Modern Medicine 1900–present

Mark Scheme (4 marks — 2 marks per inference: 1 for the inference + 1 for supporting detail from source):

Inference 1: I can infer that the discovery of penicillin was accidental/the result of chance. Details in the source that tell me this: The notebook records a "contaminated" dish — contamination was unplanned. The question mark after "Possible antibacterial substance?" shows Fleming had no prior expectation of finding this substance.

Inference 2: I can infer that Fleming immediately understood he had observed something scientifically significant. Details in the source that tell me this: Rather than discarding the contaminated dish, Fleming made careful measurements of the "bacteria-free zone" and sketched it — behaviour suggesting he recognised this as an important finding worth recording in detail.

Award 1 mark for a correct inference and 1 mark for supporting it with detail drawn from the source. Do not award marks for inferences not supported by source detail.

Mark Scheme (8 marks): Level 4 (7–8): Evaluates utility of both sources with developed reasoning about NOP; reaches a judgement about relative utility supported by contextual knowledge. Level 3 (5–6): Analyses utility of both sources; some use of NOP; links to context. Level 2 (3–4): Describes content of sources; limited analysis. Level 1 (1–2): General comments on sources.

Model Answer Points:

Source A (Bevan's speech): Useful for understanding political determination behind the NHS — Bevan was the key figure who created it, so his views directly illuminate motivation. Parliamentary speech means it is an authentic, dated record. However, purpose is persuasion; Bevan presents only his case. Context: the NHS faced fierce BMA opposition — Bevan's speech does not represent medical profession's views. Useful but one-sided.

Source B (Fleming's notebook): Useful for the role of chance in penicillin's discovery. Private notebook = no reason to distort — highly reliable as a record of what Fleming observed. Context: Fleming published findings in 1929 but could not isolate penicillin; Florey and Chain's 1942 work was needed. Source B shows only the discovery stage, not development — significant limitation for a study of the whole development of modern medicine.

Overall judgement: Source B is more useful for understanding a specific turning point (penicillin discovery) because its private nature makes it more reliable. Source A is more useful for understanding the political context of the NHS. Together they illuminate two different aspects of modern medicine's development but neither alone gives a complete picture.

Mark Scheme (8 marks): Level 4 (7–8): Analyses the process with clear links between events; shows how one development led to another; uses own knowledge beyond the prompts. Level 3 (5–6): Describes the sequence of events with some links; uses both prompts and some own knowledge. Level 2 (3–4): Describes events in sequence but limited links or analysis. Level 1 (1–2): General statements.

Model Narrative:

The development of penicillin from accidental discovery to life-saving drug required the contributions of three sets of individuals over more than a decade. In September 1928, Alexander Fleming discovered penicillin by chance when he returned to his laboratory to find a contaminated petri dish in which the mould Penicillium notatum had killed surrounding bacteria. Unlike most researchers who would have discarded the dish, Fleming recognised the significance of what he saw and investigated further. However, Fleming lacked the chemical techniques to isolate or purify the active substance, and his 1929 published paper attracted little attention.

The situation changed in 1939 when Howard Florey and Ernst Chain at Oxford University began systematically investigating Fleming's findings. Using new technology — including centrifuges and freeze-drying — they succeeded in purifying a stable form of penicillin by 1940. Their tests on mice infected with deadly streptococcus bacteria showed that penicillin-treated mice survived while untreated ones died. Human trials followed in 1941, with remarkable results.

The decisive breakthrough came from wartime urgency and government funding. Unable to produce sufficient quantities in wartime Britain, Florey travelled to the United States in 1941 and secured $80 million in US government investment. American pharmaceutical companies began mass production, and by 1944 enough penicillin was available for the D-Day landings. The drug transformed military medicine — death rates from infected wounds dropped dramatically compared to World War One. Penicillin was thus developed through a chain of linked events: chance discovery, individual recognition, team research, technological innovation, and ultimately government funding — showing that no single factor explains its impact.

Mark Scheme (16 marks): Level 4 (13–16): Sustained analysis of multiple factors; consistent and well-supported judgement throughout; uses both stimulus points and substantial own knowledge; reaches a clear, nuanced conclusion. Level 3 (9–12): Explains arguments for and against the statement with supporting evidence; some judgement. Level 2 (5–8): Describes relevant factors; limited evaluation. Level 1 (1–4): General statements.

Key Points FOR (government action is most important):

• NHS (1948): Made all medical advances accessible regardless of wealth. Without the NHS, penicillin, transplants, and scanning technology would have benefited only the rich. Bevan's political determination to overcome BMA opposition was essential.
• Penicillin mass production: US government $80m investment. Florey said without this, penicillin would never have been mass-produced in time for WWII.
• Human Genome Project (1990–2003): Required $2.7 billion of international government cooperation across 6 nations — impossible for private sector alone.
• Wartime government direction: WWII accelerated medical research through state coordination, rationing, emergency hospital planning.

Key Points AGAINST (other factors also important):

• Individual genius: Without Fleming's recognition of penicillin (1928), there was nothing for government to fund. Ehrlich's systematic research created the magic bullet concept before any government investment.
• Chance: Fleming's contaminated petri dish — government cannot plan for chance discoveries.
• Technology: DNA sequencing technology, MRI scanners, surgical advances — these relied on scientific and engineering progress not solely driven by government.
• Team research: Florey and Chain's laboratory work was the essential bridge between discovery and usefulness.

Conclusion (Grade 9 level): Government action was arguably the most important factor in modern medicine because without it, other factors (individual discoveries, chance, technology) would have remained inaccessible to most people. However, government action alone could not create breakthroughs — it needed the discoveries of individuals and the enabling power of technology to fund and distribute. The relationship is interdependent: individual genius provides the discovery; technology enables development; government action ensures it reaches everyone. The NHS represents the fullest expression of this — a government framework that makes the benefits of all other factors universally available. This, more than any single scientific discovery, is what distinguishes modern medicine from all previous eras.