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Did people worry about dirt and disease in the later middle ages?

On 29 October 1479 John Paston II wrote to his mother, Margaret:

‘I have been here in London for a fortnight and for the first four days I was in such fear of the sickness, finding my chamber and its contents not so clean as I had expected, which troubled me sore.’

John died two weeks after he wrote this letter, quite possibly of plague which was rife in London that year. The Paston letters contain a number of such references to disease, with the writers sounding at the same time both accepting of the presence of plague and deeply frightened. Another example comes from the autumn of 1471 during what John II called ‘the most universal death that ever I knew in England.’ In a letter in November Margaret lists four local friends and acquaintances in Norwich who have died from plague before saying ‘All this household and this parish are safe, blessed be God. We live in fear but we do not know where to go in order to be safer than we are.’ She then goes on to provide her son with a list of spices which she wants him to buy for her, perhaps as ingredients for a cure or medicine to ward off the plague.

Such extracts show how vulnerable people were to outbreaks of disease but did they do anything – or anything worthwhile – to prevent the spread of disease? Victorian historians painted a very grim picture of medieval towns, an image which is still to be seen in films and TV documentaries (some of which should know better) but which should have been overturned long ago. Recent research by Carole Rawcliffe and others paints a much more nuanced and positive picture of the efforts of people in the later middle ages to reduce dirt, the spread of disease and to combat plague. (For a summary of this work click here)

The material for the activity below was originally published in 1996 in my first Medicine through Time book written with Ian Coulson. As that book, while still in print, no longer fits specifications (it dates from a wiser time when books could be written for a topic not a specification) I thought I would provide that material here. It was drawn from three articles written by EL Sabine and published in the 1930s in the arts and humanities journal Speculum, a publication well-known to medievalists but possibly not to modern historians.

The articles are based on the records of the city of London and deal with Butchering in Medieval London, City Cleaning in Medieval London and Latrines and Cesspools in Medieval London.

You can see why I was excited when I found them!


A WORD version of this activity and accompanying resources can be downloaded:


At GCSE this activity can be used to introduce the topic of public health or medieval medicine as a whole as it sets out conflicting evidence about attitudes to health and public health. This would make a good introduction because it will challenge any consistently negative view of medieval attitudes – it is important that students understand that there were major efforts to improve health and the rationality of widely-held ideas about the cause of disease. Having a positive image of medieval people’s attitudes then means students have to think harder to understand why they could not tackle diseases effectively rather than just assuming that people ‘back then’ just weren’t bright enough to do so.

This activity can also be used at Key Stage 3 if you are not teaching ‘Medicine’ at GCSE. At KS3 it can be used to build students respect for people in the period rather than see them as helpless and hapless victims of plague – an image than can be fostered if work on the Black Death focusses only on the horror and death toll of ‘the pestilence’.

The Activity

The source sheet contains nearly twenty examples of actions taken by individuals or the city authorities in London in the 1300s and 1400s. The task is for students to scour this evidence for evidence of:

a) concern or efforts to keep London clean in an age of endemic plague
b) lack of interest in keeping London clean

Many of the items point both ways of course – the famous Richard le baker who drowned in a public privy tells us that there were public privies but they may well not have been well enough cared for. The cost of keeping towns clean was clearly a major issue for London and every other town – Professor Rawcliffe points out how changes in the profitability of trade in individual towns affected their efforts to clean streets and build privies. Carlisle, for example, was doubly hit by the link between reduced trade and the impact of Scottish raids, making it almost impossible to find the money to pave and clean the streets.

That point about the impact of cost on medical care is an obvious link to today – it may also be worth asking about the similarities or differences between human behaviour then and now.

The single PowerPoint slide provides an image which will help students to visualise the context – a reconstruction drawing of London in the 14th century by Steve Smith and taken from that 1996 book.

Converting the Currency

Some students (and teachers) may wonder what the sums of money in these items are worth now.

This is a notoriously hard question to answer because value differ from topic to topic but you get a rough idea by using the National Archives Currency Converter here …

One obvious limitation is that the Converter converts to 2005 value, not 2016 but in the long run that’s probably close enough!

For example:

• Item 10 refers to a latrine built for £4 which the converter puts at £1933.20

• Item 13 – 4 pence in 1326 is £5.60

• Item 16 – 2 shillings in 1345 is £54.67 – a big increase on the pervious fine of 4 pence (£5.60) – and 4 shillings is £109.35.


Having looked at the evidence students could consider some or all of the following questions:

• What evidence is there of the city government taking measures to make London healthier?

• What evidence is there of ordinary people trying to make London healthier?

• Did people care about whether London was a dirty and smelly place to live?

• Does the evidence suggest that people understood:

a) what caused diseases such as the Black Death?

b) how to make London a healthier place

• Would these laws help prevent the spread of the Black Death?

• Has anything surprised you about the evidence you have looked at? (or What is the most important thing you have learned from this evidence?)

For KS3

• What have you learned about the people of the later Middle Ages?

Or whatever works better for you!

An apology to the rest of the country

This is all about London and, in general, there’s far too much of that anyway. This is, after all, being written in Yorkshire. Carole Rawcliffe’s book Urban Bodies contains evidence from many towns (York, Gloucester, Norwich, Exeter, Beverley, Bristol, Chester etc etc) so if you see a copy in a library it’s worth checking the index for your locality. Sadly, there is no paperback edition but I do keep nagging the publisher or I’ll feel guilty about not writing up more places myself.

As I mentioned above, you can read interviews with Professor Rawcliffe here.


Constructive feedback is always welcome, particularly anything that will help other teachers.

This Page




The Activity

Converting Currency