Factors of Change: Analysing Medicine Across the Periods

A Level 3 Edexcel answer recounts what happened. A Level 4 answer explains why it happened — and does so by naming, developing and weighing factors. This lesson is the analytical spine of the course. It pulls together the factors you have met in Lessons 2–5 and gives you a framework for using them in every 8-, 12- and 16-mark answer on Paper 1. It is also where you practise the band-language distinction between Grade 4, Grade 6 and Grade 9 responses on questions about change.

The factors Edexcel recognises are: religion and the supernatural, individuals, science and technology, government, communication, war, and chance. Most answers you write will combine two or three of these. The question is not which factor was present — almost all periods show most factors in some form — but which factor was decisive in producing the change you are asked to explain.

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The seven factors at a glance

Factor	Core question	Strongest period
Religion and the supernatural	Who explains disease and controls learning?	Medieval c1250–c1500
Individuals	Whose personal work drove a specific change?	Renaissance and 19th century
Science and technology	What instruments and methods were available?	19th and 20th century
Government	What did the state fund, regulate or require?	19th and especially 20th century
Communication	How did ideas spread?	From printing press onward
War	Did conflict accelerate or redirect medicine?	20th century (especially WWI, WWII)
Chance	Did an unplanned event produce a breakthrough?	Occasional but significant (Fleming 1928)

Memorising this table is not the goal. The goal is to recognise which factors are doing the explanatory work in any question you meet.

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Factor-by-period grid

Factor	Medieval	Renaissance	18th–19th C	Modern
Religion	Dominant; Church controls universities and hospitals	Declining but still powerful; plague responses still religious	Weakening; religious objection to vaccination and anaesthesia fades	Largely absent from medical practice, though present in bioethics
Individuals	Few challenge orthodoxy; Galen is the "great individual" inherited from antiquity	Vesalius, Paré, Harvey, Sydenham	Jenner, Snow, Simpson, Pasteur, Lister, Koch, Nightingale	Fleming, Florey, Chain, Watson, Crick, Franklin
Science and technology	Almost none — no microscope, no printing, no experimental method	Printing press, early microscope, early experiment	Microscope matured, statistics, staining, anaesthetic chemistry	Antibiotics, DNA sequencing, imaging, genomics, mRNA
Government	Minimal — town-level quarantine	Limited — national Plague Orders, bills of mortality	Transformative — Public Health Acts 1848, 1875; Vaccination Acts	Dominant — NHS 1948; modern legislation
Communication	Manuscripts, Latin-only	Printing press; Royal Society journal	Medical journals (Lancet 1823), inquiries	Global digital networks, rapid publication
War	Rare as a driver of learning	Paré (battlefield surgery)	Crimean War (Nightingale)	WWI, WWII, Cold War all transformative
Chance	Rare recognition	Rare	Rare	Fleming 1928; some serendipitous discoveries

A Level 4 answer picks two or three cells from this grid and explains how those factors combined to produce a specific change.

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How to weigh factors in an answer

Edexcel judgement questions ask you to decide whether one factor mattered more than others. The strongest answers:

1. Identify the factor(s) in the question.
2. Explain how that factor produced change — with a named example.
3. Identify a different factor that also mattered.
4. Compare: which factor was necessary, and which sufficient?
5. Reach a judgement, often with a conditional: "More important because... but only because other factors were also present."

Worked example: "Germ theory was the most important reason for improvements in 19th-century medicine. How far do you agree?"

Factor identified: Germ theory is science/communication (Pasteur 1861, Koch 1876+).

How it produced change: Germ theory gave Lister (1867) the rationale for antiseptic surgery, cutting mortality from around 45% to 15% in his Glasgow compound fracture cases. It gave Koch's team the framework to identify specific pathogens, founding modern bacteriology.

Other factors:

• Individuals: Lister, Koch, Pasteur, Snow — without these individuals, germ theory would have remained abstract.
• Government: Public Health Acts 1848 and 1875, Vaccination Acts 1853 and 1867.
• Technology: The microscope made bacterial identification possible.

Judgement: Germ theory was necessary — without it, Lister could not have targeted the true cause of infection and Koch could not have founded bacteriology. But it was not sufficient — only the combination of germ theory with individuals, technology and (increasingly) government produced sustained improvement in public health outcomes.

Grade micro-contrast on the same question