Mark Scheme

Section A — Thematic Study

Question 1 (up to 4) Two features described, 2 marks each (a valid feature + supporting detail). Acceptable features: waste and sewage were thrown into the streets or rivers; water was often dirty/contaminated; towns had no organised system for removing refuse; efforts such as rakers/muckrakers or local regulations existed but were limited; disease spread easily in crowded conditions. [4]

Question 2 (up to 10) Levels-marked "explain why". Reward explained reasons, not just description:

• Level 3 (7–10): Two or more clearly explained reasons, well supported (e.g. cholera epidemics frightened people and the authorities into action; Chadwick's 1842 report linked poverty, dirt and disease and pushed for change; the discovery/acceptance of the link between dirty water and disease; the 1875 Public Health Act forced local councils to provide clean water and sewers).
• Level 2 (4–6): One reason explained, or several described with limited explanation.
• Level 1 (1–3): Simple/general points.

Question 3 (up to 20) Levels-marked essay on the factors behind improvements in health across the whole period, evaluating the role of national government against other factors.

• Level 4 (16–20): A sustained, well-supported argument using examples from across the period (medieval, early modern, 19th century, 20th century); genuinely evaluates government action against other factors (individuals such as Jenner, Snow, Chadwick; science and technology such as germ theory and vaccination; war and its effects; changing attitudes); reaches a balanced, justified judgement on "how far".
• Level 3 (11–15): A clear argument with good support and some evaluation; range of the period covered.
• Level 2 (6–10): Some relevant points, description more than argument; limited range or evaluation.
• Level 1 (1–5): Simple, general or narrow. Indicative content: government action (Public Health Acts, the NHS 1948, vaccination programmes) vs the role of key individuals, scientific breakthroughs (germ theory), and changing public attitudes. Credit a supported judgement either way.

Section B — Historic Environment

Question 4 (up to 4) Two supported inferences, 2 marks each (inference + support from the source). E.g. living conditions were very unsanitary (support: "no proper drainage... refuse... rotting"); water supplies were contaminated (support: pump "close to a churchyard and an open sewer"); disease was a recurring problem (support: "fever and cholera return... each summer"). [4]

Question 5 (up to 8) Levels-marked utility question. Reward evaluation of both sources using content, provenance (nature, origin, purpose) and own knowledge:

• Source A is useful as it comes from an official government inspector reporting first-hand on conditions, giving detailed evidence of the problems (though inspectors may emphasise the worst to prompt action).
• Source B is useful for showing the opposing attitude — that public health was not the council's/ratepayers' responsibility and that the poor were to blame — a common view that slowed reform; its purpose (opposing the cost) shapes it.
• Together they usefully show the conflict of attitudes that shaped the pace of reform.
• Level 3 (6–8): Both sources evaluated with content, provenance and own knowledge, reaching a judgement on usefulness.
• Level 2 (3–5): Both sources used but evaluation limited, or one source stronger than the other.
• Level 1 (1–2): Simple use of source content only.

Question 6 (up to 4) One explained change: by the early twentieth century the government increasingly accepted responsibility for public health and welfare (e.g. Liberal reforms such as free school meals, medical inspections, National Insurance), in contrast to Source B's view that it was not the council's business and that the poor were to blame. Change stated + explained with an example. [4]

Sample Answers with Examiner Commentary

Question 4 — Sample Answers

Grade A response. "One thing I can infer from Source A is that living conditions were extremely unsanitary. The source says there was 'no proper drainage, and refuse is thrown into the open channels where it lies rotting', which suggests waste was left to build up around where people lived. A second thing I can infer is that the water supply was dangerous to health, because the source says the water came from 'a pump close to a churchyard and an open sewer', which implies it was contaminated and likely to spread disease."

Mark: 4/4. Examiner commentary: A full-mark answer. The command is to infer — to work something out that the source suggests rather than simply copy it — and the candidate does this twice, each time stating a clear inference (unsanitary conditions; dangerous water) and then supporting it with a short, well-chosen quotation. This "inference + support" structure is exactly what the question rewards. Just quoting the source without drawing an inference, or making an inference without support, would each lose marks.

Grade C response. "Source A tells me that the alleys were filthy and there was refuse thrown into the channels. It also says that fever and cholera came back every summer and killed the poor."

Mark: 2/4. Examiner commentary: The candidate has selected relevant material from the source, but has mostly copied it rather than inferred from it. "The alleys were filthy" and "fever and cholera came back" are things the source states directly, not things worked out from it. To reach full marks the candidate needs to turn these into inferences — for example, that the poor drainage shows conditions were very unsanitary, or that the return of cholera each summer shows disease was a constant threat linked to the dirty conditions. The evidence is there; the missing skill is drawing a conclusion from it.

Question 2 — Sample Answers

Grade A response (extract). "One reason for improvements in public health in the nineteenth century was the series of cholera epidemics. Cholera struck rich and poor alike and killed tens of thousands, which frightened both the public and the government into taking action rather than ignoring the problem. A second reason was the work of Edwin Chadwick, whose 1842 report argued that dirt, poverty and disease were linked, and that cleaning up towns would actually save money by keeping people healthy and able to work. This provided the evidence and argument that reformers needed. Together with a growing acceptance that dirty water spread disease, these pressures led to laws such as the 1875 Public Health Act, which forced local councils to provide clean water and proper sewers."

Mark: 9/10. Examiner commentary: A Level 3 answer that explains, rather than merely describes, more than one reason. Each factor is developed with a clear causal link to improvement — the epidemics created fear and pressure; Chadwick's report supplied evidence and a money-saving argument; the acceptance of the water–disease link and the 1875 Act enforced change. The reasons are connected rather than listed, which is what lifts it to the top level. It falls just short of full marks because the role of scientific discovery (germ theory) could have been drawn in to complete the picture.

Question 5 — Sample Answers

Grade A response (extract). "Both sources are useful for studying attitudes towards public-health reform, but in different ways. Source A is useful because it was written by a government inspector in 1842 reporting first-hand on conditions, so it gives detailed, credible evidence of the filth, poor drainage and contaminated water that reformers were reacting against, and of the recurring cholera. Its purpose — to prompt action — means it may deliberately stress the worst conditions, but that itself reveals the reforming attitude of officials at the time. Source B is useful because it shows the opposing attitude very clearly: the councillor argues that public health was not the council's or ratepayers' responsibility and blames the poor for living 'in filth'. This was a common view, rooted in ideas of 'laissez-faire' and self-help, and it explains why reform was often slow and contested. Together the two sources are very useful because they capture the conflict of attitudes — between reformers who wanted government action and those who resisted the cost — that shaped the pace of change. My own knowledge supports this: it was only after further cholera epidemics and growing acceptance of the link between dirt and disease that the compulsory 1875 Public Health Act was passed."

Mark: 8/8. Examiner commentary: A top-level utility answer. The candidate evaluates both sources, and does so using all three of the tools examiners reward: content (the specific evidence each gives), provenance (who wrote each, when and — crucially — why, including how the councillor's purpose shapes Source B), and own knowledge (laissez-faire attitudes, the 1875 Act). Most importantly, it reaches a judgement on usefulness for the specific enquiry — attitudes to reform — rather than just describing the sources, and it recognises that a source's bias can itself be useful evidence of attitudes. This is exactly the analytical approach the question demands.

Grade C response. "Source A is useful because it tells us the conditions were dirty and there was cholera, which is true. Source B is not very useful because the councillor is just being mean about poor people and doesn't want to pay for sewers."

Mark: 3/8. Examiner commentary: The candidate uses the content of both sources and begins to notice Source B's attitude, which earns some credit, but the evaluation is limited and partly mistaken. Dismissing Source B as "not very useful" because the councillor "is just being mean" misses the point: a source expressing an unsympathetic attitude is actually very useful evidence of that attitude, which is exactly what the enquiry is about. The answer also does not use the provenance properly (who wrote the sources, when and why) or bring in own knowledge. Judging usefulness against the specific question, and treating bias as useful evidence rather than a weakness, would raise the mark substantially.