Medieval Approaches to Disease and the Four Humours (GCSE Example Answer)

Here is an example answer to the following 16-mark question on the acceptance of the four humours as a reason for the continuity of medieval approaches to disease.

‘Continuity of medieval approaches to disease can be mainly attributed to the acceptance of the four humours’. How far do you agree?

Marks: 16 marks + 4 marks SPAG

Stimulus = Theory of opposites / The influence of the Church

[Examiner commentary following each paragraph and at the end is provided in italics]

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I agree with this statement completely. Firstly, the four humours were endorsed by the Church, which meant people were reluctant to question these methods (as undermining the Church was sinful), so approaches to disease via the humours remained consistent. Secondly, in an illiterate age the four humours were an easy concept to understand, thus in theory disease was also easy to combat (especially when it came to applying Galen’s theory of ‘opposites’). This meant people had independence and control over their own diagnoses and treatments, which was especially important for a largely poor population, who mainly relied on barber surgeons for bloodletting if they were to be ‘treated’ at all. Whilst there were other causes and treatments used, the extent of their popularity did not compare with that of the four humours.

[Clear judgement from the outset established and criteria for the judgement made regarding dominance via ease of understanding and popularity.]

The four humours were central to ideas concerning the causes and treatment of disease throughout the period because they were widely accepted by all strands of society. The reason for this was because this type of thinking (where the body’s four humours were related to the four elements of water, earth, air and fire and four seasons of the year) was easy for people to understand and, in turn, provide treatment for, whether or not it was correct! These humours were then linked to physical or mental symptoms. For instance, a person suffering from a cold had too much phlegm, hence why it would run out of their nose. Accordingly, because of the ease in identifying illness, there was also an apparent ease in treating disease too. Often, common treatments centered around blood-letting. This was known as phlebotomy, which involved cutting the victim to ensure the ‘bad blood’ left the body, and purging, where patients were given an emetic to make them vomit or a laxative to help with excretion of waste. Because of the emphasis on balance and ridding the body of an excess humour, by the Middle Ages people looked to treat patients via the theory of opposites and in turn reverse the symptoms being experienced. For instance, if a person had a cold, they were recommended to eat a hot pepper. Conversely, if they had a fever, they were instructed to eat a cucumber. The simplicity of the four humour explanation permeated all strands of society and therefore had a big impact on approaches to medicine during this time.

[Accurate and relevant information with a focus on key terms precisely selected here (which will also help contribute to the SPAG marks). Clear link back to the question, supporting initial judgement in introduction.]

However, acceptance of the four humours was not the only thing that defined medieval approaches to disease. The Church had an enormous impact too. The belief that disease was caused by God punishing sins (as stated in the Bible) or was sent by the devil to test one’s faith was popular and this helps explain why common prescribed treatments were prayer, fasting and the holding of a special mass service. By the time of the Black Death (1348-51) flagellation became common too. Many people publicly whipped themselves as a way of showing God that they were sorry for the sins of man. Because scientific knowledge was minimal by this point and because the vast majority of society could not read and write, people readily accepted what the Church taught them. The enduring influence of the Church and belief in God throughout the medieval era therefore meant that the link between God and disease was ever-present across all strands of society. Crucially though, the Church also promoted the four humours, hence compounding its importance in society and meaning that these ideas co-existed alongside the four humours and were not necessarily mutually exclusive. Humoural approaches to disease therefore existed within the belief that it was God’s will. Promotion of the four humours stemmed from the fact the Church championed Galen, a famous Roman doctor who believed the four humours were central to understanding the cause and treatment of disease. Galen believed that the body was designed for a purpose and had a soul, two things that the Church believed also (hence why they promoted him). By celebrating Galen therefore, the Church was celebrating the four humours at the same time.

[Counter-argument established, which helps showcase balance in the answer. Clear demonstration of detailed knowledge again. The candidate is not scared of putting forward strong counter-arguments, despite the need to have a clear and sustained judgement.]

Importantly, treatments that at first appear different and separate in fact link back to humoural beliefs. For example, different foods were prescribed to treat illness and aloe vera was also used to improve digestion. However, food did link to the humours because it was believed the humours were created from the digestion of food. Elsewhere, bathing was a recommended remedy, as it was believed you could ‘steam out’ impurities and ease aching joints. It was also believed though that baths would help dissolve blockages in the humours. Lastly, astrology was very important to people in the Middle Ages. Physicians consulted star charts when diagnosing illness and treatments varied according to the horoscope of the patient. The alignment of the planets was then checked at every stage of the treatment prescribed, much to the disapproval of the Church. However, even though astrological charts were a different way of understanding illness, often the prescribed treatments would link back to the four humours because they would involve bloodletting and purging.

[Links to seemingly alternative treatments at first glance (but then brought back to the humours) shows a coherent, sustained focus on the question.]

There were some approaches to disease that had no link to the four humours, but they did not reach all levels of society for a sustained period of time in the same way. For example, it was widely believed that the King had the power to heal certain illnesses, especially scrofula (a type of tuberculosis). During his coronation, his hands would be rubbed with special holy oil and this, it was believed, would give him supernatural powers. Edward I, for example, aimed to touch 2000 people a year. Elsewhere, herbal remedies were a common way of treating a variety of ailments. Some of these are still used today, such as mint, rose oils and almonds. A common remedy was called theriaca which included ingredients like ginger, cinnamon and saffron.

[Criteria for judgement (the extent to which ideas permeated all levels of society) highlighted here, which simultaneously showcases wide-ranging knowledge too.]

In conclusion, the four humours did dominate thinking. Approaches to disease that were entirely separate from humoural beliefs were linked to religion, praying and the King’s touch. However, whilst God and religion were ever-present in medieval life, they existed alongside humoural ideas too. Firstly, because the Church endorsed them as well, via the promotion of Galen, and secondly because the four humours was a relatively easy concept to grasp by all members of society and apply in a variety of instances.

Overall Examiner Comments:

Level 4, 13-16 (+3-4 marks SPAG)

This is a high-level answer, it shows an in-depth knowledge of various features of the period, is balanced in judging the full influence of the four humours, yet ensures the answer still presents a sustained judgement. The answer emphatically goes beyond the stimulus points and the conclusion re-establishes clear criteria for why the four humours did dominate ideas in the medieval era.