The development of Germ Theory and its impact on the treatment of disease in Britain

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Doctors charged fees, which most working-class families could not afford, as there was no free health care before the NHS. Patent medicines such as Beecham's Pills were cheap, sold by chemists and grocers and heavily advertised in newspapers, so people bought them instead.

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Source A is useful because it describes Pasteur's famous public trial of his anthrax vaccine at Pouilly-le-Fort in 1881. It shows that the trial was a controlled experiment: half the sheep were vaccinated, then all of them were given a deadly dose of anthrax germs, and only the unvaccinated sheep died. This matches what I know of the trial, which was a complete success. The vaccine came from Pasteur's discovery in 1879, when an old culture of chicken cholera germs left over the summer by his assistant Chamberland failed to kill chickens and made them immune. Pasteur realised weakened germs could give immunity, called the method vaccination after Jenner, and applied it to anthrax, which had been identified by his rival Koch in 1876.

The provenance makes it useful in another way. It was written by a newspaper correspondent within days, apparently after seeing the dead and living sheep, so it gives detail about the crowd and the reaction. The fact that farmers, vets, doctors and journalists were invited shows that Pasteur deliberately made his trial public, partly to prove himself against Koch. The fact that a British newspaper reported it shows how much international interest his work created. However, because it was written for ordinary readers, its language is dramatic ('astonishing', 'the farmers cheered'), and the reporter could not judge the science.

The source also has limits. It does not explain how the vaccine was made; historians who later studied Pasteur's notebooks found that his team used a chemical method that he did not reveal at the time. It is about one animal disease and says nothing about his rabies vaccine of 1885 or the effect of vaccines in Britain. Overall, Source A is very useful for showing how Pasteur tested and publicised his anthrax vaccine, but only partly useful for his work on vaccination as a whole.

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One way they were similar is that both were chosen and paid for by patients themselves, outside mainstream medicine. In 19th-century Britain most working people could not afford doctors' fees, so they bought patent medicines such as Beecham's Pills or Holloway's Pills from chemists and grocers and treated themselves. In the 21st century, even though NHS treatment is free, many people choose to pay for alternative treatments such as homeopathy, herbal remedies or acupuncture, often for conditions such as chronic pain or stress where conventional medicine cannot offer a quick cure. In both periods people were making their own choices about treatment rather than relying on qualified doctors.

A second similarity is that both were sold through advertising and claims that had little scientific evidence behind them. Victorian patent medicines claimed to cure long lists of unrelated complaints, and their contents were kept secret; when the British Medical Association analysed many of them in 1909, it found they were mostly cheap, ordinary ingredients. Their makers, such as Thomas Beecham and Thomas Holloway, made fortunes from newspaper advertising. Today alternative remedies are also a large commercial industry that uses advertising and the internet, and many treatments have little evidence that they work better than a placebo. This is why NHS England stopped paying for homeopathy in 2017, just as doctors in 1909 tried to expose the claims of patent medicines. In both periods regulation was limited, so the seller's claims often mattered more than scientific proof.

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Science and technology has been the most important factor in the development of treatment since the late 19th century, but for most of the period its absence explains why treatment changed so little. Even in the modern era, scientific discoveries needed individuals, government, war and industry to turn them into treatments that ordinary people in Britain could receive.

In the Middle Ages there was very little science or technology to help doctors. Treatment was based on the four humours of Hippocrates and Galen, so patients were bled, purged or given remedies based on the Theory of Opposites, along with herbal medicines and prayer. Religion was more important than science: the Church ran hospitals such as St Bartholomew's, but these offered care rather than cure. Even in the 16th and 17th centuries, when Vesalius and Harvey improved knowledge of anatomy and circulation, treatment hardly changed, because there was no technology to see the real causes of disease. Leeuwenhoek's microscope revealed microbes in the 1670s, but no one could link them to illness.

In the 19th century science and technology began to make a real difference. Better microscopes, developed around 1830, allowed Pasteur to publish his germ theory in 1861 and Koch, using dyes and agar, to identify the microbes behind TB and cholera in the 1880s. Yet even then treatment changed slowly: most people still used home remedies and patent medicines such as Beecham's Pills, because knowing the cause of a disease did not give a cure.

The 20th century shows the full power of science and technology. Chemistry produced the first magic bullets: Ehrlich's Salvarsan 606 in 1909 and Domagk's Prontosil in 1932, followed in Britain by May & Baker's M&B 693 in 1938. Penicillin, discovered by chance by Fleming in 1928, became a treatment only when Florey and Chain purified it and new technology such as deep fermentation tanks allowed it to be mass-produced. Since then, technology has transformed treatment through dialysis, transplants, keyhole surgery and genetic research following the discovery of DNA's structure in 1953.

However, other factors were also vital. Individuals such as Pasteur, Ehrlich, Fleming, Florey and Chain made the discoveries. War speeded up development: the American and British governments paid for the mass production of penicillin during the Second World War, so there was enough for the D-Day landings in 1944. Government made treatment available to all: before 1948 many working-class people could not afford a doctor, but the NHS made treatment free at the point of use. The economy mattered too, as pharmaceutical companies, from Bayer and Hoechst in Germany to British firms such as May & Baker, invested in research and mass production.

In conclusion, science and technology has been the main factor in the development of treatment, because without microscopes, chemistry and new production methods there would have been no germ theory, magic bullets or antibiotics. Its importance was shown by its absence before 1800, when treatment hardly changed. However, it was not enough by itself: it needed individuals to make discoveries, war and industry to mass-produce them, and the NHS to give everyone access to them.