sick Pay

• The first part of the Act dealt with health insurance.

• Workers ( on a low income) , employers and the government all paid into a fund.

• Any worker who became ill could receive free medical care from a doctor linked to
the scheme.

• They could also claim sickness benefit.

• A maternity grant was given to help pay for baby essentials

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Why was this important?

• It was the first time that some groups in society had access to a trained doctor and
treatment.

• It was still not possible to treat many illnesses, especially killer diseases such as
Tuberculosis and influenza, but treatment could help with the symptoms of many
other illnesses. For example, pain relief, ointments to soothe itchy skin or
treatment to prevent infection in an open wound.

• All these measures meant that a patient was less likely to develop complications
during an illness and more likely to survive

• Sickness benefit could prevent a family from falling below the poverty line if the
main wage earner fell ill.

What were the limitations of the Act?

• Families of workers did not receive free treatment.

• Unemployed or self-employed people were not covered.

• Only for those on the lowest incomes

• After 26 weeks' absence from work, benefits were lost and the Poor Law had to
provide for the worker

Workers - The National Insurance Act - Unemployment

• The second part of the Act dealt with unemployment and underemployment.

• Additional payments could be made which would provide unemployment benefit if

they lost their jobs.

Why was this important?

• Unemployment benefit could prevent a family from falling below the poverty line if
the main wage earner lost their job.

What were the Limitations?

 It was restricted to trades where seasonal unemployment was common, including

building, ship building and engineering. It therefore covered around 2.25 million
workers - mostly skilled workers.

• Cover was only provided for a limited time depending on contributions - after this,
the Poor Law had to be used.

The Significance of the Liberal Reforms

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• By the early 20th century people had begun to accept that the central government
and local authorities should ensure the basic standard of hygiene and housing. But
they were not keen on paying for it. There were therefore even more complaints
when the Liberal government announced further measures.

• But the Liberal government’s reforms were important in improving public health.

• They showed that the government understood that poor hygiene, living conditions
and diet meant that people had little resistance to disease and that when people live
in poverty, they cannot afford treatment for illness.

• It is also significant that government accepted the role of protecting the health of
the people by taking action to prevent them becoming unhealthy.

• Only parliament had the authority to make these laws and collect taxes. Local
authorities could have organised individual actions such as providing free school
meals or providing free medical checks, but they could not have introduced
pensions.

Winston Churchill summed up the aim of the Liberals. He said:

‘If we see a drowning man, we do not drag him to the shore. Instead, we provide help to
allow him to swim ashore.’

In other words, the Liberals wanted to provide some help for the poorer sections of
society in order that they could help themselves.

Changes in medicine, c1848–c1948

Week 20: Explore Lesson Two: Government Action and

War 1905-1920. How and why did the government
improve Public Health 1906- 11?
Objectives:

 To evaluate how far there had been progress in improving public health
between 1906 and 1911.
 To gain an understanding of the trenches of WW1

Heads and Tails: The National Insurance Act

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Under the terms of this act, money claim sickness benefit.
was paid into

Any worker who was taken ill could people who were self-employed or
receive free medical care from a unemployed were not covered.
doctor and

This was significant as they could the National Insurance Scheme by

prevent a family falling below the workers and employers.
poverty line and

Unfortunately, the act only applied allow them to cope if the main wage
to workers and not members of earner became ill or lost their job.
their family or

How far had there been progress in improving Public Health in the years
1906-1911?

The Extent-o-metre

Decide how much change had taken place in public health between 1906 and
1911. Be ready to justify your decision!

The Impact of the First World War on Medicine

When the war broke out in 1914 nobody knew that it would become the first
‘world war’ or that it would last four years. People realised that it was
significant because so many European countries were involved, but they still
expected it to be ‘over by Christmas’.

However, this was to be a new style of war involving new weaponry and tactics
which was to result in slaughter on an industrial scale.

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The sheer amount of casualties on all sides placed an enormous strain on medical
services and also resulted in significant developments in treating the wounds
and illnesses caused by fighting.

The Western Front

World War One began in August 1914 and ended in November 1918.

Fighting occurred across the globe. However, it was the western front with its
series of trenches which has perhaps become most associated with the horrors
of the war.

How did the trenches develop?

Britain declared war on Germany on August 4th 1914. The British Expeditionary
Force (BEF) was sent to France to stop the Germans advancing through Belgium.

Soldiers began to dig small trenches to shield themselves from machine gun
fire.

Stalemate developed - neither side could advance, so both dug in to hold their
ground.

Eventually a line of trenches stretched from the English Channel in the north to
Switzerland in the south.

A more complex trench system developed from 1915:

There was a frontline trench, where attacks were

made from.

Behind this was the support trench. Behind the

support trench was the reserve trench. These
trenches were connected by a communication
trench. Trenches were dug in a zigzag pattern.

The space in between the two lines of trenches

was called no man’s-land.

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 Barbed wire was placed in no-man’s-land to slow down enemy attacks.

Holes called dugouts were dug into the sides of the trenches, where men could
take cover.

Trenches were generally about 2.5m deep.

Helping the Wounded - Chain of Evacuation

Medical care for the wounded changed dramatically during WW1. Soldiers
injured in 1918 had a much higher chance of better treatment than those
injured in 1914.

In 1914 the speed of events and number of casualties were much greater than
predicted. One example was that no motor ambulances were initially sent to
France in 1914. Horse drawn ambulances could not cope with the numbers of
wounded.

The army greatly improved the evacuation and treatment of the wounded once
the nature of the war was understood.

By November 1914 there were 250 motor ambulances with more arriving daily.

Medical care was important because it got fit men back to the line as quickly as
possible and so kept the army as efficient as possible.

The aim was also to treat men as quickly as possible because survival very often
depended on the speed of treatment.

Week 20 Apply Tasks

Use the textbook page 74-75 and the Apply Task ppt to complete the
table on the ‘Chain of evacuation’.
Do not need to upload but this must be completed.

Flipped Learning
Read the Week 20 flipped learning document on Canvas.

Week 24 CYCLE TEST

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On Tuesday 26th March you will have a History cycle test
The test will be 45 mins long
You will answer a part a, b & c question on Medicine.

Explain TWO ways in which the …. Was similar/different from (6

marks)

b) Explain two causes of … (8 marks)

c) ‘How far were…’ ‘How significant was…’ ‘How far did… change…’
You may use the following in your answer. (16 marks)

The questions will be on content covered in weeks 14-20.

To prepare for the Week 23 cycle test you should refer to the lesson
recordings and ppts for these weeks. You should:

Technique and structure

Familiarise yourself with the sentence starters for each question
Learn the maximum timings for each question (extra time students
should add relevant additional time)

Content
• Revisit the content from weeks 14-20
• Revise the content, remember to identify specific dates, events,
statistics, people.
• Rewatch the GCSE pods
• Revise using different techniques, flow charts, mind maps, timelines,
question planning.

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