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Houses were made of wattle and daub and overhung the streets, cutting out light and air. Rats, lice and fleas flourished in the rushes strewn over the clay floors of people’s houses. It is hardly surprising that disease thrived in medieval towns.

Personal hygiene

Contrary to popular opinion, most medieval people realised the importance of personal hygiene.

When King John travelled around his kingdom, he took a bathtub with him to ensure he could keep clean and healthy. However, cleanliness was a luxury few could afford. Most people washed in cold water unless they were rich and could afford to have it heated.

Cleaner towns and cities

By the later Middle Ages there was a growing awareness of the importance of hygiene. Town and city councils were spending money on trying to keep places clean:

• Towns began to build public latrines. By the 15th century, London had over a dozen. They were often placed on bridges, so that the waste could be taken away by the river.
• London produced about 50 tonnes of excrement per day, so muck-rakers were hired to clean the streets. They were paid much better than the average working man. There were also gong farmers, who cleared out cesspits and latrines.
• Towns had bathhouses, eg Southwark, in London, had 18 hot baths. Even smaller towns would have bathhouses, often connected to bakeries. The baths used the heat coming from the bakeries’ ovens to heat their water.
• Monasteries observed strict rules about cleanliness. They had fresh running water, lavers (washrooms), flush reredorters (latrines) connected to sewers, clean towels and a compulsory bath four times a year.
• Many towns introduced quarantine laws to combat plague and boarded up the houses of infected people. People with leprosy were confined to lazar houses.
• During the Middle Ages, the Crusaders brought soap back from the Middle East to Europe.

Even small towns had public health regulations. Sanitation was thought to be important. Dumping refuse inside a town or close to its walls was an offence, and residents were told to clean the pavements in front of their houses.

Butchers were not allowed to slaughter animals in the street and were fined if they threw offal into the street. To keep the townspeople healthy, there were also strict rules about the quality of food sold by traders. However, the biggest fines were reserved for those who disrupted business, eg three shillings for fighting and five shillings for playing tennis in the street. In the 13th century, even someone employed in a skilled trade might only earn 1 shilling for 5 days of work. These fines perhaps indicate that, for the corporation, there were more important things than public health.

The government also took steps to try to improve public health and hygiene. This law passed by Parliament after the Black Death in England (1348-1350) shows its concern:

Coventry in the medieval era

Research shows that Coventry made particular attempts to try to clean itself up in the medieval era:

• In 1420, a weekly waste removal service was set up with a small fee.
• A 1421, proclamation said that people had to clean the street in front of their house every week or be fined.
• In 1421, it was ordered that all latrines in the Red Ditch stream, which runs through Coventry, must be removed to clean it up and prevent flooding.
• Five places outside the city limits were identified as waste disposal sites to prevent dunghills and waste pits from being dug anywhere else.
• From 1421, Coventry city council banned the dumping of waste in the River Sherbourne.

Limitations in progress

However, in spite of the efforts listed above, there is no evidence of any real improvement in public health during the Middle Ages:

• People had no knowledge of the causes of disease. The extract above refers to the idea that disease was spread by miasma when it states “the air there is grown greatly corrupt and infected”.
• Public latrines emptied into rivers, which became breeding grounds for disease.
• The volume of rubbish meant that it was almost impossible to keep streets clean.
• Even in towns with bathhouses, people did not bathe very often. One medical book advised people that spring and winter were good times for bathing, but that it should be avoided in the summer.
• Improving public health was not seen as a government responsibility.
• The Church taught that illness was God’s punishment, so people believed that nothing could be done about it.