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Medieval Public Health
News from the archives – Part 1

I suppose there’s a big assumption in that title, that what’s news to me is news to others. However I don’t mind showing my ignorance if it helps spread a more nuanced image of medieval public health.

About 18 months ago I read two new publications on this theme:

Carole Rawcliffe, Urban Bodies: Communal Health in Late Medieval English Towns and Cities, Boydell and Brewer, 2013, 431pp.

Carole Rawcliffe and Linda Clark (eds), The Fifteenth Century XII: Society in an Age of Plague, Boydell and Brewer, 2013, 223pp.

The link between the two, as you’ll have noted, is Professor Carole Rawcliffe of UEA, the pre-eminent historian of medicine in the Middle Ages.

• Her monograph, Urban Bodies, provides a detailed analysis of the state of public health in English towns during the period from c1250 to the 1530s – ideas about the cause of disease, paving and cleaning streets, provision of privies, water supply, sewerage, cleaning rivers, food quality regulations, hospitals, alms-houses and many other topics are examined through the archival records of a variety of English towns.

• In contrast Society in an Age of Plague provides essays by a number of historians on a series of issues and places, ranging through England and across Europe.

Professor Rawcliffe’s contention is that we still have too negative an interpretation of contemporary thinking about public health in the later middle ages and consequently of the actual condition of public health. This negativity we owe chiefly to Victorian writers who, in their scathing descriptions of medieval ‘squalor’, were more concerned to praise the achievements of their own day than provide an objective account of medieval conditions.

At the heart of this rethinking is an approach common to other recent work on the later Middle Ages – an explicit determination to treat the people of the time as intelligent, principled individuals worthy of our respect. This may sound obvious but is a far cry from the writing of even thirty and forty years ago in which, for example, the drive for power and wealth was assumed to be the only motive behind the actions of those participating in the Wars of the Roses. Nowadays historians credit individuals with as wide a range of motives as in any period – principles, loyalty, concern for the common good and for effective government are seen as being as or more important motives than that good old lust for power.

The approach of current historians is well summed up by John Watts, Professor of History at the University of Oxford, who has said of the Wars of the Roses that they ‘were fought by serious people for serious reasons; we should come to them with the same spirit of understanding that we bring to any of the civil conflicts of the past, or indeed the present.’ It’s this determination to respect the people of the period which also underlies the work of Christine Carpenter and others on constitutional ideas and politics, of Christopher Dyer on charity and alms-giving [identifying the local, need-oriented medieval origins of the Tudor codification of aid for the poor] and Carole Rawcliffe on public health. Indeed Professor Rawcliffe ends her book with another warning against the condescension of Victorian and other later writers towards the people of the Middle Ages who ‘although their beliefs and strategies can often seem alien to our own, … are no less deserving of study and respect.’

If you are teaching about medieval public health or just interested in exploring and enjoying the topic in more detail then the obvious starting points are two documents on Boydell and Brewer’s website. In the first Carole Rawcliffe and Linda Clark summarise many of the conclusions in the collection of articles they edited;

In the second Carole Rawcliffe answers a series of questions about central aspects of her research:

To give you a flavour of the latter here is one extract:

What impact did the Black Death in 1348 have on England, with regard to communal health and disease prevention?

On its own, the 1348-9 epidemic would have had only a passing impact on the development of health measures; but plague soon became an urban phenomenon, striking towns and cities on a regular basis from then onwards. Because corrupt air (miasma) was regarded as the principal earthly cause of pestilence, efforts to clean the streets and rivers, to remove sanitary nuisances (such as slaughterhouses and blocked drains), to improve the water supply and to avoid atmospheric pollution redoubled. Since poor diet and corrupt food were also regarded as agents of disease, suppliers and markets were subject to far tighter surveillance and regulation. It must be said, though, that many communities tended to let things slide between epidemics, in part because of the expenditure involved.

At over 400 pages Urban Bodies contains a wealth of examples of the actions taken by urban authorities and by individuals to improve living conditions in their towns. London was seen as an exemplar by other towns, unsurprisingly as London had the first piped-water supply in Europe. Of course the pace and results of such efforts were variable, much depending on local economic conditions which varied from place to place and year to year. The citizens of Carlisle, for example, had to contend with repeated attacks from marauding Scots armies so that they often had to choose between spending on defence or better sanitary conditions – and defence won.

One aspect of the discussion that, for selfish reasons, I rather enjoyed is the credit given to the historian EL Sabine who wrote a series of pioneering articles in the 1930s on London’s public health provision. Sabine’s work appeared in the rather obscure medieval journal Speculum but one of the pleasures of having time to read and research GCSE books properly back in the 1990s [before government involvement led to ludicrously short deadlines] was that I did read and use Sabine’s work to create a more positive picture of urban conditions that I might otherwise have done. Anyone who’s used the ‘White’ Medicine published by Hodder will recognize the activity involving a large reconstruction drawing of 14th century London – the details in that illustration came from Sabine’s articles.

Asking why towns worked so hard to improve health conditions might seem an obvious question but the answers are more wide-ranging than might be expected. Yes, the prime motive was to keep plague at bay but civic pride and rivalry also played a part with towns eager to be seen as cleaner and more modern than their neighbours. Cleanliness was also good for business and for the city of Canterbury was undoubtedly next to godliness! The pilgrimage ‘business’ was vital to Canterbury and visitors to Becket’s shrine expected not just eternal salvation but ‘clean, well paved streets, wholesome food, a salubrious environment and attractive accommodation’. Individuals were also motivated by the desire to speed their souls through purgatory. Hence merchants and other wealthy townspeople left large sums in their wills to improve water supplies, pave streets and provide toilets and other facilities in the expectation that such charity to their fellow citizens would win God’s blessing.

Another influence was the proliferation of advice books on how to safeguard health which were much more widespread than I would have expected. There was a growing demand for such books and so the number of translations into English increased, often in verse to make them easier to memorise. Not everyone who wanted to benefit could read but others acted as readers and interpreters, passing on the authors’ insights. Amongst the advice was an emphasis on personal and domestic hygiene – washing hands and face at intervals during the day, cleaning teeth and combing hair daily. Such advice books in turn increased expectation that civic authorities would clean streets and water supplies and take away refuse to improve the town’s health.

In this brief space it’s impossible to do justice to the richness of the material in these books and the wealth of research and arguments that I’ve both enjoyed and learned a huge amount from. I’d certainly be recommending the purchase of Urban Bodies if it wasn’t for the price of £60. If you sign up for Boydell and Brewer’s e-newsletter Medieval Herald you can get 30% off featured books but it’s still a very steep price. We can only hope for a paperback edition – and that the creators of the new GCSE specifications are fully apprised of these books’ conclusions.

I have optimistically headed this item ‘part 1’. I hope part 2 will follow with some specific examples of urban public health improvements in case they are useful for teaching.


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