H17: Medicine in Medieval England

Foundation Higher AQAEdexcelOCREduqasCCEA

Religious and rational approaches to medicine c1000-1500, the role of the Church, barber-surgeons, and the devastating impact of the Black Death in 1348.

Exam Board:

📖 Overview of Medieval Medicine

Key Context: Medieval England (c1000-1500) was a deeply religious society where the Catholic Church controlled almost every aspect of life, including medicine. Two traditions coexisted: religious approaches based on faith and prayer, and rational approaches inherited from ancient Greek and Roman writers such as Hippocrates and Galen.

In medieval England, most people had little access to trained physicians. The vast majority of the population were peasants who relied on local wise women, herbal remedies, and the Church for medical treatment. Only the wealthy could afford trained doctors who had studied at universities.

Medieval Medical Framework:
Religious Approaches (prayer, pilgrimage, faith) + Rational Approaches (Four Humours, Galen) = Medieval Medicine
Both systems were supported by the Church and rarely challenged.

🙏 Religious Approaches to Medicine

The Catholic Church was the most powerful institution in medieval England and profoundly shaped how people understood illness and disease.

Beliefs About Illness

Illness was often seen as a punishment from God for sins
Disease could be a test of faith, sent by God to strengthen a person's spirit
Sickness was sometimes attributed to demonic possession or evil spirits
The Church taught that suffering on Earth would be rewarded in Heaven

Religious Treatments

Prayer: The most common response to illness. People prayed to God for recovery and attended Mass regularly
Pilgrimage: Sick people travelled to holy shrines such as the shrine of Thomas Becket at Canterbury Cathedral, hoping for miraculous cures
Confession: Since illness was linked to sin, confessing sins to a priest was considered a form of treatment
Charms and amulets: Holy relics, blessed objects, and religious charms were worn for protection against disease

Example: The Shrine of Thomas Becket

After Thomas Becket was murdered in Canterbury Cathedral on 29 December 1170, his shrine became the most popular pilgrimage site in England. Sick pilgrims travelled hundreds of miles, believing that praying at Becket's shrine could cure illnesses. The Cathedral recorded hundreds of alleged miracles. Pilgrims bought small lead flasks of holy water (ampullae) as souvenirs, believing the water had healing properties.

Why did religious approaches dominate? The Church controlled education and hospitals. Monasteries preserved ancient medical texts in their libraries. The Church taught that God caused and cured disease, so challenging this idea was considered heresy. Most people could not read, so they accepted Church teachings without question.

🔬 Rational Approaches: Hippocrates and Galen

Despite the dominance of religion, medieval medicine also drew on rational ideas from ancient Greek and Roman physicians. These ideas had been preserved and developed by Arab scholars and were reintroduced to Europe through trade and the Crusades.

Hippocrates and the Four Humours (c460-370 BC)

Hippocrates developed the Theory of the Four Humours, which became the foundation of medieval rational medicine:

Humour	Season	Element	Quality	Too Much Causes
Blood	Spring	Air	Hot and wet	Fevers, nosebleeds, headaches
Phlegm	Winter	Water	Cold and wet	Colds, coughs, lung problems
Yellow Bile	Summer	Fire	Hot and dry	Jaundice, vomiting, fever
Black Bile	Autumn	Earth	Cold and dry	Depression, constipation, dry skin

The Theory of the Four Humours: Hippocrates argued that the body contained four humours (fluids). When these were in balance, a person was healthy. When one humour dominated, illness occurred. Treatment aimed to restore balance by removing the excess humour. This theory lasted over 1,500 years because it was logical and seemed to explain symptoms.

Treatments Based on the Four Humours

Bloodletting: Removing blood to reduce an excess of blood. Performed by cutting a vein or applying leeches
Purging: Using laxatives or emetics to remove excess yellow or black bile
Diet and exercise: Prescribing foods with opposite qualities to the dominant humour (e.g. cool foods for a hot illness)
Cupping: Placing heated glass cups on the skin to draw out harmful humours

Galen and the Four Humours (AD 129-c216)

Galen was a Roman physician who built on Hippocrates' work. He provided detailed anatomical knowledge based on dissections of animals (mainly pigs and Barbary apes), and he developed the Theory of Opposites to treat illness.

Galen's Theory of Opposites:
If a patient had too much of a cold and wet humour (phlegm), they should be treated with something hot and dry (e.g. eating hot peppers, drinking warm wine).
Opposite qualities restore balance.

Why was Galen so influential? Galen's work fitted perfectly with Christian teaching. He argued that the body was designed by a single Creator, which the Church interpreted as proof of God's existence. The Church therefore promoted Galen's ideas and discouraged anyone from questioning them. His works were used as medical textbooks for over 1,300 years.

⛪ The Church and Hospitals

The Church played a central role in providing medical care through monasteries and hospitals.

Monasteries as Medical Centres

Monasteries had infirmaries for sick monks and also treated local people
Monks grew medicinal herbs in their gardens (e.g. lavender for headaches, wormwood for stomach problems)
Monasteries were centres of medical knowledge, preserving ancient texts in their libraries
The Benedictine Rule required monks to care for the sick and poor

Medieval Hospitals

Most hospitals in medieval England were run by the Church and focused on spiritual care rather than medical treatment:

Feature	Medieval Hospital	Modern Hospital
Run by	The Church / religious orders	The NHS / state
Main purpose	Spiritual care and rest	Medical treatment and cure
Staff	Monks and nuns	Doctors, nurses, surgeons
Treatments	Prayer, rest, good food	Surgery, drugs, therapy
Patients	The poor, elderly, travellers	Anyone who is ill

Example: St Bartholomew's Hospital, London

Founded in 1123 by Rahere, a courtier of Henry I, St Bartholomew's was one of the largest medieval hospitals in England. It cared for the sick poor and provided food, shelter, and spiritual comfort. Patients were expected to confess their sins and attend Mass daily. The hospital had a master, eight brethren, and four sisters who cared for the patients. It continued to operate after the Dissolution of the Monasteries and still exists today as Barts Hospital.

💇 Barber-Surgeons

In medieval England, there was a clear distinction between physicians (who diagnosed illness) and surgeons (who performed operations). Surgery was considered a lower-status trade, and most surgeons were barber-surgeons.

Barber-Surgeons: Barbers who also performed surgical procedures such as bloodletting, tooth extraction, amputations, and setting broken bones. They learned through apprenticeships rather than university education. The red and white striped barber's pole symbolised bloodletting (red for blood, white for bandages).

What Barber-Surgeons Did

Cut hair and shaved beards (their primary trade)
Performed bloodletting and applied leeches
Extracted teeth
Treated wounds and set broken bones
Performed amputations and minor surgery
Carried out cupping and cauterisation (burning wounds to seal them)

Limitations of Medieval Surgery

No effective anaesthetics - patients were awake during operations
No knowledge of infection - instruments were not sterilised
High death rate from blood loss and infection
Operations were limited to the surface of the body
Physicians looked down on surgeons as tradesmen, not scholars

Example: The Guild of Barber-Surgeons

In 1540, Henry VIII united the Company of Barbers and the Fellowship of Surgeons into the Guild of Barber-Surgeons by the Act of Union. Barbers were limited to drawing teeth and bloodletting, while surgeons could perform all other operations. This distinction reflected the ongoing tension between the two trades.

☠️ The Black Death 1348

The Black Death was the most devastating pandemic in medieval European history. It transformed English society and had lasting effects on medicine and public health.

Arrival and Spread

The plague arrived in England in June 1348, landing at Melcombe Regis (now Weymouth) in Dorset
It spread rapidly north, reaching London by autumn 1348 and York by spring 1349
By 1350, it had covered all of England
Estimated 30-50% of England's population died (approximately 1.5 million people out of 3-4 million)
The plague was caused by the bacterium Yersinia pestis, transmitted by fleas on black rats

Three Forms of Plague:

Bubonic plague: Spread by flea bites. Caused painful swellings (buboes) in the lymph nodes, especially in the groin and armpits. Death rate: approximately 60-80%
Pneumonic plague: Spread by coughing and breathing. Infected the lungs. Death rate: nearly 100%
Septicaemic plague: The plague bacteria entered the bloodstream directly. Death rate: nearly 100%, often within hours

Medieval Explanations for the Black Death

Explanation	Details	Treatment/Response
God's punishment	The Church taught that the plague was sent by God as punishment for humanity's sins	Prayer, pilgrimage, confessing sins, giving charity
Miasma (bad air)	People believed disease was spread by poisonous vapours in the air from rotting matter	Carrying sweet-smelling herbs, lighting fires, staying indoors
Four Humours imbalance	Physicians explained the plague as an imbalance of humours in the body	Bloodletting, purging, adjusting diet
Alignment of planets	Some scholars blamed the unusual conjunction of Saturn, Jupiter, and Mars in March 1345	Nothing could be done - it was seen as fate
Contagion	Some people noticed the disease spread from person to person	Quarantine, fleeing infected areas

Responses to the Black Death

Religious Responses:

Flagellants: Groups of people who marched from town to town, publicly whipping themselves to show repentance to God. They believed self-punishment would end the plague. The Church eventually banned flagellant processions in 1349 because they were causing unrest and spreading disease
Special prayers and processions were organised by the Church
People made generous donations to the Church, hoping God would spare them

Rational and Practical Responses:

Bloodletting: Physicians recommended bleeding patients to remove corrupt blood and restore humoral balance
Pomanders: People carried bags of sweet-smelling herbs (rosemary, lavender, camphor) to ward off miasma
Quarantine: Venice introduced the first formal quarantine in 1348 - ships had to wait 40 days (quarantina giorni) before landing
Fleeing: Those who could afford to left infected areas. This was often the most effective response, though it spread the plague further

Example: The 1348 Ordinances of the City of London

London authorities attempted to control the plague by ordering that all streets should be cleaned of human and animal waste. All pigs roaming the streets were to be slaughtered. The city tried to remove rotting matter that was believed to create miasma. However, these measures were inconsistently enforced and had limited impact.

Impact of the Black Death

The shortage of labour after the plague led to higher wages for surviving peasants
The Statute of Labourers (1351) tried to freeze wages at pre-plague levels
The Peasants' Revolt of 1381 was partly caused by resentment at these restrictions
The Church lost credibility because prayers and pilgrimages had failed to stop the plague
Some people began to question traditional medical ideas, though real change was very slow

🧑‍⚕️ Other Medieval Medical Practitioners

Practitioner	Training	Patients	Treatments
Physicians	University education (7+ years studying Galen and Hippocrates)	Wealthy nobles and royalty	Diagnosis by examining urine (uroscopy), bloodletting, herbal remedies
Monks and Nuns	Trained in monasteries and convents	Anyone who came to the monastery hospital	Prayer, rest, herbal remedies, good food
Barber-Surgeons	Apprenticeship (no formal qualifications)	Townspeople and soldiers	Bloodletting, amputation, tooth extraction, wound care
Apothecaries	Apprenticeship, mixing and selling drugs	Middle class and poorer patients	Preparing and selling herbal medicines and drugs
Wise Women	Oral tradition, passed down through generations	Villagers and the rural poor	Herbal remedies, charms, midwifery

Important Point: Medieval medicine was not completely ineffective. Some herbal remedies did work (e.g. willow bark contains salicylic acid, the basis of modern aspirin). However, the overall understanding of disease was limited by religious dogma, lack of scientific method, and reliance on ancient authorities.

📊 Continuity and Change c1000-1500

Continuity: The Four Humours remained the dominant medical theory throughout the entire medieval period. The Church continued to control hospitals and education. Religious approaches (prayer, pilgrimage) remained the first response to illness for most people. Galen's works were taught without question at universities.

Change: The Black Death did prompt some questioning of Church authority. The development of trade and the Crusades brought new ideas from the Islamic world. Arab physicians like Avicenna (Ibn Sina, 980-1037) wrote important medical encyclopaedias. The growth of towns led to more barber-surgeons and apothecaries. However, change was extremely slow - most medieval medical ideas persisted into the Renaissance and beyond.

❓ Practice Questions

Q1: Explain two religious approaches to treating illness in medieval England. (4 marks)

Q2: Describe the Theory of the Four Humours and how it was used to diagnose illness. (4 marks)

Q3: Why was Galen's work so influential in medieval medicine? Explain your answer. (8 marks)

Q4: How did people in medieval England explain the Black Death? (4 marks)

Q5: "The Church helped medical progress in medieval England." How far do you agree? Explain your answer. (16 marks + 4 SPaG)

Q6: Compare the treatments offered by physicians and wise women in medieval England. In what ways were they similar and different? (8 marks)

✅ Answers

Religious approaches included prayer (people prayed to God for recovery from illness, believing disease was a punishment for sin) and pilgrimage (travelling to holy shrines like Canterbury to pray for miraculous cures). Other approaches included confession and wearing religious charms.
Hippocrates' Theory of the Four Humours stated that the body contained four fluids: blood, phlegm, yellow bile, and black bile. When these were in balance, the person was healthy. When one humour dominated, illness occurred. Physicians diagnosed which humour was out of balance by examining symptoms and using uroscopy (examining the colour, smell, and taste of urine).
Galen was influential because: (1) his theory that the body was designed by a Creator fitted perfectly with Christian teaching; (2) the Church promoted his work and discouraged anyone from questioning it; (3) his detailed anatomical knowledge from animal dissections was the most comprehensive available; (4) his Theory of Opposites provided a logical treatment method that seemed to work; (5) his writings were used as standard medical textbooks in universities for over 1,300 years.
People explained the Black Death in several ways: as God's punishment for sins, as miasma (bad air from rotting matter), as an imbalance of the Four Humours, as caused by the alignment of planets, and some recognised it spread by contagion (person to person contact).
Answers should consider both sides: the Church helped by running hospitals, preserving medical texts in monasteries, and caring for the sick. However, the Church also hindered progress by suppressing new ideas, promoting Galen uncritically, and emphasising spiritual over medical treatment. A balanced answer with a clear judgement is needed.
Similarities: both used herbal remedies, both relied on traditional knowledge rather than scientific evidence. Differences: physicians were university-educated and served the wealthy, while wise women learned through oral tradition and served the poor; physicians used the Four Humours for diagnosis while wise women used practical experience; physicians charged high fees while wise women often charged little or nothing.

🎯 Exam Tips

Always use specific dates and named individuals in your answers (e.g. "the Black Death arrived in England in June 1348")
For "how far do you agree" questions, you must discuss both sides before reaching a judgement
Explain the reasons why things happened, not just what happened - e.g. explain why Galen was influential, not just that he was
When discussing factors, link them together - e.g. the Church supported Galen's ideas, which meant they lasted longer
Use the language of causation: "this led to," "as a result," "because of this"
For 16-mark questions, write at least 3-4 developed paragraphs plus a conclusion
Remember SPaG marks on 16-mark questions - use paragraphs, correct spelling, and formal language

📝 Exam Technique

History Exam Tips — Medicine in Medieval England:
1. For Medicine in Medieval England, include specific factual detail: dates, names, events and statistics where relevant
2. For source questions, analyse provenance (who, when, why, audience) before using the content
3. In evaluation questions, discuss multiple factors and weigh their relative significance
4. Always link back to the question focus — don't just narrate what happened with Medicine in Medieval England
5. Use phrases like 'the most significant factor was... because...' to show analytical judgement

⚠️ Common Errors

Watch Out!

Students often think medieval medicine was entirely backward. Wrong: Medieval medicine was entirely backward Correct: Medieval doctors used rational observation (urine analysis, pulse checking) alongside religious approaches. Monasteries preserved medical texts and some hospitals provided genuine care.

Students often think one individual caused all medical progress. Wrong: One individual caused all medical progress Correct: While individuals like Pasteur were crucial, their discoveries depended on other factors: technology, government support, and the work of predecessors.

Students often think progress in medicine has been steady and continuous. Wrong: Progress in medicine has been steady and continuous Correct: Medical progress was not a straight line — there were periods of regression, and some ideas took centuries to be accepted.

✍️ Model Answer

Full-Mark Response

8 marks: Explain why medieval medicine made limited progress.

One reason medieval medicine made limited progress was the Church's control over education and medical knowledge. The Catholic Church dominated universities and hospitals, and promoted Galen's work because his theory that the body was designed by a Creator fitted Christian teaching. The Church discouraged anyone from questioning Galen's ideas, effectively banning new anatomical research. Dissection of human bodies was restricted — the University of Padua only permitted one dissection per year by the early 1300s — so doctors could not verify Galen's errors through direct observation.

A second reason was the dominance of Galen's Four Humours theory. For over 1,300 years, physicians diagnosed illness as an imbalance of blood, phlegm, yellow bile, or black bile, and treated patients with bloodletting, purging, and diet. This theory seemed logical and was supported by the Church, so few people thought to challenge it. Treatments based on the Four Humours often made patients worse — bloodletting weakened already sick people — but there was no scientific method to test whether treatments actually worked.

A third reason was that dissection was largely banned or heavily restricted throughout the medieval period. Without systematic human dissection, anatomical knowledge could not advance. Galen's errors — such as claiming the human jaw had two bones and the liver had five lobes — persisted because doctors relied on his animal dissections rather than observing human bodies directly. The Church taught that dissecting humans was morally wrong, and most people believed the body should remain intact for resurrection.

A fourth reason was the Black Death of 1348, which exposed the limitations of medieval medicine. Despite 1,500 years of the Four Humours, neither prayer, bloodletting, pomanders, nor quarantine could stop a plague that killed approximately 1.5 million people in England (30-50% of the population). The failure of all existing medical approaches showed that medieval medicine was fundamentally unable to understand or treat major diseases. In conclusion, the Church's control of education and its promotion of Galen were the most important factors because they prevented new ideas from emerging for centuries, while the Black Death demonstrated the catastrophic consequences of this stagnation.

📊 AO Deep Dive

Assessment Objective Analysis

AQA History tests three AOs: AO1 (Knowledge, 35%) requires recall of specific facts, dates and details about Medicine in Medieval England; AO2 (Explanation, 35%) requires explaining causes, consequences and changes using detailed knowledge; AO3 (Sources and Interpretations, 30%) requires analysing provenance, content and usefulness of sources, and evaluating different historical interpretations. For grade 9, you need precise knowledge (specific dates, statistics and named individuals), sophisticated explanation showing how factors interrelate, and nuanced source analysis considering purpose, audience and context. The key difference between grade 5 and grade 9 is DETAIL and ANALYSIS — top answers support every point with specific evidence and reach substantiated conclusions.

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