Medieval Public Health

Public health in medieval towns was extremely poor, with unsanitary conditions that contributed to the spread of numerous diseases. Filthy streets, inadequate waste management, and a general lack of understanding about hygiene created an environment ripe for outbreaks of illness. The situation was worsened by a lack of medical knowledge, with authorities often unable to implement effective solutions.

Town Conditions

The state of public health in medieval Britain can be traced back to the decline of Roman infrastructure. During the Roman occupation in the 1st century, the Romans built extensive public health facilities, including public baths, toilets, fountains, and sewers, all designed to manage waste and maintain a level of cleanliness in urban areas. These systems significantly improved public health by reducing the spread of diseases like cholera and dysentery.

However, after the Romans withdrew from Britain in the 5th century, their public health systems fell into disrepair. Many of the facilities were abandoned or deliberately destroyed by those seeking to remove all traces of Roman influence. This neglect of public health infrastructure had long-lasting consequences and contributed to the unhealthy living conditions that plagued medieval towns throughout the Middle Ages.

Causes of Problems - Toilets and Waste Disposal

Medieval towns, particularly London, faced severe sanitation issues. The most pressing problem was waste disposal, as many people had little or no access to proper toilets.

• Public Toilets: In medieval London, public toilets were constructed on a bridge over the River Thames, so that human waste would be carried away by the river. However, this solution was not universally applied. Many homes had privies, which were toilets that emptied directly onto the street. In some cases, households simply used a bucket to dispose of waste, which was then thrown into the street. The accumulation of waste on the streets, especially in busy urban areas, led to the spread of disease and foul odours.
• Wealthier Households: Wealthier individuals could afford to build private toilets, which usually led to a cesspit — a pit where waste was collected. Cesspits were typically located near the home, and, while some of the waste was meant to be taken outside the city walls by gongfermers (sewage workers), the system was far from perfect. Gongfermers, who were supposed to remove the waste and take it away on horse-drawn carts, sometimes disposed of it in the river or dumped it back into other parts of the town. As a result, much human waste remained within the urban environment, adding to the unsanitary conditions.
• Impact on Disease: The poor waste management system contributed to the spread of diseases. A lack of proper sanitation was a significant factor in the spread of the Black Death in the 14th century, a pandemic that killed millions. The widespread dumping of waste into the streets attracted rats, which were known to carry fleas that transmitted the bubonic plague.

Causes of Problems - Butchers and Animal Waste

Butchers in medieval towns were allowed to slaughter animals within the cities. However, they often disposed of the offal (waste material from the slaughtering process) by throwing it into the streets or rivers. This created further sanitation issues, as the blood, entrails, and other refuse would mix with the waste already accumulating on the streets.

• Open Drains: Many medieval streets had open drains running down their middle. These drains would wash waste into rivers, which in turn contaminated water supplies. In dry periods, when there was less rain to wash away the waste, it would remain on the streets, creating a breeding ground for vermin.
• Attracting Rats: The piles of rotting waste, combined with the frequent presence of animal carcasses and rubbish, attracted rats. Rats, which carried fleas, were instrumental in spreading diseases like the plague. The poor hygiene in medieval towns created the perfect conditions for the outbreak and rapid spread of epidemics.

Attempted Solutions

Although medieval towns struggled with public health issues, there were some efforts to improve conditions. Town authorities, realising the need to address the unsanitary environment, introduced several measures to tackle waste management problems.

• Punishments for Littering: In an attempt to keep towns cleaner, authorities introduced punishments for those who dumped waste in the streets. For example, in 1309, a 40p fine (equivalent to about £400 in 2021) was introduced for anyone caught littering the streets. Butchers were also banned from slaughtering animals in the street to reduce contamination.
• New Jobs to Improve Sanitation: To help address the unsanitary conditions, several new jobs were created. These roles were designed to clear waste and improve cleanliness in towns.
• Gongfermers: These workers were responsible for emptying cesspits and removing the human waste that accumulated in pits beneath houses. They were supposed to take the waste outside the town walls for disposal, though in practice, they sometimes dumped it in rivers or other parts of the town, exacerbating the sanitation problem.
• Muck Rakers: Similar to modern-day street cleaners, muck rakers were paid to clear the streets of rubbish and waste. Their job was to gather up the refuse and ensure that the streets were kept free of excessive litter.
• Surveyors of the Pavement: This role involved overseeing the cleanliness of the pavements and ensuring that they were cleared of rubbish. These workers played a crucial role in maintaining the public spaces of medieval towns.

Long-Term Impact

Despite these efforts, public health in medieval towns remained poor. The lack of modern sanitation infrastructure, limited medical knowledge, and unsanitary living conditions meant that disease and death remained common throughout the medieval period. However, the introduction of these early reforms, such as fines for littering and the creation of sanitation-related jobs, laid the groundwork for more sophisticated public health systems in the future.

It was not until the Industrial Revolution, centuries later, that cities would see the significant public health improvements necessary to prevent the widespread outbreaks of disease. Nonetheless, the medieval period was a critical point in the development of urban sanitation practices, and some of the ideas introduced during this time would be built upon in later centuries to create cleaner and healthier cities.

Conclusion

Medieval public health was marked by unsanitary conditions that contributed to the spread of diseases like the Black Death. The fall of Roman public health systems, coupled with poor waste management practices, created a breeding ground for illness. Despite this, efforts such as the introduction of fines for littering and the creation of jobs to remove waste demonstrate that medieval authorities were attempting to address the problems, even if their solutions were often inadequate. These early efforts laid the foundation for later advancements in public health and sanitation.