Urban Bodies: Communal Health in
Late Medieval English Towns and Cities by Carole Rawcliffe

I enthused about this book back in 2013 when it was first published and I’ve been enthusing about it ever since, though more cheaply since it was published in paperback! And at 430 pages long there’s a lot to be excited about. Professor Carole Rawcliffe is the pre-eminent historian of medicine in the Middle Ages and in Urban Bodies she provides a detailed analysis of the state of public health in English towns during the period from c1250 to the 1530s, discussing 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.

Download this article as a PDF HERE …

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. Professor Rawcliffe underlines this by opening each chapter with a quotation from a Victorian (or later) writer and then eviscerating their opinions, using evidence from the archives of numerous English towns to paint a very different, though nuanced, picture.

At the heart of this rethinking is an approach common to other recent work on the later Middle Ages – a 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.

This 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 standards of living and much other social history including charity and alms-giving [identifying the local, need-oriented medieval origins of the Tudor codification of aid for the poor] and, in this case, 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.’

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. Many communities tended to let things slide between epidemics, in part because of the expenditure involved. 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 E L 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 Medicine published by Hodder in 1996 (the one with the white cover) will recognize the activity involving a large reconstruction drawing of 14th century London – the details in that illustration came from Sabine’s articles.

That activity can also be found here: HERE …

Asking why towns worked so hard to improve health conditions might seem an obvious question but Professor Rawcliffe’s 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 widely available and widely-used. 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 space it’s been impossible to do justice to the richness of the research and arguments but why take my word for it – it’s in paperback now!