IGCSE History Lesson: Disease and Illness in Medieval England


In the thirteenth and fourteenth centuries, the vast majority of people were peasants who made their living from the land. The feudal system, set up after the Norman conquest, was still in operation at the start of the medieval period. However, a terrible famine from 1315-17, followed by the Black Death, meant that there were barely enough people to tend crops and animals, which meant that the feudal system began to break down. Landowners increasingly moved into sheep farming, which did not require men for ploughing or harvesting. Wool could be sold for a profit in towns, and trade grew with other countries as British ports developed.

Larger numbers of people moved towards life in towns, and the creation of tradesmen’s Guilds began. Anyone who wanted to learn a trade such as carpentry or masonry paid a sum of money to be apprenticed to the guild. By 1400 there were many wealthy trade guilds, including the merchants’ guilds, which held a substantial amount of wealth and influence. Many guild masters became very wealthy, and they were able to set up funds to support guild members who became ill, injured or poor. Unfortunately, crowded medieval towns made ideal places for disease to spread. Although the guild-masters built lavish meeting houses, the streets were filthy, with open gutters in the middle where the townsfolk threw their waste, and people rarely had clean water. Moreover, the thriving ports enabled the spread of diseases from overseas…such as the dreaded bubonic plague, known as the black death.

The spread of diseases increased, but people had little or no knowledge of why this was - or how to treat those afflicted with them. Life expectancy was around 38 years and the infant mortality rate was high.


In the ancient worlds of Egypt and Greece, disease was often seen as having a supernatural cause. Little had changed in the beliefs of the Christians of medieval England.

You are probably familiar with the story, told in the Old Testament of the Christian Bible and in the Jewish Torah, of the ten plagues visited upon the Egyptians by the God of Israel. Taken as a source of evidence, it provides an example of the belief that God caused the deaths of the firstborn children of the Egyptians:

So Moses said, “This is what the Lord says: ‘About midnight I will go throughout Egypt. Every firstborn son in Egypt will die, from the firstborn son of Pharaoh, who sits on the throne, to the firstborn son of the female slave, who is at her hand mill, and all the firstborn of the cattle as well. There will be loud wailing throughout Egypt—worse than there has ever been or ever will be again. 

(Exodus 11: 4-6)

To NOT believe that the deaths in this story were caused by God would be to go against Religious belief and teaching. To believe it means that one must accept that at least some element of divine intervention in matters of life and death is possible. It is common practice even in modern society to pray for the sick and deceased. In medieval Britain, Christianity was an important part of life for all people, whether rich or poor, and therefore it was natural that religious explanations for outbreaks of disease were accepted without question. 

According to Christianity the marks and symptoms of disease were seen as divine punishment: each of the seven deadly sins had its own corresponding illness. It was common for individuals to examine their moral conduct to determine how they had brought illness upon themselves, and a priest as well as a healer would have been consulted (one man often fulfilled the two roles). The idea that the ‘sins of the father’ would be visited on his child in the form of a deformity or chronic illness was also widely accepted.

It is important to remember that:

  1. There was virtually no scientific evidence available to explain incidences of disease
  2. Religious belief was strong, and often rooted in fear of hell
  3. The Church was part of everyday life, and held a high degree of authority.

The belief that malevolent spirits entered the body and caused diseases was also prevalent. After all, many good Christians and innocent children became ill, and a vengeful God was not a suitable explanation for every illness. Any mental illness was attributed to possession by an evil spirit. The action of witches was sometimes blamed when a person fell suddenly ill; but on the other hand, ‘magic’ was often seen as a useful tool for the restoration of health. 

As Ian Mortimer explains in his book ‘The Time Traveller’s Guide to Medieval England’, Other ideas about the origins of disease are bound up with astrology. When the king of France asks the faculty of medicine at the university of Paris to explain the causes of the Great Plague of 1348-9, the worthy professors report that the pestilence is due to:

"An important conjunction of the three higher planets in the sign of Aquarius, which, with other conjunctions and eclipses, is the cause of the pernicious corruption of the surrounding air, as well as a sign of mortality, famine and other catastrophes…The conjunction of Saturn and Jupiter brings about the death of peoples and the depopulation of kingdoms…The conjunction of Mars and Jupiter causes great pestilence in the air." 

(Mortimer, 2008; p.190-191 taken from Rawcliffe ‘Medicine and Society’ p.82) 



The idea of disease being caused by a poisonous, foul air – later called a miasma – was first proposed by the ancient Greek physician, Hippocrates (c. 460-377 B.C), who also developed the ‘humours’ theory (see below). These ideas were widely accepted and persisted for well over a thousand years, until scientists discovered the existence of viruses and bacteria. Since we know now that many diseases are airborne, miasma theory was perhaps not so far off the mark! However, it was the air itself rather than the germs carried by it which the people feared. Bad air was thought to be the cause of epidemics and nasty smelling air made people nervous. 

In medieval England, the use of lavender and other sweet-smelling plants to freshen ones’ home and person was common. Medieval towns may not have been as clean as modern towns are, but it was not because people had no regard for cleanliness. On the contrary; it was considered very important to wash in the morning, the evening, and before every meal. Not because of any knowledge of bacteria, but out of self-respect and pride. 


Like the belief in noxious air, the theory of the four humours was still very widely accepted in all levels of medieval society. Hippocrates described the body as being made up of four liquids, or humours, which had to be in balance for a person to be healthy. Too much or too little of any of the humours would cause various kinds of ailments.

Depiction of the ‘Four Humours’

Claudius Galen (c.130-200 A.D), a prominent Greek physician to the Roman Empire, proposed that miasmas affected people differently depending on the balance of humours in their bodies. His ideas were used to explain why some people caught diseases from the bad air but other people did not. Illness from unbalanced humours could also be attributed to miasmas having entered the body and disrupting the individuals’ natural balance. Galen developed a complex system of diagnosis and treatment based on the four humours, which was accepted and used by medical professionals for over a thousand years.

Activity 1.1: watch a short video about Galen and Hippocrates here:  

Last modified: Thursday, 21 September 2017, 3:23 PM