You should spend about 20 minutes on Questions 1–13, which are based on Reading Passage 1 below.
The Voyage of the Mayflower
In the summer of 1620 a group of English religious separatists prepared to leave Europe for North America. Many of them had already moved from England to the Dutch city of Leiden about a decade earlier, where they had been free to worship as they chose. They found life there hard, however, and feared that their children were growing up Dutch rather than English. Through an agent they obtained a patent from the Virginia Company of London, granting them land near the Hudson River. Two vessels were to carry them across the Atlantic: the Speedwell, of about sixty tons, and the Mayflower, a merchant ship of roughly 180 tons that was hired for the crossing.
The expedition began badly. The two ships left Southampton in August 1620, but the Speedwell soon began to leak, and the fleet put in at Dartmouth for repairs. It sailed again, and the Speedwell leaked once more. By the time both vessels reached Plymouth, it was clear that the smaller ship could not be trusted in the open ocean. Some of her passengers gave up the journey altogether, and the rest crowded aboard the Mayflower, which sailed alone on 6 September.
On board were 102 passengers and a crew of about thirty, commanded by Christopher Jones, an experienced master who had made many voyages to France in the ship. The crossing took sixty-six days. Autumn gales battered the vessel and one of her main beams cracked; it was secured with a great iron screw. A passenger named John Howland fell overboard in a storm and was hauled back by a rope. Below decks there was no way of cooking except over a firebox shielded from the wind.
Land was sighted on 9 November, but it was Cape Cod, well to the north of the Hudson. This mattered, because the patent granted by the Virginia Company did not cover the territory where the colonists now found themselves. Some of the passengers, most of them not members of the Leiden congregation, announced that they would go their own way once ashore. To hold the group together, the leading men drew up an agreement later known as the Mayflower Compact, by which the signatories bound themselves to obey laws made for the general good. Forty-one adult men signed it before anyone landed.
Several parties went ashore to explore. They found abandoned fields and a sheltered harbour at a place the Wampanoag called Patuxet, which had been emptied by disease in the years before their arrival. They decided to settle there despite the lateness of the season. The site had fresh water, cleared ground and a hill above the harbour that could be defended. Building began in December, and throughout the first winter the ship stayed anchored offshore as the colony's only secure base.
That winter was catastrophic. Cold, hunger and disease killed about half the colonists and many of the crew, and at times only a handful of people were well enough to care for the rest. According to a tradition that the colonists' own accounts do not record, the dead were buried at night and the graves were levelled so that the Wampanoag would not see how few remained. By the spring perhaps fifty settlers were still alive, and the crew had suffered almost as badly.
Help came from an unexpected direction. In March 1621 an Abenaki man named Samoset walked into the settlement and greeted the astonished settlers in English, a language he had picked up from fishermen and traders. He later introduced Tisquantum, known to the English as Squanto, a Patuxet man who had been carried to England years before and who returned to find his own community gone. Through these intermediaries the colonists made a treaty with Massasoit, the leading sachem of the Wampanoag, which both sides kept for decades. Tisquantum showed the settlers how to plant corn in hills with fish as fertiliser.
By the autumn of 1621 the survivors had gathered a modest harvest, and they held a celebration that lasted three days, to which Massasoit came with about ninety of his men. No detailed description survives. Much of what is now associated with the occasion, including the turkey, belongs to later traditions rather than to the events of that year. The best-known contemporary reference is a short passage in a letter by Edward Winslow, printed in London in 1622.
The Mayflower sailed for England in April 1621 and reached home the following month. Her later career is obscure. She disappears from the records soon afterwards, and what became of her is not known for certain, though she was probably broken up within a few years. Christopher Jones died in 1622 and was buried at Rotherhithe, on the Thames.
Plymouth was not the first permanent English settlement in North America: Jamestown, in Virginia, had been founded in 1607. Yet Plymouth became one of the most celebrated. The word 'Pilgrims', now attached to the settlers, was not used of them in their own lifetime. It came into general use in the nineteenth century, when the colony's story was taken up as a national founding myth. Historians today are careful to add that the colony survived only because of help from its Wampanoag neighbours, and that the relationship between the two peoples later collapsed into a war that nearly destroyed the Wampanoag.
You should spend about 20 minutes on Questions 14–26, which are based on Reading Passage 2 below.
How the Hospital Was Invented
Almost every account of the hospital begins in the ancient world. In Greece, the sick travelled to sanctuaries of the healing god Asclepius. There they spent the night in a sacred hall, hoping that the god would appear in a dream and tell them how to be cured. Priests interpreted the dreams and prescribed baths, diet and exercise. Such places were religious rather than medical in any modern sense, and what they offered was probably less important than the rest, the change of scene and the belief that suffering had a purpose.
Roman armies built something closer to a hospital. Forts along the frontier included a valetudinarium, a purpose-built block with small rooms off a central corridor, a dispensary and a surgeon's office, where soldiers were treated away from their barracks. Some large households are also thought to have kept rooms for sick slaves. Provision, however, remained tied to institutions, and no one expected a sick civilian to be cared for anywhere but at home.
The religions that followed made care of the sick a duty. In about 370 the bishop Basil of Caesarea founded a complex containing a ward for the sick, staffed by men and women whose task was nursing rather than prayer. It is often described as one of the first hospitals in the modern sense: a permanent institution, rather than a place of occasional pilgrimage. Its purpose was religious as much as medical, since tending the sick was held to be a route to salvation.
In the Islamic world the hospital became a far more elaborate institution. Caliphs founded hospitals in Baghdad from the ninth century onwards. The Mansuri hospital in Cairo, completed in the 1280s, was organised into separate wards for different complaints, with a library, a pharmacy and kitchens, and is said to have admitted anyone, whatever their wealth or origin. Some institutions of this kind were also schools, where students accompanied physicians on their rounds and were examined before they were allowed to practise.
Medieval Europe inherited the idea but not always the resources. The Hôtel-Dieu in Paris is traditionally said to have been founded in the seventh century, and St Bartholomew's in London in 1123. Most foundations, however, were tiny, with only a handful of beds. Many were closer to almshouses than to hospitals: they sheltered the old, the poor and pilgrims, and offered little in the way of treatment. Nursing was done by monks and nuns, for whom the work was an act of charity rather than of medicine.
The hospitals that appeared in eighteenth-century cities were different again, because they were paid for by the public. Voluntary hospitals were financed by subscriptions from wealthy donors, who in return gained the right to recommend patients for admission, and they were governed by boards of these subscribers. The Edinburgh Royal Infirmary, opened in 1729, and the Westminster Hospital in London, founded in 1720, were of this kind. Their aims were mixed: to cure, to teach, and to improve the morals of the poor.
The nineteenth century changed the hospital fundamentally. Two developments made it possible to operate without the appalling death rates of earlier decades. The first was anaesthesia. In October 1846, at the Massachusetts General Hospital in Boston, a dentist named William Morton used ether vapour to render a patient unconscious while a surgeon removed a tumour from his jaw. The second was antisepsis. In Vienna in the 1840s Ignaz Semmelweis showed that washing the hands in chlorinated lime sharply reduced deaths among women after childbirth. A generation later, in Glasgow, Joseph Lister applied carbolic acid to wounds and dressings with similar success.
Florence Nightingale's campaign helped to turn nursing into a trained profession, and her use of statistics showed that most soldiers in the Crimea had died of disease rather than of their wounds. Yet larger hospitals created a new problem, later called hospitalism: patients who came in with one ailment might acquire another, often fatal, infection from the wards themselves. Critics argued that the concentration of sick people in one building was itself a danger.
By the 1890s the hospital had also become a place of investigation. X-rays, discovered in 1895, were in use in hospitals within a few years, and clinical laboratories began to analyse blood and tissue. Buildings changed too: the pavilion plan, in which wards were separated into blocks linked by open corridors, was widely adopted in the belief that fresh air and sunlight would limit infection.
The twentieth century brought a reversal. Antibiotics from the 1940s made many infections treatable, lengths of stay fell, and from the 1980s much surgery was performed on a day basis, without an overnight stay. The large institutions for the mentally ill, built in the previous century, were closed in many countries in favour of care in the community. Yet the hospital has not disappeared; it has become the place where the most complex work is done and where costs are highest. An institution that began as a shelter for the destitute is now the most expensive part of the whole system of care.
You should spend about 20 minutes on Questions 27–40, which are based on Reading Passage 3 below.
Should Historic Town Centres Limit New Architecture?
A writer asks whether old towns should be frozen, or allowed to build
Every generation or so, a proposal for a new building in an old town sets off a quarrel. In London in the 1980s a competition-winning extension to the National Gallery was abandoned after the heir to the throne described the design as a monstrous carbuncle on the face of a much-loved friend. A different design, by Robert Venturi, was built instead. The episode is often read as proof that the public dislikes modern architecture; it is better read as proof that the public dislikes bad architecture, whatever style it comes in.
Those who want stricter limits make three arguments. The first is that a historic centre is a work of art in its own right, whose value lies in the relationship between its parts: the height of the roofs, the line of the street, the view of a tower. A bulky building can destroy those relationships for good. The second is that developers take the profit while the town keeps the damage. The third is that the old fabric is irreplaceable: once a medieval street plan has been widened, no later generation can put it back.
Defenders of new architecture answer that towns have never stood still. Much of what visitors take to be ancient was restored or rebuilt in the nineteenth century. The glass pyramid in the courtyard of the Louvre, installed in 1989, was denounced when it was proposed and is now the image by which the museum is recognised. To freeze a town at a particular moment is to choose an arbitrary date and call it authentic.
The argument is conducted in the wrong terms. 'Modern' and 'traditional' are labels that tell us almost nothing about whether a building is any good; there are worthless modern buildings and worthless imitations of old ones. What matters is whether the new building understands the street it joins: its height, the rhythm of its windows, and the way its ground floor meets the pavement. A well-mannered modern building can add to a street; a shoddy pastiche subtracts from it.
The question of who decides is harder than it looks. Planning committees must weigh a benefit spread over millions of people against a loss concentrated on a few dozen objectors. Those who object turn up to meetings; those who might benefit from the homes or shops a scheme would provide generally stay at home. Decisions therefore tend to reflect the intensity of opposition rather than the balance of advantage.
Developers have learned to work with the rules. The result is facadism: the front wall of a historic building is kept while everything behind it is demolished and replaced. The street looks as it does in old photographs, but the building has gone. Facadism keeps the appearance of a street while destroying the substance of its buildings.
Conservation can succeed too well. Towns that preserve their centres attract visitors, and visitors push out the ordinary life that made the place worth visiting. Many historic centres have lost most of their permanent residents: the bakery becomes a souvenir shop, the school closes, and the streets are full in August and empty in January. A town conserved but emptied of its inhabitants is a stage set, and nobody builds houses in a stage set.
Modern conservation began as a revolt against restoration. The Society for the Protection of Ancient Buildings was founded in 1877 by William Morris and a group of friends. They were appalled by architects who stripped medieval churches of later work and returned them to what they supposed was their original state. The Society argued that a building should be repaired and its decay slowed, not reinvented to suit the taste of the present.
Later documents took very different views. The Venice Charter of 1964 held that any addition must be distinguishable from the original, so that restoration does not falsify the evidence; nothing in it suggests that new work should be invisible. Le Corbusier had gone much further. In 1925 he proposed to demolish a large area of central Paris and replace it with a grid of tall blocks, a scheme that was never built.
The Burra Charter, adopted in Australia in 1979, took a more cautious line, insisting that change be kept to a minimum and that, wherever possible, it should be reversible, so that a later generation can undo it. International bodies now have a say too. Liverpool's historic waterfront was removed from the World Heritage List in 2021, after new development had changed the setting that justified its inscription, and Dresden had lost its status more than a decade earlier for a similar reason. Such warnings concern the setting of a place rather than its individual buildings.
Where does this leave us? I would not freeze the historic centres of our towns, but neither would I let the market decide what replaces them. New buildings should be allowed, and judged by a demanding standard that has nothing to do with whether they look old: height, mass, materials and the quality of the spaces they create. Criteria should be published in advance, decisions reasoned in public, and consent not treated as a referendum on taste. The question is not whether a modern building belongs in an old town, but what it must do to deserve the place.
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