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First exams 2026

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Perceived Causes of Disease in the Middle Ages (Edexcel GCSE History)

Revision Note

Natasha Smith

Written by: Natasha Smith

Reviewed by: Bridgette Barrett

Diseases During the Medieval Period - Timeline & Summary

Timeline showing historical medical theories and events from the 5th century BCE to the 15th century CE, including Hippocrates' Four Humours and the Black Death.

Examiner Tips and Tricks

Nowadays, historians do not use BC and AD to measure time. This is because they are associated with Christianity. Instead, they use the non-religious terms of BCE (Before Common Era) and CE (Common Era) which you should try to use in your exams. There is no year difference in dates between BC/AD and BCE/CE.

During the medieval period, there was a lack of understanding about why people became ill. This was because scientific explanations did not exist. People looked to natural or supernatural reasons to explain the unexplainable. They followed the ideas of philosophers like Galen, who had lived in Ancient Greece. They seemed to have more answers about why people became ill.

The Church’s power was enormous in 1250. Priests were one of the very few individuals that could read and write. In Church, they taught people how disobedience would result in going to hell in the afterlife. The Church stated that it was God’s will about who was healthy or not. Ordinary people did not question the authority or wisdom of the church. The Church and people did support the ideas of Galen, as his ideas matched Christian teachings. This meant they were not challenging the Church’s power. It took the emergence of the Black Death in 1348 for some people to begin to question the Church and existing theories.

Natural Causes of Disease in the Middle Ages

Miasma

  • Miasma is bad air and was understood to be found near swamps, corpses and rotting objects

  • If you breathed in miasma, people believed that you would become ill

  • Many people believed in using pleasant smells to protect against miasma-causing illness

Urine

  • Physicians believed in examining the urine of their patients 

  • They believed the urine indicated which of the four humours was unbalanced

  • Physicians would check the colour, consistency and smell of the urine and compare it to a urine chart

The Theory of the Four Humours

What are the Four Humours?

  • The Theory of the Four Humours was a popular theory during the medieval period

    • Galen expanded on the Theory of the Four Humours to create his Theory of Opposites

  • It was believed that the four humours made up the human body:

    • Blood

    • Phlegm: A water-like substance coughed out or contained in a sneeze

    • Black Bile: Blood that had clotted, seen in vomit or poo

    • Yellow Bile (Choler): A substance contained in vomit or pus

  • People believed that for a person to be healthy, the four humours should be in balance

  • It was believed that if someone had more or less of one of these humours, the body would become unbalanced. The person would then become ill

  • The humours also linked to seasons, elements and star signs

Examiner Tips and Tricks

Although Hippocrates is not in the specification or learning resources, his name is often mentioned alongside Galen. Hippocrates was a Greek physician known as the Father of Medicine. Hippocrates created the Theory of the Four Humours, the Hippocratic Oath and encouraged physicians to observe a patient's symptoms.

Diagram showing the Four Humours: blood (spring, hot, air), yellow bile (summer, dry, fire), black bile (autumn, cold, earth), and phlegm (winter, wet, water).
A diagram of the Four Humours showing their links with seasons, elements and star signs

Worked Example

Describe one feature of the Theory of the Four Humours

2 marks

Answers:

The humours had to be balanced to be healthy (1); Having too much or too little of a humour would cause somebody to become ill (1).

Examiner Tips and Tricks

When answering ‘Describe one feature of…’ questions, two marks are given to you for:

  • Identify - write a relevant point based on the question topic

  • Describe - add some specific own knowledge about the point you have made

This question previously asked students to describe two features of a given event. This question was out of four marks. However, from 2025, Edexcel will split this question into two subsections, asking you to describe a feature of two different events. Each subsection is worth two marks.

Galen and the Theory of Opposites

  • Galen was an Ancient Roman physician who expanded on the Theory of the Four Humours

  • Galen's Theory of Opposites argued that the cure for an excess of one humour is treatment with the opposite humour

    • For example, people believed that the cure for too much phlegm (cold) was eating a hot pepper (hot)

The importance of Galen to medicine

  • Galen had a keen interest in anatomy.

    • He publicly dissected animals, particularly pigs

      • This provided Galen with evidence for his theories on the functions of organs, nerves and the skeletal structure of the human body

  • The use of pigs meant that his ideas were mostly incorrect when applied to human anatomy

    • Despite this, Galen's ideas dominated medical thinking for 1,400 years

Examiner Tips and Tricks

Do not confuse the Theory of Opposites with the Theory of the Four Humours. Both theories focus on the humours but the way Galen used the opposite humour as treatment was entirely different to the Theory of the Four Humours. Therefore, the Theory of Opposites built upon the ideas of the Theory of the Four Humours to give it more practical use for treatments.

Galen's Popularity

  • Galen's Theory of Opposites did not require human dissection, which allowed the Church to support him

    • The Church did not believe in cutting the body, as, for a person's soul to go to heaven, the body needed to be intact

  • Many people in medieval England could not read

  • Physicians who had read Galen were regarded as better-educated

    • This meant that medieval people did not question the physicians

  • Due to a lack of scientific knowledge, there were no better explanations for illness than those suggested by Galen 

Supernatural Causes of Disease in the Middle Ages

Religion

  • The belief in God played an incredibly important role in medieval people’s day-to-day lives. 

  • The Church dictated people’s lives from ‘cradle to grave’ 

    • People went to Church every Sunday

    • As a baby, they would be christened in the Church

    • They would be married at Church

    • They would go into confession and pay for indulgences to clear their soul of sin

    • When they died, they would have a funeral at Church

  • If you sinned, it was believed that God had the power to make you ill

  • People believed that certain diseases were a result of God’s punishment, for example, leprosy

Astrology

  • Astrology is the study of the position of the planets and stars

  • The Church did not like the use of astrology but it did have links to Hippocrates’ Theory of the Four Humours 

  • Physicians would consult star charts and look at when the patient was born to help diagnose their illness 

    • e.g. Capricorn, Aquarius and Pisces were linked to excess phlegm

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Natasha Smith

Author: Natasha Smith

Expertise: History Content Creator

After graduating with a degree in history, Natasha gained her PGCE at Keele University. With more than 10 years of teaching experience, Natasha taught history at both GCSE and A Level. Natasha's specialism is modern world history. As an educator, Natasha channels this passion into her work, aiming to instil in students the same love for history that has fuelled her own curiosity.

Bridgette Barrett

Author: Bridgette Barrett

Expertise: Geography Lead

After graduating with a degree in Geography, Bridgette completed a PGCE over 25 years ago. She later gained an MA Learning, Technology and Education from the University of Nottingham focussing on online learning. At a time when the study of geography has never been more important, Bridgette is passionate about creating content which supports students in achieving their potential in geography and builds their confidence.